Ep. 031 | Mental Health in Dementia Care
Today, we chat with guest, Dianna Rose, a board-certified music therapist, about mindfulness as a critical aspect of mental health care in dementia settings.
RESOURCES
Cheung DSK, Lai CKY, Wong FKY, Leung MCP. The effects of the music-with-movement intervention on the cognitive functions of people with moderate dementia: a randomized controlled trial. Aging Ment Health. 2018;22(3):306-315. doi:10.1080/13607863.2016.1251571 | Journal Article
Chapter 31 of Developments in Music Therapy Practice: Case Study Perspectives by A. Meadows | Book
Orii McDermott, Martin Orrell & Hanne Mette Ridder (2015) The development of Music in Dementia Assessment Scales (MiDAS), Nordic Journal of Music Therapy, 24:3, 232-251, DOI: 10.1080/08098131.2014.907333 | Journal Article
TRANSCRIPT
Erica: Welcome, friends! You’re listening to The Feeling is Musical — as presented by the Snohomish County Music Project. My name is Erica Lee, and today, we are talking about mental health in dementia care, with music therapist, Dianna Rose.
Dianna’s interest in music started in childhood, during which she studied piano and voice, and trained for 10 years as a percussionist. Her first vocational path was journalism, which included a masters from USC and over 30 years on-air at music-based radio stations in both Los Angeles and Seattle. Recently, Dianna shifted careers and completed her second masters from Lesley University in clinical mental health counseling, with a specialization in music therapy. She is also the music director of her synagogue, and, for the past year and a half, has worked at Aegis at Callahan House, a memory care facility in Shoreline, Washington.
[Podcast intro music plays]
Erica: Welcome, Dianna. Thanks for being on the podcast.
Dianna: Absolutely.
Erica: So, we’re in the middle of a series about dementia and memory care, and so I’m excited to pick your brain a little bit. I know your focus is a little bit more on mental health within the memory care setting, so we’re gonna —
Dianna: Kind of a hybrid —
Erica [Chuckles] it’s a hybrid —?
Dianna: [Chuckles] Kind of a hybrid. The reality is: when you’re working with people through music, it does involve mental health —
Erica: Yeah —
Dianna: So they’re really intrinsically related.
Erica: Absolutely. Before we dive deep, can you give us a little bit of background on yourself? What originally got you interested in becoming a music therapist? And then, how would you describe your therapeutic approach or philosophy?
Dianna: Well, you know, this is a common question - and I’ve heard other people respond to it - and there is kind of a unilateral theme of a combination of the love of music but wanting to help people.
Erica: Mmhmm.
Dianna: Me specifically - I was raised in a medical family, but also a musical family. And I’ve always been interested in how the brain responds to music - so thank goodness neuroscience has latched onto that.
Erica: Yeah.
Dianna: You know, even though I studied different aspects of music as a child, my original career steered my love of music into radio. And, therefore, the platform was music for entertainment. Now, entertainment is critically important, because that affects our mood -we use music when we listen to the radio or our own collection either to improve our mood or for catharsis, or as a vehicle to express what we cannot express on our own - which is a lot of the elements of music therapy.
Erica: Mmm.
Dianna: So, my career in radio allowed me to capture some of that. But then I got to a point where: A) the world of radio is very unstable and very narrow - and it narrows as you get older —
Erica: Mmm.
Dianna: And the field of music therapy has been in the back of my mind since my undergrad degree - I went to University of the Pacific, so I knew people who were studying music therapy when I was an undergrad, but I was very miopic towards radio at the time. But it was on my radar and stayed on my radar, and when I decided I was gonna shift away from my radio career and do something new, then obviously I researched music therapy as a field. And I was fortunate enough to come across a program, at Lesley University, that was a hybrid between mental health counseling and the expressive arts - and you can choose to specialize between music or art or drama or dance movement therapy. And I had spoken to music therapists who had been in the field for a very long time, and noticed that some of them had also uh gone back to school to become an LMHC or an MSW. And um - it also gives you the opportunity if you’re presenting as a counselor to say, and I’m also a music therapist. Because, believe it or not, there’s so many people that still don’t know what music therapy is. But it’s interesting to see their expressions like, ooh! Music therapy, that sounds interesting!
Erica: Mmhmm.
Dianna: They understand the 2 words by themselves, and in combination, they’re thinking, oh, so you help people through music! Yes!
Erica: Yes.
