Emotional Aspects of Caregiver Burnout and Tips for Prevention

I'd like to welcome everybody to today's presentation on caregiver burnout prevention, the emotional aspects. I'm your host, Dr. Donnelly Snipes. In this presentation, we'll identify the emotional signs of burnout, explore emotional issues leading to burnout in caregivers, and identify strategies to maintain emotional health. Think it's important to recognize when we talk about emotions, what we're talking about essentially are neurochemical processes that occur as a result of either prior learning and expectations. So if I've encountered a situation similar to this before in some way, my brain is going to say, okay, I remember this and this is what you can expect, or this was a dangerous sort of situation before. You weren't in control. This is what you should expect. So my anxiety is going to go up. So prior learning triggers memories, triggers schema that helps us anticipate and expect what may be coming up. It doesn't mean it's a fact. It means based on the knowledge I have, this is what might happen. So we need to check those feelings against facts. We need to recognize that feelings are not facts and they can be neurochemical reactions that occur as a result of the current experience. You're going through something and all your senses are saying, danger, Will Robinson. Of course you're going to feel angry, you're going to feel anxious, you're going to feel some sort of stress response. Or if you're going through a current experience that's just amazing, you may feel wonderful. And your body's saying, let's, let's keep doing that. I'm going to give you some dopamine and some endorphins. Let's keep doing that because that's good. But ultimately, feelings are not facts. They're our body's way of communicating with us and helping us survive. Feelings, our emotions, are not meant to consume us. They're meant to motivate us. When we get angry, we're not supposed to sit on the couch and stew in it and dwell in it and steep in it for hours and hours and days and days. We supposed to feel it, become aware of it, validate, acknowledge it, and then get up and figure out if there's actually a threat. Is there something based on the facts in this context at this time to be angry about? If not, okay, we can downregulate. If so, then we've got plenty of energy that we can use to address the issue. We don't want to carry around those un unchecked feelings because they get heavy when you've got all these boulders full of anger building up in the backpack that you carry around with you all the time. It's going to get heavy. We need to recognize it and deal with it. So what are the emotional signs of burnout? And one of the things that a lot of people say when I do this in a, quote, live class where peop. I've got an audience that people are, you know, it in real life, a lot of people start talking about a variety of different feelings like anger and resentment and stuff. And that's true. That comes out more. But a lot of times when we get to the point of burnout, we're at a place of apathy. We may have a loss of compassion. We don't feel compassion anymore. We're just like, suck it up, buttercup. Yeah, I don't have any more energy to give you. We may be more irritable. And by that I mean we're touchy. You know, we can dysregulate really easily and get. Get cranky. Dysregulation is definitely a emotional sign of burnout, where you go from feeling flat, unmotivated, apathetic, to. To furious, frantic, or just completely depressed. But you go to extremes, and we've talked about extremes before, and you know, again, that is the result of disregulation. Miscalibration changes whatever you want to say in the nervous system. It's not just all in your head. It is actually a difference in how your body responds to stress. And as a result of being under ongoing stress, when we get to the point of burnout, almost most people have some level of emotional dysregulation. They have some level of sympathetic stress response, sympathetic dominance. We may experience disproportionate or toxic guilt. When we're experiencing burnout. We recognize we just. We don't have it in us anymore, and we feel bad about that. We got into this profession, we had children, we, our parents raised us, and now it's our turn to take care of them. Whatever the reason, you're in a caregiving place. You recognize that it's something that in your mind, you, quote, should be doing okay. But there's only so much you can do when you don't have any energy, you don't have any gas to do it with. And then you may start feeling guilty for not being able to control everything all the time, for not being able to be the perfect caregiver. And that's what I'm talking about with disproportionate guilt. Yeah, sometimes we do things and we should, should feel a little guilty about it. We got cranky with somebody, we bit their head off, we feel bad, we feel a little guilty, we can make amends. But when we get to the point of burnout, it's not a little guilty. We dysregulate. We go from being flat to irritable to this disproportionate, overwhelming guilt. Oh my gosh, I'm such a horrible person. I bit your head off. You know, it's just extremes. Toxic guilt is that guilt that we