"I'm not okay, you're not okay and that's okay."

Self-care for caregiversJudi Maguire, Parent Partner at Wayside Youth and Family, NAMI Basics and Family to Family teacher, NAMI Connection and Family Support Group facilitator.Marla Lynch, Simmons College, Professor of Nursing, clinical specialist in adult mental health nursingKatie Hunsader, moderator, NAMI Mass, Criminal Justice Project Assistant1The 3 RsRECOGNIZEWatch for the warning signs of stressREVERSE Manage stress and seek support RESILIENCETake care of your physical and emotional health Ask audience to say hi to each other. Shake hands, hug, blow a kiss . . . .2Recognize signs of stress

What qualifies me to teach this class? Its fairly obvious that diet and exercise are fairly low in my list of priorities. Well -once upon a time in a galaxy far, far away. I failed my stress test. I was working sixty hours a week, looking after children, dealing with daily calls from school, IEPs and appointments. I crashed quite spectacularly. I didnt learn my lesson so I crashed again. Through all the years it took me to get back on my feet, I learned a few things. Despite my best effort I could not change other people. Feeling guilty if others were unhappy was a waste of energy, and that being able to relax was my top priority in keeping well.3Recognize signs of stressStress is a normal response to things that make you feel upset or in danger, whether real or imagined.When you are confronted with a stressful situation, your body senses danger, and kicks into the fight-or-flight reaction, or thestress response.The stress response is the bodys way of protecting you. But for those who are constantly stressed out, due to trying to balance caregiving with work, children, money issues, fatigue and getting services, stress stops being helpful and starts causing major damage to your health, your mood, your productivity, your relationships, and your quality of life.

So whats so bad about stress? Stress is a normal response to things that make you feel upset or in danger, whether real or imagined.When you are confronted with a stressful situation, your body senses danger, and kicks into the fight-or-flight reaction, or thestress response. The stress response is the bodys way of protecting you. But for those who are constantly stressed out, due to trying to balance caregiving with work, children, money issues, fatigue and getting services, stress stops being helpful and starts causing major damage to your health, your mood, your productivity, your relationships, and your quality of life.

4Recognize signs of stress

AngerAnxietySleep ProblemsMuscle TensionHeadachesApathyWorryingSeeing only the negativeDepressionIsolationEating too muchIve given you a list of stress warning signs. There are 98 of them. Hang the sheet on the your fridge. When you have a few minutes to spare see how many you check off. 5Recognize signs of stressStress can also cause physical symptomsMuscle TensionHeadachesStomach ProblemsAches and PainsChest Pain

Long-term stress can lead to high blood pressure, suppression of the immune system, heart attacks and strokes and speed up the aging process.

70 90% of all illnesses are stress related this includes heart disease, cancer, diabetes, fibromyalgia, asthma, obesity, depression, anxiety, Alzheimer's, accelerated aging and premature death. 6Recognize signs of stress70 90% of all illnesses are stress related

A study looked at the health effects of stress by studying elderly caregivers looking after their spouses -- people who are naturally under a great deal of stress. It found that caregivers had a 63% higher rate of death than people their age who were not caregivers7Reverse manage stress and seek support

8Reverse manage stress and seek supportLearn about your situation youll feel empoweredGo to the libraryAttend a NAMI class: Family to Family or BASICSJoin a chat roomContact illness specific non-profit organizationsAttend conferences and seminars

Build a support network Reach out to family and friendsAttend support groupsJoin in Go to the YMCA, church groups, book clubsASK FOR HELP Asking people for help is a gift from you to them

Learn as much as you can about your family members illness and about how to become a caregiver. The more you know, the more effective youll be, and the better youll feel about your efforts. You can also enroll in one of NAMIs education programs BASICS and Family to Family. Details about NAMI Programs are in your handouts.

Asking for help can be embarrassing, but most people are very happy to help. Being able to help makes people feel good.9Reverse manage stress and seek supportLearn to love the N word

Set Boundaries

Setting clear boundaries is important. Let people know what you will and will not tolerate. Caregivers often accept much less from the people they are caring for than others. Caregivers are entitled to be treated with respect, try not to normalize poor behavior. (TELL NANCY STORY)Communicate. People are not mind readers. Dont just sigh and move on, explain to the other person how you are feeling about what has or is taking place.

