Douglas et al/Woods Allan 1999).Activities such as drawing and healing,herbal medicine and aromatherapy.The painting are thought to provide individuals with results of this survey have been reviewed by Wiles the opportunity for self-expression and the chance Brooker (2003).In terms of effectiveness,it was to exercise some choice in terms of the colours and evident that careful consideration was needed to themes of their creations. identify what was meant by 'effective'(e.g.were the therapies aiming to improve cognitive abilities or Music therapy levels of well-being?). Several studies have reported benefits gained by In general,most of the complementary therapies have not received a great deal of empirical investi- people with dementia from music therapy(Killick gation.An exception to this is aromatherapy,which Allan,1999).The therapy may involve engagement is described in more detail below. in a musical activity (e.g.singing or playing an instrument),or merely listening to songs or music. Aromatherapy Lord Garner (1993)showed increases in levels of well-being,better social interaction and improve- Aromatherapy is one of the fastest growing of all ments in autobiographical memory in a group of the complementary therapies (Burns et al,2002). nursing home residents who regularly had music It appears to have several advantages over the played to them.Such improvements were not pharmacological treatments widely used for observed in a comparison group engaged in other dementia.It has a positive image and its use aids activities.Cohen-Mansfield Werner (1997) interaction while providing a sensory experience.It compared three types of intervention for people with also seems to be well tolerated in comparison with abnormal vocalisations,and found that music neuroleptic or sedative medication.The two main therapy significantly reduced the behaviour.More essential oils used in aromatherapy for dementia recently,a study by Gerdner (2000)found a are extracted from lavender and melissa balm.They significant reduction in agitation in people with also have the advantage that there are several routes dementia who were played an individualised of administration such as inhalation,bathing. programme of music as opposed to traditional massage and topical application in a cream.This relaxation music. means that the therapy can be targeted at individuals with different behaviours:inhalation may be more Activity therapy effective than massage for a person with restless- ness,for instance.There have been some positive Activity therapy involves a rather amorphous group results from recent controlled trials which have of recreations such as dance,sport and drama.It shown significant reductions in agitation,with has been shown that physical exercise can have a excellent compliance and tolerability (e.g.see number of health benefits for people with dementia, Ballard et al,2002).[An article on the use of for example reducing the number of falls and aromatherapy in dementia (Holmes Ballard,2004) improving mental health and sleep(King et al,1997) will appear in the next issue of APT.Ed.I and improving their mood and confidence (Young Dinan.1994).In addition.Alessi et al(1999)found Other therapies in a small-scale controlled study that daytime exercise helped to reduce daytime agitation and Two therapies worthy of mention in this section are night-time restlessness.An interesting approach to bright-light therapy and multisensory approaches. dance therapy is described by Perrin (1998),who Both of these have received some research attention employed a form of dance known as'jabadeo'.which and have demonstrated positive outcomes.For involves no prescriptive steps or motions but allows example,bright-light therapy has been increasingly the participants to engage with each other in used in an attempt to improve fluctuations in diurnal interactive movements.It is relevant to note that this rhythms that may account for night-time disturances may also fulfil a need for non-sexual physical contact and 'sundown syndrome'(recurring confusion or which many people with dementia find soothing. agitation in the late afternoon or early evening) in people with dementia.Three recent controlled Complementary therapy trials have been published with some evidence for improving restlessness and with particular benefit The Mental Health Foundation recently conducted for sleep disturbances (e.g.see Haffmanns et al, a study into the use of complementary therapies in 2001). the field of mental health that included their use in Multisensory approaches usually involve using dementia.From this work,it was evident that a a room designed to provide several types of sensory number of different therapies were being employed, stimulation such as light(often in the form of fibre for example massage,reflexology.reiki,therapeutic optics which can move and be flexible),texture 174 Advances in Psychiatric Treatment(2004).vol.10.http://apt.rcpsych.org/174 Advances in Psychiatric Treatment (2004), vol. 10. http://apt.rcpsych.org/ Douglas et al/Woods & Allan 1999). Activities such as drawing and painting are thought to provide individuals with the opportunity for self-expression and the chance to exercise some choice in terms of the colours and themes of their creations. Music therapy Several studies have reported benefits gained by people with dementia from music therapy (Killick & Allan, 1999). The therapy may involve engagement in a musical activity (e.g. singing or playing an instrument), or merely listening to songs or music. Lord & Garner (1993) showed increases in levels of well-being, better social interaction and improve￾ments in autobiographical memory in a group of nursing home residents who regularly had music played to them. Such improvements were not observed in a comparison group engaged in other activities. Cohen-Mansfield & Werner (1997) compared three types of intervention for people with abnormal vocalisations, and found that music therapy significantly reduced the behaviour. More recently, a study by Gerdner (2000) found a significant reduction in agitation in people with dementia who were played an individualised programme of music as opposed to traditional relaxation music. Activity therapy Activity therapy involves a rather amorphous group of recreations such as dance, sport and drama. It has been shown that physical exercise can have a number of health benefits for people with dementia, for example reducing the number of falls and improving mental health and sleep (King et al, 1997) and improving their mood and confidence (Young & Dinan, 1994). In addition, Alessi et al (1999) found in a small-scale controlled study that daytime exercise helped to reduce daytime agitation and night-time restlessness. An interesting approach to dance therapy is described by Perrin (1998), who employed a form of dance known as ‘jabadeo’, which involves no prescriptive steps or motions but allows the participants to engage with each other in interactive movements. It is relevant to note that this may also fulfil a need for non-sexual physical contact which many people with dementia find soothing. Complementary therapy The Mental Health Foundation recently conducted a study into the use of complementary therapies in the field of mental health that included their use in dementia. From this work, it was evident that a number of different therapies were being employed, for example massage, reflexology, reiki, therapeutic healing, herbal medicine and aromatherapy. The results of this survey have been reviewed by Wiles & Brooker (2003). In terms of effectiveness, it was evident that careful consideration was needed to identify what was meant by ‘effective’ (e.g. were the therapies aiming to improve cognitive abilities or levels of well-being?). In general, most of the complementary therapies have not received a great deal of empirical investi￾gation. An exception to this is aromatherapy, which is described in more detail below. Aromatherapy Aromatherapy is one of the fastest growing of all the complementary therapies (Burns et al, 2002). It appears to have several advantages over the pharmacological treatments widely used for dementia. It has a positive image and its use aids interaction while providing a sensory experience. It also seems to be well tolerated in comparison with neuroleptic or sedative medication. The two main essential oils used in aromatherapy for dementia are extracted from lavender and melissa balm. They also have the advantage that there are several routes of administration such as inhalation, bathing, massage and topical application in a cream. This means that the therapy can be targeted at individuals with different behaviours: inhalation may be more effective than massage for a person with restless￾ness, for instance. There have been some positive results from recent controlled trials which have shown significant reductions in agitation, with excellent compliance and tolerability (e.g. see Ballard et al, 2002). [An article on the use of aromatherapy in dementia (Holmes & Ballard, 2004) will appear in the next issue of APT. Ed.] Other therapies Two therapies worthy of mention in this section are bright-light therapy and multisensory approaches. Both of these have received some research attention and have demonstrated positive outcomes. For example, bright-light therapy has been increasingly used in an attempt to improve fluctuations in diurnal rhythms that may account for night-time disturances and ‘sundown syndrome’ (recurring confusion or agitation in the late afternoon or early evening) in people with dementia. Three recent controlled trials have been published with some evidence for improving restlessness and with particular benefit for sleep disturbances (e.g. see Haffmanns et al, 2001). Multisensory approaches usually involve using a room designed to provide several types of sensory stimulation such as light (often in the form of fibre optics which can move and be flexible), texture