Caregiving and Stress: How to be there for others without coming undone 

https://www.wisdomwayinstitute.com/wp-content/uploads/2018/02/KarenLaing-223×300.jpg Karen Laing creates innovative programs to bring mindful caregiving to family members and health professionals, is a Certified MBSR instructor, and is the Founder of Birthways and WisdomWay™ Institute. ​

Caregiving is stressful. New research on the effects of stress and aging explain not only how so much in our bodies can fall apart with unbuffered stress but also how the simple and persistent effort you are making to be present with life as it is, slows this down and reverses stress-related damage. 

Elizabeth Blackburn and her colleagues have discovered some interesting changes in our chromosomes that tell us about health and wellbeing and also about stress and its impacts. Telomeres are the ends of chromosomes. Blackburn describes telomeres as not unlike the plastic ends of a shoelace, because they keep the chromosome from unraveling in much the same way. When they are long we are set up for good health and longevity. When they shortened, they indicate a more rapid aging and disease process is taking place.  

Her research has shown the particular ways that mindfulness plays a role in longer telomeres, a discovery that she found by investigating the chromosomes of meditators. This has been confirmed by other studies and is forming an interesting area of inquiry for understanding how our minds impact our health.  

 Let’s explore the two opposing mind states in the face of difficulty and how each impacts our wellbeing over time, threat cognition versus mindfulness. 

Threat cognition 

In the mind state of threat cognition, we appraise a situation in an activated way, a sort of primal amygdala-led reactivity. We know it’s something we don’t want. From there, we lurch into the past, considering all the ways we may have had negative experiences, or ruminating over ‘what if’s’ or ‘if only’ scenarios. We ruminate over it, reliving a painful conversation or a situation that may or may not be actually occurring in the moment. Once our stress activation has occurred, we tend to increase our negativity bias where we see everything that could be threatening. We go from “maybe my co-worker doesn’t like me” to “no one likes me” maybe adding in “this always happens to me” and “I will never be able to work successfully with these people, I’ll lose my job, I won’t have any friends”.  

This is the process by which stress effects grow exponentially. The spiral of thought keeps the sympathetic nervous system (SNS) activation going well beyond a moment or two. This is what Blackburn has identified as a significant contributor to shortening telomere length. Her subjects faced similar amounts of stress burden. She studied caregivers, knowing that this responsibility comes with significant stress. Subjects practicing mindfulness versus threat cognition showed longer telomeres, and those in the control group, shorter ones.  

Understanding the Impacts of Cognition in the Face of Difficulty 

In research around depression and anxiety, understanding this thought loop has helped researchers to better understand what causes relapses and to help create programs to aid in recovery and relapse prevention.  

Cognitive approaches to treat depression had focused on changing the ‘channel’ as if it were of a thought loop. If someone is thinking “I don’t have any friends,” for instance, they could practice challenging that thought by asking if it’s really true. “What about so and so? I had dinner with some people from work last week. I guess maybe it’s not true that I don’t have any friends.” But this retraining of thought only went so far, and sometimes backfired with self-judgment: “There I go ahead, having this ‘bad thought’.” 

When Zindel Segal, Mark Williams and John Teasdale began their efforts to solve the limits of cognitive therapy alone, they turned to mindfulness. In what would be known as Mindfulness-Based Cognitive Therapy, the team invited participants to have a compassionate, curious, mindful exploration of the feeling and body sensations of negative mind states. When they got to know ‘loneliness’ or ‘sadness’ and the way it feels in the body, the participants had more options than just balancing out the self-talk. They could also practice and build up some tolerance for the feelings themselves while they practiced seeing thoughts as thoughts, emotions as emotions. They could also recognize the thought spiral before it got out of control. 

Bringing awareness to the body sensations, thoughts, and emotions early on and learning to both recognize them as the beginning of a spiral, and abide with them, without judging or trying to ‘out-think’ it led to big changes in their participants. 

This is now one of the most effective treatments to prevent relapse episodes of depression.   

Mindfulness as a Stress Buffer 

We all experience stressful events and negative emotion. The inquiry that can support us to greater health and wellbeing is how we might ‘buffer stress’ and reduce the impact it has on our wellbeing. These studies and others are validating how stress buffers play a significant role in our overall health and happiness. Let’s explore what can buffer stress to help reduce its impact on our wellbeing, our health and our longevity. 

Mindfulness has an immediate impact on how we first encounter stress. Through more open awareness and less reactivity we might for instance, see that our co-worker who was short with us might simply be having a bad day, rather than concluding that they don’t like us. We can hold multiple interpretations of events. Another way that mindfulness helps us is by using a courageous ‘looking into’ a stressful event that.  Being present-moment focused, allows us to feel it and free it from our system, as we’ve described in the Mindfulness-Based Cognitive Therapy (MBCT) model. Another outcome is that we build up distress tolerance. “I can feel it, I’ll survive it, it’s not that bad.” 

By working with everyday discomforts and stress, we can build up a healthy tolerance for something that might be uncomfortable in the moment. When we face a situation, we are less likely to engage in other behaviors that add to our suffering in the long run, but in the moment feel compelling as a strategy to escape or avoid pain. Much of our health compromising habits (overeating, caffeine, sugar and alcohol habits, sedentary ‘checking out’ versus activity and exercise) come from trying to cope with stress using escape or avoidance.