Know your limits. Dont take on to much youll either burn out, or start to resent the extra work. If you are realistic about how much you can handle, you will earn respect by not being seen as a pushover. Youll be more dependable and less stressed. 10

Reverse manage stress and seek support

NOW I WANT EVERYONE TO Yell OUT NO! AGAIN AND LOUDER. DID THE WORLD COME TO AN END?11Spirituality in the Recovery ProcessMarla Lynch RN MS PMHCNS-BC

Spirituality is a key aspect to the recovery process for individuals and their families and important in cultivating resilience in coping.

My goals today are to: 1. Highlight the importance of spirituality 2. Summarize current research 3. Give you some practical tips to enhance the spiritual aspects of your everyday life.

Holistic Health Care:mind body - spirit

Questions in the journey of life

What is my lifes purpose?What is meaningful to me?How can I get beyond my upsetting, and painful circumstances?How can I find comfort, sustenance, relief and recover? What offers me hope? A way forward?

Spirituality is the personal quest for understanding answers to the ultimate questions about life, about meaning, and about the relationship with the sacred or transcendent, which may (or may not) lead to or arise from the development of religious rituals and the formation of a community. (Harold Koenig, 2000)

Spirituality is concerned with meaning and purpose, love and harmonious relationships, forgiveness, trust, sources of hope and strength, expressions of personal beliefs and values, and the expression of the concept of God through spiritual practices. (McSherry, 2006)

Spirituality definitions

Almost 90% of Americans describe themselves as religious or spiritual. (Adler, 2012)*

92% of Americans believe in God or a higher power50% of Americans state that religion/ spirituality is very important in their lives. (Gallup Poll, 2011)*

50% of patients receiving medical and psychological care wish to discuss spiritual matters with their health care providers. (Rose et al., 2000, 2001)*

49% of Americans report that they use prayer to address their own health concerns. (Wachholtz & Sambamthoori, 2011)* *Lake, James, (2012).Spirituality and Religion in Mental Health: A concise review of the evidence. Psychiatric Times,March 2012. www.PsychiatricTimes.com/cme.Spirituality matters!

Religion/ Spirituality is a complex topic. (R/S).Professional caregivers tend to avoid it.Science based priorities have been on establishing the biological roots and explanations of mental illness. These scientific advances have helped ease the myths and stigma of mental illness. The latest research suggests that the relaxation response, meditation, quiet time contemplation, prayer, and yoga all offer similar neuro-physiological health benefits! * (Lake, J., 2012)

Research

"The relaxation response is a physical state of deep rest that changes the physical and emotional responses to stress... and the opposite of the fight or flight response.

-www.RelaxationResponse.org

Herbert Benson, MD

One small health promoting practical step is to add a daily relaxation response or meditation or a quiet, contemplative time. Lets try this now

Promoting Health

calmer physiologyfocused aware mindrelaxed peaceful emotional statespiritual contemplation, renewal and hope allows you to bring an attentive, caring presence to the relationship arenaThere are multiple health benefits . . .

These are the areas in our lives where stress may originate:Physical CognitiveEmotionalSpiritualInterpersonal

SELF CARE

Be aware of your sleep, diet, exercise & rest patterns.When we pay attention to the messages our body sends us, we can adjust our plans and priorities more readily.Remember the more adjustments or changes in your life, the greater the risk is for physical symptoms of stress.

Your Body

Try to be mindful. Stay in the present.Consider establishing a meditation practice.This may allow you to become more centered in yourself and calmer.Be aware of your thought patterns.Try creative visualizationsTry reframing. Is there is some new learning amidst your current dilemma or upset?

Your Mind

How do you find solace?How do you nourish and renew yourself?Do you have some alone, quiet time each day?What are your creative passions? Hobbies?Loneliness is poverty of self, solitude is richness of self. ~ May SartonYou may want to consider keeping a journal.