Dianna: Everybody is impacted by music. So it’s not a huge leap to get somebody to understand the concept of what music therapy is. As long as you make sure they understand it’s more than just, you know, playing a guitar and singing in a circle like you would around a campfire - which is great, but it goes way beyond that.
Erica: Absolutely.
Dianna: In the framework of therapy, you typically have a specific goal - an objective - and a plan - a treatment plan.
Erica: Mmhmm.
Dianna: It can be very fluid, but there’s also the constant assessing. When I’m working with people in a dementia venue, I’m always looking at their responses to see am I getting to them or not - am I triggering a trauma or not? And to constantly adjust - depending on what the goals and objectives are for that moment.
Erica: Mmm.
Dianna: So, that’s one of the differences between music purely for entertainment, which is very therapeutic, but also for therapy - it’s more. Of a clear goal and direction that you’re trying to achieve.
Erica: Absolutely, yes. You mentioned your work with dementia folx - could you tell us your experience working in dementia settings?
Dianna: So, for the past - well over a year and a half - I have been working at one of just a few Aegis living facilities that are dedicated to memory care. Started there as an intern - now I’m working there. And so, learning about the disease of dementia - the brain disease of dementia, the different types of dementia, and how it presents in a general sense, but also in an individual sense. And how to constantly navigate, you know, whether this person has Alzheimer’s or is it alcohol-induced dementia? Is it vascular dementia? And each one presents differently, and that can impact how you work with an individual. Certain dementias, like alcohol or Lewy Body can present earlier - sometimes speech and behavior is affected. And, even with a specific diagnosis, each individual presents differently.
Erica: Mmm. For people that - say a listener knows nothing about music therapy, but they have a loved one that’s experiencing dementia or maybe they have a history of Alzheimer’s in their family —
Dianna: Mmhmm —
Erica: Um, can you explain how the elements or qualities of music support people that have dementia - in a clinical or therapeutic setting?
Dianna: So, music can help stimulate what’s called associative memory. Associative memory is when the brain processes connects current stimuli, which in this case would be music, to memories - and music has the ability to activate all areas of the brain. And so - in a verbal dialogue, there may be elements of recall that just aren’t being facilitated, but when you’re engaged in music, those parts of the brain that music engages with also taps into long term memory. And so it really kinda brings them back, to some degree. And that can also spark conversations and, you know, just kind of unearth a whole uh treasure trove of memories.
Often times, music therapists refer to the sweet spot of someone’s musical memory over the lifespan - tends to be teens and 20s - so whatever music was popular during their teen years and 20 years is the type of music you wanna hone in on. There are residents where I work, that their sweet spot is the 1930s and ‘40s, and there’s also other residents who, their sweet spot is the ‘60s and ‘70s —
Erica: Mmm –
Dianna: And knowing that can really help facilitate whatever your goal is in working with an individual. So, if you have somebody in your family who is starting to show signs of dementia - it’s finding that sweet spot - finding the music of their era. And thank goodness for technology - you can go to YouTube and find music of the ‘40s, music of the 5’0s . You can also work with, you know, there was some music-based shows that evolved during the ‘50s: Dick Clark and American Bandstand —
Erica: Mmhmm —
Dianna: That provides uh a visual element to listening to the music. So if you have a loved one who is showing signs or has been diagnosed with dementia, and it’s still early stages, obviously finding the music of their era - but get ‘em to dance, get ‘em to move. Make it a whole body experience. Or, if their mobility is limited - again, watching music and dance - put on a movie that is a musical that has a lot of dance elements to it - it just helps to activate more parts of the brain. Sometimes when I’m working with residents, the only way I can tell they’re engaged is if they are tapping their toe. They may not be giving me eye contact - they may not be singing - but their toe is tapping.
Erica: Mmhmm.
Dianna: And you want those little cues. And that tells you that they’re present and that they’re engaged. And uh, sometimes being able to - if they can’t remember to do something, make it a song and use a melody that they’re familiar with and then just change the words. And that can help them recall things. So there’s a lot of ways you can use music therapy techniques even if that individual is still living with the family.
Erica: Absolutely. At the Music Project, we practice trauma-informed care and that’s a really important value for us. Um and so I generally ask most of my guests, how do you practice trauma-informed care within your practice?
Dianna: It goes back to constantly assessing.
Erica: Mmm.
