Class #9: Practicing How to Increase Everyday Pleasant Events and Activities What We Will Cover in Class #9: 1. Review Homework From Class #8 20 min. 1. Daily Mood Scale 2. Pleasant Event Tracking Form 2. Mini-Lecture and Discussion: Graphing the 30 min. Relationship Between Mood and Events Estimated Time 3. Refreshment Break 10 min. 4. Mini_Lecture: Identifying Pleasant Activities 20 min. to Be Shared With My Relative 5. Begin Review and Discussion: 30 min. Material Covered in the Class 1. Relaxation Technique 2. Tracking Unhelpful Thoughts Related to Caregiving 3. Challenging Those Unhelpful Thinking Patterns and Developing Moer Adaptive Ones 4. Seeing How Thoughts Influence Behavior and Everyday Actions 5. Learning to Be More Assertive Regarding Caregiving 6. Learning to Identify Pleasant Events or Activities Than Can be Done on a Regular Basis 7. Tracking Mood and Understanding How Thoughts and Behaviors Influence and Control Mood 8. Identifying Pleasant Events to do with Your Relative 6. Relaxation Ratings and Practice 10 min. 7. Review Homework for Next Week 5 min. Total Time = 120 min. 1
1. REVIEW HOMEWORK A. Daily Mood Rating Form. Let us go around the room and share our completed assignments. Leaders: Ask participants to turn to their completed forms for today, then go around the room and ask each person to share their completed homework assignment and any obstacles they encountered. B. Revised Pleasant Event Tracking Form. Let us go around the room, again to share completed assignments. We ll ask for several volunteers to share their homework. Leaders: Ask class participants to share what happened when they were trying to increase their daily total of pleasant events. Encourage participants to continue to engage in as many pleasant activities as they can per week. Also, encourage the recognition of pleasant feelings that result from participating in the activity. 2
2. MINI-LECTURE: GRAPHING THE RELATIONSHIP BETWEEN MOOD AND EVENTS We will now use your completed homework to illustrate once again how events affect mood. The graph is a picture that will illustrate tow concepts: 1. Your mood level on each day for one week. 2. The number of pleasant events that are experienced each day. 3. The power and influence that these events have on raising or lowering your mood level. The Graph will consist of: 1. Lines that indicate each day of the week. 2. A number scale. 3. Two colored lines: A Red line will represent the mood level. A Green line will represent the number of pleasant events which occurred on each day. Note: Leaders need to be prepared to take the homework and work with it on the spot. Have each person begin to graph their own mood and pleasant activity data. You will need to go around and assist people, so they do it properly. Also, plan to spend time discussing graphs that will illustrate the main points and one or two that do not? For the latter, you will need to ask the participants for their ideas about why it did not work (e.g. not enough time or other barriers that were mentioned). Leaders help the individual problem solve how to overcome these obstacles for the next week s tracking exercise Leaders: Eventually every participant should have a completed mood and pleasant event graph to demonstrate the relationship between their own pleasant events and mood. If leaders are unable to review every caregiver s graph in class, offer either individual attention after class or arrange another time to explain their graph. 3
RELATIONSHIP BETWEEN MOOD AND PLEASANT EVENTS (in class use) Pleasant Events: (Use a green marker) Step 1: Write the days of the week a the bottom of the graph in the slots next to the work Day. Step 2: Correlate the dates with the days of the week. Step 3: The numbers listed on the left hand side of the graph (pleasant events) ranging from 0-10, represent the total number of pleasant events you have experienced in a single day. Use your Pleasant Events Tracking From to determine how many pleasant events you had each day. For example, if you experience 3 pleasant events on day 1, you would plot a point on line 3, day 1. Step 4: Continue plotting until you have reached day 7 and then connect the dots. Daily Mood (Use a red marker) Step 1: The numbers listed on the right hand side of the graph ranging from 1 (very depressed) to 9(very happy) represent your mood. Step 2: Use your last week s Daily Mood Tracking Form to determine your mood score for each day. For example, if you have rated your mood as a 5 (so-so) for day 1, plot a point on line 5, day 1. Step 3: Continue plotting until you ve reached day 7 and then connect the dots. 4
