Non-pharmacological interventions in dementia (cushions and vibrating pads),smell and sound. perspective is very suitable for people with dementia, The use of these resources is tailored to the as many of the behavioural difficulties encountered individual and therefore not all of the available emerge through one or more of the following forms of stimulation may be used in one session.A cognitive features:cognitive misinterpretations, description and discussion of multisensory therapy biases,distortions,erroneous problem-solving in psychiatric care has appeared in an earlier issue strategies and communication difficulties.In other of APT(Baillon et al.2002). words,many of the challenges posed by people with The use of such rooms with people with dementia dementia are due to their thinking style-the very has centred mainly on those with more severe thing that is addressed in CBT.Hence,CBT offers symptoms.A study by van Diepen et al(2002) a framework within which to understand the showed some positive effects on agitation,but the individual's distressing experiences,and this results failed to reach significance.Burns et al(2000) understanding allows the clinician to target have reviewed the increasing use of multisensory interventions more appropriately.In this sense,it is rooms.They concluded that the area was worthy of argued that CBT is a person-centred therapy. future research,but that the available evidence lacked scientific rigour. Conclusions Briefpsychotherapies Having reviewed many of the treatments currently Cognitive-behavioural therapy available,it is worth noting their common features. One striking thing is the move towards more person- Over the past 10 years there has been an increasing centred forms of care(Kitwood,1997).Within this interest in applying some of the brief therapeutic approach,greater attempts are made to understand frameworks such as cognitive-behavioural therapy the individual's experience of dementia and to (CBT)and interpersonal therapy to dementia.For employ strategies to improve the person's quality of example,Teri Gallagher-Thompson (1991) life.A further shared feature is the systemic reported positive findings from a clinical trial of perspective,that is,the need to work with systems CBT with people in the early stages of Alzheimer's (families,professional carers,organisations,etc.). disease.Individual and group CBT has also been Indeed,care staff and families are usually integral used by other researchers with some favourable to treatment strategies.They are essential in results (Kipling et al,1999). obtaining valid and reliable information and constructing appropriate formulations.Also,they Interpersonal therapy are key to conducting any interventions reliably.It Interpersonal therapy,as the name suggests. is evident,therefore,that training of carers (both examines the individual's distress within an professional and family)is an important part of most interpersonal context (Weissman et al,2000).In treatment programmes.In fact,one study study(Bird this sense,there is a great deal of overlap with the et al,2002)suggested that the most common person-centred work of Kitwood (1997)and Stokes interventions for psychological and behavioural (2000).It uses a specific framework in which the symptoms of dementia were not necessarily specific individual's distress is conceptualised through one therapies but working with carers or nursing home of four domains:interpersonal disputes;inter- staff to change the attitudes and behaviour of those personal/personality difficulties;bereavement;and in their care.Despite the relevance of this issue,there transitions/life events.Despite there being good remain relatively few high-quality studies in the area empirical evidence of the success of this form of (e.g.Marriott et al,2000).Clearly,training and treatment with older people (Miller Reynolds, support are important and worthy of further study: 2002).it has only recently been used with dementia future studies need to be large and also include (James et al,2003). follow-up methodologies. The field of dementia care is expanding.with an Limitations increasing number of articles on psychosocial interventions;to that extent the future looks Both CBT and interpersonal therapy have limi- promising.However,it is noted that there is a tations,particularly with severe dementia.Never- fundamental weakness within the current literature theless,owing to the fact that these therapies have that clearly requires addressing.This concerns the relatively simple conceptual models underpinning limited attention paid to process issues(i.e.details them,they have been shown to be helpful,even for outlining the mechanism of change underpinning severe cognitive impairment (ames et al,1999:James, the interventions).The available studies have been 2001).For example,James believes that a CBT good at presenting the contents of intervention Advances in Psychiatric Treatment(2004),vol.10.http://apt.rcpsych.org/ 175Non-pharmacological interventions in dementia