Your Emotions

Pray when you can, in whatever form you choose.The deportment of prayer is one of receptivity and openness.Try to see the wonder and beauty in everyday & in ordinary eventsPrayer

You may not be able to attend to your planned agenda Allow yourself to relinquish control Allow yourself to be spontaneous Be in the present moment, where ever you are.Cultivate Flow

When we cultivate an attitude of gratitude we may become appreciative for what we have, our talents, our resources, moments of thankfulness, happiness and joy.Gratitude

Stay connected to othersRemember: everyone has vulnerabilities.Try to be kind and compassionate.Try to avoid judging yourself and /or others.What is the most loving thing I could do right now?Interpersonal Realm

If you have lingering regrets, hurts, anguish, disappointments, or have suffered betrayals and lossesProactively consider your path forward to peace and resolution by letting go, forgiving yourself and others.If necessary, ask for forgiveness.

Moving Forward with Positive Intentions

Do you have a vision of yourself 1 year from now?Do you have a vision of yourself 5 years from now?

Are you role modeling the person you want to be?What adjustments would you like to make?Your new and renewed self

All life is suffering. [Buddhism concept dukkha: Also impermanence or change, and interconnected-ness.]

The purpose of our lives is to be happy. ~ Dalai Lama

Follow your bliss. ~ Joseph Campbell, American expert in comparative mythology & comparative religionFavorite Quotes

Develop emotional awareness Recognize your moment-to-moment emotional experience Handle all of your emotions without becoming overwhelmedThe Dalai Lama is really good at this. Thats why he looks happier than you or me!Resilience look after yourself

Emotional awareness involves two basic abilities: Recognizing your moment-to-moment emotional experience. This means trying to stay in the present not allowing your emotions to be affected by what has happened in the past or may happen in the future Handling all of your emotions without becoming overwhelmed: Recognizing that your response to the situation is affected by your emotional response and affects how you perceive the incident and how you handle it.32Resilience look after yourselfWe are motivated by our emotions Emotional awareness allows us to, understand our behavior, manage our emotions and accurately read the wants and needs of othersMake friends with all your emotionsBy avoiding emotions we dislike, we distance ourselves from emotions we do like.

We can overcome loss and great challenges, but only if we retain our ability to experience joy.

We are motivated by our emotions Emotional awareness allows us to, understand our behavior, manage our emotions and accurately read the wants and needs of othersMake friends with all your emotionsBy avoiding emotions we dislike, we distance ourselves from emotions we do like.

We can overcome loss and great challenges, but only if we retain our ability to experience joy.33Create a worry period. You cant stop worrying but you can limit it!

Choose a set time and place for worrying. It should be the same every day During your worry period, youre allowed to worry about whatevers on your mind. The rest of the day, however, is a worry-free zone.

Postpone your worry. If an anxious thought comes into your head during the day, note it down. Go over your worry list during the worry period. If the things on your list are still bothering you, allow yourself to worry about them.

As you develop the ability to postpone your anxious thoughts, youll start to realize that you have more control over your worrying than you think.

Resilience look after yourselfWORRYYour worries bother you - you can't sleep, and you become pessimistic. But there is a way that these worries make sense to you. For example, you think:Maybe I'll find a solution. I don't want to overlook anything. I don't want to be surprised. I want to be responsible

Create a worry period. Choose a set time and place for worrying. It should be the same every day (e.g. In the living room from 5:00 to 5:20 p.m.) and early enough that it wont make you anxious right before bedtime. During your worry period, youre allowed to worry about whatevers on your mind. The rest of the day, however, is a worry-free zone. Postpone your worry. If an anxious thought or worry comes into your head during the day, make a brief note of it on paper and postpone it to your worry period. You can use a short relaxation technique to help you handle this situationGo over your worry list during the worry period. If the thoughts are still bothering you, allow yourself to worry about them.

As you develop the ability to postpone your anxious thoughts, youll start to realize that you have more control over your worrying than you think.

One of my favorite quotes is Our anxiety does not come from thinking about the future, but from wanting to control it.

