There's Still No Cure For Dementia, But Being A Little Theatrical Could Help Improve Communication

Mar 6, 2018

On a Saturday afternoon, a group of about 25 people, ranging from teenagers to seniors, were gathered at the Steel City Improv Theatre in Shadyside for a workshop. 

During a warm-up exercise, the group crowded onto the stage of the small black box theater, smiling and laughing at the occasional awkward bump with a neighbor.

Improv classes are a common occurrence, but this workshop, "Agreeing To Remember," was geared specifically towards people who take care of or interact with dementia patients.

Rachael Wonderlin, who runs the workshop with partner Chris Wright, has been an improv enthusiast since college, but she's also made a career in the field of dementia care. She received her master's degree in gerontology and worked at several senior living facilities before taking on her current role as a dementia care consultant.

"Your brain is always working to make sense of things that don’t make sense," said Wonderlin. "Usually, with people with dementia, you end up with an amalgamation of facts that isn’t necessarily in any kind of order that makes sense. And they put it together and they go, ‘Ok, here’s the reality.' "

She said, in her experience, people without dementia don't always respond well.

"Family members and caregivers usually try to correct people with dementia. So they’re going, like, 'you know, Mom, it’s 2018 and your father’s dead,'" said Wonderlin.

This strategy — arguing, contradicting — will not shake the patient out of it in any lasting, meaningful way. But it can strain relationships.

"I had a client who once told me, 'My son hates me. He argues with me all the time, and I don’t know why.' And she remembered that," said Wonderlin. "He couldn’t bend at all to be able live in her world, and so he just… he broke."

This is where improv comes in—by improvising, you can help create a new reality that you can inhabit together. 

Sometimes improv performers lead the conversation, and sometimes they build on the efforts of others by agreeing and adding to them. That second part is a sort of a rule of thumb in improv, called “Yes, and.”

"If you were to say, 'that chair is blue', I would say, 'Yes, and I bought it yesterday,'" said Wonderlin, to continue the conversation.

The theory of the workshop, said Wonderlin, is that these techniques are a helpful way to communicate and enjoy spending time with dementia patients, especially those who are further along with the disease.

Deborah Witchel is a counselor who attended the workshop in 2016. She remembered that when her late mother, who had Alzheimer's disease, first started having mix-ups about who was who, Witchel would correct her, and her mother would try to play it off.

"She would be embarrassed. And she’d go, ‘Oh, of course you are!’” said Witchel.

As the condition progressed and the confusion deepened, Witchel said her mother more or less retreated into herself.

"She would just go 'huh' or not really respond at all. It became very hard for us, my brother and I, to connect with her," said Witchel.

A few weeks after she attended the workshop, Witchel was scheduled to visit her mother in Florida, and decided to take the lead using the improv strategies.

"We created these whole fantasies. We went on cruises, we took airplane rides to different countries, we went to many Broadway shows," said Witchel. "And she smiled, she laughed, she spoke a little bit... there was no more pushback. No more of her feeling embarrassed because she didn’t remember anything, or shutting down. "

Witchel said her mother passed away later that year, but that her last few visits were far more positive than the previous ones and that it made a difference to her.

Christine Noonan, a physical therapist who often works with dementia patients at the senior healthcare facility Community Life in McKeesport, also attended the workshop and said these techniques can be a practical tool that helps professionals like her do their job.

"If you try to change their version of reality, then agitation often occurs. And so it’s really [useful for] keeping them calm and in the moment and being able to care for them the way they need to be cared for," said Noonan.

At this point, there's not yet much evidence in academic research about improv and dementia.

"It has to be proven, so you have to do it in the context of other interventions. By itself, it may work, but I haven’t seen many large-scale studies," said Oscar Lopez, director of of the Alzheimer’s Disease Research Center at the University of Pittsburgh.

Through the center's BRiTE program, Lopez said he and his colleagues are studying how a combination of activities including improv, music and art-making, could help prevent patients with mild cognitive deficits from further decline.

Cognitive issues aside, Lopez said that when it comes to dementia patients, any form of improving communication is important.

Wonderlin said that improved communication is her aim, and that in her experience, that tends to be the outcome when people approach learning about and applying the strategies with an open mind.

"Some people just need to see it in action and then they go, 'Well that was way better than what I was doing last week,' " said Wonderlin.

Wonderlin said she expects her next workshop at Steel City Improv Theatre to be held within the next few months.

WESA’s Bridges to Health covers the well-being of Pennsylvanians and is funded by the Jewish Healthcare Foundation.