Psychosocial interventions for individuals with dementia: An integration of theory, therapy, and a clinical understanding of dementia

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Abstract

We reviewed six psychosocial interventions for individuals with dementia. Interventions are described in terms of theoretical basis, how knowledge about dementia is incorporated, techniques, and empirical support. Psychodynamic approaches appear helpful for understanding intrapsychic concerns of demented individuals. Support groups and cognitive/behavioral therapy assist early stage individuals to build coping strategies and reduce distress. Reminiscence and life review provide mild to moderate stage individuals with interpersonal connections. Behavioral approaches and memory training target specific cognitive and behavioral impairments and help to optimize remaining abilities. Reality orientation reflects a similar goal, yet is probably more useful for its interpersonal functions.

Section snippets

Psychodynamic approaches

The psychodynamic theories relevant to this review encompass psychoanalytic and ego analytic theory, ego developmental psychology, object relations theory and self psychology. While these approaches have much in common, ego analytic psychology puts relatively more emphasis on how the ego successfully copes with and adapts to conflict, rather than how it defends against it (Wolitzky, 1995). Object relations theory and self psychology view the self as determined by relationships and people as

Reminiscence and life review

Reminiscence and life review approaches have been developed specifically for older adults, and most tend to refer to Erikson 1950, Erikson 1959 theory of psychosocial development for a theoretical framework. The primary goals of reminiscence therapy are to facilitate recall of past experiences so to promote intrapersonal and interpersonal functioning and thereby improve well-being. Reminiscence functions intrapersonally to enhance self-understanding and a sense of personal continuity, aid in

Support groups

The basis for using support groups as a psychosocial intervention is the assumption that when individuals who have experienced a similar traumatic event (stressor) gather together to share their concerns, they can cope with the stress better than on their own. The group supplies: (a) emotional bonding that creates closeness and reduces feelings of isolation; (b) enhanced self-esteem in having information to share about current coping strategies; and (c) information exchange that creates a sense

Reality orientation

Reality Orientation (RO) is a general philosophy of inpatient treatment articulated by Folsom (1968) in concert with the nursing staff of a rehabilitation program for geriatric patients with long-standing and severe psychiatric problems, including confusion. According to the RO philosophy, confusion results from: (a) understimulation, (b) a lack of insistence or expectation that normal behaviors be performed, and (c) non-reinforcement of desired behaviors when they are performed. It was

Memory training

Memory training refers to a set of techniques to: (a) enhance objective memory performance, such as mnemonics or memory skills training, (b) develop adaptive beliefs about memory functioning and perception of control over performance, such as cognitive restructuring and/or (c) manipulate variables that can influence memory performance such as depression or anxiety, for instance, through relaxation exercises (e.g., Hill, Sheikh, & Yesavage 1989, Hill, Allen & Gregory 1990, Hill, Storandt, &

Behavioral approaches

Behavioral interventions focus on managing disabilities and problem behaviors using principles of learning. Change may be defined as the elimination of undesirable behaviors; decrease in behavior frequency, duration and intensity of undesirable behaviors; or increase in desirable behaviors. Before initiating change, a functional analysis is recommended, in which observations are made about frequency, antecedents, and consequences of behavior. If a change program is not successful, the way in

Conclusion and recommendations for future directions

We have provided an overview of approaches used by mental health providers who work with older adults with dementia. At the same time, we proposed a framework for evaluating any intervention. (a) Does the intervention articulate a theoretical view for understanding the person and psychological health prior to dementia? (b) Does the approach incorporate knowledge of the psychological impact of dementia, including how changes caused by dementia contribute to distress? (c) Does the intervention

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