Family caregivers of loved ones with dementia often suffer from depression, a ramification of the chronic stress and intensive demands of their role.
Until now, therapy for those caregivers has usually meant group therapy, which has had inconsistent results in decreasing levels of depression in caregivers.
Recently, however, new research is bringing hope for a therapeutic offering that can both reduce depression and boost well-being in family caregivers. Called mentalizing imagery therapy (MIT), it marries two pre-existing concepts – mentalization and mindfulness – to help caretakers build their “empathetic imagination” in ways that help them better identify with the feelings of both themselves and their loved one.
And new research has shown it’s more than 40% more effective at reducing feelings of depression.
…new research has shown [mentalizing imagery therapy] is more than 40% more effective at reducing feelings of depression.
Mentalizing imagery therapy
Originally conceptualized by Felipe Jain and Peter Fonagy, mentalizing imagery therapy is designed to decrease depression and anxiety by training people to use guided imagery and mindfulness to better process their emotions and emotional responses during challenging interpersonal situations.
Family caregivers of older adults with dementia are constantly faced with such situations, thus serving as the perfect test subjects for the first randomized controlled trial of the efficacy of this therapy, conducted by researchers from the Massachusetts General Hospital at Harvard Medical School.
Published in the journal Psychotherapy and Psychosomatics, the study found that caregivers who participated in MIT had lower rates of depression and anxiety and better well-being than caregivers who attended a traditional support group. Further, the researchers found that MIT enhanced the neural networks associated with cognitive control and emotional regulation. In other words, it appears that MIT might decrease a caregiver’s anxiety and depression, and also increase their ability to control their thoughts and emotions, all while enhancing their overall well-being—and that some of these changes are occurring at the neurological level.
“We were able to show that there is an underlying neurobiological basis for the improvements that were reported by caregivers in the MIT [mentalizing imagery therapy] group,” said Dr. Felipe Jain, MD. “This finding helps us understand how psychotherapies work and why it is so important that caregivers receive them. MIT is now the first therapy to show beneficial changes in the brain circuitry of caregivers.”
MIT is now the first therapy to show beneficial changes in the brain circuitry of caregivers.
How does mentalizing imagery therapy work?
Mentalizing imagery therapy uses guided imagery and mindfulness practices to facilitate mentalization, or the ability to put ourselves in another person’s experience—both mentally and emotionally. Peter Fonagy, who coined the term mentalization in 1989, described it as, “having one’s mind in mind.”
According to experts, the stability, flexibility and benevolence with which we can mentalize lies at the root of our psychological health and resilience. Mentalization works well in simple and stress-free scenarios. In low-stress situations, it’s fairly easy for most of us to put ourselves in another person’s shoes, empathize with their feelings, and respond appropriately.
However, in the torrential chronic stress of caregiving, all bets are off.
It’s understandable, if not expected, that caregivers would have difficulty with mentalization, especially when their loved one’s behaviors and emotions can deviate so markedly from their own. Caregivers often report acting out of irritation and frustration due to their inability to mentalize in the stress of the moment. As a result they struggle with feelings of shame and guilt stemming from their own reactions and behaviors.
In fact, research has shown that when people (temporarily) disconnect with their ability to mentalize during emotional and/or stressful situations, they have a difficult time understanding other people’s behavior as well as their own. Instead, they become reactive, impulsive and self-centered, and often lack perspective.
“MIT teaches mindfulness and guided imagery skills to help caregivers better understand the mind of their loved one and how they are reacting to that person,” Jain said.
When developing the MIT framework, Jain was inspired by techniques in mindfulness, tantra and Upanishadic/Vedantic meditation traditions to create non-religious meditation and imagery practices that directly promote mentalization during stressful situations.
In the study, MIT sessions began with breathing and stretching exercises that emphasized facets of mindfulness—particularly awareness of and attention to physical and mental experience, and then followed with one of four specific MIT meditation and imagery practices.
The results were quite impressive. The researchers measured levels of depression, anxiety, mindfulness, self-compassion and well-being in both groups of participants. One week after both therapies ended, the participants who received MIT had a 41% decrease in depression symptoms compared to before therapy, compared to participants who received group therapy, who only had a 15% decrease in symptoms.
Similarly, participants who received MIT were 20% happier after their therapy, compared to participants who received group therapy, who were only 5% happier after their therapy.
Participants who received MIT were 20% happier after their therapy, compared to participants who received group therapy, who were only 5% happier after their therapy.
Neuroimaging results paralleled these findings. The MIT participants who received MIT had substantial increases in neural activity/connectivity in the dorsolateral prefrontal cortex, the area of the brain associated with emotional regulation. This increase correlated with increases in levels of mindfulness and decreases in levels of depressive symptoms in participants who received MIT therapy. No such neurological findings were present in participants who received group therapy.
How mentalizing imagery therapy can help caregivers
MIT is intended to help caregivers learn to view emotional reactions to challenging situations from different perspectives, while also encouraging a focus on self care, stress reduction and self-compassion.
One 70-year-old study participant, who had been caring for her spouse with dementia for more than eight years, described her state of mind before the therapeutic intervention:
“When I came, I was feeling terribly frustrated,” she said. “I was feeling really ‘dead end,’ like nothing was going to change. I was thinking – even very rarely but it would come up – ‘What’s the value of my even being here?’ I felt that my life was so limited and that his life was taking over mine completely, whereas [before his dementia] I had been completely independent and living my own life.”
After the four-week study during which she received mentalizing imagery therapy?
“My friends are all very happy for me … that I’m doing something for myself … I learned how to recognize the oscillations and accept them for what they are, and then try to ride along with them and also to grab the joy when I could. This is not a four-week turnaround completely for my life, but I feel like I know the direction to go.”
Jain said he’s seen similar reactions from MIT participants.
“MIT teaches mindfulness and guided imagery skills to help caregivers better understand the mind of their loved one and how they are reacting to that person,” he said. “This therapy pushes the boundaries of how we think about ourselves and interact with others and incorporates new views on self and identity.”
Because the research supporting MIT is so new, therapists nationwide are still being trained in the MIT protocols. In the meantime, another similar evidence-based therapy is available that also works with the concept of mentalizing called Mentalization-Based Therapy (MBT), which is offered fairly widely among practitioners. Click here to find an MBT therapist in your area.