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Caring for the Caregiver, Part 2: Managing Caregiver Stress

Part 1: Caring for the Caregiver

It’s not stress that kills us, it is our reaction to it.
–Hans Selye

Life brings with it a few guarantees: death, taxes and stress. Stress is universal, and we all experience it from time to time. A reasonable amount of stress is actually thought to be helpful: it can be a source of energy that moves us toward change. Sometimes, however, circumstances are such that the stress involved seems almost overwhelming.

By: Shannon Haragan, LPC-Intern Supervised by Lora Ferguson, LPC-S

By: Shannon Haragan, LPC-Intern
Supervised by Lora Ferguson, LPC-S

If stress is defined as the gap between our expectations and our reality, this is a constant for the Alzheimer’s caregiver. As any chronic and incurable disease progresses, new normals are a steady force that bring with them new realities that often defy our expectations. Chronic stress of this type can impact not just our emotional and mental health, leading to depression, anxiety, and more, but it also can have a profound effect on our physical well-being.

Stress and Your Physical Health

In a recent study, the stress of caregiving was found to have a significant negative impact on the physical health of caregivers. Three-fifths of all caregivers rated their physical health as “fair” or “poor” compared to one-fifth of non-caregivers. Caregivers also experience chronic conditions (including heart attacks or heart disease, cancer, diabetes or arthritis) at nearly twice the rate of non-caregivers. According to the National Center on Caregiving, the stress of caregiving also causes a decreased immune response. Studies indicate that caregivers have a 23% higher level of stress hormones, and a 15% lower level of antibody responses.

Although the perception of stress is subjective (what’s stressful to you may not be to somebody else), there are several factors that can influence our perceived level of stress in a caregiving context:

–Is the caregiving voluntary or not? Were you forced into the role because nobody else was available?
–How well have you coped with stress in the past? This is a strong predictor for how you will cope with it now and in the future.
–What was your relationship like with the care receiver before the diagnosis? If it was a difficult one, higher amounts of stress if more likely.
–What kind of support is available to you?


Caring for the Stressed-Out Caregiver: Steps

Clearly, stress management and reduction should be important goals for caregivers and for anyone who supports a caregiver. Though there is nothing that can be done to improve the long-term outcome of a care receiver diagnosed with Alzheimer’s or other type of dementia, there are definitely things that can be done to help reduce stress in the caregiver, which ultimately helps both the caregiver and the care receiver:

  1. Learn to recognize the early signs of stress. Everybody’s different. What happens when you get stressed out? Is your sleep impacted? Your temper? Your eating habits? Are people commenting on changes in your appearance or behavior? Know yourself, and become familiar with how stress manifests for you, so you can recognize it while it’s still in a manageable stage.
  2. Identify your sources of stress–even those not associated with caregiving, as these can directly impact your caregiving abilities. The possibilities are wide-ranging and very subjective, but can range from financial stressors to the care receiver’s diminishing abilities to the negative attitudes of people close to you and much more.
  3. From this list, figure out the items you can change, and those you can’t. This one can be the most challenging, as most of us would like to believe we can change the unchangeable. Be willing to look objectively at those things you can’t change, and foster a sense of acceptance. Educate yourself on the disease and identify any unrealistic expectations you may have for the future. Focus on the things you still have, rather than what you don’t.
  4. For those items that can be changed, take action. Try to make sure each part of you is being cared for: physical, emotional, mental and spiritual. Seek out resources and be willing to accept support. Take small steps. Seek meaning in the journey.

    Those who have a ‘why’ to live can bear with almost any ‘how.
    –Viktor Frankl

Give yourself permission to take care of you. In order to better care for your loved one, you must learn to first care for the caregiver, and this includes managing caregiver stress.

November is National Family Caregivers Month! If you know a family caregiver in need of support, now is a great time to offer a word of encouragement or even to ask how you can help to reduce their stress.

(Sources: The Caregiver Helpbook, 3rd edition, AGE of Central Texas)

The Teen Brain

The Teen Brain

By Christel Gilbreath, LCSW

By: Christel Gilbreath, LCSW

By: Christel Gilbreath, LCSW

Do you ever wonder why your tween or teen acts so crazy? Teens, do you ever wonder why you feel like your emotions are all over the place?

Part of these “strange” behaviors that seem to emerge around the time of puberty are, in part, due to part of the “thinking” area of the brain not being developed yet.   One of the thinking parts of the brain often referred to as the CEO of the brain is scientifically called the prefrontal cortex and it performs many important duties. It The prefrontal cortex is in charge of a large number of functions including controlling emotions, planning ahead, organizing multiple tasks, controlling impulses, practicing self-control, having insight, empathizing with others, strategizing and problem solving, and making sound judgments.

This is why it may be difficult for teens to think through choices and make a decision that is in their long-term best interest. It may feel like a teen’s emotions are calm and collected one minute and deeply perturbed the next minute. It also explains why teens might make a poor choice in an emotionally charged situation like peer acceptance. They may make a risky choice in order to fit in that they wouldn’t normally make if they weren’t emotionally motivated.

