Because You Can How to Improve Communcation with S-T-O-P
by Emily Egerton,
Educational Content Designer
News reports that Kaya Morgan, Stan Lee’s former assistant and caregiver, was arrested for and charged with five counts of elder abuse, has recently shaken the Marvel fan base and has left many people wondering how or why anyone would mistreat and exploit such a creative genius. While Stan Lee may have been a beloved comic book icon, his case is not unique. According to the National Council on Aging (NCOA), “Approximately 1 in 10 Americans aged 60+ have experienced some form of elder abuse. Some estimates range as high as 5 million elders who are abused each year”.
One population that is particularly vulnerable to elder abuse is that of people living with dementia (PLwD). This is because many interactions with care partners involve one or both people who react in a way that is emotionally charged rather than respond in a way that is productive and promotes communication. Even someone we love and have committed to care for can bring out the worst in us if we don’t take measures to understand what is really going on in the mind of a PLwD.
Although their brains may be in a general state of decline, PLwD have one part of their brains that becomes exceptionally tuned in to new and potentially unsafe stimuli. The amygdala, or primitive part of the brain, responsible for pleasure-seeking and protecting the body, is highly reactive, when it senses danger of any kind. While this reactive survival response may be useful in the presence of a ferocious animal or a gun-wielding-thief, it is rarely helpful in promoting constructive conversations. In fact, quite the opposite is true. When the amygdale gets triggered, two things happen. First, no new information can come in, so any point you are trying to make will go simply unheard. Think back to cavemen days. When man spotted a life-threatening beast, his amygdala told him to do one of three things: run away (flight), attack and bring his family home dinner (fight) or hide (freeze). Notice, how none of these involved sticking around to gather more information or ask the beast how he was feeling? The second thing that happens when you try to communicate with a PLwD who has an activated amygdala is that you run the risk of imprinting on their brain that you are a dangerous and harmful person. Hence, a negative interaction during a triggered state will send a message to their brain that they should avoid you and not listen to you because you will cause them harm.
When interacting with PLwD, it is important to keep in mind that you are the one with the healthy brain; you are the one who can see a situation from multiple perspectives; and you are the one who can continually gauge the conversation to ensure that it progresses in a productive way. One tool that may be helpful in promoting strong, non-combative conversation is the acronym, S-T-O-P, that encourages you to:
- See things from their perspective
- Think about how you’re coming across
- Observe the effect of your actions
- Pause and reflect on what you might do differently
The acronym may be especially useful during communication where both you and the PLwD have triggered amygdalae, causing you to become frustrated and overwhelmed. It is during these times that you can use S-T-O-P to remind yourself that you are the one with the healthy brain and the PLwD is going through brain changes that are not in their control.
It is important to remember that PLwD are likely to feel a sense of danger when emotions are high. They are keenly in tune to your tone, body language, and demeanor and may react negatively when they sense anger or frustration.
- What is the emotion and at what level?
- Is what I'm asking them to do different from what they would prefer to do?
- How does this situation look to them? Could it be perceived as annoying, risky, or dangerous?
- Have I said anything that might be perceived as disrespectful or inconsiderate?
- When have I seen this behavior before?
If you're not sure how you're coming across, seek more information with phrases like:
- "Tell me more about...."
- "It looks like you might be (name feeling) that..."
- "It seems like..."
- "It sounds like...
Since PLwD are tuned in emotionally and have a highly reactive amygdala, they may be especially sensitive to the way you behave when you ask them to do something.
- Am I acting in a way that is respectful and caring?
- Is my frustration/aggravation showing?
- Does my tone communicate compassion?
- Am I giving them enough time to process what I've said?
Reflect the words used by the person to guide the conversation and to dig deeper for history or information that may assist in understanding the current or future issues. Repeat back to the person what you heard them say, but adding a question mark at the end.
- PLwD “I want to go home”
- Care Partner “You want to go home?”
PLwDs' heightened sense of awareness may make them suspicious of anyone they feel is not acting in their best interest. Negative emotions may illicit fear, and they may react by fighting, freezing, or fleeing, none of which are productive or helpful.
- What is their body language telling me?
- Has their body language/behavior changed through the course of this conversation? If so, how?
- How might this conversation go if I were talking to someone other than this PLwD? What is different?
This is also a good time to explore some possible options to demonstrate that you are considering the persons needs and want to determine what could be done to help. Create two viable options that could create a positive shift for the person.
If you're in a conversation with a PLwD that is not going well, catch your breath and evaluate the situation.
- How is this conversation going so far?
- What is working?
- At which point did I notice a change in their behavior?
- What could I do to change how this is going to turn out?
When you make an intentional effort to use the acronym S-T-O-P, you create an opportunity to convert a primitive high amygdala reaction to a thoughtful low amygdala response. Think of it as a mindfulness tool that you can use to break old habits and patterns in exchange for genuine empathy. An added benefit to going through these steps is that your amygdala state will lower as well. This shift out of the high amygdala state then re-engages the compassionate part of your brain and will pave the way for things to go forward in a positive way.