Name: DOLL THERAPY for managing challenging behaviour
Uploaded: 2022-07-17
Duration: 16 min 40 s
Description: Prepared by: YASMIN SHAMIMI BINTI SUHAIMI (20 20859982 ) MUHAMMAD ARIF AIMAN BIN AZLAN (2020840576).

Prepared by: YASMIN SHAMIMI BINTI SUHAIMI (20 20859982 ) MUHAMMAD ARIF AIMAN BIN AZLAN (2020840576). 

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Prepared by: YASMIN SHAMIMI BINTI SUHAIMI (20 20859982 ) MUHAMMAD ARIF AIMAN BIN AZLAN  (2020840576)

DOLL  THERAPY for managing challenging behaviour

Holding. Talking. Feeding. Cuddling. Dressing. A nonpharmacological intervention for patients with advanced dementia A person-centred and person-driven therapy A valuable tool to promote positive mood , behaviours , and social interactions Involves behaviours like:. 

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A  nonpharmacological intervention  for patients with advanced dementia  A  person-centred  and  person-driven therapy A valuable tool to promote  positive mood ,  behaviours , and  social interactions   Involves behaviours like:

Miesen (1993) Application of Attachment Theory. Bowlby (1969) Attachment Theory. 

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Miesen (1993) Application of  Attachment Theory

Toy Therapy Milton and MacPhail (1985)  Mayers and Griffin (1990)  USA & Australia

Doll Therapy Bailey, Gilbert and Herweyer  (1992) USA (Turner & Shepherd, 2014)

Winnicott (1953) Transitional Object (Mitchell & O’Donnell, 2013)

Attachment Theory. (Mitchell & O’Donnell, 2013). The therapeutic use of doll therapy is best understood at a theoretical level from the work of the psychologist John Bowlby (1969) that work on attachment theory which was originally focused on child attachment with limited reference to older people with dementia. Attachment theory holds that the tendency of human beings to seek closeness & protection when feeling vulnerable or frightened is an expression of an innate (natural) motivational system. This system activates attachment behaviors directed to achieve proximity & protection from another person (eg: crying, calling, approaching & holding) The attachment behaviors persist during the entire life cycle, “from the cradle to the grave”.. 

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The therapeutic use of doll therapy is best understood at a theoretical level from the work of the psychologist John Bowlby (1969) that work on attachment theory which was originally focused on child attachment with limited reference to older people with dementia. Attachment theory holds that the tendency of human beings to seek closeness & protection when feeling vulnerable or frightened is an expression of an innate (natural) motivational system. This system activates attachment behaviors directed to achieve proximity & protection from another person (eg: crying, calling, approaching & holding) The attachment behaviors persist during the entire life cycle, “from the cradle to the grave”.

Application of Attachment Theory. (Mitchell & O’Donnell, 2013). 

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Miesen (1993) supports the application of attachment theory to people with dementia that drew parallels with Bowlby attachment theory by suggesting parent fixation, or the in which some people with dementia often search for their  parents, is an expression  of an attachment need. This searching behavior was considered to be important by Miesen, as it signalled that the person was insecure and was seeking to be reunited with or attached to a  familiar  figure in order to find safety. Stephens et al (2012) appear to agree, stating that experience of loss, separation and insecurity are all themes of attachment theory that are likely to be experienced to some degree by people with dementia.

Transitional Object Theory. (Mitchell & O’Donnell, 2013). 

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Attachment theory can extend beyond early life, as evidenced by Winnicott (1953), who claimed that a transitional object is sometimes used by children when separating from their primary caregiver in route to adulthood. Winnicott stated that blankets, soft toys or repetitive words and phrases were some of the transitional objects frequently used by children. Loboprabhu et al (2007) stated this concept of the transitional object and its application on care in dementia has received limited empirical study: however it is suggested that it has the potential to act as an ‘anchor’ for people with dementia in a period of uncertainty.

Why should doll therapy be used?. Ultimately, the use of the doll was perceived by participants as meeting residents individual needs. 

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Ultimately, the use of the doll was perceived by participants as meeting residents individual needs

Attachment   Comfort Activity Inclusion Communication and interaction Identity/role Innate drives Memories (Fraser & James, 2008)

Why should doll therapy be used?. (Fraser & James, 2008). 

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When residents move into a care home, they often lose meaningful attachment. such as family members & sentimental belongings.

