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Stress Management Skills for Caregivers of Older Adults
This program is sponsored by the
Nevada Aging and Disability Services Division and is presented by the
Nevada Geriatric Education Center
Be sure to access the Aging and Disability Resource Center website at
http://www.nevadaadrc.com/ when you have an opportunity.
It is a great resource for providers and community members.
12/5/2011
1
Stress Management
Skills for Caregivers of
Older Adults
Luciana Guardiano Payne
Overview
What is stress and how does it impact you?
Self-Care
Skills for managing stress and stressors
Breathing
Mindfulness
Tolerating distress
Communicating effectively
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What is Stress?
• Your reaction when the demands
of a situation exceed your ability
to cope effectively
The Stress Scale
Resources
*Stressors
*Stressors cause stress
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How Does Stress Impact You
✴Physical health ✴Physiological symptoms
✴Exhaustion, muscle tension,
headache, indigestion
✴Behavior ✴Impatience, difficulty concentrating,
interpersonal difficulties
✴Emotions ✴Feelings of hopelessness,
depression, overwhelmed
✴Thoughts ✴Negative attitudes towards caregiving,
family members
Why is stress management
important?
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Vulnerabilities
Anything that can make you more susceptible to negative emotions
Lack of sleep
Poor diet, not eating, or overeating
Lack of exercise
Misuse of substances
Not taking care of prior stressful situation
Reducing Vulnerabilities
• P.L.E.A.S.E.
• PhysicaL Illness: take care of your body and treat physical
illnesses
• Eating: eat a balanced diet; avoid being too full or too
hungry
• Avoid mood-Altering drugs: try a skill instead
• Sleep: get enough but not too much sleep
• Exercise: get active
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Eat Well
✴Consume Less:
✴Simple carbohydrates
(sweetened, sugary
foods)
✴Caffeine (coffee,
soda, etc.)
✴Eat breakfast and lunch
✴Spread out your eating
✴Drink plenty of water
Exercise ✴Find a physical activity
that you enjoy
✴Find an exercise buddy
✴Set aside time for
exercise
✴Start slow and work up
✴Include exercise in your
daily routine
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Sleep Hygiene: Dos
✴Most adults require 7-8 hrs
✴Get regular exercise (preferably in the AM)
✴Take a warm bath
✴Go to bed at the same time each day
✴Get up at the same time
✴Ensure a reasonably cool and quiet environment
✴Use your bed only for sleep and sex
✴Get up and read something boring if you can’t fall asleep within
20 minutes – repeat if necessary
Sleep Hygiene: Don’ts
✴Oversleep
✴Exercise just before bed
✴Engage in a stimulating activity
✴Have caffeine in the evening
✴Read or watch television in bed
✴Use alcohol to help you sleep
✴Take daytime naps (over 15 minutes)
✴Command yourself to go to sleep
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Managing Stress
Breathing
Breathing exercises can help you
slow down emotional and physiological arousal
give your mind a break from negative thoughts and
feelings
notice other important things that you are missing
(thoughts, feeling, vulnerabilities)
relax
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Diaphragmatic Breathing
Diaphragmatic Breathing Get comfortable - lying on firm surface or seated with lower
back supported
Place right hand on your chest
Place left hand just below your rib cage
Take a deep breath. Imagine that there is a balloon inflating
and deflating inside of you
Notice the movement of your left hand - it should move
outwardly while your right hand should lie fairly still
Exhale through your nose and mouth completely
Inhale for 2 seconds - hold for 2 seconds - exhale for 2
seconds
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Mindfulness
Mindfulness
What is mindfulness?
Mindfulness means paying attention, on purpose, in
the present moment, and without judgment.
Why should I be mindful?
You spend 100% of your time in the present!
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Mindfulness Observe and Describe
Notice your body, your thoughts, what and who is around you
Describe it without judgment: physical characteristics, your experience, facts
Do one thing at a time: when eating, eat; when taking a break, take a break; when worrying, worry!
Redirect your attention to what is really happening now
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Leaves on a Stream
When to Practice
Mindfulness Daily!!!
You can set aside a time for daily practice
You can practice with things you already do
When you feel overwhelmed, anxious, stressed
When you notice judgments, or thoughts and feelings about anything else other than what is happening now
The more you practice, the more mindful you become
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Check in with yourself several times daily
Notice and be aware of your rising emotional arousal
Let go of shoulds, right or wrong, good or bad
Treat your emotion by:
Accepting: this is the only way out of hell
Changing: soothe, distract, or act opposite
Mindfulness
Distress Tolerance
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Tolerating Distress
Negative and distressing things will undoubtedly
happen but you can use a few skills to get through them
Distract: use mindfulness to redirect your attention. This is not a long term solution, but will get you
through a tough moment
Self-Soothe
Tolerating Distress Use your senses:
Take a walk
Listen to music
Drink a cup of tea
Rub lotion on your hands
Rub a soft cloth on your arms and hands
Wash the dishes
Splash some cold water in your face
Breathe!
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Distress Tolerance
Be prepared!
Try out a few things and have them handy
Make a Care Box: place a variety of items that are
effective for distracting or soothing in a box (at home) or a ziploc bag (in your purse).
Use skills before going into stressful situation
Use skills over and over and over and over again
Communication
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Communicating with Others
Effective communication reduces some of the biggest challenges
of caregiving
challenges when communicating with an elderly person/person with dementia
challenges when communicating with others (e.g. family members, etc.)
