Stress in the Caregiver

One of the best antidotes to stress in caregivers is a sense of control over some aspects of a life that can often end up revolving completely around the person being cared for, according to professor of psychology at Trinity College Dublin, Ian Robertson.
“Caregiving can be very stressful, particularly if the carer feels unsupported, lonely or isolated and is not getting enough sleep. If you add financial challenges to that concoction, it’s almost inevitable your stress will be out of control.The most difficult situations are where the person being cared for has a condition like Alzheimer’s or dementia or a severe brain injury where there are changes in personality and behaviour combined with memory problems, and the person as you know them has changed,” he says.
Robertson will be addressing a symposium on Healthy Aging – Focus on Caregiver Stress at University College Cork this Thursday, June 23rd.
He highlights the need to mitigate the stress of carers by trying to help them to build some sense of control into their lives.
External interventions that can give carers a sense of control include trying to relieve any financial burden either by the State, charities or family, and trying to ensure that carers have some time to pursue their own activities and interests. Maintaining or renewing social interaction and contact is also very important, he says.
“Sometimes a carer’s life and interactions can end up revolving completely around the person they are caring for rather than around their own interests and motivations. Everything else becomes secondary to the main focus of the demanding job of caring, and carers can end up losing the habit of doing things for the sake of pleasure,” he says.
One very effective internal intervention, says Robertson, involves flipping a simple mental switch that allows you to see your situation as a problem to solve or a challenge to meet, rather than a stress that totally overwhelms you. This simple switch in thinking has been shown to greatly diminish the symptoms of stress.
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“I know if somebody has been up all night caring for a person with dementia, they would say this idea was ridiculous, and I agree that in some situations, no amount of mental switching will diminish stress. That being said, there are many instances where you can turn stress into a challenge, which is a very healthy state of mind.”
The best way to get that sense of control, says Robertson, is to set small tangible goals, for example, to create a small pocket of time in the day – even just 15 or 30 minutes – to do something that gives you pleasure like going into a neighbour for a chat, or out to a cafe for a pot of tea and a scone. You need to do whatever it takes to achieve this goal, for example, get a carer or neighbour in to help.
Emotional care
It’s also important for carers to take control of their own emotional state, says Robertson, who points out that there are many excellent methods for doing this, including mindfulness meditation, yoga and relaxation.
“Every carer should find their own emotional care activities and learn the skills to control their mood and stress. There are so many ways to do this and the great thing about modern technology is that there is very little you can’t learn online this days from your own home.”
While stress can have deleterious effects, both physically and mentally on people, Robertson says in his new book, The Stress Test, How Pressure Can Make You Sharper and Stronger (Bloomsbury), that a moderate amount of stress can actually benefit people. It’s all about finding that “sweet spot” before your level of stress becomes overwhelming.
“Stress is a two-edged sword. It can make you stronger and sharper and have a good impact on emotion and cognition if managed in the right way. If you have no stress in your life, you might be under-stimulated and underperforming, while too much stress can be overwhelming.”
Prof Costança Paúl, University of Porto, Portugal, will tell the symposium about her research into psychological resources to counteract the adverse impact of caregiving. Her team is involved in carrying out psycho-educational programmes in the community which provide caregivers with both educational and emotional support.
Intervention groups
The intervention groups are organised according to category of care recipient, for example, stroke or dementia patient, and each group is coordinated by a psychologist. The aim is to benefit caregivers by equipping them with strategies to diminish their burden of care and promote self-care, and to benefit care recipients by helping their carers to understand their diseases and teach them better care practices.
“The results to date show improved physical health of caregivers and reduced psychological distress. The carers who complete the course feel they are better carers, and there is a greater chance that the care recipient will not end up in an institution.
“One of the issues we found was that the primary caregiver could not leave the person they were caring for alone while they did the intervention which is two hours a week for seven weeks, so we have to arrange for somebody to stay with the recipient of care either at home or near our intervention setting.”
Costança says the level of burden and stress differs from one carer to another, depending on their age and the stage of their career.
Caring for a person with dementia can be particularly difficult, she says, as they can display aggressive behaviours, may not recognise the person caring for them and are never grateful because they are often not aware of what is going on.
“The first hour of our intervention focuses on practical skills such as how to bath a person or transfer them from bed to chair. The second hour deals with the emotional side and is a little bit like group therapy. People can share their experiences with others and realise that it is normal to feel angry or resentful of the person they are caring for, and they need to work on not feeling guilty about this. They have to remember that it is neither their fault nor the person they are caring for that they are in this situation.”

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