Tools and Skills for Dealing with Irrational Thoughts and Behaviors in Huntington's Disease11/18/2017 by Debra E Andrew
What gives? Suddenly, your loved one with Huntington's Disease is making no sense at all; their behavior is totally off the wall. What in the world is going on? When it comes to irrational thought, and irrational behaviors, it's important to note that rational thought includes logic and reasoning. When the brain is impacted by Huntington's Disease, there is often a lack of reasoning or logic. This is because of damage to the brain in the frontal lobe. As brain cells die, logic, and rational thought are interrupted, confused, or even absent. If the thoughts and behaviors of the person with Huntington's Disease aren't based on logic or reasoning, then what are they based on? The answer is need and an extreme anxiety that is overwhelming to them. Each person has many needs throughout a given day. Most of the time, we can meet those needs on our own with little thought. This isn't the case with Huntington's Disease. When HD is involved, the inability to act, process, sequence, and come to a logical conclusion, doesn't happen the way it does when HD is not present. Although it can be very frustrating for loved ones, and caregivers to understand and have patience with irrational thoughts and behaviors, the truth is this is a time for understanding and compassion. Remember that the thoughts in a person's mind who has HD, may demand the fulfillment of a need that doesn't even make sense to you at the time. To them, it is a pressing need, that must be met. Yes, it's true that a person with HD can respond very rationally at times. That makes things even more confusing for those around them. It could be easy to think that sporadic irrational thought or behavior is on purpose. It isn't. What is a person to do? One thing that doesn't work with irrational thought and behaviors is reasoning with the person. They can't be rational or logical at that time. Don't even expect it. You might as well ask them to spread their wings and fly! The capacity to do so just isn't there. Even worse, trying to use logic or trying to reason with a person in this state will probably escalate the situation and could lead to aggression or violence. Just don't do it. In addition to providing reassurance , love, and support to your loved one with Huntington's Disease, the following techniques may be helpful when interacting with someone who is experiencing irrational thought patterns or in an HD episode. Distractions: Distraction #1 - The Switch - Sometimes it is much easier to distract a person who is behaving irrationally. Assisting them to switch their thoughts can be helpful. To do this, present something to the person that will catch their attention, and require some type of response or interaction. Offering a favorite food perhaps, or shifting the conversation to something they really enjoy and have an interest in. Sometimes handing an unexpected object to them that really catches their attention can help. Whatever safe, and kind, distraction you can come up with that fits them, and the current need that they have, is an option. The more extreme the distraction, the faster it will catch their attention. Again, we are speaking of safe, and kind, options. Something mean may seem to work, but it isn't appropriate to use a negative behavior to “re-frame” another negative behavior. Doing something negative or mean will only backfire anyway. Any type of abuse is unacceptable. Treat your loved one with Huntington's Disease with kindness, love, compassion, and understanding. They truly aren't trying to be difficult, and they certainly didn't ask to have Huntington's Disease. Be compassionate. Distration #2 -The “Oh No! Shocker - In an extreme situation, the, “Oh No!” technique offers a quick redirection of thought, by presenting a type of shock or emergency. This of course isn't really a serious emergency that you have created, but is framed in a way to create surprise and urgency. Pervasiveness can be a real challenge with HD, so it may take some very consistent distraction to make a shift from irrational thought patterns to something else. Sometimes, the pervasiveness is so severe, an average distraction won't work. Something a little bit shocking and unexpected can redirect the mind very quickly. This is helpful when things are more extreme, and the person is getting aggressive, or violent. Even a loud, unexpected, sound, can stop behavior in its tracks. Perhaps “accidentally” turning on music loudly, or banging a cupboard extra loud, blowing a whistle, or other loud sound can do the trick. It's important to immediately follow the sound with another distraction. The idea is to take the person's mind off of the thought patterns they are having, and to distract them to something else. If this technique is used, use it only rarely or you will dilute its effectiveness. Misuse of this technique can aggravate aggression, so use it wisely, and with common sense. Avoidance Avoidance #1- The Subject Changer – If the subject or experience at hand is causing the irrational behavior to escalate, it's important to change the subject, scenery, or other focus as quickly as possible to avoid continuing the negative escalation. It is possible to catch the irrational thought patterns or actions early. By acting quickly, trouble can be avoided. A soft reply, directed at something completely different, and more distracting replies to follow, can sometimes avoid an escalation of irrational behavior. Sometimes quickly removing your loved one from a situation that is creating anxiety is the best option. Take them to a quiet area, and help them to calm down. Reassure them. Often this is what is needed. The point is to find a way to avoid the irrational behavior by using this technique. Avoidance #2 – Remove Yourself – Sometimes the