Dolls offers opportunities for simple activity, bringing purpose to residents life, such as care taking activities (feeding / bathing)

Doll offering comfort to the residents through some sort of tactile/sensory stimulation. The resident received comfort from gaining companionship & overcoming a sense of loneliness.

Doll created opportunities for residents to gain a sense of inclusion.  (a situation of joining a group of residents)

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Doll provides a basis for conversation that the residents is able to be involved in.

“Instinct-like” behavior in relation to the dolls. (Women: Childbearing is really innate)

Doll recall past memories & the feelings associated with them, providing a sense of continuity with the past. (Doll reminded the residents of being a mother)

It was thought that the dolls played a role in recall memories. It was beneficial in relieving distress for residents who believe they are at an earlier time in their life.

Reduction in episodes of distress behaviour such agitation, wandering, anxiety and disengagement from others. 

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Reduction in episodes of  distress behaviour such  agitation, wandering, anxiety  and disengagement from  others

Facilitates  opportunities for  communication with  others

Fullfilment of  attachment, comfort,  identity, inclusion and  occupation needs

Improvememt in  activities of daily living  include eating/drinking  and sleeping

Potential therapeutic results of doll therapy based on all the empirical studies identified in systematic review by Mitchell et al. (2014)

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INDICATION ? Moderate to Severe Dementia. The effectiveness of doll therapy was not found to be acceptable with mild dementia.. 

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INDICATION  ?   Moderate to Severe Dementia

The effectiveness of doll therapy was  not found to be acceptable  with  mild dementia.

residents who believe their “baby” is real to become

PRECAUTION  ?   Any major negative behaviour changes

2 most common types of dolls used in DT for people with dementia. 

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2 most common types of dolls used in DT for  people with dementia

Dolls should have…. Soft bodies. Eyes open and close: to avoid distress over the doll being asleep/ dead.. 

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Eyes open and close:  to   avoid distress  over the doll  being asleep/ dead.

and peacefulness , and they  did not cry or laugh. Does not make noises:

can  upset and confuse  older  people with dementia and the  feeling of batteries within the  doll is  distracting, confusing  and unrealistic .

Blankets and additional clothing  should be supplied and these  should be kept clean.

Dolls should be introduced  indirectly by leaving dolls in  communal areas and on chairs, to  allow for free interaction.

If patient live in care centre, dolls  must have different faces and  clothes to avoid confusion over  ownership.

Clothing and skin colour should  be considered for gender/ ethnic  suitability.

Therapist should.... Educate family members to practice in a similar manner. 

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Educate  family members to practice in a  similar manner

Ensure that having dolls was a  voluntary decision   Not specify  to residents that it was a  doll or baby Call  the dolls  “dolls”  if patients believed them to be dolls,  or  “babies”  if residents believed they were babies Allow  patients to have dolls  as long as they wanted  to have them   Remove  dolls from patients if they were  tired  from nurturing   the dolls or had  poor posture  because of holding the dolls,   returning   the dolls after the patients  felt better Not depend solely  on dolls and omit other activities   Not use  dolls as  punishment  in any way

Suggested approaches when beginning doll therapy. 

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Suggested approaches when beginning  doll therapy

Enter the area of the resident and sit next to them

The doll can be left sitting in a chair, on the bed, or a table

Do not force the resident to hold  the doll.

Allow the resident to show you  that they accept & enjoy  interacting with the doll.

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Observe the interaction of the  resident with the doll, identified  the doll as a

If the resident recognizes it as a  doll,

Observe the resident reaction  and intervene if they are  uncomfortable or agitated.

During doll therapy session. Assess whether it is a suitable intervention by monitoring the person’s response throughout.. 

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Assess whether it is a suitable intervention by monitoring the person’s response throughout.

Follow the resident’s thoughts as conversation prompts during the session. Eg:	talking	about	their	own children when they were babies.

Family Perspective. When introducing a doll, it is important to consider the family’s viewpoint.. 

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When introducing a doll, it is  important to consider the  family’s viewpoint.

Most family members, once they  have seen the benefits of their  loved one caring for dolls and  toys will accept and embrace  the concept.

When the family remain  unsupportive with doll therapy,  it is recommended to discuss  the benefits with them and  explain the reasons doll therapy  was chosen.

