Welcome to the educational program Caregiver Stress: Coping Strategies. This program will discuss strategies for managing stress and informal and formal support systems.
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This is Lesson 7 of The Alzheimer’s Caregiver. You may view the topics in order as presented, or click on any topic listed in the main menu to be taken to that section. We hope that you enjoy this program and find it useful in helping both yourself and those you care for.
There are no easy answers when it comes to the care of another, as every situation and person is different. In addition, every caregiver comes with different experiences, skills, and attitudes about caregiving. Our hope is to offer you useful information and guidelines for caring for someone with dementia, but these guidelines will need to be adjusted to suit your own individual needs.
Remember that your life experiences, your compassion, and your inventiveness will go a long way toward enabling you to provide quality care.
Let’s get started.
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Caregivers are at risk for long-term or chronic stress, because they usually provide care to another person over long periods of time and experience increasing levels of caregiving burden. Stress that becomes chronic or unresolved can have serious impacts on the mind and body and cause difficulties in daily life.
Chronic stress increases the risk for:
- Heart disease
- Digestive problems (such as reflux disease and indigestion)
- Physical illnesses (such as the common cold, flu, infections, skin conditions, asthma attacks, and autoimmune diseases)
- Sleep problems
- Low sex drive
- Depression and anxiety
- Memory loss
- Earlier death
Therefore it is important to monitor and manage your level of stress.
Managing Your Stressors
One strategy to managing your stress is to first identify the stressors in your life. Try to identify specific things in your life that cause stress. Second, try to find solutions to those stressors.
Once you have identified the stressors in your life, go through each one to explore solutions to the problem, and then try out the solutions until you find ones that reduce the stressor. Start with the bigger stressors, and work on finding solutions to one or two stressors at a time.
Another strategy is a preventive approach: try to reduce the stressors by changing the circumstances that cause the stress.
Another strategy is to reduce the effects of the stressor. For example, relaxation techniques can reduce the effects of stress. Let’s discuss each of these strategies.
When identifying stressors, it is helpful to categorize them into two main groups: external and internal.
External stressors are things that happen to you. Examples include:
- Caregiving activities
- Unpredictable events and behaviors
- Family situations
- Work-related situations
- Social situations
- Environmental factors
- Financial concerns
You may be able to control some aspects of external stressors. By identifying the sources of external stress, you may be able to modify them. But if you cannot modify the stressors, you can modify your response to them and how much you let the stressor affect you.
Having a positive attitude and a sense of humor can help decrease your perception of stress. Set realistic expectations to avoid disappointment and frustrations. Learn about Alzheimer’s disease and try to plan for the future as much as possible. Talk to somebody you trust about your fears.
Internal stressors are those thoughts and feelings that cause stress or increase the degree of perceived stress. Examples of internal stressors include:
Attitude. Having a negative attitude can be stressful in itself. Additionally, it can magnify the perception of a stressful event to increase its effects. So routinely check your attitude. Ask yourself if the stressor is really that bad or that important in the grand scheme of things. Having a positive attitude and a sense of humor can help decrease your perception of stress.
Unrealistic expectations. Having unrealistic expectations about the care recipient and caregiving responsibilities will lead to unnecessary frustrations and stress. Therefore set realistic expectations to avoid disappointment and frustrations.
Uncertainty and fears, for example, about the future, finances, disease progression, care recipient’s behavior and functionality are very stressful. Learning about the disease and planning for the future as much as possible can help you deal with some of these fears and uncertainties. You should also talk to people you trust about your fears.
It is important to find ways of keeping the effects of stress under control. We will discuss four different types of coping strategies for stress.
First, active coping strategies.
Second, emotion or relationship-focused coping strategies.
Third, cognitive or educational coping strategies.
And finally, spiritual-focused coping strategies.
Active Coping Strategies
Active coping strategies refer to strategies that require people to “do” things that help themselves.
For instance, when you schedule a respite caregiver or call a neighbor to do an errand for you, you are using an active strategy.
Asking and planning for support and assistance is a positive approach to stressful situations.
Emotion- or Relationship-Focused Coping Strategies
Emotion-focused, or relationship-focused, coping strategies include strategies such as having optimism, compassion, and empathy.
For example, when you put yourself in the shoes of someone with Alzheimer’s disease and try to view the situation from that person’s viewpoint, you are practicing an emotion-focused strategy.
