The way people living with dementia experience the world can change as the disease progresses. Their sense of reality or place in time can become distorted, which can cause agitation and distress.

One of the best ways to support people experiencing changes in perception and behaviour is to manage their environment. This can have profound benefits including reducing the need for sedatives.

One such strategy is the use of dolls as comfort aids.

What is ‘doll therapy’?

More appropriately referred to as “child representation”, lifelike dolls (also known as empathy dolls) can provide comfort for some people with dementia.

Memories from the distant past are often more salient than more recent events in dementia. This means that past experiences of parenthood and caring for young children may feel more “real” to a person with dementia than where they are now.

Hallucinations or delusions may also occur, where a person hears a baby crying or fears they have lost their baby.

Providing a doll can be a tangible way of reducing distress without invalidating the experience of the person with dementia.

Some people believe the doll is real

A recent case involving an aged care nurse mistreating a dementia patient’s therapy doll highlights the importance of appropriate training and support for care workers in this area.

For those who do become attached to a therapeutic doll, they will treat the doll as a real baby needing care and may therefore have a profound emotional response if the doll is mishandled.

It’s important to be guided by the person with dementia and only act as if it’s a real baby if the person themselves believes that is the case.

What does the evidence say about their use?

Evidence shows the use of empathy dolls may help reduce agitation and anxiety and improve overall quality of life in people living with dementia.

Child representation therapy falls under the banner of non-pharmacological approaches to dementia care. More specifically, the attachment to the doll may act as a form of reminiscence therapy, which involves using prompts to reconnect with past experiences.

Interacting with the dolls may also act as a form of sensory stimulation, where the person with dementia may gain comfort from touching and holding the doll. Sensory stimulation may support emotional well-being and aid commnication.

However, not all people living with dementia will respond to an empathy doll.

The introduction of a therapeutic doll needs to be done in conjunction with careful observation and consideration of the person’s background.

Empathy dolls may be inappropriate or less effective for those who have not previously cared for children or who may have experienced past birth trauma or the loss of a child.

Be guided by the person with dementia and how they respond to the doll.

Are there downsides?

The approach has attracted some controversy. It has been suggested that child representation therapy “infantilises” people living with dementia and may increase negative stigma.

Further, the attachment may become so strong that the person with dementia will become upset if someone else picks the doll up. This may create some difficulties in the presence of grandchildren or when cleaning the doll.

The introduction of child representation therapy may also require additional staff training and time. Non-pharmacological interventions such as child representation, however, have been shown to be cost-effective.

Could robots be the future?

The use of more interactive empathy dolls and pet-like robots is also gaining popularity.

While robots have been shown to be feasible and acceptable in dementia care, there remains some contention about their benefits.

While some studies have shown positive outcomes, including reduced agitation, others show no improvement in cognition, behaviour or quality of life among people with dementia.

Advances in artificial intelligence are also being used to help support people living with dementia and inform the community.

Viv and Friends, for example, are AI companions who appear on a screen and can interact with the person with dementia in real time. The AI character Viv has dementia and was co-created with women living with dementia using verbatim scripts of their words, insights and experiences. While Viv can share her experience of living with dementia, she can also be programmed to talk about common interests, such as gardening.

These companions are currently being trialled in some residential aged care facilities and to help educate people on the lived experience of dementia.

How should you respond to your loved one’s empathy doll?

While child representation can be a useful adjunct in dementia care, it requires sensitivity and appropriate consideration of the person’s needs.

People living with dementia may not perceive the social world the same way as a person without dementia. But a person living with dementia is not a child and should never be treated as one.

Ensure all family, friends and care workers are informed about the attachment to the empathy doll to help avoid unintentionally causing distress from inappropriate handling of the doll.

If using an interactive doll, ensure spare batteries are on hand.

Finally, it is important to reassess the attachment over time as the person’s response to the empathy doll may change.

Nikki-Anne Wilson, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

As a clinical psychologist, I often have clients say they are having trouble with thoughts “on a loop” in their head, which they find difficult to manage.

While rumination and overthinking are often considered the same thing, they are slightly different (though linked). Rumination is having thoughts on repeat in our minds. This can lead to overthinking – analysing those thoughts without finding solutions or solving the problem.

It’s like a vinyl record playing the same part of the song over and over. With a record, this is usually because of a scratch. Why we overthink is a little more complicated.

We’re on the lookout for threats

Our brains are hardwired to look for threats, to make a plan to address those threats and keep us safe. Those perceived threats may be based on past experiences, or may be the “what ifs” we imagine could happen in the future.