best thing you can do, is to remove yourself from the situation. That may mean going into another room. If needed, use a locked door. At times, and if it's safe for your loved one with HD, you may need to leave the house for a short time. Although you may need to avoid the situation, abandonment or neglect aren't the answers. Make sure you aren't leaving a vulnerable person unattended. Speaking of safety, in no way should you allow yourself to be abused in any way. Your loved one with HD may say terrible things when they are in an episode, they may also become aggressive or violent physically. It isn't OK for you or for them to be abused emotionally, mentally, or physically. If you are not safe, get to safety and call for help. It is important to stop any abusive cycles before they begin. There are techniques for dealing with verbal abuse. Those will be addressed in a future article. If at all possible, simply walk away, without any response. Or if you must, say, “what you are saying to me isn't OK. I'm going to leave until you are calm, and speaking to me appropriately again”. Remember, don't rationalize, don't get caught up in arguing, or talking about it right then. Just walk away. Avoidance #3 – Remove Them – It may be necessary for the person who is experiencing irrational behavior to physically change their environment. If caught early, this may mean taking a walk, exercise, listening to soothing music, or similar ways to remove them from the situation. If they are wheelchair bound, consider taking them on a walk outside. We all get sick of four walls and need to get out. If they can exercise, see if they can do that. That may be difficult when they are extremely irrational. However, if you can get the exercise started early, it can help relieve the anxiety and confusion they are feeling. In extreme cases, you may need help from others to remove them for a period of time. Either to take them outside, or in the extreme for medical care until they are calm and stabilized again. If you need medical help and intervention, call for it. Sometimes it takes a stay in the hospital to get them stabilized again. Although that is more of a rare situation, it does happen, and if it does, be strong enough to do what needs to be done. You are the protector and caregiver to your loved one with Huntington's Disease. They can't do these things for themselves and rely on you to do what is in their best interest and well being. Medications help to manage these types of symptoms, and it may take a hospital stay to get the right medications found and going. Calming Calming #1 – Music – As mentioned before, soothing music can help with anxiety, and often the high levels of anxiety experienced by a person with Huntington's Disease is contributing to their irrational thoughts and behaviors. Nature sounds are also a good alternative. Music can calm a person, and can actually tap into their mental brain patterns. If possible dancing with the music can also help to relieve anxiety, and has been shown to actually benefit the brain. Or if movement limitations don't allow for dance, try to add some type of fun to the music. Which brings us to #2 Calming #2 – Laughter – Humor is a must when it comes to dealing with Huntington's Disease, and when the irrational hits, it can save the day. Try to find the humor to laugh “with” your loved one, and to get them also laughing and being silly or humorous. Laughter releases wonderful things in our brains, and can release anxiety very quickly. Don't be afraid to do something really silly and unexpected if it will get them laughing. Calming #3 – Relaxation – We all love a warm shower or bath, or to feel comfy and cozy in some form or another. Some have found that essential oils can help to calm, as can the use of melatonin. Melatonin helps a person relax. That means reduced anxiety levels, and a better result for both of you. Melatonin is often used to aid in sleep, however, a smaller dose can simply help a person to relax. Consult with your doctor before adding any substance, even a natural one such as melatonin, to what your loved one is taking. The right medications are a must. Help your loved one to get them, and take them as directed. In addition to these, a soft, snugly , blanket may help, or a weighted blanket. Treat pain, as quickly as possible. Check for room temperature as well. Although the person with HD may think they feel hot, their skin may be cold, and that is subconsciously aggravating them. They may also be hot, and need to become cooler to relax. Work with them on filling their needs. Find The Need Pain, hunger, being uncomfortable in some way, having an infection or other health problems can cause undue anxiety which contributes to irrational thought. The best way to deal with an unmet need, is to fill the need. It sounds simple; the problem is sometimes the person with HD doesn't even know what the need is themselves. And if they do, they may not be able to communicate or express the need. Using visual cards, charts with images, phone apps, or apps on a tablet or other device that use pictures and other visual clues, can offer another option for communication. This is especially helpful when the ability to speak is diminishing. If the problem is pervasive thought that just won't go away, they need your help to change the mental topic. Coping well is not something easy to do for someone with HD. They are overwhelmed, frightened, confused, and their brains are giving them grief. Assisting them to cope with whatever is going on, is what they need from you. It can be overwhelming to be a caregiver to someone with Huntington's Disease. It may seem like you are always doing the hard work. That is because you are. Your loved one can't do it for themselves. You can learn and use valuable techniques that can help you and them, to have a better quality of life each day.