Another emotion-focused strategy is called reframing, which involves viewing a negative situation in a new and more positive way. It is similar to changing the frame of a photograph and finding that the picture somehow looks different. If you are feeling negative about an aspect of caregiving, try reframing that thought into something positive by identifying the good aspects of your situation. You may find that your emotions follow your thoughts, and you will feel more positive.
Daydreaming is also an example of emotion-focused coping, because being able to see a difficult situation in a better light can be helpful as times. But keep in mind that wishing that a problem will simply go away is usually not constructive.
Educational or Cognitive Coping Strategies
Educational or cognitive coping strategies involve learning new information or new skills that help decrease stress. Knowledge itself can help you better manage your stressful situation. Learning about Alzheimer’s disease and different aspects of caregiving can help you understand and feel more confident and less stressed about your situation.
In fact, by watching this educational program, you are practicing a positive form of cognitive coping. You are also practicing cognitive coping when you read a book or article, subscribe to a newsletter, or get involved in community forums about caregiving.
Knowledge about Alzheimer’s disease and caregiving can help you feel more confident as a caregiver and better manage your stress.
Spiritual-Focused Coping Strategies
Spiritual-Focused Coping Strategies include prayer, meditation, spiritualism, and professional pastoral counseling. Whatever form of spirituality you practice can bring a sense of peace and calm that may help you better cope with stress and difficult situations.
Spiritual-focused coping can help with:
- Personal growth.
- Acceptance of loss.
- Finding meaning in the experience.
- Finding inner strength through spirituality.
It is important to note that you can and should use multiple coping strategies. Trying new coping strategies and continuing to practice old ones are important for creating a wide variety of coping skills to apply to various situations.
Let’s consider some specific coping techniques.
Caregivers often find that there is less time to enjoy the things that they used to enjoy doing prior to assuming the caregiving role. Bringing back everyday joy is a simple, and often powerful, tool for coping with stress. Joyful activities in your daily life don’t have to be complicated or expensive … they just need to be pleasant!
Coping Techniques: Joyful Activities
Examples of Joyful Activities include:
- Exercise (such as walking, biking, yoga, swimming, aerobics, and dancing)
- Socializing with friends or neighbors
- Talking on the phone
- Participating in clubs
- Attending concerts
- Attending church
- Writing in a journal
- Watching movies
- Playing cards
- Visiting family
- Enjoying pets or animals
Incorporating Daily Joyful Activities
It is important that you consciously identify activities that you find pleasant and try to increase the frequency of those activities. Over time, you can add an extra joyful activity to your day, or expand the time of an activity you are already enjoying.
You can also find activities that you can still enjoy together with the person you care for, such as bird watching, visiting loved ones, or taking walks.
A simple but effective coping strategy is called positive self talk. This is a deliberate effort on your part to remind yourself of the extraordinary things that you do each day and how special you really are. Focus on the good things in your life and the positive things that happen every day, no matter how minor.
When you are having negative thoughts or feelings, you can challenge those thoughts with a more positive dialogue about yourself and how you are doing.
Replace negative thoughts with positive ones. Take note of how important you are. You are a hero in the eyes of those you care for … even if they may not be able to tell you this.
Benefits of Caregiving
Another coping strategy is to remind yourself of the benefits of caregiving. Studies have shown that caregivers who focus on the positive aspects of caregiving feel less stressed. Caregivers can view the more positive aspects of their roles by identifying how the experiences of caregiving have improved their lives and the lives of their care recipients. Identifying the benefits of an experience can help you reframe a difficult situation.
So take time every day to remind yourself of the benefits of your caregiving to you and your care recipient.
Common Benefits of Caregiving
Here are some benefits of caregiving cited by other caregivers. Caregiving provides a purpose for your life, develops character and personal growth, improves self-esteem, creates personal satisfaction with a job well done, makes you feel appreciated, gives you comfort knowing that someone benefits from your assistance and care, and leads to spiritual rewards for those who believe that a higher power will reward such acts of caring.
Can you think of other benefits to add to this list?
Relaxation techniques are effective coping strategies that can help you relax mentally and physically. There are several relaxation techniques, many of which can be performed in a short amount of time and in most settings. Practicing daily relaxation can be a valuable tool in combating stress.
It can have numerous benefits including:
- Lowering blood pressure
- Slowing the heart rate and breathing rate
- Relaxing tense muscles
- Improving headaches
- Reducing negative thoughts
- Improving concentration
- Refreshing the body and mind
Basics of Relaxation Techniques
Most relaxation techniques involve focusing your mind on something calming and increasing awareness of your body.
To practice any relaxation technique, it is best to fine a quiet place without distractions. And you should find a comfortable, resting position. For example, sitting on a chair or on the floor works well.
