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1.Welcome - 5 minutes
- Facilitator greets participants as they arrive.
2. Sharing Among Participants - 10 minutes
- Facilitator could focus on topic discussed in Workshop 5 and invite participants to reflect on what was meaningful to them.
3. Introduction of Topic - 5 minutes
Share the observation that caregivers face multiple demands in their lives which are potentially stressful. Share objectives of session with caregivers. Introduce the concept of stress management: the approach that we can alter our reactions to stressors.
4. presentation - 50 minutes
(See #5 after presentation)
Presentation
Workshop Six - Stress Management
Introduction
What is Stress?
Hans Selye describes stress as "the nonspecific response of the body to any demand made upon it" (Stress Without Distress, p. 27). Stress is always present in our lives. In fact, Dr. Selye says: "Complete freedom from stress is death." Stress comes from multiple sources, from all the many demands made on us by home, family, relationships, work, routine activities, and commitments. On the other hand, having many sources of interactions can also offer support. Family caregiving is usually an "add-on" to existing responsibilities. Caregivers juggle many new demands that call on different skills, result in changed roles and relationships, and mean changes in day-to-day routines. There is also an emotional component to caregiving which can result in a wide range of feelings. Stress can be either a positive or a negative force (eustress or distress). It is not necessarily the event itself that determines the positive or negative nature, but rather our reaction to it. The event is referred to as a "stressor". This is clearly evident in caregiving situations where people report many positive outcomes from their caregiving situations as well as negative reactions.
EXAMPLE: A Rainy Day (stressor)
Stress Reaction: The event of a "rainy day" is not in itself either positive or negative but our reaction depends on our perception of it.
The event would elicit a negative reaction from a person who was planning an outdoor wedding reception. The event would elicit a positive reaction from the individual who was looking for a "good excuse" to curl up with a favourite book and a cup of tea.
Positive stress can arise from feelings of achievement, exhilaration, challenges, and being in control. Negative stress can arise from feelings of intense anger, worry, fear, anxiety, frustration, and helplessness. Not all stress is alike. There can be varying degrees of stress and it can take different forms: mental, emotional, and physical. Stress exerts an effect, whether good or bad, on both the mind and the body. It is not possible to isolate the effects in one sphere. Stress can be the "spice of life" (Selye), or it can have damaging effects on our well-being.
How Can Stress Affect Us?
- Stress can have social, physical, emotional and economic effects on us and on our ability to be effective caregivers.
- Our bodies have a definite physiological response to stress. Dr. Cannon of Harvard Medical School termed the negative response as "fight or flight": in other words, the body readies itself to ward off a potential threat. This is very useful when we are being attacked by a wild animal - we run faster and become stronger! However, the ordinary "distress" we encounter in everyday life tends to be more subtle.
- The presence of many stressors which elicit negative responses can keep some people in a constant state of "fight or flight" resulting in some unpleasant long-term effects on the body.
- Triggering the "distress" response over and over can accelerate the rate of wear and tear on our bodies and can actually make us more susceptible to disease. It is now well understood that prolonged exposure to negative stress can affect our immune systems, predisposing us to different illnesses. The cumulative effects over time can appear many years later in chronic diseases.
- Many illnesses we experience are related to "mismanaged" stress.
- "Management" refers to how we handle stress in our lives. When stress is "mismanaged", a variety of physical symptoms can occur. The mind and body are intertwined - if we "bottle up" our emotional tensions, they will erupt in some form or other. Compare this to a "pressure cooker", where steam has to be let off to avoid an explosion. In the individual, physical or mental health can be threatened. Our bodies can betray our inner turmoil.
- Our bodies give us signals. If we pick up on these signals and listen to our bodies, often problems can be averted or even prevented. If we ignore these signals (mismanage our stress), then illness may result.
- Managing our stress means looking at age-old wisdom: our grandmothers knew that living wisely was a good thing. They knew that the key was moderation: eating well, sleeping well, working hard, and playing well were good practices.
- When we understand that poorly managed stress can affect us negatively, then we need to examine our reactions to stressors.
What Factors Affect Our Reactions to Stressors?
- It was mentioned earlier that it is not the event (or stressor), per se, but rather our reaction to the stressor that determines the level of the stress we experience.
- The "rainy day" example showed that one stressor may elicit a negative response from one individual but a positive response in another.
- What factors, then, affect our reactions to stressors? As caregivers, you face many demands: home, family, community, work. Your individual responses will be shaped to some extent by your personalities, attitudes, coping skills, health status, support system, and your ability to make choices.
- The ability to make choices gives us a feeling of control in any situation. When we feel we have no choices, we can feel helpless or trapped, leading to an increased level of stress. When we feel in control, we have a different perspective. Feeling helpless in a situation can trigger some intense reactions within us - we may act in ways that we would not normally do. If we feel that we are at the "end of our rope", it is important to seek some help. Your family doctor is a good resource in this circumstance. Others may be able to turn to other family members. The most important message is not to ignore those intense feelings of being overwhelmed.
- Personality:
People's personalities develop over time and play a role in the coping skills or strategies which develop as we encounter life experiences. One strategy for helping ourselves cope in the present circumstances is to look at how we have coped in the past when encountering major challenges. Everyone has an unique way of coping with the demands s/he encounters. Some ways are more effective than others.
Periodically, we need to review the way we respond to events (coping strategies). We need to ask some honest questions, such as: Is this an effective way to respond?
- Attitudes:
Our attitudes are extremely important in determining our reactions. Much research has focussed on attitudes and the relationship to well-being.