34Resilience look after yourselfChallenge Automatic Negative Thoughts

Automatic NegativeThoughtsANTSChallenge those automatic negative thoughts that march through your brain, stealing your happiness and leaving a trail of destruction35Resilience look after yourselfWatch for Cognitive DistortionsAll-or-nothing (polarized) thinking Ill never get this rightMind reading I know she thinks Im fatCatastrophizing Im late. Im going to lose my job!Control fallacies Why arent you happy? Is it because of something I did?Fallacy of fairness Its not fair. She can eat as much as she wantsBlaming I hit you because you made me madEmotional reasoning I really screwed up. Im so stupid!Watch for cognitive distortions . .

All-or-nothing (polarized) thinking Ill never get this rightMind reading I know she thinks Im fatCatastrophizing Im late. Im going to lose my job!Control fallacies Why arent you happy? Is it because of something I did?Fallacy of fairness Its not fair. She can eat as much as she wantsBlaming I hit you because you made me madEmotional reasoning I really screwed up. Im so stupid!36Resilience look after yourselfLaugh or elseYour sense of humor is one of the most powerful tools you have to make certain that your daily mood and emotional state support good health.

Laughter relaxes the whole body. A good, hearty laugh relieves physical tension and stress, leaving your muscles relaxed for up to 45 minutes after. Laughter boosts the immune system. Laughter decreases stress hormones and increases immune cells and infection-fighting antibodies, thus improving your resistance to disease. Laughter triggers the release of endorphins, the bodys natural feel-good chemicals. Endorphins promote an overall sense of well-being and can even temporarily relieve pain. Laughter protects the heart. Laughter improves the function of blood vessels and increases blood flow, which can help protect you against a heart attack and other cardiovascular problems. Laughter dissolves distressing emotions. You cant feel anxious, angry, or sad when youre laughing. Laughter helps you relax and recharge. It reduces stress and increases energy, enabling you to stay focused and accomplish more. Humor shifts perspective, allowing you to see situations in a more realistic, less threatening light. A humorous perspective creates psychological distance, which can help you avoid feeling overwhelmed.

Watch a funny movie or TV show. Make time for fun activities (e.g. bowling, miniature golfing, karaoke). Do something silly. Goof around with children. Host game night with friends. Play with a pet. Go to a comedy club. Read the funny pages. Seek out funny people. Share a good joke or a funny story. Check out your bookstores humor section. Go to a laughter yoga class.

37Resilience look after yourself

Laugh at yourself. Share your embarrassing moments. The best way to take yourself less seriously is to talk about times when you took yourself too seriously. Look for the humor in a bad situation, and uncover the irony and absurdity of life. Surround yourself with reminders to lighten up. Keep a toy on your desk or in your car. Put up a funny poster in your office. Choose a computer screensaver that makes you laugh. As you go to sleep think of the good things that happened in your day. Youll find one and sleep better.

FIDO and FLUFFY can be a comfort to you and your loved one. Having a dog is a great reason to go for a walk. Get some exercise and take a break.Laugh at yourself. Share your embarrassing moments. The best way to take yourself less seriously is to talk about times when you took yourself too seriously. Look for the humor in a bad situation, and uncover the irony and absurdity of life. Surround yourself with reminders to lighten up. Keep a toy on your desk or in your car. Put up a funny poster in your office. Choose a computer screensaver that makes you laugh. Keep things in perspective. Many things in life are beyond your controlparticularly the behavior of other people. Deal with your stress. Stress is a major impediment to humor and laughter.As you go to sleep think of the good things that happened in your day. Youll find one and sleep better.

