Taking Care of Yourself: A Parents Guide to Mental Health, Stress Reduction & Parental Guilt

Tina Drossos, Ph.D.Assistant ProfessorDepartment of Psychiatry and Behavioral NeuroscienceUniversity of Chicago

Rates for pediatric chronic illness

20 million children suffering from one chronic health problem 3 in every 10 children in the US

For JIA:294,000 children under the age of 18

It is important to know that you are not alone

Response to pediatric chronic illness

Initial diagnosis Overwhelmed/fear/worry ANGER Denial (“This cannot be happening to me, to

my child, to my family.”) Grief Feel that you do not have all/enough

information Confusion Feelings of isolation Powerlessness Blame/guilt*

Blame/Guilt

“Did I do something to cause this?” “ Am I being punished for

something I have done?” “Did I take care of myself when I

was pregnant?” Can transform into religious or

spiritual blame It is normal but you must find a way

to let go of the blame

Long-term consequences

Long-term consequences Financial problems Marital problems Work problems Continued uncertainty and fear/worry Hospitalizations etc.

“Rollercoaster”

Responses (cont’d)

“You can’t make it better. I think that’s the hardest thing I found: that Mommy couldn’t make it better.”

Struggle for control over their lives Strain of not being able to help a child in pain Changed life (unplanned and unexpected) Burden of needing to follow a treatment regimen Increased parental distress Increased negative affect

Most of these responses are NORMAL

Taking care of a chronically ill child is one of the most draining and difficult tasks a parent can face

Effects of parental mental health on children

Greater emotional distress (in mothers) -> higher levels of reported pain

More psychological distress -> greater pain related disability in youth

Parental reports of mental and physical health is related to the psychological adjustment and functional status of children

What to look out for

Depressed mood Diminished interest or pleasure in activities you used to

enjoy Decreased appetite/weight loss Sleep problems Fatigue/loss of energy Increased tearfulness Feeling hopeless and helpless Problems with attention/concentration Excessive worry/nervousness Intrusive thoughts/worries Increased irritability *thoughts of death

Rates of mental health problems

Lifetime Prevalence rates for adults (in the general population) 10%-20% depression 16%-20% for anxiety

Lifetime Prevalence rates for adults with chronically ill children Approx 30% for depression Up to 55% for anxiety

Mental health in parents of children with JIA

Parents (specifically mothers) are at heightened risk for mental health problems

Association between perceived impact of JIA on the family and mothers’ mental health

Association with medications the child is prescribed

Our working model

• Biology cannot be separated from other experiences

• Social context is essential to consider

• Change is part of each level of experience

What can you do?

Educate yourself Talk openly with your child Do NOT neglect your relationship with

your significant other Set aside time to spend together Communicate openly with your partner Respect your partners’ opinions Have a “game plan” for working together Be on the same page as much as you can Counseling, if necessary

What can you do? (cont’d)

Identify positive coping strategies Respect individual differences in coping

Social support VERY IMPORTANT “In order to receive help, you have to ask for

it.” Friends and family Parent-to-parent support groups JIA professionally led peer support groups Internet based support groups Religious support groups

What can you do? (cont’d)

Focus on the joys and accomplishments of today—a smile, interest in a favorite toy, contagious laughter—not on what tomorrow may or may not bring.

Your feelings are valid, so be easy on yourself to not feel guilty when you have had a bad day. Find a way to release your anger, sadness, jealousy and elation.

Stress reduction strategies

Take time out for yourself Walk Exercise Read Cook Warm bath

Stress reduction strategies (cont’d)

Scripted Relaxation strategies Deep breathing Progressive Muscle Relaxation Guided visual imagery techniques Hypnosis

Deep Breathing

Lie down or sit in a comfortable chair, maintaining good posture. Your body should be as relaxed as possible. Close your eyes. Scan your body for tension.

Pay attention to your breathing. Place one hand on the part of your chest or abdomen that seems to rise and fall the most with each breath. If this spot is in your chest you are not utilizing the lower part of your lungs.

Place both hands on your abdomen and follow your breathing, noticing how your abdomen rises and falls.

Breathe through your nose.

Notice if your chest is moving in harmony with your abdomen.

Now place one hand on your abdomen and one on your chest.

Inhale deeply and slowly through your nose into your abdomen. You should feel your abdomen rise with this inhalation and your chest should move only a little.

Exhale through your mouth, keeping your mouth, tongue, and jaw relaxed.

Relax as you focus on the sound and feeling of long, slow, deep breaths.

Deep Breathing (cont’d)

Complete Natural Breathing

Sit or stand with good posture.

Breathe through your nose.

Inhale, filling first the lower part of your lungs then the middle part, then the upper part.

Hold your breath for a few seconds.

Exhale slowly. Relax your abdomen and chest.

Practice these two exercises, in whatever combination feels best for you, for ten minutes, twice a day.

(Taken from Davis, Eshelman, and McKay; The Relaxation and Stress Reduction Workbook, 2nd edition; New Harbringer Publications, 1982.)

