The National Dementia strategy (2009) outlines that 'by 2014 services are expected to be able to..enable everyone to live well with dementia'. There is increasing recognition that psychological interventions for people with dementia and their carers are of value (NICE, 2007). Neuropsychological considerations and exploration of the literature point towards the potential benefits of dance and movement therapies as non-verbal, body-oriented interventions that can be used to work psychotherapeutically with people as their cognitive abilities deteriorate. This group uses circle dancing with a view to enhancing the quality of life and emotional well-being of people with moderate to advanced dementia and their carers.
East London NHS Foundation Trust
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To explore the use of a circle dance movement therapy group, aiming to enhance the quality of life and emotional well-being of people with moderate to advanced dementia and their carers. The National Dementia strategy (2009) outlines that 'by 2014 services are expected to be able to...enable everyone to live well with dementia'. There is increasing recognition that psychological interventions for people with dementia and their carers are of value (NICE-SICE, 2007). People who have been given the diagnosis of dementia can face major issues of loss, which can result in anxiety and depression Not only does the person diagnosed have to accept the permanent nature of these losses but they also have to adjust to the certainty of future deterioration, which is made all the more complex and difficult due to failing memory and capacity to use words to express feelings and make sense of the world (Cheston et al, 2006). The contribution that family carers make to support people with dementia is better acknowledged in recent years (NICE, 2007; Woods, 2008). Caring for someone with dementia can be a complicated, unpredictable and lonely experience, and carers can also face their own significant issues of loss and emotional pain (McCurry, 2008; Meisen, 2006; Woods, 2008). This group was developed to try to understand and work through the resulting emotions and distress associated with these changes to enhance the well-being and lives of people with dementia and their carers.
Although a range of individual and group psychotherapeutic interventions for people with dementia has been described (Woods, 1996; Scott & Clare, 2003,), these often involve individuals in the earlier stages of the disease and/ or focus on improving the patient's cognition or reducing psychiatric symptoms rather than the person's subjective experience of dementia (Wilkinson et al., 1998). Although group psychotherapy for carers and people with dementia is still in its infancy, initial results using different sensory activities including music, dance and reminiscence are promising and show improved quality of life for both parties (Haupt, Siebel, Palm, Kretschmer and Janner, 2000; Schweitzer & Bruce, 2008). It was the lack of psychotherapeutic interventions for people with advancing dementia and their carers within the service that formed the background for this group. Pre and post measures were used as well as collecting qualitative data during each group. The group was set up by the Psychotherapy for Older Adults service following reference to the literature in conjunction with the Dementia Care team with supervision and training.
The therapeutic intervention had a positive impact on participants' general well being and mood, including improving people's concentration and communication with others providing support for the use of such groups as a psychological intervention for people with dementia and their carers. The only cost incurred was a one day training for both group therapists in circle dancing, which was £140.
18 suitable people (11 people with moderate to severe dementia and 7 family carers) were identified within the Mental Health Care of Older People's service and consented to partake. Of these 18, ten (three carers and seven people with dementia) attended the group. The group ran for 45 minutes once a week for ten weeks in an NHS community setting. Measures (MMSE, Quality of Life in Dementia scale, and General Health Questionnaire for carers) were completed for everyone before and after the group therapy. Weekly progress monitoring sheets were also completed and participants were interviewed after the group for their views and feelings about the group. This pilot group was approved by the NHS Ethics committee and has been written up for publication in a peer reviewed journal with a view to disseminating the findings.
It was an encouraging experience for both carers and therapists to see how people in the advanced stages of dementia, especially those who were withdrawn and relatively unresponsive, could move freely, sway, smile and re-connect in the group, emphasising that they can still experience emotions deeply. As Sacks (2008, p384) wrote 'that dementia, at least at these times, is no bar to emotional depth. Once one has seen such responses, one knows that there is still a self to be called upon'. We would encourage other clinicians with an interest and experience in psychotherapy and psychosocial interventions to explore and integrate such methods into their practices to address the psychological needs of people with advancing dementia and their carers in addition to improving their quality of life.
Dr. Michelle Hamill
East London NHS Foundation Trust
Is the example industry-sponsored in any way?