Evidence-based of Doll Therapy. Authors Sample Interventions Outcome Cantarella et al. (2017) 29 nursing home residents aged from 76 to 96 years old, with severe dementia 20 sessions of doll. 5 times a week, for 1 month. 60 minutes/ session. The sessions took place in quiet room and avoiding distracting stimuli. DT group showed a reduction in BPSD and related caregiver distress. This study suggests that DT is a promising approach for reducing BPSD in people with dementia. Yilmaz and 29	elderly	(aged 8 weeks DT	was	effective	in Asiret 82-89)	patients decreasing	agitation	and (2020) diagnosed	with dementia Researchers visited the nursing home once a week to observe. behavioral	problems in people	diagnosed	with moderate-to-severe dementia.. 

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Authors Sample Interventions Outcome Cantarella  et al. (2017) 29 nursing home  residents aged  from 76 to 96 years  old, with severe  dementia 20 sessions of doll. 5 times a week, for 1 month.  60 minutes/ session. The sessions took place in quiet  room and avoiding distracting  stimuli. DT group showed a  reduction in BPSD and  related caregiver distress. This study suggests that DT  is a promising approach for  reducing BPSD in people  with dementia. Yilmaz and 29	elderly	(aged 8 weeks DT	was	effective	in Asiret 82-89)	patients decreasing	agitation	and (2020) diagnosed	with dementia Researchers visited the nursing home once a week to observe. behavioral	problems in people	diagnosed	with  moderate-to-severe  dementia.

Evidence-based of Doll Therapy. Authors Sample Interventions Outcome Bisiani and 1	woman	with Administered	when the Reduction in anxiety, and Angus severe dementia participant	showed negative behaviors. (2013) behaviors or emotions. Braden and Gaspar (2015) 16 older adults (age range 60–94 years) DT sessions: One at week for approximately 10 minutes each time. Participants had an increase in level of happiness, activity/ liveliness, interaction with staff and others, and ease of giving care. There was also a reduction in the level of anxiety.. 

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Authors Sample Interventions Outcome Bisiani and 1	woman	with Administered	when the Reduction in anxiety, and Angus severe dementia participant	showed negative behaviors. (2013) behaviors or emotions. Braden and  Gaspar  (2015) 16 older adults (age range 60–94 years) DT sessions: One at week for  approximately 10 minutes each  time. Participants had an increase  in level of happiness, activity/  liveliness, interaction with  staff and others, and ease of  giving care. There was also a reduction in the level of anxiety.

Evidence-based of Doll Therapy. Authors Sample Interventions Outcome Shin 51 older adults with DT sessions: DT was administered Significant	improvement (2015) dementia for 3 months occurred	in	verbalization, aggression,	obsessive behavior,	wandering,	and depression	at	1	and	3 months. Residents felt calmer immediately after applying therapeutic dolls at 1 week and 3 months.. 

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Authors Sample Interventions Outcome Shin 51 older adults with DT sessions: DT was administered Significant	improvement (2015) dementia for 3 months occurred	in	verbalization, aggression,	obsessive behavior,	wandering,	and depression	at	1	and	3 months. Residents felt calmer  immediately after applying  therapeutic dolls at 1 week  and 3 months.

Evidence-based of Doll Therapy. Authors Sample Interventions Outcome (Fernandez et al., 2014) adults (age >18years) diagnosed with dementia and living in a community setting or residential accommodation. DT sessions: DT three months follow-up an improvement in agitation and aggressive behaviors among residents who used the dolls Improvements in positive behaviors. 

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Authors Sample Interventions Outcome (Fernandez et al., 2014) adults (age >18years) diagnosed with dementia and living in a community setting or residential accommodation. DT sessions: DT three months follow-up an  improvement in agitation and aggressive behaviors  among residents who used the dolls Improvements in positive behaviors

Evidence-based of Doll Therapy. Authors Sample Interventions Outcome (James, 2006) 33 residents with dementia offered either doll or bear The impact of the toys was assessed on five domains over a 12-week period. Noted greater activity, interaction and happiness . Doll therapy did not worsen of any residents, but improved the wellbeing of some residents.. 

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Authors Sample Interventions Outcome (James, 2006) 33 residents with dementia offered either doll or bear The impact of the toys was assessed on five domains over a 12-week period. Noted  greater activity,  interaction and happiness . Doll therapy did not  worsen of any residents, but  improved the wellbeing of some residents.

FITT Principle. Frequency Ranging from 1 – 5 times/ week Time & Duration Ranging from 1 – 3 months Ranging from 10 – 60 minutes/ session Type of doll Life-like, lightweight dolls (weighing around 1500 g) Soft materials Eyes open and close (eyes would close in the supine position and open when upright) Does not make noises Smiles (Cantarella et al., 2017; Yilmaz & Asiret, 2020; Bisiani & Angus, 2013); Braden & Gaspar, 2015; Shin ,2015; Turner & Shepherd, 2014). 

