Handling Difficult Emotions

Coping with emotional outbursts in Alzheimer’s patients

Caring for a person with Alzheimer’s can be difficult. And when the person you’re caring for gets upset and has an emotional outburst, it’s even harder.

“It’s very hard for well-intentioned family members not to take attacks or outbursts personally,” says Lisa P. Gwyther, MSW, LCSW, Associate Professor, Department of Psychiatry and Behavioral Sciences, at Duke University in Durham, N.C. “Families feel misunderstood and unappreciated by the person they are trying to help or protect.”

The most common causes for emotional outbursts, says Gwyther, include:

  • Miscommunication, misperceptions, or misunderstanding of what is being said or requested
  • Feeling rushed, discounted, left out, or abandoned
  • Feeling threatened or lost in a world that isn’t making sense
  • Untreated pain, discomfort, or illness
  • Reminders of their lost capacity
“Caregivers should expect the person to respond best if he or she is treated with respect and dignity, and not marginalized or excluded.”
“Caregivers should expect the person to respond best if he or she is treated with respect and dignity, and not marginalized or excluded.”

“Caregivers should expect the person to respond best if he or she is treated with respect and dignity, and not marginalized or excluded,” says Gwyther. “The person needs more time, more visual or other sensory cues or reminders, more reassurance and more attention to maintaining predictable routines with less to remember.”

Gwyther adds that people living with progressive dementia can have a good quality of life. Caregivers should try to balance the person’s continuing need for both stimulation and retreat. “The person will tire easily from thinking and responding, not just physical exertion,” she says. “Individuals with dementia will have more difficulty starting new activities or remembering where they are in a task.”

What triggers an emotional outburst? Often loud, confusing environments with lots of distractions or many simultaneous conversations can upset someone with Alzheimer’s, says Gwyther. A change in environment or routine (like travel or a hospital stay) can also be upsetting, as can situations that test the person’s memory. “Loud popping sounds to veterans with PTSD, who may now have dementia, can be especially threatening,” she adds.

“Each person is different,” says Gwyther. “Certain places or activities will upset one person and comfort another.”

When it comes to handling these emotional outbursts, Gwyther advises first calming yourself. “The person is probably sensitive to your mood and non-verbal tension or anger more so than the content of what you say,” she says.

Gwyther offers these additional tips to help with emotional outbursts:

  • Make efforts to normalize the situation deflect, distract, and reassure.
  • Acknowledge that the person is upset and assure them you will help them feel better and stand by them until they calm down.
  • You don’t have to agree with the person’s delusions, but do validate their feelings of loss or fear.
  • Try to reduce fears of abandonment in a world that, to them, seems scary or confusing.
  • Help the person do as much as possible for himself and find ways to acknowledge and reward contributions.

If the triggers of the emotional outbursts aren’t addressed, says Gwyther, the outbursts will escalate. “Wise families learn how to change their communication, the environment, activities or demands, to minimize disruptive outbursts,” she says.

“Families are well-advised to take time for themselves and to seek activities they can continue to enjoy both on their own and with the person,” she says. “It helps to become less task-centered, less type-A,” she adds. “Jump off the fast lane and enjoy shared moments of pleasant activities.”

And it’s important that caregivers not neglect their own well-being. “Caregivers need restorative sleep, healthy diets, exercise, respite options, social and intellectual engagement,” says Gwyther. “[They need] opportunities to share and learn from the experience of others in a similar situation—support groups, online support, and dependable listening and support of family and friends.”

By Jason Schneider