Jennifer Allen in her article, "The Smarter Caregiver: Balancing Your Roles and Responsibilities" (Solutions, Fall 2000) recommends that the key to staying healthy under stress is "in balancing the responsibilities and caregiving with your everyday life."
Good supportive relationships, physical exercise, and a sense of humour are factors which mitigate our reactions.
In summary, our reactions to stressors are influenced by many factors, such as:
- Personality: including attitudes, coping strategies and sense of humour;
- Quality of relationships: including support systems;
- Physical and emotional fitness: including a general sense of well-being;
- Lifestyle habits: including eating choices, exercise, general "healthy" behaviours;
- Sense of satisfaction from daily activities: including paid and unpaid work; and
Ability to ask for and accept help.
Specific circumstances need to be considered as well. It is impossible to judge the level of stress for an individual simply by looking at the stressor (event). Furthermore, the same event occurring at different time periods doesn't always produce the same reaction in an individual. For example, have you ever noticed that when you are in a rush to meet someone at a particular time, every traffic light you encounter is red, and each stop seems twice as long as usual? Whereas, if you had plenty of time to get to a location, the red lights would be quite insignificant.
What Is Your Personal Reaction to Stressors?
We respond emotionally as well as physically to stressors. This response arises from our perceptions - our understanding and judgement of a fact or situation as we see it based on our world view
Encourage Participants to Talk about their own Physical and Emotional Reactions to Stress. Some possible reactions include: muscle tension, headache, backache, stomach pain, digestive upset, diarrhoea, heavy perspiration, insomnia, constipation, fatigue, skin rashes and eruptions, shakiness, inability to concentrate or think clearly, feelings close to surface (teary), loss of appetite, increased hunger, difficulty breathing, heart palpitations, feeling tense and edgy, feelings of wanting to laugh at inappropriate times...and there may be others that you have experienced. There are many possible sources of stress for you. Some categories may be family, home, relationships, work, finances, beliefs, schedules, expectations...
Exercise: Select one area, outline a situation and discuss some choices that may reduces stress. A participant may volunteer a scenario or the facilitator may suggest one. Examining our own personal reactions to stress can be stress-producing itself! However, getting to understand our reactions better is one way of assuming more control over events in our lives and is a step in developing healthy response strategies.
What Does "Stress Management" Mean?
Dr. Peter Hanson says, "The key to surviving and thriving on stress is control." (The Joy of Stress, p.15)
Control is the essence of stress management: it means being able to make choices, and being on top of the situation, rather than letting the situation crush you. Authorities in the field believe that by understanding our individual reactions and having some knowledge of our abilities and limitations we can help to prevent excessive stress. Stress management means looking at every aspect of our lives and assessing how the overall picture is affected. It means changing things we can change for a more positive effect, and learning to accept the things we cannot change. There are some definite choices that we can make to enhance our ability to manage stress. Some suggestions to consider are:
- Balance your life.
Work and play need to be intertwined; sometimes a change of activity is all that is needed to gain some perspective.
- Allow yourself to "do nothing".
Some short periods of "loafing" can refresh and recharge a person. The housework can wait!
- Get enough sleep/rest.
It can be difficult when your sleep is disrupted by care demands, but try to be flexible and grab a nap if you can.
- Redirect some energy.
You can work off some tension by physical exercise (with the added benefit of improving your physical condition) or tackling a project.
- Talk to someone you trust.
Often, confiding in another person helps you to see a situation in a new light.
- Reflect on your attitude.
Learn to accept what you cannot change, and look for the best in others. Caregiving presents many challenges to both the caregiver and the care recipient. Sometimes, people have to be accepted as they are with an understanding of the stresses they face.
- Get away from it all.
This can be as simple as going into another room to enjoy a cup of tea or going out for a walk. Move away long enough to catch your breath so you can come back and face the problem - this will give you a chance to think about your response.
- Avoid self-medication.
Over-the-counter medications can cause various drug interactions and reactions. If you find yourself self-medicating on a regular basis, consult your doctor about the symptoms you are experiencing. Be alert also to excessive use of caffeine.
- Have regular check-ups:
Your health is a critical factor in your ability to provide care. Tell your doctor that you are a caregiver, and share some details of the situation. Your doctor will be alert for signs of undue stress or may offer helpful information on community resources.
Become aware of and access community resources.
Health charities are an excellent source of information and often offer a great deal in the way of support if you are caring for someone with a specific chronic condition. Other sources include public libraries or university centres and community organizations.
In attempting to manage stress, we have three basic choices:
- Change the situation: this may offer limited options.
- Change the other person: the least successful approach.
Change yourself: this approach has the highest success rate.
It is essential to recognize that we can control our thoughts, feelings and actions/reactions. Thus we can control the impact of stress even when we cannot control the stressor. Stress management does not advocate avoiding stresses; rather, it implies making choices.
5. Nutrition Break - 10 minutes
- Participants can partake of refreshments and browse through Community Resource material.
6. Discussion among Caregivers - 55 minutes
Focus On:
- Stressors and Reactions
- Respond to any questions about the presentation.
- Clarify terminology if necessary.
- Explore some effective stress-reduction techniques
- Encourage participants to share some techniques which work for them.
7. Evaluation of Workshop 6 and Overall Program - 10 minutes
- Distribute Evaluation Forms. Completed sheets can be left in a designated spot.
8. Closing Remarks - 5 minutes
- Facilitator can briefly reflect on the major points illustrated in the workshop. Particular attention should be paid to the issues arising from the discussion.
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