38Resilience look after yourselfYES YOU DO HAVE TIME TO:Eat Breakfast - Drink fruit juice instead of coffeeStop trying to multitask - Do mini relaxation exercisesDo little things to make your environment more relaxingCelebrate your birthday - Find the funnyIgnore the news filter your callsAllow extra time for appointments - Relax while driving no need for road rageResist the urge to judge or criticize Be kind Say hello with a smile

REMEMBER ITS EASIER TO DEVELOP A NEW HABIT THAN CHANGE AN OLD ONERESILIENCE YES YOU DO HAVE THE TIME TOEat Breakfast some protein will help you get through your day, even if you grab a piece of cheese and a hard boiled egg Drink fruit juice instead of coffee Caffeine gives you a temporary lift juice is better for youStop trying to multitask Did you know that most people cannot multitask, they just transition quickly between tasks. Transitions can be stressful.Do your mini relaxation exercises theyre easy and youll feel better straight awayDo little things to make your environment more relaxing tidy up a little, buy a plant, even if its fake!Get some exercise take a walk or sit on a balance ball Sitting on a balance ball is great exercise while watching TV or working at your deskCelebrate your birthday You can be 29 as many times as you likeFind the funny Its thereIgnore the news If the world is coming to an end someone will tell youFilter your calls everybody does it.Allow extra time for appointments Waiting to see someone allows you to relax, or read a magazine that youd never buy for yourself (even if its dated 1983)Relax while driving no need for road rage youll feel better and vastly superior to all those people going crazy.Resist the urge to judge or criticize a waste of energy the only person you can change is yourself and KARMA can be a bitchBe kind Random acts of kindness make everyone feel greatSay hello with a smile Chances are youll get one back

39

THANK YOU

41 Anne-Marie Barron PhD, RN, PMHCNS-BCAssociate ProfessorAssociate Dean for Undergraduate Curriculumand Student AffairsSimmons College School of Nursing and HealthSciencesClinical Nurse Specialist and Faculty NurseScientistMassachusetts General Hospital Reverend Bonnie-Jean Casey Simmons Chaplain Simmons CollegeSpecial Thanks

Baetz, M. & Toews, J. (2009). Clinical implications of research on religion, spirituality, and mental health, The Canadian Journal of Psychiatry, May, 54:5.Bassett, H., Lloyd, C., Tse, S. (2008). Approaching in the right spirit: Spirituality and hope in recovery from mental health problems, International Journal of Therapy and Rehabilitation, June,15:6.Clarke, J. (2010). Body and soul in mental health care, Mental Health, Religion & Culture, Sept. 13:6.Cooke, C. (2012). Pathway to accommodate patients spiritual needs, Nursing Management, May, 19:2.Grafton, Gillespie, & Henderson, (2010), Resilience: The power within, Oncology Nursing Forum, Nov, 2010, 37:6. Hadzic, M., (2011). Spirituality and mental health: Current research and future directions, Journal of Spirituality in Mental Health, 13:223-235.*Lake, James, (2012).Spirituality and Religion in Mental Health: A concise review of the evidence. Psychiatric Times, March 2012. www.PsychiatricTimes.com/cme.Ledger, P. & Bowler, B. (2013). Meeting spiritual needs in mental health care, Nursing Times, Feb 28. www.nursingtimes.net.References

Lindridge, A. (2007). Spirituality matters, Mental Health Today, Dec 2007.Lloyd, C., & OConnor, C. (2007). Integrating spirituality into mental health rehabilitation, International Journal of Therapy and Rehabilitation, April, 14:4.Melvill, G, Chang, D, Colagiuri, Marchall, P., & Cheema, B. (2012). Fifteen minutes of chair-based yoga postures or guided meditation performed in the office can elicit a relaxation response, Evidence-Based Complementary and Alternative Medicine, Vol. 2012, Article ID 501986.Rosmarin, D., Wachholtz, A. & Ai, A. (2011). Beyond descriptive research: advancing the study of spirituality and health, Journal of Behavioral Medicine, 34: 409-413.Sternthal, M, Williams, D., Musick, M., & Buck, A. (2012). Religious practices, beliefs, and mental health: variations across ethnicity, Ethnicity & Health, Feb/April, 17:1-2.Walsh, J. (2012). Spiritual interventions with consumers in recovery from mental illness, Journal of Spirituality in Mental Health, 14: 229-241.Wilding, C., Muir-Cochrane, & May, E., (2006). Treading lightly: spirituality issues in mental health nursing, International Journal of Mental Health Nursing, 15, 144-153.

References continued . . .