Dementia Support Line
Getting treatment for depression, anxiety or apathy
Talking therapies can be effective for people in the early to middle stages of dementia. In psychological therapy or ‘talking therapy’ sessions, a person will be supported to talk about how their thoughts and feelings affect their mood and behaviour. Talking therapies can also benefit the carers of people with dementia.
- Depression and dementia
- Anxiety and dementia
- Apathy and dementia
- You are here: Getting treatment for depression, anxiety or apathy
- Apathy, depression and anxiety – useful organisations
Apathy, depression and anxiety
Seeing a doctor
A person with dementia should talk to a healthcare professional, such as their GP, if they are concerned about feeling low or anxious. If they’re unable to do this by themselves, a family member or carer can do it for them.
A healthcare professional will talk to the person and, if possible, with a family member or carer. They will try to assess the person’s mood, behaviour, and any changes that have happened recently which might be related to their symptoms.
It can be difficult to diagnose depression in a person with dementia because some of the symptoms of depression and dementia can overlap, as can symptoms of apathy and depression.
Talking therapies for people with dementia
In psychological therapy or ‘talking therapy’ sessions, a person will be supported to talk about how their thoughts and feelings affect their mood and behaviour.
Talking therapy sessions are delivered by a professional, such as a counsellor, a clinical or counselling psychologist, a psychotherapist, or a psychiatrist. People can have some types of talking therapy over the telephone or online. This includes counselling and cognitive behavioural therapy (CBT).
The therapy will be adapted to each person. It will be based on them and the therapist working together to find out what might be causing the person’s problems, as well as ways to manage these problems. Sessions can also involve talking together with the person and their partner, or a family member or friend.
Successful therapy depends on developing a trusting relationship between the person and the therapist. It is important that the person is comfortable with the therapist’s approach and manner.
The relationship between a person and their therapist is confidential. This means the therapist won’t tell anyone what they discuss during therapy. There are some exceptions to this, which the therapist should explain during the first meeting. For example, if the person with dementia gives their consent, they may be accompanied and supported in the sessions by a family member.
Benefits of talking therapies for people with dementia
Talking therapies can be effective for people in the early to middle stage of dementia. They are unlikely to help if a person is in the later stage. This is because the person may have problems with their attention, communication, understanding and memory, which are all key to being able to benefit from talking therapies.
However, there are other ways to support people in the later stage of dementia, such as through sensitive listening or sensory stimulation.
Talking therapies can give a person with dementia the chance to speak openly about their feelings, including how they feel about a recent diagnosis. This can help them adjust and live with their condition more successfully. They might find it helpful to discuss problems with a therapist rather than their friends or family members.
A therapist can give the person a safe space to explore the reasons why they feel how they do and ways to support them. This can be comforting. It can also help them maintain healthy relationships with their friends and family members.
There is evidence that having talking therapy over several weeks may reduce depression and anxiety in people in the early stage of dementia. It is important that the therapy is adapted to the person’s level of communication, understanding and memory. It’s therefore likely to be most effective if the therapist has experience of working with people with dementia and a good understanding of the condition.
Suitable talking therapies are not always available in the person’s local area. People in care homes may find it particularly difficult to access talking therapy services.
Types of talking therapy
There are many different types of talking therapy. The main ones are explained below. The most suitable type will depend on:
- the difficulties the person is facing
- what the person wants to get out of therapy
- the type and stage of their dementia
- the symptoms they are having
- their personality and feelings about therapy.
How can talking therapies help carers?
Dementia is a complex, unpredictable and progressive condition. Caring for a person with dementia can be very rewarding and fulfilling, but also stressful and exhausting, particularly if there are no or few other people who can help.
Carers may suppress their feelings to protect the person they are caring for and become socially isolated and sleep deprived. This reduces the ability to cope with negative feelings and stress. As a result, it is common for carers to feel anxious and depressed, with feelings of guilt if they want to do things for themselves.
When you are caring for a person with dementia it’s important that you look after yourself and take regular breaks.
Carers may also find talking therapies useful as a way to acknowledge and explore their feelings in private. This may be especially important when making decisions about how to look after the person with dementia.
For example, if the person moves into residential care, the carer may need time to adjust and learn to accept that they now have less responsibility for them. Therapy can also help if a carer is feeling guilty or embarrassed about how they feel about the person with dementia.
Counselling can help carers to:
- talk openly about their own emotions, including any grief they are experiencing as the person’s dementia progresses.
- have an uninterrupted block of time to focus on themselves rather than the person they are caring for. The counsellor should help the carer to find strategies and approaches to support them in the caring role.
- be more aware of their thoughts, behaviours and reactions when dealing with the challenges and unpredictability of dementia. Finding ways to cope more effectively with difficult situations can help reduce tension and stress for both the carer and the person with dementia.
Telephone or online sessions of talking therapy may be more convenient for people who have caring responsibilities than face-to-face ones. Therapy through apps that allow video calls may also be available.