David Cresswell and Elizabeth Lindsay (Creswell & Lindsay, 2014) have also investigated the mechanisms by which mindfulness practices buffer stress. They too found that this open awareness, the capacity to be with and to look at difficulty in a new way is one of the essential mechanisms by which the practices we are doing ‘work’ or show effectiveness in decreasing stress, increasing wellbeing, and lead to improved health outcomes.    

Noticing Life’s Pleasures 

Mindful awareness doesn’t just give us courage to be with difficulties, it also gives us a way to soak in positive experiences and to bathe in the benefits of experiencing positive mind states. I don’t know about you, but I would find that even when I had a pleasant experience, I would often pass over it in anticipation of getting more of it. Whether it’s a bite of delicious ice cream and my spoon is already reaching for more before I’ve savored what is already in my mouth, or having a planning or judging mind in the midst of a pleasant afternoon, my habitual way of being caused me to pass up many opportunities to bathe in the pleasant aspects of life. 

One funny example I recall was mustering up the courage to get on a motorbike in the northwoods at my partner’s cottage. It had required concentration for me, not being familiar with manual transmissions let alone riding a motorcycle. As soon as I started to release the grip of my fear and experienced the confidence of mastery and the joy of wind at my face, I began an inner monologue that went something like this: “I don’t do things like this very often. Why don’t I? I really should. What is wrong with me that I can’t let go? How can I schedule this in my life when I get home from vacation?” 

All that lovely benefit of releasing fear and experiencing pleasant sensation was zapped by my rumination! In contrast, I recently moved into a home with an in-ground pool and a beautiful canopy of trees. By committing to fully experiencing the sensations of the moment, the feel of slipping into the cold water on a hot day, the feeling of my arms stretching and my body experiencing weightless grace, the sense of gliding into the smooth surface and the smell of summer air, the leaves waving in patterns above me… I can even now on a cold day in early spring experience the pleasure in my body that I felt then. Do I remember to create time for such pleasure as I think about my summer? Yes. My planning mind can still be ‘online’. But this is what I think of as I decide when to open my pool. Now, in this moment, I am planning. When I am swimming, I am swimming.  

Mindful awareness training doesn’t just help us with the really lovely stuff, like swimming on a summer day or being on vacation. It helps us to notice what is right here, right now, even in a difficult moment. When I feel a soft shoulder and the warmth of my breath, the ease in my forehead, I increase my capacity to be with the aching in my back or the painful news I am just taking in. Nothing is ever all one thing or another. It’s everything. With mindfulness we take a broader view more and more of the time.   

Relaxation Response 

Herbert Bensen has authored important work on the impacts of stress on the body and how triggering / activating a relaxation response can dial down our cortisol and activate the parasympathetic nervous system and its capacity to put us back into a calm and restorative functional state. Relaxation and techniques to induce relaxation may arise from mindfulness practice but we like to talk about it as separate and distinct. Remember, with mindfulness, we cultivate the ability to be with whatever is, including difficulty, tension, and maybe that short choppy breath. Often when we bring awareness, things do shift and change. We invite it, but don’t set out to make it happen. Relaxation breathing techniques and mind/body practices like yoga have a direct and targeted impact on calming the central nervous system. These can be additional resources for you as you build your mindfulness practice. 

Friendship and community 

Social support may moderate genetic and environmental vulnerabilities and confer resilience to stress, possibly via its effects on the hypothalamic-pituitary-adrenocortical (HPA) system, the noradrenergic system, and central oxytocin pathways. (Ozbay F, 2007) 

In our courses we learn about stress responses, the hypothalamic-pituitary-adrenal (HPA) axis and spend time looking at oxytocin. We experience oxytocin when we have a warm connection with a friend or when we have a sense of safety and belonging. We have high oxytocin levels when we help others as well as when we receive the kindness of others. Touch, eye contact, hugs; these all hold the possibility of a dose of the healing hormone—a hormone that dials down stress hormones and brings a healing, anti-inflammatory, calming, effect on the body. Oxytocin improves digestion, circulation, and sets us up for optimal metabolism and brain function.  

Blackburn found that social support is one of the important stress-buffers that impact our telomeres. 

Eating a balanced, anti-inflammatory diet 

Blackburn also found that nutrition plays a supportive role in telomere length and mitigating stress related aging. Diets high in plant fiber, low in processed food and proteins balanced with healthy fats may be another key to keeping us young and vibrant for longer. 

Activity and restorative sleep 

Sleep habits and exercise keep the effects of stress at bay in multiple ways. Getting outdoors for activity adds the benefit of sunshine and the healing power of nature. Movement keeps us connected to our bodies and medium to high intensity exercise gives our heart muscle the workout it needs to stay healthy. Managing our weight mitigates the risk of diabetes. 

Support for change 

So many aspects of preventative health lie in ‘lifestyle medicine’. But making changes isn’t always easy! Duke Integrative Medicine has found that mindfulness is the key to making lasting changes for our health and wellbeing. When we can see with awareness the habits that might not serve us, we are given another opportunity to act intentionally in ways that will best serve our health and wellbeing. 

WisdomWay Institute has designed programs that support family caregivers and professional caregivers, activists and others to practice a framework for mindful and sustainable caregiving. Tell us more about you and we’ll keep you updated on Certification programs, short, manageable programs for family carers, retreats, free meditation groups and more.  Let’s be there for others in ways that aren’t depleting!