Coping with Stress
Family caregivers are frequently the subject of research studies about stress. Rightly so! As grown-up daughters and sons care for aging parents, they are faced with many new physical, emotional, financial, and practical demands. And this on top of their already busy lives!
Prolonged stress is indeed hazardous to your health. But you do have choices. Many adult daughters and sons report feeling they have no choice about caregiving. Although family obligation may be a factor in your situation, you do have a choice about how you handle your responses.
There are ways to manage stress so it does not get the better of you. It requires attention and time. It may mean you have to look at beliefs about yourself. You may have to take risks. You might need to say things or behave in ways that are new and perhaps uncomfortable. And sometimes it will require letting go, realizing you can't do it all, and asking for help. For instance, you need time away from caregiving responsibilities to recharge your batteries. And hard as it may seem to be, experienced family caregivers will confirm that taking breaks actually makes you a better caregiver in the long run.
Below are some stress management tips based on years of research with family members. They can help you become more emotionally resilient. And, even if only in small glimmers, these strategies can remind you that there are also rewarding and sometimes fun aspects to caring for a family member.
- Is caregiving hazardous to your health?
- Learning to set limits
- Reducing stress: Proven relaxation techniques
- The value of support groups
- Getting support from your spiritual beliefs
- Don't forget your partner
- A remedy for stress: Focus on the rewards of caregiving
Is caregiving hazardous to your health?
When caring for an ailing loved one, it is natural to focus on issues related to his or her health. An unintended consequence, however, involves risks to your own well-being. For instance, family caregivers often forego doctor visits for their own checkups. They are much more likely to be depressed than non-caregivers. They are also more likely to eat poorly and not get enough sleep. In addition, many family caregivers turn to alcohol or prescription drugs to get relief. This is understandable, but not good for anyone.
The major culprit is stress. Higher rates of physical, emotional, and mental health problems among family caregivers are most strongly associated with the stress of providing care. It's not how much care you provide. The issue is how stressful the situation is for you. Research has found the more stressed you feel as a caregiver, the more likely you are to develop health problems of your own.
Stress, for instance, causes anxiety and depression. It actually suppresses the immune system and increases the likelihood of heart disease, diabetes, cancer, colds/flu, and other infections. Family members caring for a loved one with dementia (memory loss) seem to experience the most stress. Not surprisingly, they also tend to develop more health problems.
Stress-relief activities are the best remedy. To keep yourself healthy and able to care for your family member over the long haul, write yourself a prescription for at least one of the following:
- Social time. Spend time with others simply for fun and relaxation. Make it a point NOT to talk about the person you care for.
- Exercise. Work off your frustrations and reinvigorate yourself physically. Or unwind mindfully through yoga or tai chi.
- Crafts and hobbies. Do something you love, whether it's art, music, writing, gardening, cooking, painting, or some other creative pleasure.
- Religious/spiritual practice. If spirituality is a part of your life, make time for prayer or meditation. Attend the services of your faith community.
- A support group. Meet with others in situations like yours to laugh, cry, and share tips.
- Respite. Take a break from caregiving. It's not selfish, it's essential!
Sleep is key to good health. As a society, we seem to think we can safely carve more hours out of the day by taking it from our sleep. Not so. People who are sleep deprived have greatly compromised immune systems. They also get in more car accidents and have higher rates of depression. Sleep is not a luxury. It is crucial to good health!
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See the doctor for regular checkups. Ignoring your own health issues will only put you and your loved one at risk. Make sure you keep up with regular screenings. And see the doctor if you feel depressed, fatigued, or not well. Too often, family members put their loved one's illness before their own. Although your own health may not be as impaired as your family member's, that does not mean you are invincible. If for no other reason, keep your regular checkups just to be sure you stay healthy enough to continue giving care. You need to preserve your health for your loved one's sake, as well as for your own.
Learning to set limits
There is always more to do when you're caring for an aging parent. It’s difficult to know when you've done enough. Your ability to set limits for yourself is crucial to your ability to care for your loved one over the long haul. If you're not clear about when to say "no," you're headed for exhaustion and burnout. And THEN where will your loved one be?
Setting limits can bring up many conflicting thoughts and feelings. The science of cognitive–behavioral therapy takes a very constructive approach. Its message is, "Don't believe everything you think!" That means we often get caught up in thoughts and feelings that seem true. On deeper examination, however, they are biased by inaccurate assumptions.
Inaccurate assumptions about caring can get in the way of wise decisions. For instance, we may believe that we can show our love only in certain ways. Or that we must be all-giving. If we aren't, then we don't love the person we care for. You will be doing yourself, and your family member, a favor if you take a second look at your assumptions and consider alternate perspectives.