RELATIONSHIPS BETWEEN MOOD AND PLEASANT EVENTS Day 1 2 3 4 5 6 7 Events # P L E A S A N T S Day: Date: 10 9 8 7 6 5 4 3 2 1 0 Mood Scores 9 = very happy 8 7 6 5 = so-so 4 3 2 1= very depressed 5
3. REFRESHMENT BREAK 10 MIN. 6
4. MINI-LECTURE: IDENTIFYING PLEASANT EVENTS TO DO WITH YOUR RELATIVE Many of the pleasant events you have identified in previous classes can be done alone or with the person you are caring for. Now we would like to generate a list of possible activities you might add to the previous ones and we will make them ones you can share. You will notice that many of these activities involve movement People with Alzheimer s disease are often restless and have relatively short attention spans. You may want to vary the activity often and plan to do them in short time spurts. Since there are different levels of functioning of those we care for, lots of these activities can be done at different levels, too. For example, Taking a Walk can be anything from a hike in the woods to a trip around the block to a stroll in the backyard. You can tailor the activity to the capacity of you and your relative. Let us begin, Remember, not all of these will be appropriate for all of you, but you might find some that will be possible some of the time. 1. Listening to music (or playing a simple instrument). ** 2. Shopping. 3. Going to the beach. 4. Taking a walk. 5. Listening to stories, newspaper articles, poems. 6. Looking at travel brochures or magazines. 7. Watching TV. 8. Doing jigsaw puzzles, crosswords, or word game. 9. Going out to eat. 10. Being with animals or pets. 11. Cooking. 12. Helping around the house. 13. Being with family or friends. 14. Watching birds or animals (in yard or zoo). 15. Writing (and getting) letters, cards. 16. Playing cards. 17. Doing handwork or crafts. 18. Going to museums or cultural events. 19. Looking at photo albums. 20. Going to church. 21. Going for a ride in the car. 22. Exercising. 23. Recalling and discussing past events. 24. Watching sports. 25. Camping. 7
**Many researchers agree that music plays an important part in the lives of most Alzheimer s patients. Even in later signs when verbal communication is poor, most people respond to music. Now Let us think of some activities that you and your relative might enjoy that are not on the list. 1. 2. 3. 4. 5. The goal of this exercise is to identify some4 activities that you and your relative can do together to generate pleasant feelings. This may help you avoid feeling that the only contact you have left with your relative is work. Please Use This Page for Taking Notes 8
Review of the Skills I Learned 9 in This Class
5. REVIEW OF THE COPING CLASSES Today we will begin to review the skills you have learned and the experiences you have had in this group. With our help, you will begin to develop a personal plan for using and maintaining the skills learned in this class. 1. First, we talked about the multiple sources of frustration that caregivers experience List possible sources of frustration, and then write down what your primary source of anger was. 2. Next, we introduced a Relaxation Exercise which you have been practicing each week. How do you use relaxation to reduce feelings of tension, and when do you find relaxation most effective? 3. We also talked about how a source of anger can contribute to our thoughts and attitudes about a situation. What source of anger have you been able to identify that contribute to your own thoughts about a given situation? 4. What are the thoughts each of you have identified that lead to anger? 10
5. What are the feelings and emotions that you have identified when you are in an upsetting situation? 6. What are the unhelpful thought patterns that you have identified? 7. What danger signals have you noticed that warn you that you are upset? 8. What Stop Signs do you use? 9. How have you challenged these thoughts? What new adaptive thoughts are most helpful for you? 10. Remember the D in ABC-Stop-D? What do you do differently or what new actions do you exercise now? 11
11. Next, we talked about how effective communication can reduce anger. We focused on assertiveness and the differences between passive, assertive, and aggressive responses. What are some of the differences that stand out most for you? 12. We also introduced and practiced assertive techniques. When have you found such techniques to be most helpful? We also talked about personal assertive rights that everyone has. What right that we discussed was most meaningful to you? Did you identify any blocks that prevented you form accepting these rights? 13. We discussed common signs of depression and we taught you to identify pleasant events that can be done on regular basis. We taught you how to monitor your mood, so that you could understand how thoughts and behaviors influence and control mood. We helped you identify pleasant activities to be shared with your relative who suffers from memory problems. What are some pleasant activities that you can enjoy even with all demands of caregiving? What are some pleasant activities that you and your loved one can do together? 6. RELAXATION EXERCISE 12