Computerised CBT packages for carers generally aren’t specific to each individual. While it’s very important that therapy is tailored to the individual and their circumstances, CBT may still be helpful and should be considered if it is the only available option. For example, when a carer doesn’t have much time available for therapy.
Caring for a person with dementia can also affect personal relationships. Therefore, partners may find relationship counselling or couples therapy helpful. Relate offers relationship counselling.
Some carers find it very helpful to speak to professionals who specialise in dementia care, such as an Admiral Nurse (available in some parts of the UK but not everywhere).
Carers- looking after yourself
Read our advice and tips on looking after yourself.
What to look for in a therapist for a person with dementia
It is important for anyone who is having therapy to feel comfortable with both the therapist and their approach. The relationship will depend on a number of factors, including the personalities of the person and the therapist. Find a type and style of therapy that works for the person and what they wish to achieve through therapy.
For both someone with dementia or a carer, it is likely to be most helpful to find a therapist who has experience or an understanding of the condition.
It is important to meet the therapist face to face (for sessions in person) or to speak to them on the telephone or via video call to have a chat to see whether they seem suitable. It may be necessary to speak to several therapists before the most suitable person is found.
Before committing to sessions, ask the therapist questions to ensure that they:
- are accredited by the relevant professional body and abide by their professional code of ethics
- have regular professional supervision (a form of mentoring and reflecting on their process) to make sure their practice is safe and ethical
- explain their approach, confidentiality, fees (if applicable), length of sessions and responsibilities (theirs and the person who is having the therapy).
Once a therapist is found, if the therapy is not working or if the person is no longer connecting with the therapist, then there is no obligation to continue with the sessions. The person can find a new therapist at any time.
How to find a therapist for a person with dementia
Many GPs can give people details about therapists in the local area. Some GP surgeries also have talking therapy services based in their practices.
Many of the talking therapies for depression and anxiety mentioned in this factsheet are available through an NHS England programme called NHS Talking Therapies for Anxiety and Depression (previously known as ‘Improving Access to Psychological Therapies)’.
A person’s GP can refer them to a local service, which will assess them and offer support. This could include signposting to relevant activities, self-help materials or psychological therapies.
Some NHS Talking Therapies services also let people refer themselves without having to go through their GP.
Talking therapies that people access through the NHS are usually free of charge, although there can be a long waiting list.
Some local charities, faith groups and other organisations may also offer counselling or informal support services.
A person’s GP or local social services department may have more information about this. Our dementia directory can also help to find local support services for people with dementia and carers.
Another option is to find a private therapist. A person’s friends and family members may be able to recommend a therapist they have had sessions with. Someone who has a lower income will generally be charged less than a person who can afford to pay the full rate.
Try to ensure that any private therapist is accredited and a member of at least one recognised organisation such as British Association for Behavioural and Cognitive Psychotherapies, British Association for Counselling and Psychotherapy or British Psychological Society.
Useful organisations to be aware of
Find out more about organisations that can help you support a person with dementia who has apathy, depression or anxiety and learn more about the recognised organisations therapists can be a part of.
Counselling is the general term for a range of talking therapies, including individual, group and couples sessions. It aims to help a person better understand their problems and then explore ways to manage them. A counsellor should not give the person ‘answers’. They will give them time to think about their problems with the guidance of a professional.
Counselling is often used to help a person cope with events they’ve found difficult. It can be particularly helpful for people who have recently been diagnosed with dementia. The process of being assessed for suspected dementia can also be confusing, stressful and make the person feel anxious.
Many people with dementia struggle to make sense of their diagnosis and how their life is changing. They may feel lost, confused, vulnerable or anxious. Counselling can help them manage these worries, such as feeling less depressed, more hopeful and accepting of their diagnosis.
Psychotherapy is a term for another range of talking therapies. The type of psychotherapy that a person is offered will depend on what is most appropriate for them.
A psychotherapist will help a person understand how their personality, beliefs and experiences influence their thoughts, feelings, relationships and behaviour. This can change the way they think and behave. It can also help them deal with problems and difficult situations more successfully.
Psychotherapy can support people with dementia to feel less depressed and anxious, maintain a good quality of life and cope with their condition.
Cognitive behavioural therapy (CBT) is based on the way we think and reason (our ‘cognition’), and the affect this has on how we feel and then how we behave. The therapist will help the person to identify unhelpful thoughts and actions, and replace them with more positive thoughts, new skills and techniques.
CBT for depression or anxiety is most suitable for people in the earlier stage of dementia. They are likely to have fewer difficulties with their memory, communication and reasoning. They are also usually more aware of their condition and their own thoughts and emotions than a person in the later stage of dementia. This will mean they can effectively engage with the therapy.
CBT sessions may need to be adapted to meet the specific needs of the person with dementia. This might include having shorter sessions, using memory aids (such as cue cards or digital devices) and summarising ideas throughout the sessions.
If the person with dementia agrees, a family member or close friend may attend sessions with them. This supporter can also help them use CBT strategies outside of the sessions.