Types of Relaxation Techniques
Some of the main types of relaxation techniques include:
- Deep breathing. The key to this technique is breathing deeply from the abdomen, inhaling through the nose and exhaling through the mouth. This can be performed in any comfortable place within a few minutes. Deep breathing can also be combined with many other relaxation techniques, such as progressive muscle relaxation, music therapy, and aromatherapy.
- Progressive muscle relaxation. This technique involves a two-step process in which you systematically tense and relax different muscle groups in the body. You become aware of what tension and relaxation feel like. The goal is to be able to relax your muscles at the first sign of tension. As your body relaxes, so will your mind.
Deep Breathing Relaxation Exercise
This relaxation exercise will guide you through the basic steps of deep breathing. With practice, deep breathing can help relax tense muscles and slow down your heart rate and breathing. You can reduce negative thoughts and the harmful effects of constant stress. During the breathing exercise, you may have a slight feeling of lightheadedness or dizziness. This should go away with practice. If you do feel lightheaded or dizzy, you should stop the exercise and breathe normally. If you are doing the exercise while standing and you feel light-headed or dizzy, sit or lie down to prevent a fall.
There are three basic steps in the deep breathing exercise: Inhaling deeply. Holding the breath. And exhaling the breath. Over time you can also include other forms of meditation like imagery or progressive muscle relaxation. But for now, the relaxation begins with the simple act of breathing.
Let’s begin. First, position yourself comfortably. A sitting position is usually best, but you can also lie down or even stand, as long as you are able to concentrate on your breathing. If you are standing, you may want to hold onto something to help stabilize yourself.
Now, relax your muscles. Let’s start by taking one, deep, quiet breath in through your nose while counting silently as you inhale – 1, 2, 3, 4. Next, hold that breath as you count silently to 7 – 1, 2, 3, 4, 5, 6, 7. Now, exhale loudly through the mouth for a silent count of 8 -1, 2, 3, 4, 5, 6, 7, 8. That was the first full cycle. You should do at least 4 full cycles in a session. Let’s try this together with Mary.
Progressive Muscle Relaxation Technique
To practice the progressive muscle relaxation technique, find a quiet place to practice the technique. Remove your shoes and sit or lie down with your hands at your sides.
A common way to start is by tensing and relaxing the muscles in your foot and work your way up to your neck and head.
Tense the muscles in your right foot for 5 to 8 seconds and then relax for 15-30 seconds, and repeat. Then tense the muscles in your right lower leg and foot for two cycles. Then do two cycles of tensing and relaxing with your entire right leg.
Next, do two cycles of tension-relaxation with your left foot, then lower leg and foot, and then entire left leg. Next, move onto your right hand, right forearm and hand, and entire right arm.
Then complete this cycle with your left arm. Then your stomach region. Next your chest. Then the neck and shoulders. And finally the face.
A shorter version of this involves tensing and relaxing a group of muscles at one time (sometimes called a summary muscle group) for two cycles each. You can start with the lower limbs (feet and legs), then do the abdomen and chest, then hands, arms, shoulders and neck, then finally the face. •Try to practice the full progressive muscle relaxation twice a day for about a week before trying the shortened version.
Additional Relaxation Techniques
Another relaxation technique is known as visualization or guided imagery. This technique involves imagining a scene in which you feel calm and at peace. Choose whatever setting or situation is most calming to you. For example, a beach or childhood park. Close your eyes and picture as vividly as possible the sights, sounds, smells, tastes, and textures.
Meditation also a great relaxation technique. In some forms of meditation, you choose a point of focus, such as an object, parts of the body, or a word or phrase to repeat over and over.
Other relaxation techniques include: yoga, tai chi, massage, aromatherapy, and music therapy.
You can learn and practice some of these techniques on your own. Some of these techniques take time to master, so be patient. Once you learn a technique, you should practice it at least once a day and whenever you feel stressed.
Exercise and Health Maintenance
Getting regular exercise is another great way to manage stress. Exercise in any form helps both the mind and body better deal with stress. It also improves your energy and mood. Start out slow and gradually build up the intensity and duration of your exercise routine. Set exercise goals. Consider exercising with a friend to turn it into a social event. Consult with a physician before starting a new fitness program if you have any risk factors such as heart, lung, or joint disease.
Try to get enough sleep. Sleep is critical for mental and physical health. Sleep deprivation makes you more sensitive to stressful events.
Eat healthy. Eating nutritional foods makes you feel better and provides more energy.