Progressive Muscle Relaxation (PMR)

Progressive muscle relaxation is an exercise that relaxes your mind and body by progressively tensing and relaxation muscle groups throughout your entire body. You will tense each muscle group vigorously, but without straining, and then suddenly release the tension and feel the muscle relax. You will tense each muscle for about 5 seconds. If you have any pain or discomfort at any of the targeted muscle groups feel free to omit that step. Throughout this exercise you may visualize the muscles tensing and a wave of relaxation flowing over them as you release that tension. It is important that you keep breathing throughout the exercise.

PMR (Cont’d)

Begin by finding a comfortable position either sitting or lying down in a location where you will not be interrupted.

Allow your attention to focus only on your body. If you begin to notice your mind wandering, bring it back to the muscle you are working on.

Take a deep breath through your abdomen, hold for a few second, and exhale slowly. Again, as you breathe notice your stomach rising and your lungs filling with air.

As you exhale, imagine the tension in your body being released and flowing out of your body.

And again inhale…..and exhale. Feel your body already relaxing. As you go through each step, remember to keep breathing . Now let’s begin. Tighten the muscles in your forehead by raising

your eyebrows as high as you can. Hold for about five seconds. And abruptly release feeling that tension fall away.

Pause for about 10 seconds.

PMR (cont’d)

Now smile widely, feeling your mouth and cheeks tense. Hold for about 5 seconds, and release, appreciating the softness in your face.

Pause for about 10 seconds. Next, tighten your eye muscles by squinting your eyelids tightly

shut. Hold for about 5 seconds, and release. Pause for about 10 seconds. Gently pull your head back as if to look at the ceiling. Hold for

about 5 seconds, and release, feeling the tension melting away. Pause for about 10 seconds. Now feel the weight of your relaxed head and neck sink. Breath in…and out.

PMR (cont’d)

In…and out. Let go of all the stress In…and out. Now, tightly, but without straining, clench your fists and hold this

position until I say stop. Hold for about 5 seconds, and release. Pause for about 10 seconds. Now, flex your biceps. Feel that buildup of tension. You may even

visualize that muscle tightening. Hold for about 5 seconds, and release, enjoying that feeling of limpness.

Breath in...and out. Now tighten your triceps by extending your arms out and locking

your elbows. Hold for about 5 seconds, and release. Pause for about 10 seconds.

PMR (cont’d)

Now lift your shoulders up as if they could touch your ears. Hold for about 5 seconds, and quickly release, feeling their heaviness.

Pause for about 10 seconds. Tense your upper back by pulling your shoulders back

trying to make your shoulder blades touch. Hold for about 5 seconds, and release.

Pause for about 10 seconds. Tighten your chest by taking a deep breath in, hold for

about 5 seconds, and exhale, blowing out all the tension. Now tighten the muscles in your stomach by sucking in.

Hold for about 5 seconds, and release. Pause for about 10 seconds. Gently arch your lower back. Hold for about 5 seconds,

relax. Pause for about 10 seconds.

Guided Visual Imagery

Visual imagery is a process that affects every aspect of your body. During guided imagery, you control your breathing and relax your muscles. You focus on something specific – such as a therapist’s voice or the instructions on a DVD or audio tape. You enter into a state of deep relaxation, success, and wholeness – similar to meditation.

Hypnosis

Hypnosis is the induction of a deeply relaxed state, with increased suggestibility and suspension of critical faculties. Once in this state, sometimes called a hypnotic trance, patients are given therapeutic suggestions to encourage changes in behavior or relief of symptoms.

Hypnosis for a patient with arthritis might include a suggestion that the pain can be turned down like the

volume of a radio.

Self Help Books

Depression Burns, D.D. (1999) The feeling good handbook:

New York, NY: Penguin Group (USA) Pettit, J., Joiner Jr., T.E., & Rehm, L.P. (2005).

The interpersonal solution to depression. Oakland, CA: New Harbinger

Addis, M.E. & Martell, C.R. (2004) Overcoming depression one step at a time. Oakland, CA: New Harbinger

Strosahl, K.D. & Robinson, P.J. (2008) The mindfulness and acceptance workbook for depression. Oakland, CA: New Harbinger

Self Help Books (cont’d)

Anxiety Zeurcher-White, E. (2998). An end to panic.

Oakland, CA: New Harbinger Greenberger, D. & Padesky, C.A. (1995)Mind

over mood. New York, NY: Guilford Press Insomnia

Hauri, P. & Linde, S. (2996). No more sleepless nights, Revised Edition. Hoboken, NJ: Wiley

Self Help Books (cont’d)

Stress Davis, M., Eshelmen, E.R. & McKay, M.

(2008). The relaxation and stress reduction workbook. Oakland, CA: New Harbinger

Quote

“I have learned, and grown, moresince Johnny’s birth than any othertime in my life. You learnpatience, and you get to witnessmiracles that you otherwisewould have been too busy to havenoticed... You learn acceptance,you realize you have been wrongto judge, and you learn that thereis a thing called unconditionallove.”

Thank you

Contact Information

Tina Drossos, Ph.D. University of Chicago 773.702.5887 tdrossos@yoda.bsd.uchicago.edu