Public Health

How improv is helping patients with Alzheimer's disease

Two actors are approaching Alzheimer’s disease with a creative way to break through. Find out how the rules of improvisational theatre can actually help forge stronger connections with people who have dementia.

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What Alzheimer’s disease and improvisational theatre have in common

“I love performing, but I’m lousy at memorization, so I took up improv30 years ago,” Karen Stobbe told physicians during a special performance with her husband, Mondy Carter, at TEDMED2015 last month. “My dad, Manfred, passed away from Alzheimer’s disease in October of 2000, and my mom, Virginia, has been living with Alzheimer’s for the past 13 years. I realized in caregiving for both of my parents that the guidelines for improv and the guidelines for being with a person with Alzheimer’s are parallel.”

“And we say ‘guidelines’ because really there are no rules for either. Also, you can’t rehearse either one,” Carter said. However, he noted that unlike Alzheimer’s, improv does offer games and exercises that help people practice certain guidelines for performing. People can rehearse these guidelines until they are familiar enough to use on stage or during interactions with people who have Alzheimer’s.

Channeling inspiration from theatre and her own experiences with Alzheimer’s disease, Stobbe created a training guide and workshop for dementia caregivers based on the rules of improvisation. Carter, who is a trained actor and improviser, also writes creative stage plays and hosts workshops on Alzheimer’s with Stobbe.

In order to reach people with Alzheimer’s, some of the rules of improvisation Stobbe and Carter encourage workshop participants to use include:

Accepting the reality given to you

Instead of following a prescribed script or trying to predict every moment, improv actors are encouraged to fluidly accept and act upon the ideas, plots twists and characters their fellow actors propose on stage. This allows them to avoid rationalizing and free themselves to create lively, imaginative moments.      

Communicating with people who have dementia requires a similar break from reality. “Sometimes it’s incredibly hard to jump into the world of a person with Alzheimer’s,” Stobbe said. “Accepting their reality means letting go of ours …. Stepping into their world provides a launching pad that is positive instead of negative. It provides a connection that you can talk about—[you can] have a conversation.”

Listening fully

“Going with the flow is really the crux of improv,” Carter said. “[Be] spontaneous …. You never know what the next moment might hold.”      

“That’s exactly the same for being with a person who has Alzheimer’s. Be spontaneous and accepting of whatever comes your way,” Stobbe said.

Making an extra effort to say “yes and”

“Now, it’s crucial to commit to practicing saying ‘yes and’ and not ‘yes but’” when performing, Stobbe said. She noted that denying or saying “no” while acting can swiftly put an end to otherwise creative and enjoyable scenes.     

Instead, she encourages workshop participants to say “yes and” during scenes with their acting partners as a way of validating someone else’s ideas. This logic also applies to interactions with Alzheimer’s patients, she said.   

“‘Yes and’ provides agreement. It provides validation—even empathy. Persons with Alzheimer’s receive ‘no’s’ all the time,” Stobbe said, noting that dementia patients regularly encounter “no’s” when people tell them they remembered something or completed a basic task—like buttoning their shirt—incorrectly.  

That’s why “for a person living with Alzheimer’s, hearing the word ‘yes’ can feel really good,” Carter said.

Stobbe and Carter said practicing the rules of improv with people who have dementia can offer practical support for patients and families.

“This approach is not a solution to every issue that comes about with Alzheimer’s disease, yet we know that it can help those who are struggling day to day to find more connections … have a better quality of life,” Stobbe said.