[Session 2: version 2]

START: Strategies for Relatives

Session 7:

Pleasant events and your mood

Facilitator Version

Numbers in blue boxes let you know how long each section should take.

Information in yellow boxes give instructions on how to facilitate tasks, as well as prompts for feedback and discussion.

Quotations in orange boxes should be said as written.

Facilitator Key

Copyright 2018 Gill Livingston and Penny Rapaport. Licensed under CC BY-NC-ND 4.0 For permission requests, write to the publisher addressed “Attention: Permissions Coordinator” at the address below: UCL Division of Psychiatry 6/F Maple House 149 Tottenham Court road London W1T 7NF United Kingdom

This manual was adapted from original (Dolores Gallagher-Thompson and colleagues, Stanford

University School of Medicine, 2002) by University College London Division of Psychiatry in 2008,

with kind permission of the author. This is the revised second edition of the manual, created in 2018.

Session 7 2nd Edition 3

Plan for today’s session

Recap on planning for the future

p. 4

How pleasant events affect your mood

p. 5

Pleasant events planning

p. 7

Monitoring your mood

p. 11

Stress reduction: Stretching

p. 13

Summary

p. 15

“This is the contents page for you to refer back

to”

Refer to the contents but do not read the full list

For each session:

Encourage the carer to write down what works or key strategies or plans to refer back to.

If content is clearly irrelevant or does not fit, miss it out.

When setting exercises at the end, check that they remember what to do if not explicitly covered in the content.

Session 7 2nd Edition 4

Recap on session 6: Planning for the future

We talked about:

The importance of planning for the future

Options for care

Managing your relative’s physical health

Legal issues in care planning

Making a plan

Managing stress 6: Guided imagery – Ocean escape

Did you have a chance to consider making a plan for the future?

How did it go?

What went well?

What struck you?

What do you think got in the way?

What would make it easier in the

future?

5mins

Discuss their experience of thinking about and planning for the future.

If they have written down ideas, questions or a plan:

o Talk through any questions, give them space to describe how they felt and

do not rush in with solutions or answers.

If they did not do the exercise, talk through a possible decision or issue that has been on

their mind and what might be their next steps on addressing it. Discuss potential ideas

and who they may want to involve and talk to etc. Encourage them to read the CHOICE

factsheets if they have not done so.

Check in with them if they have used the behaviour / thought records, Encourage

continued practice using the communication thought and behaviour records.

Session 7 2nd Edition 5

How pleasant events affect your mood

Caring for a relative with dementia can also mean that you find it hard to make

time for your own enjoyment and activity, which may make you feel burned out

and frustrated.

Feeling down is often related to having too few pleasant events. A lack of

balance between unpleasant and pleasant events can make you feel like you

have no control.

You may think “It seems like there’s nothing I can do to make things better.”

However, you can feel better by making sure your day has a few events that

bring you pleasure.

Pleasant events don’t have to be long or need a lot of planning. They aren’t just

big events like holidays. Reading the newspaper, a cup of coffee, gardening or

talking to a friend can all be pleasant activities.

20mins

Anything you like to do is a pleasant event

Session 7 2nd Edition 6

List two activities that you enjoy:

1.

2.

Adding pleasant events to your daily life can seem difficult. You may

think “I don’t have time” or feel guilty about doing things for yourself, but

being good at taking care of your relative with Dementia also means

taking good care of yourself too!

Key point: You don’t need to plan big activities to make a difference to

people’s lives – it is about building on what is already happening

Session 7 2nd Edition 7

Planning pleasant events

Pleasant events can be for you alone or for you and your relative. Having

pleasant activities to do together will help you enjoy each other’s company.

Take a few moments to look over this list and tick the activities you think you

would enjoy either together or separately.

Events Tick

✓

Events Tick

✓

Listen to music Go to a place of worship

Go to the shops Watch sports

Go for a walk Talk about happy memories

Read/listen to books, newspapers, magazines or

prayer books

Holding things like a stress ball or bubble wrap

Sit with them for a tea/coffee and chat

Have a leisurely bath

Relaxation and sensory exercises

Chat to friends or family on the phone

Write letters or cards etc Spend time on an ipad using apps or skype

Drawing, painting, crafts

Play cards, games or puzzles

Exercise e.g. yoga, chair based exercise, stretching,swimming

Talk about family or current events

Watch a film Special occasion meals or parties

Go into the garden or balcony Dance

Have a picnic or a BBQ Live musicians / concerts / singing

DIY / Sewing Bingo

Gardening Cook or bake

Listen to the radio Helping with domestic tasks e.g. setting the table

Watch a favourite TV programme

Have a glass of wine or beer (if appropriate)

Watch wildlife or be around animals or pets

Have hair done / manicure / pedicure

Look at photos Hand or foot massage

Memory books / boxes

Other activities:

“Are there any other activities or events that you would add to the list?”