experience when it feels like we're burned out. It feels like we're losing control over everything and we feel like we should have control over more things than we actually have control over. And that is really important in addressing burnout and preventing burnout is to only take responsibility for the things that you actually possibly could control and not feeling guilty over things that you can't control. Including, and we'll put a caveat on this, including your feelings. Feelings are automatic reactions that happen. There's a stimulus, you have a feeling. There's less than a second between the time something happens and you have that feeling. That's an automatic reaction. Generally you can't control that. There's not enough space in there for you to think about it. Once you feel the feeling, then you have the ability to, to take a beat and identify it and decide how you're going to react to it. But just because something happens, you know, maybe you're caring for somebody who's just in a really bad mood today and you think to yourself, I, if, if they keep going, I just want to ring their ever loving neck. Not that you would actually do it, but you, you may have a thought like that and that could cause you to feel guilty. You start recognizing that you're not being compassionate. You start recognizing, hey, they're doing the best they can and oh my gosh, I'm an awful person for feeling that way. No, you're a human person for feeling that way. The toxic guilt is thinking that you can prevent feeling in some way. Now you can address how you react to it. Once you have that feeling, obviously you're not going to act on it. But believing that you can stop yourself from having feelings is not real realistic. A sense of hopelessness. Sometimes, whether you're a teacher or, or a doctor or a counselor or a parent or a caregiver for somebody who's elderly, there are going to be things that happen with your careg that you can't control. And it may cut right to the core of you if you can't fix it. My cousin struggled for a long time with drug addiction and my aunt felt extremely hopeless, felt extremely helpless. And she got to the point where she just didn't know what to do. She was just sort of paralyzed. And that was one of the signs of emotional burnout for her. She just couldn't, she didn't know what to do next and was having a hard time just coping. And as I mentioned earlier, maybe I should have led with this loss of motivation to actually caregive. If you're a caregiver by trade, you wake up in the morning and go, do I really have to go see these people again? Or if you're a, a caregiver for a family member, a child, an adult, whatever, you may just not really have a lot of motivation. And you're like, you know, I really wish, I can't wait till this child goes back to school. And we've been there sometimes if you're a full time caregiver over the summer, it's exhausting. And a lot of times parents feel kind of burned out because they were juggling not only what they normally do with work and everything else, but they were also juggling child care and camp schedules and all this other stuff. And it was exhausting. So there can be a place where you get to just a lack of motivation to do the caregiving. It's like, okay, not gonna, not gonna cook. We're just gonna order pizza for the whole week and we'll go from there. It's important to recognize what's going on here. There are chemical changes as brain continues to secrete stress hormones and cortisol. Eventually the stress receptors we'll call them, become less receptive and it becomes harder to motivate somebody to get up. It gets harder to excite them. Your excitatory neurochemicals have a hard time, harder time exciting you. Dopamine, norepinephrine, glutamate, they lose their, it's kind of like soda. When it loses its fizz, it's just, it's just kind of flat understanding that. And again, it's not all in your head. I'm going to say that a bunch of times today because too often people think that they can just suck it up and fake it till they make it and push right through it. You can't squeeze blood from a turnip. And unless you start healing that nervous system, reducing this activity of the stress response and increasing the activity of the rest, digest and repair response, you're going to be stuck in that burnout limbo. The body is telling you when you lose compassion, it's not telling you you don't care about anybody else anymore. Your body's telling you we're down to our final reserves of energy. And to survive, you need to focus on you buttercup, not everybody else out there. And I don't know why everybody's buttercup today. It's just, we're gonna go with it. But the loss of compassion doesn't mean you're a bad person. It's your body saying, we don't have energy to spare to take care of other people right now. Irritability. When we are low on energy, we're vulnerable, that we, we can't run as fast or as far from that hungry lion. So we become more irritable, we become more easily triggered because we're feeling vulnerable. We're, we're feeling instead of, I don't know what's between a lion and a rabbit, instead of feeling confident and safe and empowered, we're feeling more like a bunny rabbit that is really, really