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by Debra E Andrew
It happens out of the blue. There you are, going along with what appears to be a somewhat normal moment in time, when suddenly the irrational rears its ugly head! It isn't that you have never seen this before. It is that even though you have seen it, you are still caught off guard. One second your loved one who has Huntington's Disease seems rational then suddenly, they are anything but. How does one cope with irrational behavior? First, let's talk about the why. Knowing the why won't change the behaviors you see. It may help you to wrap your head around what is going on. The brain of the person with HD is being attacked. We could go into all kinds of medical and scientific descriptions about that, but rather than do that, let's understand it in simple terms. The brain is being attacked, injured, damaged, and brain cells are being murdered. When that happens, in the frontal lobe of the brain, it impacts behaviors. Some factors that trigger irrational behaviors in HD are: Anxiety A person with Huntington's Disease can feel very anxious when their brain isn't working for them like they realize it should be. Their ability to cope, is undermined, they feel a loss of control, and the anxiety begins to rise. This isn't the basic anxiety that a person without Huntington's Disease faces. This is an intense, all consuming, anxiety that begins to overwhelm them completely. Being overwhelmed With so many emotions swirling around all at once it is confusing and extremely overwhelming. There is no way for a person with Huntington's Disease to sort through all of those extreme emotions. It becomes so overpowering that it removes rational thought from them. Just coping with those emotions is more than they can do, forget adding rational thought to that. Even if the processing of their brain allowed rational thought at that point, this extreme mixture of emotions would hijack it. Impulse control Frontal lobe damage erodes impulse control. At times we may all have some irrational thoughts, but our impulse control allows us to get rational again and to get control of any irrational thoughts. That is an impossibility for someone with Huntington's Disease who is experiencing irrational thoughts or irrational understanding. Their brain has taken off on its own direction of thought and what the brain believes to be true is true to them. To them, every one of those thoughts are real, and true. And they behave accordingly. Confusion of thoughts and emotions Part of the person with HD will fight to find what is true, what is going on, and even what is rational. Much like being in a room full of mirrors with hundreds of reflections, they are seeing all of these thoughts, and emotions, and trying to figure out which is real. They may doubt if any of them are real, yet then believe all of them are real. Imagine how overwhelming that would be. The only survival available is to choose, to decide what is real and hang on to it. Unfortunately, that often can be the irrational thoughts that take over. Frustration Things just aren't adding up. Things aren't working like they should work. And there is no way to understand why, or to sift through them, and get them lined up again like they should be. That is where the frustration begins. A loss of control. A loss of understanding, that is frightening, and overwhelming. It often comes out as frustration because acknowledging the fear that they truly are “losing their mind” is too much to process or accept. Unmet Needs Being hungry, thirsty, or having pain, or other unmet needs isn't something that a person with HD can always express or process. Their body may hurt, but their mind may not tell them what they are feeling is pain. They may be hungry but can't express their hunger. Gnawing at them, is some feeling they can't communicate, process, or meet for themselves. And yet, the feeling is relentless. They are at a loss of what to do. Remember, that HD erodes the ability to know how to choose, or how to do an act. The desire to act is there, yet all that comes out is to be frozen, unable to act on what they want to act on or choose how to do it. Perception, Unawareness, Lack of Emotional Recognition Adding to this terrifying scenario, is the inability to perceive exactly the responses around them. They may be unaware of others responses, emotions, and much more. Although the facial cues that we normally would see and understand are there, they can't pick up on those cues. They are left without understanding of any response, or become extremely confused at the responses being received. When responses are negative, or unexpected, and they are all unexpected, it's like being hit in the head by a two by four. The person with HD is caught off guard, and now, added to all of the above extreme confusion they are going through, they are baffled, and confused. Even though it is natural to attempt to rationalize with a person who is behaving irrationally, all of these factors make a rational discussion or reasoning with them futile. This may sound hopeless, but it isn't. Thankfully there are ways to manage and to cope with irrational behaviors. Those will be discussed in a follow up article. © 2017 HD INSIDER All Rights Reserved. This Blog and site is designed to give new insight, support, and assistance to those who care for loved ones with Huntington's Disease, and those impacted by Huntington's Disease. Welcome.
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Debra E Andrew
Debra E Andrew is happily married, has 7 children, 4 step children, 23 grandchildren, and 1 soon to be great grandchild. Her love of health and wellness has led her to empower others in all 8 areas of health and wellness in her daily life and businesses. Archives
November 2017
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