[Session 2: version 2]

START: Strategies for Relatives

Session 8:

What works? Using skills and

strategies in the future

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 8 2nd Edition 3

Plan for today’s session

Putting it all together

p. 4

What works? Pleasant events

p. 5

What works? Managing behaviours and making a plan

p. 6

What works? Challenging unhelpful thoughts

p. 7

What works? Assertive communication

p. 8

What works? Communicating with your relative

p. 9

What works? Planning for the future

p. 10

What works? Relaxation

p. 11

Keeping it going – Making a plan

p. 12

Summary

p. 17

Session 8 2nd Edition 4

Putting it all together

Today we are going to do a recap of the previous sessions and bring together

what works for you, both old and new strategies. We will use this to make a

plan so that you can keep using START in the future.

Session 8 2nd Edition 5

What works? Pleasant events

Last week we discussed the importance of pleasant events for both you and

your relative (session 7, page 5) and the impact that doing more for yourself

can have on your mood.

Did you try out any pleasant events over the past week?

How did you feel during and after the pleasant activities?

What got in the way of doing more pleasant events?

What might help you overcome these obstacles in the future?

Summary: What worked best?

Session 8 2nd Edition 6

What works? Managing behaviours and making a plan

In the first three sessions we discussed trigger-behaviour-reaction patterns for

your relative.

Recording in detail what is happening can help understand what is causing

difficulties and help us to find different strategies and ways to react.

Remember, there is always a cause for behaviours but your relative is not doing

it on purpose.

Have you been able to use this approach to behaviours? If so, did you find it

helpful?

Summary: What worked best?

Session 8 2nd Edition 7

What works? Challenging unhelpful thoughts

In session four (page 7) we discussed how learning to change the unhelpful

thoughts we have in stressful situations can help us to feel less sad and

frustrated.

We discussed three steps to challenging unhelpful thoughts:

1. Stop and identify your current thoughts.

2. Challenge and replace your unhelpful thoughts with more helpful ones.

3. Pay attention to how you feel now.

Shall we talk about how you found challenging unhelpful thoughts?

Summary: What worked best?

Session 8 2nd Edition 8

What works? Assertive communication

In session five we looked at different ways to communicate. This included assertive

communication when and how to use these skills when asking for help from others.

Have you used assertive communication skills? If so, how did it go?

What effects have you noticed?

What made it easier to try out these communication skills?

Summary: What worked best?

Session 8 2nd Edition 9

What works? Communicating with your relative

In session five we also looked at how memory problems can affect your relative’s

communication.

We looked at some techniques to help improve communication with them and

included helpful tips.

Have you used these techniques? If so, what was helpful?

What effects have you noticed?

What made it easier to try out these techniques?

Summary: What worked best?

Session 8 2nd Edition 10

What works? Planning for the future

In session six we discussed planning for the future and the issues that this can

raise. We talked about how making decisions can be difficult but that planning

before a crisis can be helpful. We discussed some of the most common concerns

including:

Options for care

Managing the physical health of someone with dementia

Legal issues

Have you had a chance to think about or have these discussions with your relative or

other family members? If so, have you found this helpful?

Summary: What worked best?

Session 8 2nd Edition 11

What works? Relaxation

Each week we have practiced a different relaxation technique for you and/or your

relative to use. These included:

1. Signal breath

2. Focused breathing

3. Physical grounding

4. Guided imagery: Meadow and stream

5. Meditation

6. Guided imagery: Ocean escape

7. Stretching

You can listen to these managing stress exercises any time on your CDs or

by visiting: https://soundcloud.com/user-971142120/sets/start-relaxation-tracks

Let’s talk about how you found the relaxation exercises. Which did you find

most helpful?

Summary: What worked best?

Session 8 2nd Edition 12

Keeping it going: Making a plan

We know from experience that making changes and keeping them going is

difficult. Some changes work and others will not. Try not to be too discouraged.

Some of the reasons it can be difficult include:

o The advice and strategies are not relevant to you.

o It is tricky to get the hang of some of the strategies.

o It is hard to break established patterns.

Here are some suggestions to help you keep going!

o Make use of the manual to remind yourself what you learnt in sessions.

o Using record forms to notice patterns, especially when there is a new

problem.

o Remember small changes can make a big difference over time, so keep

trying things out and practicing.

Please continue to put into practice what you have learnt during START. Focus on doing what works and be flexible. If it stops working, try something else.

Session 8 2nd Edition 13

Based upon what you have said works best and has been most

useful, l am going to make a list of skills/techniques/strategies that you

intend to keep using in the future:

Action plan: Skills, techniques and strategies for the future

1.

2.

3

4.

5.

6.

7.

8.

The key to really understanding the concepts discussed in these sessions is to practice. With practice, you can then share these

techniques with others.

Session 8 2nd Edition 14

Managing Stress 8:

Choose your favouriterelaxation technique

Signal Breath(Session 1, p. 15)

Focused Breathing(Session 2, p. 17)

Physical Grounding(Session 3, p. 12)

Guided Imagery -Meadow & Stream

(Session 4, p. 15)

Meditation(Session 5, p. 15)

Guided Imagery -Ocean Escape

(Session 6, p. 18)

Stretching(Session 7, p. 13)

Session 8 2nd Edition 15

Stress Rating Before Exercise

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

favourite relaxation technique.

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

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

Session 8 2nd Edition 16

Tension Rating After Exercise

How would you rate your tension level now, after trying your favourite relaxation

technique?

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

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

Session 8 2nd Edition 17

We have now looked back at the skills covered in these sessions.

How to improve your mood by engaging in more pleasant activities

How to relax in stressful situations.

How to identify and change behaviours.

How to challenge your own negative thoughts and replace them with more helpful thoughts.

How to ask for help from others.

How to communicate better with the person with memory problems you look after.

How to plan for the future and talk to your family about difficult decisions.

Summary

We hope you have found these sessions helpful and will in future keep using the

skills you have listed as useful.

Please try to keep using the skills that work for you and refer back to this manual to

remind yourself of the techniques discussed in these sessions.

There are blank copies of the Thought, Behaviour, Communication and Pleasant

Event records in the appendix for you to use in the future. I will be sending you the

Action Plan we completed in today’s session.

Please also feel free to share this manual with anyone else involved in the care of

your relative.

Thank you for taking part

Session 8 2nd Edition 18

Copies of Record Forms: Behaviour Record

Day Morning/Afternoon/

Night

Who was

there?

Trigger Behaviour Reaction What strategy did you

try?

What happened?

Session 8 2nd Edition 19

Communication Record

Situation

What I said or did?

How did it turn out?

How did I feel?

Session 8 2nd Edition 20

Pleasant Events Record

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 8 2nd Edition 21

Thought Record

What was happening?

What were you

thinking?

How did you feel?

An alternative

response would be…

How do you feel

now?