Understanding that this part of the brain is still “under construction” helps makes sense of teen unruliness and thus builds compassion for our teens. It also helps build self-compassion for teens who feel ashamed of their behaviors or are trying to understand some of their actions and feelings. We can let go of some of the moral judgment we put on our teens and understand that some of their actions are based on where their brain is developmentally. In the same way that we have compassion on toddlers when they are crying because their peanut butter sandwich wasn’t cut the right way, we can extend this compassion to our teens.

May you go out and love your teen or your teen-self better, acknowledging that the teen brain is still a work in progress.

If you want to learn and understand more about the teen brain I recommend reading Brainstorm by Dan Siegel.

Photo from

Photo from


Greenspan, L., & Deardorff, J. (2014). The new puberty: How to navigate early development in today’s girls. New York: New York: Rodale.

Seigel, D. (2014). Brainstorm: The power and purpose of the teenage brain. New York: Penguin Putnam

Definition of Mindfulness

Definition of Mindfulness

In my previous entry, I critiqued Mindfulness’s rise in the West. Today I will provide some working definitions of Mindfulness, explain its core principles and virtues, and enumerate some of the benefits of regular practice.

By: Andrew Wade, LMFT-Associate Supervised by Nadia Bakir, LMFT-S

By: Andrew Wade, LMFT-Associate
Supervised by Nadia Bakir, LMFT-S

Spiritual Context

While mindfulness meditation was conceived within the religious and philosophical context of Eastern spiritual traditions, it is not unique to them. Other faith traditions, including Judeo-Christian and Islam, as well as secular ones, have contemplative practices as part of their story too. Regular practice has shown to enrich and strengthen one’s spirituality, but there is nothing inherently religious in cultivating mindfulness.

Toward a Uniform Definition of Mindfulness

There is little consensus regarding its definition, however. John Kabat-Zinn, an author and advocate of the mindfulness movement in the West, defines mindfulness as “maintaining a moment by moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment.” Another leader in the field and the Education Director at U.C.L.A.’s Mindfulness Awareness Research Center, Diana Winston, defines Mindfulness as simply, “paying attention to our present moment experience with openness, curiosity, and a willingness to be with what is.” These definitions are similar, but Diana’s includes a more explicit intention in approaching practice, in naming curiosity and openness as defining features.

A common thread tying together all definitions of mindfulness is that it does not endorse any particular modality of experience; rather it embraces the totality of existence, from the simplicity of the breath, to the most complicated thought. Mindfulness is about opening up to experience – to connecting with the vital force of existence within us and without. It purports that all experience is valid and real; we observe it without judgment or critique or rumination.

How to Practice Mindfulness Meditation

How do we do it? Begin by setting an intention. You might say, “Today I intend to focus my attention on the breath.” With more practice, you might intend to cultivate a particular virtue of Mindfulness, such as forgiveness, generosity, or loving-kindness. Practice in a quiet room on a comfortable chair or meditation cushion where you will not be interrupted. Sit with an upright posture but not so erect you cannot relax. Close your eyes and rest your hands comfortably on your lap. Use your breath to anchor your experience. Feel your stomach expand and contract, or focus on the sensation of the air traveling through your nostrils as you inhale, and subtly grazing your lip on the exhale. When thoughts or emotions or sensations arise, notice them, and gently invite yourself back to the breath. No matter how compelling they seem, thoughts and emotions are temporary, and do not reflect the totality of who we are. They are merely waves atop an ocean of near infinite depth.

Why do this? This is the training ground for the real world. A disciplined, consistent practice on the cushion facilitates a deeper connection with your breath and increased awareness of your immediate experience when navigating the complexity of life.

Mindfulness in Everyday Life

A concrete example may bring clarity. You drive by a restaurant where you once had a heated argument with your partner. When you see it, you are reminded of the argument through an image that pops in your head of the two of you yelling at each other and you are overwhelmed by the memory. The common response is to think about that image and relive the injustice and pain they inflicted upon you, and begin to consider ways of seeking retribution. You might feel guilty for these thoughts or ashamed of your behaviors. Your experience narrows as you feel trapped by a familiar story of powerlessness and anger.

Alternatively, you could approach this situation mindfully that might fundamentally shift your experience. By using the breath as an anchor, you approach the restaurant with openness and curiosity. First you might feel a wrenching sensation in your stomach, followed by an increase in body heat and heart rate, and a sense you are feeling angry, and then an image of the argument appears in your mind’s eye. You note the bodily sensation, emotion, and corresponding image as they happen by remaining grounded in your breath; you name each as it arises, “gut-wrenching, heat, emotion, image,” without attaching a story or judgment about them. In doing so, you maintain an open field of awareness in which new experiences may arise, including compassion, generosity, and forgiveness.

I invite you to take twenty minutes a day to practice Mindfulness meditation for an entire week. After each sit, write down common themes or challenges in your practice and see how they change over the week. You will learn something everyday. You can do it!

Definition of Mindfulness


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