“Include things that you are already doing, some are activities can easily be done and others require a bit more planning?” (Give a couple of minutes)

Session 7 2nd Edition 8

Let’s make a list of pleasant activities (by yourself)

1.

2.

3.

4.

Rule A: Start small and be simple. The most important thing to remember is to

choose events that you can do at least a few times a week. A realistic activity

would be going to the shops, cycling or walking.

Rule B: Focus on events you want to do more often.

Refer back to list on previous page

Session 7 2nd Edition 9

Now let’s think of four pleasant activities (for you and your

relative together). If possible choose at least two that would need your relative to be

physically active:

1

2

3

4.

When planning activities, ask yourself: Is it possible to still do those activities? If not, can they be changed in any way?

For example, if you used to take long walks together, can you now take short walks? As long as you find things your relative enjoys and is able to do, you will be helping them to be stimulated and feel better.

It is important to plan activities or events that are manageable and achievable.

Encourage people to choose activities that are realistic and can easily be built into existing routines without too much adjustment.

Session 7 2nd Edition 10

Some activities require more planning than others. Because we want you to be successful in planning pleasant events for your relative, we have put together a list of questions to help you plan:

Pleasant event

1. 2.

What materials or preparations are needed?

When will it take place?

How often can it be done?

How long will it take?

Remember:

Don’t force them to participate: Encourage or show you’re pleased often.

Try to think of things that are similar to hobbies or interests they used to enjoy.

Have a few activities available, so if they become bored you can switch easily.

Plan to do activities in short bursts.

Try to involve other friends or family if at all possible.

Activities that involve movement can be good, since people with dementia are often restless and have relatively short attention spans.

There is no harm if your relative enjoys crafts, games, magazines or music that are simpler than before.

“Before the next session we would like you to try out a new pleasant activity with your relative”

“Choose one of the pleasant events that you would like to try out with your relative?”

Session 7 2nd Edition 11

Monitoring how pleasant events affect your mood

Doing pleasant events can improve your mood.

By keeping a daily record of your feelings, this will allow you to identify whether your mood follows a particular pattern.

=

On a scale of 1 to 10 how would you rate your mood

right now?

On the next page is a record form for monitoring pleasant events

and the effect on your mood. Let’s talk through this now and you can use the form to record any pleasant events and mood over the next week.

“To understand the effect of pleasant events, I want you to keep track of how you are feeling. Ask yourself, “How am I feeling today?” The number 1 represents the lowest you could possibly feel. The number 10 represents the best you could possibly feel”.

Session 7 2nd Edition 12

Pleasant Events Record Form

Day

What did you try?

How did it go?

How was your mood?

Events for you Events for you and your relative

Rating (1-10)

“When you rate your mood, think about how you felt overall. Most of us have lots of ups and downs in a day so try and take an average of these feelings”.

“Here you can include any comments about how the events have gone, e.g. what worked well, what did you and your relative enjoy and how did it affect your mood”

“This can be any of the events listed above and planned out, or it may be other ones that you had not thought of before”

Session 7 2nd Edition 13

Managing Stress 7: Stretching

Simply stretching tired muscles can go a long way towards reducing tension and stress.

Stretching exercises can be used almost anywhere, at any time, for as long as you want, so they can be an especially convenient relaxation technique.

It is important to do stretching exercises that feel good to you. As we practice this today, please tell me if you experience any discomfort.

Stress Rating Before Exercise

First, please rate your level of stress or tension right now, before we practice the

Stretching exercise.

On a scale of 1 to 5, how would you rate your tension? _____

10mins

“Now we are going to try a new stress reduction

technique, last week we learnt the guided imagery –

ocean escape. This week we will practise a stretching

exercise.

First, let’s think about the guided imagery. Did you

get a chance to try it out this week?

If you gave it a go, how did you find it? When did you

use it? What effect did it have on how you felt?

If you did not get a chance to try it, what got in the

way?

Please try and carry on practicing the guided imagery

exercise.”