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Frequency Ranging from 1 – 5 times/ week Time & Duration Ranging from 1 – 3 months Ranging from 10 – 60 minutes/ session Type of doll Life-like, lightweight dolls (weighing around 1500 g) Soft materials Eyes open and close (eyes would close in the supine position and open when upright) Does not make noises Smiles (Cantarella et al., 2017; Yilmaz & Asiret, 2020; Bisiani & Angus, 2013); Braden & Gaspar, 2015; Shin ,2015; Turner & Shepherd, 2014)

There is no specific FITT principle for doll therapy as it varied according to studies .

Video. https://www.youtube.com/watch?v=JsYlAsduIbA. 

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https://www.youtube.com/watch?v=JsYlAsduIbA

Video. https://www.youtube.com/watch?v=tS-S1DHAmxc. 

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https://www.youtube.com/watch?v=tS-S1DHAmxc

Video. https://www.youtube.com/watch?v=420KucWPUJ4 https://www.youtube.com/watch?v=hnPPGDfr30Y https://www.youtube.com/watch?v=vPn6rN1brjU https://www.youtube.com/watch?v=CML2bKcjaZ0 https://www.youtube.com/watch?v=EVz9aBpm1Rc https://www.youtube.com/watch?v=r8o31joPB0g https://www.youtube.com/watch?v=1X1zPVI4fZE. 

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https://www.youtube.com/watch?v=420KucWPUJ4    https://www.youtube.com/watch?v=hnPPGDfr30Y    https://www.youtube.com/watch?v=vPn6rN1brjU    https://www.youtube.com/watch?v=CML2bKcjaZ0    https://www.youtube.com/watch?v=EVz9aBpm1Rc    https://www.youtube.com/watch?v=r8o31joPB0g    https://www.youtube.com/watch?v=1X1zPVI4fZE

References. Baharudin, A. D., Din, N. C., Subramaniam, P., & Razali, R. (2019). The associations between behavioral-psychological symptoms of dementia (BPSD) and coping strategy, burden of care and personality style among low-income caregivers of patients with dementia. BMC Public Health , 19 (4), 447. Bisiani, L., & Angus, J. (2013). Doll therapy: A therapeutic means to meet past attachment needs and diminish behaviours of concern in a person living with dementia–a case study approach. Dementia , 12 (4), 447-462. Braden, B. A. (2014). Baby doll therapy in dementia residents. Braden, B. A., & Gaspar, P. M. (2015). Implementation of a baby doll therapy protocol for people with dementia: Innovative practice. Dementia , 14 (5), 696-706. Cantarella, A., Borella, E., Faggian, S., Navuzzi, A., & De Beni, R. (2018). Using dolls for therapeutic purposes: A study on nursing home residents with severe dementia. International journal of geriatric psychiatry , 33 (7), 915-925. Devshi, R., Shaw, S., Elliott-King, J., Hogervorst, E., Hiremath, A., Velayudhan, L., ... & Bandelow, S. (2015). Prevalence of behavioural and psychological symptoms of dementia in individuals with learning disabilities. Diagnostics , 5 (4), 564-576. Fraser, F., & James, I. (2008). Why does doll therapy improve the well-being of some older adults with dementia. PSIGE Newsletter , 105 , 55-63.. 

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Baharudin, A. D., Din, N. C., Subramaniam, P., & Razali, R. (2019). The associations between  behavioral-psychological symptoms of dementia (BPSD) and coping strategy, burden of  care and personality style among low-income caregivers of patients with dementia.  BMC  Public Health ,  19 (4), 447. Bisiani, L., & Angus, J. (2013). Doll therapy: A therapeutic means to meet past attachment  needs and diminish behaviours of concern in a person living with dementia–a case study  approach.  Dementia ,  12 (4), 447-462. Braden, B. A. (2014). Baby doll therapy in dementia residents. Braden, B. A., & Gaspar, P. M. (2015). Implementation of a baby doll therapy protocol for  people with dementia: Innovative practice.  Dementia ,  14 (5), 696-706. Cantarella, A., Borella, E., Faggian, S., Navuzzi, A., & De Beni, R. (2018). Using dolls for  therapeutic purposes: A   study on nursing home  residents  with  severe  dementia.  International journal of geriatric psychiatry ,  33 (7), 915-925. Devshi, R., Shaw, S., Elliott-King, J., Hogervorst, E., Hiremath, A., Velayudhan, L., ... &  Bandelow, S. (2015). Prevalence of behavioural and psychological symptoms of dementia  in individuals with learning disabilities.  Diagnostics ,  5 (4), 564-576. Fraser, F., & James, I. (2008). Why does doll therapy improve the well-being of some  older adults with dementia.  PSIGE Newsletter ,  105 , 55-63.

