How mindfulness can help when caring for people with dementia

By: Eva van der Ploeg

Picture: http://www.yogalifestyles.com

Mindfulness. Did you cringe a little when you saw the word in the title of this blog? I think a lot of people may have. I know I used to, because when I heard about mindfulness fleetingly I understood it to mean ‘having an empty mind’. Now that troubled me, because that seemed like a state of mind that was 1) impossible to achieve, and; 2) did not seem desirably. However, when I looked into it, mindfulness turned out to be something that helps me a lot, both when working with people with dementia as well as in daily life. I’ll give you a brief description of how I see mindfulness and then an example of how we can apply it in our care for people with dementia.

I now see mindfulness as noticing what is going on in your mind. Observing which thoughts, emotions, (action) tendencies pop up and how you react to those in turn. Sometimes there is no filter between our brain and our behavior, especially when strong emotions occur. It almost feels like someone else takes over and acts before we know it. Quite often we regret our actions later, for example when we have a yelled at a young child, because we were terrified that they would hurt themselves. Mindfulness is like putting a filter between our brain and actions. Jon Kabat-Zinn who came up with the idea of mindfulness, uses the word awarenessing. Being aware what is happening, mainly on the inside.

There are 7 Mindfulness Attitudes that can help with putting in the filter. I’ll describe them, using the case that I introduced in my previous blog (Why stories are not enough). To refresh your memory: Eddie was a man in his 80’s, living with dementia in a nursing home. He was renown for ‘disruptive behavior’: moving all the furniture in the living room, with screeching sounds and some verbalizations. He contributed to a restless environment, frequently unsettling his co-inhabitants and sometimes staff and visitors too.

1. Non-judging

The first attitude we can use is called non-judging. If that sounds like an impossible step, you may start with noticing the judgments that automatically pop into your mind and then realizing that this is an actual judgment and that you do not have to act on it. So that it becomes a choice if you act on this preconception. Please know, that having instant opinions is absolutely normal, even more so it fulfills the essential task of making a quick scan and selection of our environment, for example of good and bad, leave or stay. You may call this another filter and this filter should definitely stay in place. This attitude is more about noticing this immediate judgment and how it influences you. A question to ask is: did my acting on my judgment help me?

Let’s look at Eddie. A typical reaction when he would start pushing furniture around, may be ”Oh my, he is having one of his bad days” or “he is up to no good”. Now you could act on this judgment and feel agitated, behave irritated etc. You can see why this will not help the situation, even though your judgment may be ‘right’. It is not about right and wrong. It is about creating a more peaceful environment for everyone. So how about you ‘park’ your judgment and you go up to Eddie and ask ‘May I ask what you are doing?’. As you may remember, Eddie told us, he was preparing his workplace. With that information in mind: is he displaying bad behavior? Is he intentionally trying to disrupt everyone around him?

2. Patience

When you have latched onto your judgment, probably your next thought would have been “I want Eddie to stop now”. This may escalate quickly, because we now know, Eddie is on a mission: he has to prepare his workplace before shop opens. Our first patient step was to ask him what he was doing. The next step would be to look for a way that Eddie may continue what he is doing without disrupting his environment. On the longer term, that could mean creating a space that he can actually use as a workplace (or him going to a workplace to help out). On the short term, it may be explaining to others what he is doing or offering him another meaningful activity.

Mind you, do not forget to apply Patience (and all other attitudes) to yourself also. If you are in a hurry, have other people who need your assistance etc., be patient with yourself. You can alert someone else or you may return to the situation later. It all begins with you. We all know that when we are stressed or feel forced, we respond in different ways than we wish.

3. Beginner’s Mind

This attitude asks that you do not only notice your judgments, but acknowledge all the information and emotions that you have regarding a particular person or situation. To notice this backpack that you carry around and again to stow this away for a moment. Not disregarding it, but saying: hey, it is a new day, let’s start over. With Eddie one might think ‘Here we go again!’ if we have a negative association with his behavior (or him in general). In Social Psychology terms, this may lead to a ‘self-fulfilling prophecy’: how you appraise a situation will influence your response to it and your appraisal may very well come true. You have a negative association with Eddie, you respond to this negativity with more negativity and things spin out of control quickly. Taadaa: Eddy is a very disrupting person!

Now with a Beginner’s Mind, again you would have noticed your negative thoughts and feelings to Eddie’s behavior, but you do not act on them. You ask ‘Why is this happening?’, which brings us back to Attitude 1 where this question was answered by Eddie himself.

4. Trust

I find this Attitude quite difficult to understand. I am not sure if it is about trusting yourself or something like ‘I trust the universe/ God that all will be good in the end’. For Eddie’s case, I look at it this way, if we forget to be mindful we will get ahead of ourselves adding to our feelings of frustration or panic: “Eddie will trigger everyone else, this is going to be a horror shift”. Immediately the ‘problem’ at hand has become so much bigger, in your head. With the added potential danger of triggering a self-fulfilling prophecy. In this case, we are trusting things to spiral out of control and this may well come true. If we take a big breath and tell ourselves “I can do this, if I take some time (or ask some help)”, something else may transpire.

5. Non-striving

For me, there is some overlap between the attitudes, but I see non-striving as putting pressure on yourself (to be perfect) or feeling real (or imagined) pressure from others. Again, this will make the ‘problem’ so much bigger and again this is only happening in your mind. Did Eddie’s daughter just walk in? And have you been keen to show her how well Eddie is after your last conversation with her about her concerns? Or are you hoping to get a promotion and is this putting even more pressure on you to be perfect? Or are you a perfectionist in general? Now, when you answer these questions, try to steer away from any judgments that pop in your head. There is nothing wrong with being a perfectionist. It comes in handy in so many situations. But if you feel it is limiting you in this moment, if it is putting too much pressure on you, it is again time to say ‘Perfection, I am parking you for the moment’. I am going to do what I can without burdening myself. So when non-striving, you basically park your own and other people’s expectations, ambitions etc., you just zoom in on the situation on hand.

6. Acceptance

When Eddie starts playing up, you may find yourself thinking “This is the last thing I needed today – I do not want this to happen”. Resistance! But hey, it is already happening. Anything that may have avoided this from happening (like Eddie having a meaningful place or activity) has unfortunately not been put in place yet. And that is ok. You can work on that in the future. It is what it is.

You may remember that with Eddie, we did a sorting activity looking at photos of motor bikes. He would sit down for this activity, engage, smile. He would not move furniture and create mayhem. Moreover, after 20 minutes he would feel tired and take a nap after the cognitive stimulation. Staff reported that he never played up after these meetings for the rest of the day. Anyone have 20 minutes to spare?

7. Let it be

For me this attitude is the summary of all of the above. It does not mean a passive(-aggressive) acceptance, but an active choice. This is happening, if I fight with it things will not improve.

From a Mindfulness perspective, I would say: Whatever happens, stop for a moment, notice all the big and small responses in your head and choose what may help you or the situation, never force yourself, ask all the help you may need. Then see what happens and repeat.

 

Dr. Eva van der Ploeg has a PhD in Public Health from the Erasmus Medical Centre in Rotterdam. She has worked and lived in the U.S.A., the Netherlands and Australia. She is now based in Indonesia. She works internationally as a researcher, consultant and trainer of ‘Original Montessori for Dementia’ hoping to improve the life of people with dementia and those caring for them.