Advances in Psychiatric Treatment (2004), vol. 10. http://apt.rcpsych.org/ 175 (cushions and vibrating pads), smell and sound. The use of these resources is tailored to the individual and therefore not all of the available forms of stimulation may be used in one session. A description and discussion of multisensory therapy in psychiatric care has appeared in an earlier issue of APT (Baillon et al, 2002). The use of such rooms with people with dementia has centred mainly on those with more severe symptoms. A study by van Diepen et al (2002) showed some positive effects on agitation, but the results failed to reach significance. Burns et al (2000) have reviewed the increasing use of multisensory rooms. They concluded that the area was worthy of future research, but that the available evidence lacked scientific rigour. Brief psychotherapies Cognitive–behavioural therapy Over the past 10 years there has been an increasing interest in applying some of the brief therapeutic frameworks such as cognitive–behavioural therapy (CBT) and interpersonal therapy to dementia. For example, Teri & Gallagher-Thompson (1991) reported positive findings from a clinical trial of CBT with people in the early stages of Alzheimer’s disease. Individual and group CBT has also been used by other researchers with some favourable results (Kipling et al, 1999). Interpersonal therapy Interpersonal therapy, as the name suggests, examines the individual’s distress within an interpersonal context (Weissman et al, 2000). In this sense, there is a great deal of overlap with the person-centred work of Kitwood (1997) and Stokes (2000). It uses a specific framework in which the individual’s distress is conceptualised through one of four domains: interpersonal disputes; inter￾personal/personality difficulties; bereavement; and transitions/life events. Despite there being good empirical evidence of the success of this form of treatment with older people (Miller & Reynolds, 2002), it has only recently been used with dementia (James et al, 2003). Limitations Both CBT and interpersonal therapy have limi￾tations, particularly with severe dementia. Never￾theless, owing to the fact that these therapies have relatively simple conceptual models underpinning them, they have been shown to be helpful, even for severe cognitive impairment (James et al, 1999; James, 2001). For example, James believes that a CBT perspective is very suitable for people with dementia, as many of the behavioural difficulties encountered emerge through one or more of the following cognitive features: cognitive misinterpretations, biases, distortions, erroneous problem-solving strategies and communication difficulties. In other words, many of the challenges posed by people with dementia are due to their thinking style – the very thing that is addressed in CBT. Hence, CBT offers a framework within which to understand the individual’s distressing experiences, and this understanding allows the clinician to target interventions more appropriately. In this sense, it is argued that CBT is a person-centred therapy. Conclusions Having reviewed many of the treatments currently available, it is worth noting their common features. One striking thing is the move towards more person￾centred forms of care (Kitwood, 1997). Within this approach, greater attempts are made to understand the individual’s experience of dementia and to employ strategies to improve the person’s quality of life. A further shared feature is the systemic perspective, that is, the need to work with systems (families, professional carers, organisations, etc.). Indeed, care staff and families are usually integral to treatment strategies. They are essential in obtaining valid and reliable information and constructing appropriate formulations. Also, they are key to conducting any interventions reliably. It is evident, therefore, that training of carers (both professional and family) is an important part of most treatment programmes. In fact, one study study (Bird et al, 2002) suggested that the most common interventions for psychological and behavioural symptoms of dementia were not necessarily specific therapies but working with carers or nursing home staff to change the attitudes and behaviour of those in their care. Despite the relevance of this issue, there remain relatively few high-quality studies in the area (e.g. Marriott et al, 2000). Clearly, training and support are important and worthy of further study; future studies need to be large and also include follow-up methodologies. The field of dementia care is expanding, with an increasing number of articles on psychosocial interventions; to that extent the future looks promising. However, it is noted that there is a fundamental weakness within the current literature that clearly requires addressing. This concerns the limited attention paid to process issues (i.e. details outlining the mechanism of change underpinning the interventions). The available studies have been good at presenting the contents of intervention