Papers by Richard Cheston
Aging & Mental Health, Sep 27, 2016
Psychological therapies take many different forms, and can be used in different contexts to meet ... more Psychological therapies take many different forms, and can be used in different contexts to meet different needs. In dementia care, psychological therapies can be used in a formal or informal way. The formal, or structured, use of psychological therapies focuses on talking about feelings, emotions and ways of thinking; occurs regularly within a specific context; draws on psychological formulations (a set of hypotheses about a person’s difficulties which link theory and practice); promotes change within the individual or the system around the person (including changes within relationships and families); and aims to enhance wellbeing either by helping individuals to understand themselves and their illness or by changing their patterns of thinking or behaviour. Increasingly, however, psychological therapies are being used informally, either as elements of multi-component interventions or with people with more severe levels of cognitive impairment
Springer eBooks, 2019
This chapter continues our exploration of dementia as an existential threat by focusing on one wa... more This chapter continues our exploration of dementia as an existential threat by focusing on one way by which we protect ourselves from distress when we encounter reminders of dementia in our everyday lives. The specific coping mechanism we will discuss is known as mnemic neglect. This is a self-protective memory bias that shields us from being consciously aware of information about our self that is threatening. We will outline some of the research from social psychology on mnemic neglect before describing our own research that extends these findings into a clinical domain. This programme of studies shows that older people without dementia, as well as those who are living with dementia, both selectively forget information about the condition that threatens their sense of self. This indicates that the same self-protective strategies are at play in people with and without dementia. We conclude by discussing the therapeutic implications of these findings.
Springer eBooks, 2019
A diagnosis of dementia threatens not only many of the core aspects of what it is to be human, bu... more A diagnosis of dementia threatens not only many of the core aspects of what it is to be human, but leads, through a progressive deterioration, to death. Dementia thus represents an existential threat that creates profound emotional and psychological challenges for those who are directly affected by the illness. In this chapter, we argue that the psychological threat dementia represents needs to be viewed within the context of research from social psychology, and in particular Terror Management Theory (TMT). TMT proposes that humans experience a basic psychological conflict that results from having a self-preservation instinct on the one hand while on the other hand also knowing that death is inevitable. As a way of managing the distress that would otherwise arise from this knowledge, a series of defences operate to build psychological resilience and to reduce or to eliminate awareness of death. These defence strategies include the person investing themselves in religious and cultural belief systems which hold the possibility of spiritual immortality, as well as internal psychological processes such as repression and avoidance. We explore how the TMT framework might help us to make sense out of the experiences of people living with dementia.
Diagnosis without support may not be beneficial, and in some respects may be harmful. This is bec... more Diagnosis without support may not be beneficial, and in some respects may be harmful. This is because earlier diagnosis provides more opportunity for people to adjust, resulting in prolonged independence. However, many people affected by dementia report that after being given a diagnosis they received little support, if any.•Good post-diagnostic support services are often the key to living well with dementia. •Adjustment to diagnosis is complex and is an important stage in offering help to living well with the condition. •Equitable access to specialist post-diagnostic support is important. •There are many evidence–based psychosocial treatments available for people living with dementi
Springer eBooks, 2019
This chapter sets out the results from a research programme that has explored the benefits of nos... more This chapter sets out the results from a research programme that has explored the benefits of nostalgia for people who are affected by dementia. First, we replicated the finding from social psychology that nostalgic reminiscence increases levels of self-esteem, social connectedness, and meaning in life for people living with dementia. We then found that by increasing psychological resources, participants with dementia were better able to recall more information about their condition, including material deemed threatening, without at the same time becoming distressed. This suggests that enhancing psychological resources will enable people to manage the distress of their dementia. Additionally, these findings may mean that current practices in Reminiscence Therapy need to be revised such that the focus is on the recall of specific nostalgic memories rather than non-specific ones.
Th* prlaolpal «la oí tklo tkaalo la to axaaloo tiM roaaons tkat apaolal aducatioa laavara with a ... more Th* prlaolpal «la oí tklo tkaalo la to axaaloo tiM roaaons tkat apaolal aducatioa laavara with a aaatal haadlcap glTa for tbalr laballlag. Tha thaala eoaalata of thraa parta. la tha pilot atudy aavaa tralaaaa at aa Adult Traíalas Caatra wara latarvlawad botwaaa larch and April 1089. 81a of thaaa tralaaaa wara ralatanrlawad batwaaa lova^bar 1088 aad Jaauary 1087. la thf aacoad part of tha thaala, tha aoraatlra atudp, a aurray waa oarrlad out which aatabllahad tha aaployaaat hlatory of 80 of tha 105 laawara froa a apaolal aohool aad a apaolal ualt batwaaa 1082 aad 1085. Tha aoraatlTO atudy alao aatabllahad that at laaat 35 of tha 80 laavara oa whoa It was poaalbla to gathar laforaatloa tad baaa tha vlotlaa of laforaal laballlag. la tha flaal part of tha thaala, tha Ipaatlva atudy, alavaa apaolal aohool aad apaclal ualt pupila wara latarvlawad. Tha flrat latarvlawa wara oarrlad out la tta tara bafora tha partlolpaata laft achool la 1089. Tha flaal latarviawa wara conductad at tta aad of tta partlclpaata' flrat yaar after laavlag achool, la Jaauary 1087. I argua that tta laavara that I latarvlawad actively latarpratad laballlag aad produced oftaa quite detallad aad c o p l e a axplaaatloaa., For tta laavara thaaa aaplaaatloaa aarvad tta fuaotloa of llaltlag tha aztaat to idiloh they waro paraaaally raapoaalbla for thalr plaoaaaat la a apaolal aohool or a apaolal ualt.