Dianna: For one person, hearing a song could trigger positive memories, and for somebody else, that same song could trigger a trauma. Uh, there are some residents who lived through the war, and maybe a wartime song could, you know, motivate patriotism - maybe it triggers trauma. And so it’s that constant assessing - reading their facial cues to determine if this song supportive or detrimental. So that’s really really important. Again, it - it involves associative memory —
Erica: Mmhmm —
Dianna: Someone’s memory of the war era, where it - you know, that’s kind of the sweet spot era that a lot of residents in dementia care are in - although, we’re now moving towards the rebellious hippy era of the ‘60s and 70’s. So as populations age, that sweet spot of music will age. But even so, back in - you know - it was the Vietnam War, and that can be very traumatic. So —
Erica: Mmhmm —
Dianna: It’s about being mindful - switching repertoire - again, it depends on goals and objectives… You know, the challenge with dementia is that the reality is it is, right now at least, a one-way street. You can bring up moments of joy, you can bring up moments of childhood - elements in their lives, and then it wanes. But sometimes the emotional impact stays. So you just have to be very, very mindful when you are digging into those long-term memories - using music as a conduit - that their could be minefields, and you just have to be cautious about it. Maybe it’s an opportunity for them to talk through it… but most likely, you just have to be careful about your music selection and application.
Erica: How does your extra training in mental health, in addition the way your degree program encompassed a variety of creative arts, how do those 2 things support you as maybe you encounter trauma in a resident?
Dianna: Right. Everybody’s experienced trauma. I call them - you know, some of us may have experienced microtraumas, which means it doesn’t inhibit our everyday ability to function in life, but they’re definitely there. It’s tricky with dementia because a lot of people who’ve experienced trauma - not everybody, but a lot of people - they can recall those elements that sparked the traumatic response - not always, but often. Sometimes, in working with dementia, if a trauma memory emerges, they may be able to express what that is or not. It may just be purely an emotion —
Erica: Mmm —
Erica: And they don’t know where it came from.
Erica: Mmhmm.
Dianna: You know, there’s a variety of different theories and approaches in psychotherapy - most of them, if not all of them, very much adaptable when you’re incorporating music in music therapy. And just in the context of your question of studying mental health counseling, it just provides a deeper learning of different types of theoretical approaches.
Erica: Mmm.
Dianna: Because you cannot extrapolate the experience of music without incorporating mental and behavioral health.
Erica: Yeah. Um, we are still in the middle of the global pandemic with COVID-19. How are you addressing mental health care within your facility right now?
Dianna: Yes. So it has been challenging. What has changed in our facility because of the pandemic: we have families not visiting and that takes its toll.-We have 3 wings - or what we call 3 neighborhoods - that often times come together for different activities - everybody’s staying separate in their own neighborhoods. And it is hard to tell if changes in behavior and mood is due to the disease itself of dementia, or due to the changes in their environment. And I think it’s probably both. I personally think that the changes in their routine - not being able to see family, uh not being able to go out on excursions and bus rides and to the park - al that - even if they can’t articulate it, they know something has changed. There have been more behavior issues - more depression, more confusion, more agitation. And, to be fair, I think [chuckling] we’ve all experienced that to some degree —
Erica: Yes. Yeah —
Dianna: Because of our isolation and lack of, you know, normal life. But it just can be compounded by the diagnosis. And so, when the world is changing around them, it’s hard for them to understand why.
We do Facetimes - we help the residents connect with their family visually. You know - because that’s a lot of anxiety - you know, we focus on the clients of course, but the families are going through their own emotional traumas. What if I never see m loved one again- what if they pass and I’m - haven’t seen them in several months? And so it’s to be mindful of what the families of the residents are going through, and how to support them as well. And things like Facetime or having the opportunity to tell them stories - take photos and videos of them engaging in music can really help.
Erica: Absolutely.
Dianna: You know, in a way, music is more important than ever.
Erica: Yeah —
Dianna: It can kinda take them out of confusion and bring them into a state of joy. And memory recall - often I’ll sing several songs, and I’ll take a theme of a song, and I’ll stimulate conversation, so then they can live in the - live in the past in a positive way - not to avoid the present, but where they can recall times of their childhood —
Erica: Mmm —
Dianna: And - and kind of shift their focus to that instead of why can’t my family come visit.
Erica: Yeah.
Dianna: And one thing I wanted to touch upon —
Erica: Sure —
Dianna: Was what working with this population has done for me.
Erica: Mmm.