Following are common misconceptions that can interfere with setting appropriate limits:
"Mom/Dad did so much for me growing up. It's selfish to say 'no.'"
- Alternate perspective: Self-respect is an essential life skill, as is self-knowledge. You need to pace yourself so that you can continue to give care for weeks, months, maybe even years. Consider this perspective instead: "I need to budget my time and energy so that my own batteries don't lose their charge. I will be a better caregiver in the long term if I avoid situations that are not genuinely productive."
"If I show Dad how much I really care, then he'll show me his love."
- Alternate perspective: We can never predict another's behavior. Caring with "strings attached" sets you up for disappointment or, even worse, resentment. Consider this perspective instead: "Dad's actions are about him, not me. I accept that he may never show gratitude. I am helping because helping is a value that is important to me."
"Mom is so sick. I need to do everything I can for her."
- Alternate perspective: There is much in life that we can't control. Be careful that you don't assume responsibility for what you really don't have the power to cure. Consider this perspective instead: "If I were to do one thing, what is the single most beneficial thing I could do right now to help Mom feel better?"
Stay flexible. Quite often we go to all-or-nothing thinking. Agree to do more, or less, depending on your needs at this moment, as well as their needs. Saying "no" today does not mean that you won't say "yes" tomorrow. It just may be that this task at this time is not as important as keeping your own well from running completely dry.
Acknowledge to yourself what you have done so far. It's probably quite a lot. And if you need to say "no" to a specific task, perhaps you can say "yes" to something else. "I'm sorry, Dad, I can't make dinner for you tonight, but I can take you to your doctor's appointment tomorrow." Framing your willingness to help in this way gives you the ability to set personal boundaries while also participating in your loved one's care.
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Remember the instructions when an airplane is in trouble: If you are traveling with someone who needs help, you must first put on your own oxygen mask and then help the person you care for. This is not selfish behavior. It's simply the wisest way to allocate a scarce resource: You!
Reducing stress: Proven relaxation techniques
Anxiety is no stranger when you are caring for a family member. Whether you live with your relative, or far away, the feeling of responsibility adds to your mental load. Medical emergencies, financial worries, everyday care issues… they all cause stress. And if your relationship is strained or you and your siblings are not in sync, the strain can be greatly amplified. It doesn't take much to feel overwhelmed.
Emotional distress sets off a physical reaction. When we feel scared or angry, our heart rate and blood pressure increase. Our breathing speeds up. When the stress is chronic, our "fight or flight" response may be engaged for days, weeks, or months. That's hard on the body. Stress creates tension, which generates anxiety, which creates more stress. It's a nasty downward spiral.
You may not be able to control the course of your parent's condition or the family's dynamics. But you can take the edge off by learning to relax, and it doesn't take a lot of time. Relaxation stops the stress reaction. It also clears the mind, enabling less anxious thinking about any issue at hand.
Following are three proven relaxation techniques. They are recommended by organizations such as the American Heart Association. Experiment. Pick one and try it for 10 minutes.
- Deep breathing. Sit comfortably, feet on the floor. Put one hand on your chest, the other just under your ribs. Inhale slowly through your nose, counting to five. Only the hand at your belly should rise. Exhale slowly, counting to five. Repeat.
- Muscle relaxation. Lie down or sit comfortably. Starting with your toes, tense and relax your muscles. Move up your body to the calves; tense and relax. Then up to the thighs, tense and relax. Count to five while tensing and to 30 while relaxing. Notice the difference between tense and relaxed. Continue up through your abdomen, your chest, your arms, your neck and shoulders, and your face.
- Visualization. Find a quiet room to lie down or sit comfortably. Imagine yourself at your favorite place of tranquillity (beach, mountains, etc.). Bring in as many elements of the place as you can: what would you be seeing, smelling, hearing, touching?
You can even share these techniques with the person you care for. (He or she may also be feeling stressed. It's not easy to have health problems or to accept the need for help.)
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Stress management takes practice and perseverance. But everyone benefits from 10 minutes or so of genuine relaxation. Surely you can give yourself (and ultimately your family member) that small but potent gift of relief.
The value of support groups
Caring for an older family member presents a range of emotions and experiences. You may find yourself feeling sometimes puzzled, sometimes sad, or sometimes just plain mad, and then guilty! The people most likely to understand your feelings and most able to provide useful tips are those in the same situation. You'll find them in support groups.
Support group benefits. Does a support group sound like just "one more thing" in your busy schedule? Consider these benefits:
- Relieve stress. Share the humor and the tears that are normal parts of caregiving. Learn how others cope with their frustration. Get support for taking a needed next step, such as getting extra help.
- Find community. Hear others voice feelings and thoughts similar to yours. You are not alone. These folks "get it"! You'll feel suddenly lighter.
