2.2.5 PSYCHOSOCIAL INTERVENTIONS IN DEMENTIA
These specific psychosocial treatments for dementia
can be divided into four broad groups: behavior oriented, emotion
oriented, cognition oriented, and stimulation oriented (American Psychiatric Association, 1997).
Behavior-oriented Approaches
The first step is a careful
description of the behavior in question, including where it occurs, when
it occurs, and how often it occurs. The next step is an assessment of the
specific antecedents and consequences of each problem behavior, which will
often suggest specific strategies for intervention. Activities that
consistently precede the problem behavior may be acting as precipitants
and should be avoided whenever possible. If the activity is a necessary
one, such as bathing, it may be helpful to decrease its frequency or alter
the environment so that the negative consequences are minimized. When
multistep activities, such as dressing and eating, precipitate problem
behaviors, it often helps to simplify them or to break them into parts. It
is critical to match the level of demand on the patient with his or her
current capacities, avoiding both infantilization and frustration, and to
modify the environment insofar as possible to compensate for deficits and
capitalize on the patient's strengths. Behavioral interventions have
strong support in clinical practice and deserve careful trials with
patients who have behavioral problems that are difficult to manage (American
Psychiatric Association,
1997).
Emotion-oriented approaches
These interventions
include supportive psychotherapy (Burnside and Haight, 1994), reminiscence
therapy (Jones, 1985), validation therapy (Robichaud et al., 1994),
sensory integration (Woods and Ashley, 1995), and simulated presence
therapy (Baines et al., 1987).
Cognition-oriented approaches
These techniques include reality
orientation (Powell-Proctor and Miller, 1982) and skills training (Hanley
et al., 1981). The aim of these treatments is to redress cognitive
deficits, often in a classroom setting.
Stimulation-oriented approaches
These treatments include activities
or recreational therapies (e.g., crafts, games, pets) and art therapies
(e.g., music, dance, art). They provide stimulation and enrichment and
thus mobilize the patient's available cognitive resources. There is some
evidence that these interventions decrease behavioral problems and improve
mood while they are in use (American Psychiatric Association, 1997).
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