Get regular medical care for yourself. Taking care of yourself is as much a priority as taking care of your care recipient.
Social Support and Connections
Another way to manage stress is to find social support systems.
Caregivers need to maintain healthy social connections with friends, family, and the community. Finding time for some forms of social connections may require respite care provided by family, friends, or professional services. But seeking social support and taking the time to maintain social connections can help decrease caregiver stress and the risk of depression.
Social support systems can be divided into two types: informal support and formal support.
Informal Social Support
Informal social support includes:
- Clubs and organizations
- Church members
People in your informal support system can do a number of things, small and large, to help you manage the difficulties of caregiving for someone with Alzheimer’s. For home caregivers, they may be willing to help with:
- Cooking or sharing meals
- Running errands
- Helping with the daily care of your care recipient
They can provide respite care to give you some time away from home.
For all caregivers, members of your informal social support system can listen to you, offer comfort and advice, and provide companionship during social activities. They can be a source of love, strength and attention when you need it.
Formal support systems refer to people or groups that provide assistance or information to you that may be outside your traditional circle of family or friends. People in your formal support system may include doctors, nurses, community groups, church members, or professional agencies that provide assistance or information.
Formal support systems include:
- Caregiving and skills training programs and information resources. Caregivers who seek out new information may not only learn new ways of providing care, but also feel comforted to know that others have shared similar experiences.
- Professional counseling. A professional counselor can serve as a mediator in family conflicts or changing family relationships. A qualified counselor can also assist someone who is overwhelmed, distressed, or depressed.
- Respite care. Respite care is short-term care of a person that is provided either voluntarily or for pay. It provides the caregiver temporary relief from the responsibilities of caring for someone. All caregivers need breaks once in a while and should take them. Respite care is often referred to as a gift of time.
- Support groups. Support groups are groups of people who share similar situations and can provide emotional and social support.
- Religious or faith-based programs. If you participate in a formal religion, there may be programs or individuals available to help you. Ask at your local place of worship if there are support groups, learning groups, or perhaps a religious leader who could provide counseling to you.
Another approach to managing stress is being organized. Being organized can help you better manage your time and reduce stress.
Set priorities. Make a list of the things that need to get done in order of importance. Update the list daily. Make separate lists for daily, weekly, and long-term goals. And set realistic goals and deadlines.
Use a planner. This will help you keep track of priorities, activities, appointments, and phone numbers.
Organize the environment and reduce clutter. A disorganized environment can contribute to frustrations and make accomplishing tasks more difficult.
Keep a Journal
Another approach is to keep a journal. Caregivers can find meaning in their experiences by telling their personal story. One way to do this is to keep a journal of your caregiving story. Write about your daily accomplishments, no matter how small. Include at least one positive aspect of your caregiving experience every day.
Additionally, a journal is a good way to keep track of your stress level. Keep a list of your daily stressors, rate how stressful they are, how you tried to solve the stressor, and how you coped with the stress. This can help you figure out which stressor solutions and coping strategies work for you. Keep track of the successful solutions and coping techniques, so that you can refer to them later or share them with other caregivers. Remember to monitor your overall stress level and look for signs that you might need help.
If your symptoms of stress are chronic, unbearable, or overwhelming, or you have symptoms of depression, consult a healthcare professional, counselor, or therapist. Make it a priority to take care of yourself, because your health affects the quality of care you can give, and therefore the quality of life of the person you care for.
In summary, there are many sources of stress associated with caregiving for someone with dementia. These stressors can have serious impacts on the caregivers mental and physical well-being.
One way to decrease stress is to identify your external and internal stressors and try to find solutions to them.
Another approach is to use coping strategies to decrease the impact of stress. The four categories of coping strategies include:
- Active coping strategies
- Emotion- or relationship-focused coping strategies
- Cognitive or educational coping strategies
- Spiritual-focused coping strategies
Coping techniques include:
- Participating in daily joyful activities
- Using positive self talk
- Identifying the benefits of caregiving
- Getting regular exercise
- Attending to one’s own health by getting enough sleep, eating healthy, and getting medical care
- Using informal and formal social support systems
- Being organized
- Maintaining a caregiver journal
- Seeking professional help
- And using relaxation techniques, such as:
- Deep breathing.
- Progressive muscle relaxation.
- Visualization or guided imagery.
- Music therapy.
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Written by: Lena G. Ernst, PhD, MA, LBSW, LNHA (University of New Mexico)
Edited by: Mindy J. Kim-Miller, MD, PhD (University of Chicago School of Medicine)
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