Dianna: It is really another avenue of experiencing mindfulness. Where all you have is that moment, and it has taught me that on such a deep level. Because you can work with a resident one day where they’re more aware, and engaging, and responsive - and the next day not at all. And so, you really have to enjoy the moment you have and are creating with that individual, because tomorrow is unknown. What are their needs - right now. And what can I do - right now to manifest what needs to be done in that moment?
Erica: Mmm, yeah. I think mindfulness is just a theme that comes up over and over and over again. Whether you’re being mindful of yourself in a moment - what you’re feeling, thinking - or mindful of the other person - the group of people, etc. Especially right now in a time where things are really confusing, chaotic, distressing - practicing mindfulness is critical. I think mindfulness and gratitude are like the 2 things I would say are the most critical to being quote unquote resilient, and to continue to walk through hard stuff.
Dianna: Right. There’s a principal in music therapy that can be applied, and is being applied, in - in the context of mental health, they just don’t have the term that we use, which is Iso Principle.
Erica: Mmhmm.
Dianna: Meet them where they’re at. And that involves mindfulness - you have to know where they’re at. You have to pay attention. And not just trying to, you know, focus on getting them out of that state - it’s to understand and listen and empathize. There’s a lot of times where, especially working with individuals, I don’t spend the whole time doing music - a lot of the time is being a counselor. And especially if they’re in their early stages, where they know they’re forgetting things but they don’t know why - which is incredibly frightening —
Erica: Mmhmm —
Dianna: And, to meet them in that fear and confusion, and to acknowledge it and support them in however they are feeling in that moment - validating, validating, validating - and then, hopefully through conversation, and through music, helping them gently move to a more state of peace and less anxiety. But in order to do that, you need to be mindful and you need to be completely present with that individual - where they’re at - without judgement, and honor that —
Erica: Mmhmm —
Dianna: Before you can work towards a goal and objective.
Erica: Absolutely. I - what I really hear you saying is like, it comes down to llike, all people want to be seen, and they want to be heard, and they want to be known. And I think, because there’s greater body of research around the relationship of music and neuroscience —
Dianna: Right —
Erica: We over-pathologize people with dementia and we just see it as dementia - and we stop seeing the whole person.
Dianna: Absolutely true! You know, my father was a doctor, and he said, you never treat a person based upon their lab results. And I think that translates to any type of healthcare paradigm, where you are not just treating a diagnosis, you’re treating a human being who happens to have this diagnosis. And that presents differently in each person. For some, it affects behavior, for some it affects memory, for some it affects speech ability. And, even though a lot of established techniques can work with a variety of individuals, you really have to - again, going back to mindfulness - you really have to be mindful, well - well, what really works for this person? What’s their life story? What is their musical life story? And how can I use that to support them in this moment?
Erica: Mmm. I love that so much. So we’re running. Out of time, so before we go, do you have any resources you can share with us if listeners want to investigate further?
Dianna: As you mentioned, thank goodness in music therapy there is a lot of research regarding the population of people dealing with dementia. So there’s a lot available. There is something that some people might not be aware of, and it’s called MiDAS - that’s the acronym. It is actually an assessment tool that was designed with with working with people that have been diagnosed with dementia.
Erica: Mmm!
Dianna: It’s kinda, you know, in the medical model or in the healthcare model. It allows you to quantify, to some degree, you know, baseline how are they before the session? How are they after the session? What are their not only cognitive abilities - what are their motor abilities? SO, it’s capitol M, small I, and then capitol D-A-S.
Beyond what research has been done solely with dementia and music therapy, there’s emerging research on using expressive arts in working with this population. Music and movement working with dementia. Music and art - because as we’re talking about engaging the whole person, it allows the music therapist additional tools in the toolkit. And also, just to kinda become more familiar with the different types of dementia. Everybody tends to think, oh - dementia/Alzheimer’s - well, Alzheimer’s I believe, is about 70%, then there’s that whole other 30%.
Erica: Mmm. Absolutely. So all of the resources that Dianna has sent me will be on our website. Our website is S, as in Sam, C, as in Cat, Music Project dot org (scmusicproject.org). You can find out all about us - our programs - the podcast. You’re also welcome to follow us on all of our social media channels to stay up to date with the latest things that we’re doing.
We encourage you to stay tuned for upcoming episodes. We’re gonna continue this series about dementia and older adults. We have an episode about hospice care coming up - I’m really looking forward to that.
I wanna thank you, Dianna, for talking with me today. I so appreciate you and all the work you do. Thank you, listeners, for listening. And we’ll talk to you next time.
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