There is always a transaction between you and the other person
What you do affects them, and what they do affects you, round and round
Communicating with People
with Dementia
✴A person with dementia may not be able to fully
engage in a conversation anymore because of
difficulties
✴ using appropriate words, following conversations
or instructions
✴But then can still benefit from interpersonal
interactions by engaging in
✴small-talk, telling stories, asking or answering
questions, discussing present events
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Communicating with People
with Dementia DO NOT ARGUE!!!!!!!!
Focus on emotion not the content of words
Let go of winning the argument: what happens if you win?
Use “caring detachment”: step back, notice what is happening for you and your care recipient
Use “compassionate misinformation”: appeal to authority, don’t remind them of their deficits or of distressing past events
Use distraction: move on to a topic or activity that they enjoy
Be P.O.L.I.T.E Patience: don’t be in a hurry; do one thing at a time; speak slowly
and clearly, not necessarily louder
Organize and Observe: eliminate distractions; break it into small steps; use gestures and signs; observe their behaviors
Laughter: smile; use warm and respectful tone of voice, use cheerfulness and humor, give praise
Ignore what you can unless it is unsafe: pick your battles!
Tone of voice: persons with dementia are highly sensitive to non-verbal cues
Eye and body contact: look directly at them, at eye level; use
gentle touch to orient them to you
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Behaviors communicate
what words no longer can
Whatever they say or do, there is always something that is VALID
Validate
You can validate through words: focus on the emotion and communicate
1. what you understand
2. what makes sense and is normal about it
You can validate through your behaviors and actions
Remember: you can validate even if you don’t agree!
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Communicating with
yourself
Not knowing what you are feeling or ignoring it when you know what you feel
Discounting what you feel: saying it doesn’t matter or that you shouldn’t feel that way
Allowing someone to treat you disrespectfully
Not observing your limits
Self-Invalidation
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Consequences of Self-
Invalidation
It is de-skilling: reducing your ability to cope with a given situation
It promotes depression, guilt, shame, and burden
It decreases our general sense of well-being
It increases emotional vulnerability
Self-Validation Use mindfulness to identify your emotions
Acknowledge your emotion by labeling it
Validate yourself as you would if someone else expressed that feeling
Accept your feelings: you might not like them, but they are there
Identify areas where you most self-invalidate: what are your favorite judgments?
No shoulds: your feelings and reactions are your feelings and
reactions!
Do not second guess your feelings
Observe your limits
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Observing Your Limits
• Why
✴ Helps reduce burn out and stress
✴ Helps preserve relationships
✴ Helps preserve your sense of self
How
✴ Identify what you are willing to accept
✴ Identify what goes beyond your
limit and your sense of self-respect
✴ Accept that it is ok to say no
Communicating Effectively with Others
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Interpersonal
Effectiveness Don’t let hurts and problems build up
Resolve conflicts before they get overwhelming
Say no when necessary
If overwhelmed, reduce or put off low-priority demands
Set realistic goals and, preemptively, ask for help
Be prepared to accept the help of others when offered
Guidelines for
Effectiveness Getting your objectives or goals met: DEAR MAN
Describe the current situation
Express your feelings and opinions
Ask for what you want
Reward the other person for giving you what you requested
Be Mindful: keep focus on your objective
Appear confident and effective
Negotiate when needed. Be willing to give to get.
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Options for Approaching
Stressors
1. Solve the problem or eliminate the stressor
2. Change or manage your reaction
3. Acceptance: accept and tolerate both the stressor and
your response to the stressor
4. Stay stuck and miserable
“When you understand, you cannot help but love.
You cannot get angry.
To develop understanding, you have to practice looking
with eyes of compassion.
When you understand, you love.
And when you love, you naturally act in ways that relieve
the suffering of people”
- Thich Nhat Hanh
REDUCING VULNERABILITIESPhysicaL illnessEatingAvoid mood-Altering drugsBalanced SleepExercise
MINDFULNESSNotice and Describe your body, sensations, emotions, what is around you.
Do one thing at a time: direct your full attention to what you are doing now.
Let go of judgments and be present in the moment you are in, not the one you wish you were in.
Practice Diaphragmatic Breathing for relaxation, and Leaves on a Stream to let go of judgments.
DISTRESS TOLERANCE Remember to:Use your sensesUse distractionBe preparedUse skills over and over and over
My Self-soothing list1. ______________________________________2. ______________________________________
3. ______________________________________4. ______________________________________
Radical acceptance• Acceptance is the only way out of hell• Don’t attempt to change what can’t be
changed• Accept that other’s behavior may still
bother you
Acting opposite to the current emotion• Fear: Do what you afraid of doing• Sad: Get active• Anger: Gently avoid person you are angry
with or do something kind for them
COMMUNICATIONDon’t argue and be P.O.L.I.T.EPatience: take your timeOrganize and Observe: break into small steps and observe their behaviorLaughter: praise, use humor and be cheerfulIgnore what you can unless it’s unsafeTone of voice: be mindful of your behaviorEye and body contact: look directly at eye level and use gentle touch
VALIDATIONIden t i f y ing and communica t ing your understanding in a clear way. Remember that you can validate even if you don’t agree!
Validate through words by saying with Of Course, Me Too or I Agree! You can also reflect, ask questions and show interest.
Self-validationBe mindful of thoughts & feelingsValidate yourselfIdentify areas of self-invalidationAccept your feelings and let go of shouldsObserve your limits
Interpersonal Effectiveness: Getting what you want
DescribeExpressAssertRewardBe MindfulAppear confidentNegotiate
Stress Management Workshop Cheat Sheet
Your options for approaching stress are:Solving the problem or eliminating the stressor
Changing or managing your reaction Acceptance of reality
Staying stuck and miserable!