5 = Terribly tense 4 = Really tense 3 = Moderately tense 2 = Slightly tense 1 = Not at all tense

Session 7 2nd Edition 14

Stretching: Practice Session

“Today, we will do a few stretching exercises that will help you relax. First, let’s start by standing up, or if you prefer, you may choose to do this exercise in your chair. Whatever is the most comfortable for you is all right.

Take a deep signal breath, all the way down to the bottom of your stomach, (pause 2s) and slowly let it out. Feel the tension drain from your body. (pause) Take one more breath and hold it for a moment (pause 2s) and let it out slowly. With each breath you are becoming more and more relaxed.

Now, gently reach your arms out to the sides, as though you were trying to touch the walls. Relax your shoulders and stretch yourself a little. Gently reach your arms out in front of you. Feel the muscles in your back and shoulders loosen up. Stretch out in front a little further. And now reach up as high as you can. Push up your arms towards the sky, as if you were trying to reach the sun.

Again, reach your arms out to the sides as though you were trying to touch the walls, as though you were trying to push the walls outward. Reach out in front of you. Feel your muscles in your back and shoulders become looser and less tense. Reach up toward the sky one more time. Reach as high as you can. Try to touch the sun. Lower your arms to your sides.

Now, roll your shoulders back. Feel the tension drain from your body. Roll your shoulders back again. One more time roll your shoulders back. Now roll them forward. Roll them forward again. One more time forward. Now shrug your shoulders, lifting them up and then pushing them down. Shrug your shoulders again. Shrug them one more time.

Now take in another deep and refreshing breath, and exhale all of the tension in your body. To complete this session, take one more breath... and exhale, letting go of any remaining tension…Are you feeling calmer and more relaxed now?

Tension Rating After Exercise

How would you rate your tension level now, after practicing the Stretching exercise?

Q! Now, please rate your tension or stress level from 1 to 5 _____

“Now I am going to talk you through the stretching exercise…”

5 = Terribly tense 4 = Really tense 3 = Moderately tense 2 = Slightly tense 1 = Not at all tense

Discuss: • Did your level of tension change? • What was this experience like for you? • Can you think of specific times when this might have helped?

Session 7 2nd Edition 15

Summary

Today, we have talked about:

How pleasant events affect your mood

Pleasant events planning

Monitoring your mood

Stress reduction technique: Stretching

“Thinking about what we have

discussed, is there any

information from today’s

session that you would want

to share with someone else

(e.g. a family member, a

friend or a neighbour) ”.

Session 7 2nd Edition 16

FOR NEXT WEEK: Putting it into practice

Stress reduction – Stretching:

Try to practice this at least once a day and notice how it feels.

Pleasant events and your mood:

Please complete the pleasant events record on page 17 at least three

times this week trying out the pleasant events we discussed and

planned for you and your relative. Remember to monitor the effect on

your mood.

Optional exercises:

Please continue to use the behaviour and thought records if this is

something that you have found useful in previous weeks.

START: Putting it into Practice

When will you have an opportunity to do this?

What might get in the way?

What might make it easier?

Anything that you or your relative enjoy doing is a pleasant event. It is

important to plan activities or events that are manageable and achievable.

***Look at your notes from all

prior sessions before the final

session so that you are able to

suggest and review ideas around

each of the sessions e.g. “Do you

think that using this strategy

helped with xxx” or being able to

remind people of the list of

communication tips, pleasant

events, options for care etc.”***.

Session 7 2nd Edition 17

Pleasant Events Record Form

Day

What did you try?

How did it go?

How was your mood?

Events for you Events for you and your relative

Rating (1-10)

Session 7 2nd Edition 18

Extra Pleasant Events Record Form

Day

What did you try?

How did it go?

How was your mood?

Events for you Events for you and your relative

Rating (1-10)

Session 7 2nd Edition 19

Thought Record

What was happening?

What were you

thinking?

How did you

feel?

An alternative response

would be…

How do you feel now?

Session 7 2nd Edition 20

Extra Thought Record

What was

happening?

What were you

thinking?

How did you feel?

An alternative

response would be…

How do you feel

now?

Session 7 2nd Edition 21

Behaviour Record

Day Morning/Afternoon/

Night

Who was

there?

Trigger Behaviour Reaction What strategy did you

try?

What happened?

Session 7 2nd Edition 22

Extra Behaviour Record

Day Morning/Afternoon/

Night

Who was

there?

Trigger Behaviour Reaction What strategy did you

try?

What happened?

Session 7 2nd Edition 23

Notes

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________