vulnerable. So we're hyper vigilant, we're irritable. And as a result of all that, we start seeing literal changes in the gut microbiome, in the activity of the vagus nerve, and in the nervous system balance itself. That disproportionate or toxic guilt, that's anger at yourself. And that's something that we've learned. That's something that we've learned from knee high to a grasshopper, that we're supposed to take care of others, we're supposed to put others first, blah, blah, blah. And that guilt is anger at ourselves because we remember anger is a response to a threat. So we are criticizing ourselves. So in our own mind, we're not even safe from ourselves. That sense of hopelessness is your brain, is your body saying we need to check it and recognize that some of these things we may not be able to fix, which is not what we want to hear. You know, if we're a caregiver, we want things to go the way we want them to go. That's just the way we are most of the time. And motivation requires energy and dopamine. And when we don't have that, when we don't have energy, where we haven't been sleeping well, we're going to start feeling apathetic. And if you want more clarity on what's going on under the hood, so to speak, go back to that video I did on the physical signs of burnout and caregiving and how to prevent that. Because in order to heal the system, we need to heal the causes of burnout, or we need to address the causes of burnout in each piece of our life. So physical, interpersonal, emotional, cognitive, and environmental. So let's talk about some of the issues that are causing this burnout. You start caregiving for somebody for whatever reason, you know, maybe it's your job, maybe it's a loved one. Doesn't matter. There's a lot of stress there because you're responsible for them. And I remember when we used to do a lot of animal rescue when my children were little, and we had some incidents where we had some animals that. That passed away for failure to thrive, or we'd get an animal from the pound that was sick, and we were trying to nurse them back to health. And I remember my daughter looking at me one day and saying, you're not leaving them in my care, not on my watch, because I'm not having something go bad with them. And at that point, it kind of clicked with me that even though I knew she wasn't responsible for what happened to this kitten or this puppy or whatever, and I had told her that, you know, a bazillion times, and we talked about why some of these things happened in her mind. If something bad happened when I wasn't there, then that animal died on her watch, and it was her fault. And I was like, oh, no. Okay, let. Let's back up here. And we actually stopped fostering for a little over a year because I didn't want her to be feeling like she was saddled with that every time I left the house. And I bring that up because a lot of us feel that way. Not on my watch. My husband just went down to Florida for. For his granny's funeral. And I think most of you know that one of our dogs has aggressive cancer. And he's doing great. I mean, he doesn't seem to be in pain. He's responding well to the meds. Everything's going well. But there was a part in me that really didn't want him to go, because I don't want the dog to die on my watch. Even though there's. I know there's nothing I can do about it other than what I'm already doing. And so that whole not on my watch thing is something we need to recognize when we're caregivers. If you're a counselor and somebody is your patient and they try to commit suicide, it's horrible. It's awful, and you don't want that to happen, quote, on your watch, there's a part of you that may feel responsible and that's a whole different video. But I want you to think about that and recognize when you're starting to tell yourself that not on my watch, it's my responsibility. How much of it really is your responsibility and how much of it is totally out of your hands Anyhow, I jumped ahead of myself. But we have anxiety because when we're caregiving, we are fearful that something may happen on our watch. We are fearful about the financial and physical care of the person. Older adults as they get older and older animals, as they get older, they get more expensive. Medical bills get more expensive. It's just the way it is. And if you've got an somebody whose finances that you've got to make last, it may be very anxiety provoking. Every time something financial happens, if you have this budget planned out and then all of a sudden the their roof on their house needs to be replaced, well, that's $20,000 you hadn't planned for. Oh my gosh. So how's that going to impact how much money they have to live for the rest of their life? You can see where that would be stressful. Even though it's not directly their care, it is ensuring that they can have the quality of life that they deserve henceforth and forevermore. And physical care of the person, we can have anxiety about that. How do I do this? Am I doing it right? Oh my gosh. When my kids were little, both my son was a micro preemie and my daughter was a preemie. She cooked a little bit longer, but they both had issue physical issues that I was worried about and worry worrying about the physical care of