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.

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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!