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Redirecting frightening hallucinations

Key points

  • Always validate the feeling first before redirecting—say 'That must be scary' rather than 'It's not real.'
  • Use the dominant hand or arm for redirection because it is more connected to the brain's language and sequencing centers.
  • Keep a 'Safe Object Kit' handy with soft, familiar items that can be placed in their dominant hand.
  • Brighten the room and move to a different location if possible—light and change of scene often reduce hallucinations.
  • Never argue, grab, or use complex instructions—keep it simple, calm, and physical.
  • If the hallucination involves hitting or kicking, use a bolster pillow for safety and redirect their dominant hand to a safe object.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Step 1: Stay calm and approach from their dominant side. Move slowly and speak in a low, soothing voice. Say, 'I'm right here. I see you're upset. Let's take a breath together.' Do not touch them suddenly—ask first, 'Can I hold your hand?'

  2. Step 2: Validate the feeling, not the hallucination. Say, 'That sounds really scary. I'm sorry you're seeing that. I'm here to keep you safe.' Avoid saying 'It's not real' or 'There's nothing there.' This validation lowers their fear and opens the door for redirection.

  3. Step 3: Identify the dominant side. If you're unsure, watch which hand they use to reach for things or gesture. For a right-handed person, gently place a familiar object in their right hand—like a soft cloth, a favorite mug, or a small stuffed animal. For a left-handed person, use their left hand.

  4. Step 4: Engage the dominant hand in a simple, repetitive motion. For example, if they feel bugs on their skin (tactile hallucination), say, 'Oh, I see something there. Let me help you brush it off.' Then use their dominant hand to gently brush their own arm or leg, or hand them a soft brush and guide their hand to brush the area. This gives their brain a real tactile sensation that competes with the false one.

  5. Step 5: If the hallucination involves a visual threat (like a stranger), use the dominant side to 'point' at something safe. Say, 'Oh, I think I see something over there—look at this pretty flower on the table.' Then gently take their dominant hand and point together toward a real, pleasant object (a plant, a photo, a window). This redirects their gaze and attention.

  6. Step 6: Offer a drink or snack using their dominant hand. Hand them a cup of warm tea or a small, easy-to-hold snack (like a cracker or a piece of fruit). The act of bringing the cup to their mouth uses the dominant side and provides a grounding oral sensation. Say, 'Here, take a sip. This will help you feel better.'

  7. Step 7: Move them to a different room or a well-lit area, using their dominant arm to guide them. Gently take their dominant hand and say, 'Come with me, let's go look at the garden/kitchen.' The change of environment often makes the hallucination fade, especially in brighter light where shadows are less likely to trigger false images.

  8. Step 8: If the hallucination persists, use a 'sensory anchor' that involves their dominant side. For example, give them a small, textured object like a stress ball, a piece of velvet, or a smooth stone. Say, 'Feel this—it's so soft. Can you hold it for me?' The tactile input can override the visual hallucination.

  9. Step 9: After the hallucination subsides, engage them in a simple, familiar activity that uses their dominant hand—like folding a towel, sorting coins, or drawing. This reinforces the redirection and helps them feel calm and capable. Say, 'Thank you for helping me with this. You're so good at it.'

  10. Step 10: If the hallucination is frightening and involves physical aggression (like hitting or kicking at imagined animals), protect yourself and them. Use a pillow or bolster between you (as suggested by one caregiver) and redirect their dominant hand toward a safe object like a stuffed animal or a soft blanket. Say, 'Let's give this little guy a hug instead.'

What not to do

  • Do NOT argue or tell them it's not real. This increases confusion and agitation because their brain is genuinely experiencing the hallucination. Instead, validate the feeling and redirect using their dominant side.

  • Do NOT touch them suddenly or grab their dominant hand without warning. This can startle them and make them feel attacked. Always ask permission or approach slowly.

  • Do NOT use the non-dominant side for redirection. The non-dominant hand is less connected to language and sequencing, so it may not be as effective at interrupting the hallucination. Always use the hand they naturally favor.

  • Do NOT leave them alone in a dark or shadowy room. Shadows can trigger or worsen visual hallucinations in Lewy body dementia. Turn on lights, open curtains, or move to a brighter area before attempting redirection.

  • Do NOT use complex instructions or multiple steps. Their brain is already overwhelmed. Keep the redirection simple: one object, one action, one gentle phrase.

  • Do NOT ignore the hallucination if it is causing distress. While it's true that some hallucinations are harmless, a frightening one requires intervention. Use the dominant-side redirection to help them feel safe.

Practical tools

  • The 'Safe Object' Kit

    Prepare a small basket with 3-4 objects that are soft, familiar, and easy to hold with one hand. Examples: a small stuffed animal, a smooth river stone, a piece of velvet, a stress ball. Keep it in a drawer near where hallucinations often occur (e.g., bedside or living room). When a hallucination starts, pick one object and place it in their dominant hand, saying, 'Here, hold this for me. It's so soft.'

  • The 'Point and Shift' Phrase

    Memorize this exact phrase: 'Oh, I see something over there—look at that [real object].' Then gently take their dominant hand and point together toward the real object. This uses their dominant side to shift their gaze and attention away from the hallucination. Practice saying it calmly so it becomes automatic.

  • The 'Warm Mug' Anchor

    Keep a microwave-safe mug or a thermos of warm (not hot) tea or water nearby. When a hallucination occurs, pour a small amount into the mug and hand it to them using their dominant hand. The warmth and weight of the mug provide a strong sensory input that can override the hallucination. Say, 'Here, take a sip. This will help you feel better.'

  • The 'Brush Away' Technique for Tactile Hallucinations

    If they feel bugs on their skin, use a soft-bristled brush (like a baby hairbrush) or a soft washcloth. Gently place it in their dominant hand and guide their hand to brush the area they are scratching. Say, 'Let me help you brush that off. There, it's gone now.' This gives them a real tactile sensation that competes with the false one.

  • The 'Light and Shadow' Check

    Before redirecting, quickly assess the lighting. If the room is dim, turn on a lamp or open curtains. Shadows from furniture or curtains can trigger visual hallucinations. A well-lit environment reduces the likelihood of the hallucination returning after redirection.

  • The 'Bolster Pillow' Safety Tool

    If the hallucination involves hitting or kicking at imagined animals or people, keep a long bolster pillow between you and them in bed. This protects you from accidental strikes while you redirect their dominant hand toward a safe object like a stuffed animal. Say, 'Let's give this pillow a hug instead.'

Discuss with your clinician

If the hallucinations are frequent, severe, or involve physical aggression, discuss with the neurologist whether a medication adjustment is needed. Some antipsychotics can worsen Lewy body symptoms, so only a specialist can guide this.

If the person is on medications for other conditions (e.g., Parkinson's, pain, sleep), ask the doctor if any of these could be causing or worsening the hallucinations. Medication side effects are a common trigger.

If the hallucinations are accompanied by sudden confusion, fever, or changes in consciousness, seek immediate medical attention—this could indicate an infection or electrolyte imbalance.

If the person is experiencing tactile hallucinations (feeling bugs on skin) and scratching excessively, ask the doctor to rule out a skin condition, medication side effect, or other medical cause before assuming it's purely dementia-related.

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