Managing Hallucinations and Delusions

For many people and families, these symptoms of hallucinations and delusions are among the most bothersome. Hallucinations are seeing, feeling or hearing things that aren't there. Delusions lead a person to firmly believe in scenarios or situations that never happened or are not true. Ava Butler, whose husband Richard lived with Lewy body dementia, shares her tips:

Respect and Reassure

• It's nearly impossible to convince someone that what they see or believe isn't real. And arguing can lead to frustration and loss of trust. If your loved one experiences hallucinations, ask them to describe what they see. This helps them focus, and lets you understand what they are feeling (anxious and afraid about a scary person in the home, for example) and how to respond. If they have delusions, don't dismiss the belief but don't completely buy into it either. Ask non-intense, probing questions to learn more about what they believe and why.
• These actions may help a person understand how they came to a particular conclusion and why it may be mistaken. Remind your loved one that they are safe and secure and that you are on their side.

Reframe and Redirect

• Aim to turn the negative into positive and, if possible, cast the experience in a different light. Ava Butler found it helpful to respond to her husband Richard's hallucinations about "bad guys" with statements such as: "It first looked like a bad guy, but he's actually very friendly." Or, "I've seen that guy, and he's really harmless and here to keep us safe."
  Direct attention and discussion away from the hallucination or delusion. Draw your loved one's gaze away from a hallucination by, for example, gently approaching from the opposite side. Transition conversation to a related topic. For instance, if your spouse sees a band playing on the balcony, you might ask about an instrument they used to play.

Encourage a Peaceful Environment

• Create a calm atmosphere. Consider a sage or lavender diffuser or air freshener, keep the television off or watch an uplifting show together, and keep routine and order in the home and schedule.
  If your loved one has glasses or hearing aids, make sure they use them. (Decreased vision and hearing can promote hallucinations.)

Work Through the Experience Together

• As you ask for more description and context, find creative ways around the hallucination or delusion. If your loved one sees intruders, for example, you might encourage them to tell the intruders to "back off" and leave you alone. Or, you could ask where the intruders are and then walk slowly and calmly toward them saying,
  "It's time to go now." Some also find it helpful to open a door and usher unwanted visitors out. But use caution as offering an exit around a person with hallucinations or delusions could be unsafe.

Be Mindful of Your Emotions

• Frustration, anger and anxiety are normal and common feelings when living with a loved one who experiences psychosis. But if unchecked, these emotions could make managing symptoms even tougher.

Talk to your doctor and your loved one's doctor and, if helpful, other care partners or a therapist, to help process your feelings.

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