Self-care for caregivers

1. Self-care for caregivers Judi 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 nursing Katie Hunsader, moderator, NAMI Mass, Criminal Justice Project Assistant

2. The 3 R’s RECOGNIZE Watch for the warning signs of stress REVERSE Manage stress and seek support RESILIENCE Take care of your physical and emotional health

3. Recognize signs of stress

4. Recognize signs of 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 the stress response. The stress response is the body’s 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.

5. Recognize signs of stress Anger Anxiety Sleep Problems Muscle Tension Headaches Apathy Worrying Seeing only the negative Depression Isolation Eating too much

6. Recognize signs of stress Stress can also cause physical symptoms Muscle Tension Headaches Stomach Problems Aches and Pains Chest 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.

7. Recognize signs of stress 70 – 90% of all illnesses are stress related

8. Reverse – manage stress and seek support

9. Reverse – manage stress and seek support Learn about your situation – you’ll feel empowered Go to the library Attend a NAMI class: Family to Family or BASICS Join a chat room Contact illness specific non-profit organizations Attend conferences and seminars Build a support network Reach out to family and friends Attend support groups Join in – Go to the YMCA, church groups, book clubs ASK FOR HELP – Asking people for help is a gift from you to them

10. Reverse – manage stress and seek support Set Boundaries Learn to love the N word

11. Reverse – manage stress and seek support

12. Spirituality in the Recovery ProcessMarla Lynch RN MS PMHCNS-BC

13. Holistic Health Care:mind – body - spirit 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.

14. Questions in the journey of life… • What is my life’s 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?

15. Spirituality definitions… “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)

16. Spirituality matters! Almost 90% of Americans describe themselves as religious or spiritual. (Adler, 2012)* 92% of Americans believe in God or a higher power 50% 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.

17. Research 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)

18. Herbert Benson, MD "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

19. Promoting Health One small health promoting practical step is to add a daily “relaxation response” or meditation or a quiet, contemplative time. Let’s try this now…

20. There are multiple health benefits . . . • calmer physiology • focused aware mind • relaxed peaceful emotional state • spiritual contemplation, renewal and hope • allows you to bring an attentive, caring presence to the relationship arena

21. SELF CARE These are the areas in our lives where stress may originate: • Physical • Cognitive • Emotional • Spiritual • Interpersonal

22. Your Body 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.

23. Your Mind 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 visualizations… Try reframing. Is there is some new learning amidst your current dilemma or upset?

24. Your Emotions 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 Sarton You may want to consider keeping a journal.

25. Prayer 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 events

26. Cultivate ‘Flow’ 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.

27. Gratitude 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.

28. Interpersonal Realm Stay connected to others… Remember: 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?”

29. Moving Forward with Positive Intentions If you have lingering regrets, hurts, anguish, disappointments, or have suffered betrayals and losses… Proactively consider your path forward to peace and resolution by letting go, forgiving yourself and others. If necessary, ask for forgiveness.

30. Your new and renewed self 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?

31. Favorite Quotes “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 religion

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

33. Resilience – look after yourself 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 others Make friends with all your emotions By 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.

34. Resilience – look after yourself Create a “worry period.” You can’t 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, you’re allowed to worry about whatever’s 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, you’ll start to realize that you have more control over your worrying than you think.

35. Resilience – look after yourself Challenge Automatic Negative Thoughts Automatic Negative Thoughts ANTS

36. Resilience – look after yourself Watch for Cognitive Distortions • All-or-nothing (polarized) thinking • I’ll never get this right • Mind reading • I know she thinks I’m fat • Catastrophizing • I’m late. I’m going to lose my job! • Control fallacies • Why aren’t you happy? Is it because of something I did? • Fallacy of fairness • It’s not fair. She can eat as much as she wants • Blaming • I hit you because you made me mad • Emotional reasoning • I really screwed up. I’m so stupid!

37. Resilience – look after yourself Laugh or else “Your 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.”

38. Resilience – 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. You’ll find one and sleep better.

39. Resilience – look after yourself YES YOU DO HAVE TIME TO: Eat Breakfast - Drink fruit juice instead of coffee Stop trying to multitask - Do mini relaxation exercises Do little things to make your environment more relaxing Celebrate your birthday - Find the funny Ignore the news – filter your calls Allow extra time for appointments - Relax while driving – no need for ‘road rage’ Resist the urge to judge or criticize – Be kind – Say hello with a smile REMEMBER IT’S EASIER TO DEVELOP A NEW HABIT THAN CHANGE AN OLD ONE

41. THANK YOU

42. Special Thanks Anne-Marie Barron PhD, RN, PMHCNS-BCAssociate ProfessorAssociate Dean for Undergraduate Curriculum and Student AffairsSimmons College School of Nursing and Health SciencesClinical Nurse Specialist and Faculty Nurse ScientistMassachusetts General Hospital Reverend Bonnie-Jean Casey Simmons Chaplain Simmons College

43. References 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.

44. References continued . . . Lindridge, A. (2007). “Spirituality matters”, Mental Health Today, Dec 2007. Lloyd, C., & O’Connor, 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.