What is CST and Why Does it Matter?
What exactly is CST, and why is it so incredibly important in supporting people living with dementia?
CST stands for Cognitive Stimulation Therapy. It's a structured and engaging programme of activity sessions specifically designed to improve well-being and confidence for people living with mild to moderate dementia.
The original research outlined 14 sessions, delivered twice a week over seven weeks. This intensive format showed significant positive results, and we strive to adhere to this structure whenever possible, as the evidence supporting its effectiveness is strong.
However, we understand that real-world implementation often presents challenges. Community settings might struggle with the twice-weekly commitment due to transport limitations and the practicalities of attending a one-hour session.
At Memory Matters, we've adapted CST to fit various needs. This includes:
Integrating a full hour of "by-the-book" CST within a longer day, surrounded by social interaction.
Delivering CST once a week, acknowledging that while it might not yield the same level of benefit as twice-weekly sessions, it still offers valuable engagement.
The sessions cover a wide range of stimulating topics (which we'll touch on later).
Crucially, CST employs implicit learning. This means that as facilitators, we're not acting as traditional teachers. Instead, we sit alongside participants, discussing and discovering together. It's about fostering curiosity and shared learning, creating a supportive environment where everyone feels empowered to contribute.
A core principle of CST is to encourage participants to function at their maximum capability. We take the time to truly know each individual in our groups, identifying their strengths and finding ways for them to shine. Perhaps someone has a knack for mental math and can help with scoring games, or someone excels at using scissors and can assist with craft activities. There's a "gem" within everyone, and by recognising and nurturing these abilities, we can significantly lift mood, self-esteem, and self-worth.
To facilitate meaningful discussion and individual attention, groups are kept small, with a maximum of eight people. We've found that a group of six often creates a particularly dynamic environment, but the flexibility of up to eight allows for potential absences.
CST was developed in 1998. At that time, there were limited non-pharmacological interventions routinely recommended for dementia due to a lack of robust evidence. Professor Amy Spector, Professor Bob Woods, and Martin Orrell (pictured) and their team aimed to change this.
They conducted a systematic review of existing non-pharmacological therapies. Their goal was to identify approaches with enough evidence to be incorporated into a comprehensive and effective intervention.
Reality Orientation (RO): While popular in the past, RO, which focuses on constantly reminding individuals of time and place, fell out of favour due to its potential to cause distress. Imagine someone happily recalling their younger years being abruptly told they are in their 80s and in an unfamiliar place. CST takes a much more subtle approach to orientation.
Reminiscence Therapy: Focusing on recalling past experiences to strengthen identity, reminiscence was included and is used in CST in a stimulating way. We use personal stories and memories as anchors to explore current topics, prompting comparisons and new associations to fire new neural pathways.
Validation Therapy: A key principle of CST is validating everything a participant says, fostering self-esteem and quality of life. Even if a statement isn't factually accurate, the feeling and intent behind it are acknowledged. We have no wrong answers here!
Multi-Sensory Stimulation: The evidence highlighted the power of engaging multiple senses to reduce anxiety and enhance communication. In CST, we like to use props that appeal to touch, feel, taste (when appropriate), and smell, enriching the experience and creating more connections in the brain.
The beauty of CST lies in its structured approach. Whether you attend a session in Cornwall or Edinburgh, you'll experience the same fundamental framework. This consistency provides a sense of predictability and security for participants.
A typical CST session follows this reliable structure:
The Opening (approximately 10 minutes):
Reality Orientation (RO) Board: We use a visual aid to subtly orientate to time, place, and the weather. Instead of direct questioning, we might say, "The sun is shining brightly today," implicitly conveying the time of day and season.
Group Song: A familiar song helps to create a sense of routine and enjoyment. Music is deeply ingrained in our brains and can evoke positive emotions.
Word Warm-up: Engaging in brief word-based activities to stimulate cognitive function.
News and Views: Discussing a pre-selected news item to encourage opinions and engagement. The focus is on sharing thoughts, not reciting facts.
Main Topic (approximately 30-40 minutes): This is where we delve into a specific theme. The example here is Current Affairs, where the group might collaboratively create a newspaper, deciding on front-page headlines and sharing their "stories."
The Ending (approximately 5-10 minutes):
Thank everyone for attending.
Summarising the key discussions and ideas raised during the session. CST is not rigid; we value and incorporate participants' suggestions for future sessions.
Singing the group song again.
Reminding participants of the time and topic of the next session.
Saying our goodbyes.
CST offers a diverse range of 14 session topics, including:
Physical Games
Sounds
Childhood
Food
Current Affairs
Faces and Scenes
Word Association
Being Creative
Categorizing Objects
Orientation
Using Money
Number Games
Word Games
The Team Quiz: Now, this is where we put a CST twist on a familiar activity! Instead of general knowledge questions, our "team quiz" focuses on the group members themselves. We might ask, "If you needed a haircut, which member here would you trust?" or "Who would you ask to bake a pavlova for a dinner party?" This encourages connection, shared laughter, and reinforces the bonds formed within the group.
The evidence base for CST is substantial. The first major trial of CST involved 201 people living with dementia. It was found that there were significant improvements in the CST group compared to the control group. Importantly, the trial used the same evaluation tools as those used for dementia medications, allowing for direct comparison, which is rare when studying psychosocial therapies.
CST has a wide range of benefits; not only does it improve thinking skills, language and communication but it improves quality of life and mood. Participants have positive experiences of participating in CST, it makes them feel more positive, relaxed, and confident. Being in a safe environment with people who share their diagnosis realising they are not alone, which in turn made them feel well supported. Further research has shown that CST goes beyond the groups themselves but impacts everyday life, where participants found it easier to talk in group settings, greater willingness to engage in conversation and improved concentration.
CST isn't just beneficial for participants; it impacts the families and loved ones of those living with dementia, too.
CST is recommended for people living with mild to moderate dementia, which is outlined in the NICE guidelines for the management and support of people living with dementia, reinforcing its importance in dementia care and treatment.
To leave you with a clear understanding of why CST is so effective, here are some of the key principles:
Mental Stimulation: Encouraging new ideas, thoughts, and associations is central to CST. Unlike simply recalling the past, we actively aim to create new neural connections and facilitate a process of ongoing learning. When faced with the question, "But what's the point? They won't remember?", we respond that we are engaging the brain in the process of learning, fostering new connections that can enhance function in the present.
Stimulating Memory: We use triggers to aid recall in a supportive and non-pressurising way.
Consistency: The predictable structure of each session provides comfort and security.
Promoting Implicit Recall: We ask questions and facilitate activities in a way that encourages recall without direct interrogation or the pressure of right or wrong answers.
Orientation to Time and Place: We gently weave orientation cues into conversations and activities without directly testing memory.
Validation: We prioritise and encourage opinions over factual recall, improving self-esteem and encouraging their sense of value.
Cognitive Stimulation Therapy (CST) is a structured, evidence-based program that uses engaging activities and a consistent approach to enhance well-being, stimulate cognitive function through implicit learning, and ultimately improve the quality of life for individuals living with mild to moderate dementia.