Make yourself as comfortable as possible. First, I d like you to remove any objects from your lap and place your feet on the floor. Place your hands on your thighs. Don t cross your legs or your arms. Close your eyes so you can t see the light or other people and so you won t be distracted by what s going on around you. Now breathe deeply, and imagine that you are in an empty vase that you have to fill up to the rim with air. Inhale deeply again, and exhale... while you re exhaling say the word Amen or calm silently to yourself... continue breathing as deeply as possible... always filling up the bottom of your lungs and then exhaling... Right now, notice where your body is most tense. Make yourself as comfortable as possible. Relax the tension in your neck, shoulders, arms, back, legs and feet... Keep breathing deeply and exhale, saying to yourself the work that you ve chosen. Now imagine that you re searching for the most safe and peacful place that you know... Are you searching for it indoors or outdoors? When you find it, look at it closely. What is it like? Use all of your senses to enjoy it as much as possible. What s around you? What colors do you see? What smells do you notice? What sounds do you hear? Do you hear the chirping of birds? Or are you on the beach and hear the calls of the seagulls and the crashing of the waves? Or maybe you re listening to the pleasant sound of a river s current. Can you make out the breeze moving through the branches of the trees?... Perhaps you re listening to the silence of a mountain peak. Pay attention to the colors. Are they bright?... The sounds, are they loud or soft?... What sensations do you feel? Is it warm out or do you feel cold?... Do you like being here alone? Look closely at your place, enjoy it, you are in peace. Enjoy for a few moments the experience of being in your peaceful place. Soon I am going to ask you to come back from your peaceful place, knowing that you can always go back to this place just by closing your eyes... and by breathing deeply three times... Slowly leave your place and focus all of you attention on your breathing. Little by little you will leave your place, and tell yourself that you can always return to this place just by closing your eyes and breathing deeply three times. I m, going to count from 5 to 1, and when I reach 1, I lll ask you to come back to the classroom... 5... 4... 3... 2... and 1. Open your eyes and come back to the classroom. RELAXATION DIARY: TENSION EVALUATION 13
Use This Scale to Rate Your Level of Tension 1 2 3 4 5 1 = Not at all tense 2 = Slightly tense 3 = Moderately tense 4 = Really tense 5 = Terribly tense In=Class Practice Rating: 1. First, write the number that represents your current tension level. Before the relaxation exercise, I feel (rate your tension from 1 to 5) 2. Now, we will conduct a brief relaxation technique that will last about 5 minutes. 3. Finally, evaluate your tension level after you have practiced the relaxation technique. After the relaxation exercise, I feel (rate your tension from 1 to 5) 7. HOMEWORK TO DO BEFORE CLASS #10 14
1. Daily Mood Rating From. Please complete at least one Daily Mood Rating per day during the week. 2. Pleasant Events Tracking Form. Please complete the Revised Pleasant Event Tracking Form everyday. Remember the more you practice, the easier it will be to use these skills in your everyday life. DAILY MOOD RATING FORM 15
1. Please rate your mood for each day, i.e., how good or bad you felt, using the nine-point scale shown below. If you felt good, put a high number on the chart below. If you felt "so-so," mark a 5. And if you felt low or depressed mark a lower number.! 1 2 3 4 5 6 7 8 9 very "so-so" very depressed happy 2. On the two lines next to your mood rating for each day, please briefly give two major reasons why you think you felt that way. Try to be as specific as possible. DATE: MOOD SCORE: 1. 2. 1. 2. WHY I THINK I FELT THIS WAY: 1. 2. 1. 2. 1. 2. 1. REVISED/FINAL PLEASANT EVENTS TRACKING FORM 16
List Pleasant Events Day Date 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Totals for each day: 17