- Get answers. Learn about a new resource. Ask how others have handled a challenging behavior.
Support group formats. Choose the option that suits your style or scheduling needs.
- Structured, educational groups typically meet weekly for up to 8 weeks. Most are led by a professional who directs discussion of specific issues.
- Open-ended or "drop-in" groups allow you to show up when it's convenient for you over many months or many years. These groups are usually facilitated by professionals or trained laypersons.
- Online groups provide the ultimate in flexibility. You can "attend" any time of night or day. And there's no need to talk. You can sit back and "listen" until you are ready to share.
Getting support from your spiritual beliefs
Do you want to feel more emotionally stable and "up" as you care for your family member?
Studies show that religion and spirituality help family caregivers maintain a sense of well-being. In fact, individuals who draw upon their religious or spiritual beliefs report feeling less burdened and depressed. Those who stay involved with their church or spiritual community also report more optimism and less stress related to caregiving.
But in today's fast-paced world, it's easy to get overwhelmed and fall out of touch with yourself or out of step with your spiritual practices.
Take a moment for self-reflection. These questions may help you recall simple ways to nurture yourself spiritually.
- How do you describe your beliefs about life? What gives your life meaning? When you are struggling with your family member's needs, recalling those deeper beliefs can help you regain emotional balance.
- What can you do to connect to your spirituality? One way might be to spend time in nature. In daily prayer or meditation. Saying grace at meals. Or regularly visiting a place of special significance.
- What activities give to you spiritually? Does singing with others bring you alive? Or would you prefer a weekly reading and discussion group? Perhaps an annual retreat or periodic talks with a member of the clergy?
- Do you feel drawn to a faith community? Give yourself the flexibility to participate when you can. You will have more to give to your family member if you take the time to fill your spiritual well.
- How can your faith community help you find meaning in your caregiving? Are there other family caregivers in your congregation? You might meet together to support each other spiritually.
Don't forget your partner
In an online poll of family caregivers, 81% reported that caregiving tested their marriage in ways they never imagined. Maintaining balance between caring for an elder and nurturing significant relationships can be a big challenge. Since the average American family will spend years assisting an aging relative, it is essential to have a long-term strategy.
For this topic, we adapt the recommendations of Dr. John Gottman of the University of Washington. His research with couples points to ways you can maintain the health of your marriage as you care for the health of your aging family member.
- Review values and goals. Establish a sense of shared purpose. What is the meaning behind the care of an elder? Having a shared vision makes it easier to accept inconveniences.
- Discuss fears, concerns, and expectations. You and your partner may have strong memories and assumptions based on watching your parents care for, or not care for, your grandparents.
- Show interest when your partner shows signs of stress. Demonstrate that his or her emotional and physical needs are also a priority.
- Stay positive. Even when there are problems between you, notice and point out the good things.
- Set aside time for your spouse. Whether it's a walk, a movie, a weekend away, make sure to have fun together regularly and often.
- Show your interest in spending time together by initiating and planning "dates."
- Make it quality time. Pay attention to your spouse and be "present" for your moments together.
- Don't discuss problems. Separate your problem-solving time from time together for nurturing your relationship.
Your primary support person also needs support. With a regular loving connection, you and your partner can come through this stronger than ever.(Return to top)
A remedy for stress: Focus on the rewards of caregiving
No matter how much you love your parents, taking care of an aging relative can be stressful.
To offset the stress, consider the power of positive thinking. A University of North Carolina stress study has shown that people who "seed their lives" with moments of positive emotions are more resilient in the face of challenges. This approach doesn't mean ignoring or denying the negatives. Instead, it means taking time to notice the "micromoments" of things that are going well.
So does this mean you should go to more movies or eat more chocolate? Not really. According to Dr. Martin Seligman, a University of Pennsylvania researcher and former president of the American Psychological Association, these activities might feel good in the moment. More lasting avenues to happiness, however, come from focusing your attention on activities that feel meaningful. Often this strategy involves taking a new perspective on your daily routines, looking at the glass as "half full."
The good news is that a shift in attitude or attention costs nothing and generally does not add inches to your waistline!
Despite the hardships, family members frequently mention the following rewards in caregiving:
- "I am grateful to be able to give back."
- "I now feel much closer to my mother."
- "I've become more compassionate."
- "I've learned to appreciate the little joys and triumphs in each day."
- "I'm proud of the new skills I've learned. I had no idea I could do these things."
- "This has given me a chance to reexamine my priorities and be sure I am living the life I want to lead."
If you are looking for ways to feel stronger and less stressed, perhaps it's time to think in terms of the rewards in what you are doing. By accentuating those activities that have meaning for you ("seeding" your caregiving with positives), you can find more enjoyment. Very likely the person you care for will also feel the benefit.(Return to top)