International Journal of Geriatric Psychiatry, Apr 8, 2015
1.56 (large) and 1.26 (large). A weighted comparison (Larner and Hancock 2014) showed a small net... more 1.56 (large) and 1.26 (large). A weighted comparison (Larner and Hancock 2014) showed a small net loss (À0.13) for mACE versus MMSE (at cutoff ≤24/30) for dementia diagnosis, with an equivalent increase of À22 cases of dementia detected per 1000 tested, but a large net benefit for MCI diagnosis (0.38) with an equivalent increase of 133 cases of MCI detected per 1000 tested. At the cutoffs specified in the index paper, for dementia diagnosis (Table 1, left hand columns), mACE was very sensitive (1.00, 0.92) but not very specific (0.28, 0.61); sensitivity and specificity for MMSE (cutoff ≤24/30) were 0.92 (surprisingly high) and 0.72. For MCI diagnosis (Table 1, right hand columns), mACE was both sensitive (0.77) and specific (0.82) at the lower cutoff; figures for MMSE (cutoff ≤24/30) were 0.54 and 0.86. This study showed that mACE is quick, easy to use and score, and acceptable to patients. At prespecified cutoffs, its performance for dementia diagnosis was comparable with MMSE and better for diagnosis of MCI. In summary, mACE appears to be an acceptable alternative to MMSE for the initial assessment of cognitive complaints in a dedicated cognitive disorders clinic.
Journal of Social Work Practice, Nov 1, 1998
This article argues that good dementia care must inevitably be psychotherapeutic in the sense of ... more This article argues that good dementia care must inevitably be psychotherapeutic in the sense of addressing emotional as well as physical needs. Three key aspects of psychotherapeutic work with dementia sufferers are identified: helping the dementia sufferer to grieve for the multiple losses that they have suffered and which are yet to come; bearing witness to this process; and attending to the context of care. These themes are then illustrated through a case example. Although formal psychotherapeutic work with individuals and in groups can be extremely useful, counselling skills can also be used as part of a general care plan. In many ways it is more important to think in terms of being psychotherapeutic in dementia care, rather than in terms of doing psychotherapy with dementia sufferers. This article provides an account of using psychotherapeutic work with dementia sufferers. Inevitably this involves addressing issues of loss and change in the lives of people with
BMJ Open
ObjectivesTo investigate staff experiences of, and approaches to behaviour that challenges displa... more ObjectivesTo investigate staff experiences of, and approaches to behaviour that challenges displayed by patients with dementia in the emergency department (ED). Behaviour that challenges is defined as ‘actions that detract from the well-being of individuals due to the physical or psychological distress they cause within the settings they are performed’, and can take many forms including aggressive physical actions, shouting and verbal aggression and non-aggressive behaviour including repetitive questioning, inappropriate exposure and resistance to care.DesignMixed-methods study consisting of an online survey and semistructured telephone interviews. Quantitative data were analysed and presented using descriptive statistics. Qualitative data were analysed thematically.SettingThe EDs of three National Health Service (NHS) Hospital Trusts in Southwest England.ParticipantsMultidisciplinary NHS staff working in the ED.ResultsFifty-two online survey responses and 13 telephone interviews we...
FPOP Bulletin: Psychology of Older People
This paper sets out an argument for understanding the subjective experience of people with dement... more This paper sets out an argument for understanding the subjective experience of people with dementia in terms of Terror Management Theory (TMT). This theory is a broad and detailed account derived from experimental psychological research of the way in which material that represents an existential threat to psychological equanimity triggers a range of social and personal defences. These responses are mediated by levels of self-esteem and include the process of mnemic neglect in which threatening material is processed less efficiently and recalled less thoroughly. Using TMT to understand the responses of people with dementia has a range of clinical implications.Judith:I just wonder where it’s all going to end, that’s my fear …Janet:Whenit’s going to end?Judith:Whereit’s going to end, where am I going to end up, just before the end, you know.Janet:Oh, I see you mean, I talk about death…Judith:YeahJanet: …to my family and I think the only thing that I’m frightened of is the unknown and t...
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Papers by Richard Cheston