References. Lary-Waller, J. (2020). Implementation of Doll Therapy for Agitated Residents with Dementia. McCracken,	P.	N.,	Kagan,	L.,	&	Parmar,	J.	(n.d.).	Recognizing	and Treating Behavioral and Psychological Symptoms of Dementia. Mitchell,	G.,	&	O’Donnell,	H.	(2013).	The	therapeutic	use	of	doll	therapy	in dementia. British Journal of Nursing , 22 (6), 329-334. Mitchell, G., & Templeton, M. (2014). Ethical considerations of doll therapy for people with dementia. Nursing ethics , 21 (6), 720-730. Mitchell, G., McCormack, B., & McCance, T. (2016). Therapeutic use of dolls for people living with dementia: A critical review of the literature. Dementia , 15 (5), 976-1001. Romero, A. P., & Garrido, S. G. (2018). The importance of behavioural and pyschological symptoms in Alzheimer disease. Neurología (English Edition) , 33 (6), 378-384. Shin,	J.	H.	(2015).	Doll	therapy:	An	intervention	for	nursing	home	residents	with dementia. Journal of psychosocial nursing and mental health services , 53 (1), 13-18. Turner, F., & Shepherd, M. (2014). Doll Therapy in Dementia Care: A Review Of Current Literature. Communicare , 1 (1). Yilmaz, C. K., & Aşiret, G. D. (2020). The Effect of Doll Therapy on Agitation and Cognitive State in Institutionalized Patients With Moderate-to-Severe Dementia: A Randomized Controlled Study. Journal of geriatric psychiatry and neurology , 0891988720933353.. 

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Lary-Waller, J. (2020). Implementation of Doll Therapy for Agitated Residents with Dementia.  McCracken,	P.	N.,	Kagan,	L.,	&	Parmar,	J.	(n.d.).	Recognizing	and Treating Behavioral and Psychological Symptoms of Dementia. Mitchell,	G.,	&	O’Donnell,	H.	(2013).	The	therapeutic	use	of	doll	therapy	in  dementia.  British Journal of Nursing ,  22 (6), 329-334. Mitchell, G., & Templeton, M. (2014). Ethical considerations of doll therapy for people  with dementia.  Nursing ethics ,  21 (6), 720-730. Mitchell, G., McCormack, B., & McCance, T. (2016). Therapeutic use of dolls for people living with dementia: A critical review of the literature.  Dementia ,  15 (5), 976-1001. Romero, A. P., & Garrido, S. G. (2018). The importance of behavioural and pyschological  symptoms in Alzheimer disease.  Neurología (English Edition) ,  33 (6), 378-384. Shin,	J.	H.	(2015).	Doll	therapy:	An	intervention	for	nursing	home	residents	with dementia.  Journal of psychosocial nursing and mental health services ,  53 (1), 13-18. Turner, F., & Shepherd, M. (2014). Doll Therapy in Dementia Care: A Review Of Current  Literature.  Communicare ,  1 (1). Yilmaz, C. K., & Aşiret, G. D. (2020). The Effect of Doll Therapy on Agitation and Cognitive  State in Institutionalized Patients With Moderate-to-Severe Dementia: A Randomized  Controlled Study.  Journal of geriatric psychiatry and neurology , 0891988720933353.

DOLL  THERAPY
for managing challenging behaviour

 https://www.youtube.com/watch?v=JsYlAsduIbA

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 https://www.youtube.com/watch?v=tS-S1DHAmxc

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 https://www.youtube.com/watch?v=420KucWPUJ4    https://www.youtube.com/watch?v=hnPPGDfr30Y    https://www.youtube.com/watch?v=vPn6rN1brjU    https://www.youtube.com/watch?v=CML2bKcjaZ0    https://www.youtube.com/watch?v=EVz9aBpm1Rc    https://www.youtube.com/watch?v=r8o31joPB0g    https://www.youtube.com/watch?v=1X1zPVI4fZE