Our “what ifs” are usually negative outcomes. These are what we call “hot thoughts” – they bring up a lot of emotion (particularly sadness, worry or anger), which means we can easily get stuck on those thoughts and keep going over them.

However, because they are about things that have either already happened or might happen in the future (but are not happening now), we cannot fix the problem, so we keep going over the same thoughts.

Who overthinks?

Most people find themselves in situations at one time or another when they overthink.

Some people are more likely to ruminate. People who have had prior challenges or experienced trauma may have come to expect threats and look for them more than people who have not had adversities.

Deep thinkers, people who are prone to anxiety or low mood, and those who are sensitive or feel emotions deeply are also more likely to ruminate and overthink.

Also, when we are stressed, our emotions tend to be stronger and last longer, and our thoughts can be less accurate, which means we can get stuck on thoughts more than we would usually.

Being run down or physically unwell can also mean our thoughts are harder to tackle and manage.

Acknowledge your feelings

When thoughts go on repeat, it is helpful to use both emotion-focused and problem-focused strategies.

Being emotion-focused means figuring out how we feel about something and addressing those feelings. For example, we might feel regret, anger or sadness about something that has happened, or worry about something that might happen.

Acknowledging those emotions, using self-care techniques and accessing social support to talk about and manage your feelings will be helpful.

The second part is being problem-focused. Looking at what you would do differently (if the thoughts are about something from your past) and making a plan for dealing with future possibilities your thoughts are raising.

But it is difficult to plan for all eventualities, so this strategy has limited usefulness.

What is more helpful is to make a plan for one or two of the more likely possibilities and accept there may be things that happen you haven’t thought of.

Think about why these thoughts are showing up

Our feelings and experiences are information; it is important to ask what this information is telling you and why these thoughts are showing up now.

For example, university has just started again. Parents of high school leavers might be lying awake at night (which is when rumination and overthinking is common) worrying about their young person.

Knowing how you would respond to some more likely possibilities (such as they will need money, they might be lonely or homesick) might be helpful.

But overthinking is also a sign of a new stage in both your lives, and needing to accept less control over your child’s choices and lives, while wanting the best for them. Recognising this means you can also talk about those feelings with others.

Let the thoughts go

A useful way to manage rumination or overthinking is “change, accept, and let go”.

Challenge and change aspects of your thoughts where you can. For example, the chance that your young person will run out of money and have no food and starve (overthinking tends to lead to your brain coming up with catastrophic outcomes!) is not likely.

You could plan to check in with your child regularly about how they are coping financially and encourage them to access budgeting support from university services.

Your thoughts are just ideas. They are not necessarily true or accurate, but when we overthink and have them on repeat, they can start to feel true because they become familiar. Coming up with a more realistic thought can help stop the loop of the unhelpful thought.

Accepting your emotions and finding ways to manage those (good self-care, social support, communication with those close to you) will also be helpful. As will accepting that life inevitably involves a lack of complete control over outcomes and possibilities life may throw at us. What we do have control over is our reactions and behaviours.

Remember, you have a 100% success rate of getting through challenges up until this point. You might have wanted to do things differently (and can plan to do that) but nevertheless, you coped and got through.

So, the last part is letting go of the need to know exactly how things will turn out, and believing in your ability (and sometimes others’) to cope.

What else can you do?

A stressed out and tired brain will be more likely to overthink, leading to more stress and creating a cycle that can affect your wellbeing.

So it’s important to manage your stress levels by eating and sleeping well, moving your body, doing things you enjoy, seeing people you care about, and doing things that fuel your soul and spirit.

Distraction – with pleasurable activities and people who bring you joy – can also get your thoughts off repeat.

If you do find overthinking is affecting your life, and your levels of anxiety are rising or your mood is dropping (your sleep, appetite and enjoyment of life and people is being negatively affected), it might be time to talk to someone and get some strategies to manage.

When things become too difficult to manage yourself (or with the help of those close to you), a therapist can provide tools that have been proven to be helpful. Some helpful tools to manage worry and your thoughts can also be found here.

When you find yourself overthinking, think about why you are having “hot thoughts”, acknowledge your feelings and do some future-focused problem solving. But also accept life can be unpredictable and focus on having faith in your ability to cope.

Kirsty Ross, Associate Professor and Senior Clinical Psychologist, Massey University

This article is republished from The Conversation under a Creative Commons license. Read the original article.