that person. Am I catching it? Am I taking them to the doctor when I'm supposed to? Or am I taking them to the doctor too much? Am I doing this right? Am I doing that right? Thankfully, we had a wonderful pediatrician who had eight children himself and he had very clear boundaries that he could set. And he's like, if their fever is this for more than four hours, definitely bring them in. If they have cold symptoms, but they don't seem to be acting, you know, too weird. Even if they have a fever, a lot of times, most of the time it's a virus. So unless they've had it for seven to 10 days, it's not going to do you any good to bring them in because I'm not giving them an antibiotic. Okay. Now obviously if they had an ear infection, he would treat that but he had very concrete rules, which made me. Because I love my rules, I love my structure, made me feel better. And one of the things we can do, if we're responsible in some way for the financial or physical care of the person, and that's not our bailiwick, make sure that we're working with somebody who knows about that stuff and can give us guardrails to follow between so we're not as anxious, so we have somebody we can consult with and go, huh. When my kids were little, I remember calling my mom, go. And a friend of mine who was a nurse sometimes going, this just happened. Do I need to be worried? And most of the time they just laughed and said, no, it'll be fine. But it's anxiety and it's exhausting. We need. We have anxiety about the unpredictability of the situation. Counseling people can be in our office and talking to us and yeah, they may be expressing depression, but we do all of our, you know, preventative stuff. We think things are fine and they leave our office and it's not fine. We can't guarantee what's going to happen when. When they walk out of our office. We can't guarantee with our children what's going to happen as they grow up or if they get sick or there's just a lot of unpredictability. And we worry. I. I think as caregivers, we worry about the upcoming demise of the caregiver. That's something else we have anxiety about, particularly, and as two little asterisks by it, when we're dealing with an older adult, when we're dealing with somebody whose death is somewhat imminent, you know, in the next decade, they may pass away. They're more frail than they were 20 years ago, and we can worry about that. How is, you know, how is their spouse going to do once they pass? What are we going to do about, you know, all of their belongings? How am I going to do when I no longer have my. My mom, my dad, my whomever? When we're working with people who are sick, if you're a doctor, if you're a. Well, even if you're a caregiver, like a teacher, and you have students who get sick and may go into the hospital or even, heaven forbid, die, you can start worrying about your own health. Is that going to happen to me? Well, we're all going to die. We know that. But hopefully it won't be for a long, long time. And I have a dear friend of mine who has unfortunately had a couple of students pass away recently. She teaches high school. Yeah, high school. And not only does it increase, she, she's got grief and all kinds of other stuff, but it increases her anxiety about her daughter's health and her own health and her own death. We need to understand that we don't live in a vacuum. People who are caregivers also often have anxiety about other relationships failing because the people around us don't understand why we're so tired. The people around us don't understand why we don't have the energy to give them right now. The people around resent the fact that we're spending so much time caregiving. They worry about loss of connection with the people around them because the caregiver requires a lot of time because the caregiver requires a lot of energy and they don't have the time and energy to give to others. So they worry about not being able to connect and they worry about those that they would connect with being resentful that they don't have the energy to connect again. I think most of us can relate to this. And caregivers can have concerns and anxiety about losing themselves, especially if caregiving is thrust upon them. It's not something that they chose. They can fear that they're going to lose their friends, they're not going to be able to engage in their hobbies, they're going to lose their identity pre care of who they were pre caregiving. And for some people, that does happen. If they're 247 caregiving for someone, they can, if they aren't careful, set aside a lot of things that are important in their rich and meaningful life. And then when the caregive is no longer there, the person feels like they're in a vacuum because they lost their pre caregiving self. And then their caregiving self is, or caregiving role is now gone. And they're like, who am I? What do I do? It's reasonable to have anxiety that you are going to lose yourself. However, you can set boundaries in terms of handling anxiety. We want to recognize that anxiety is energy tied up in the present and the future. You know, I'm tying up this energy right now about something that I don't know if I can control. I, I don't even know if it's going to happen. We want to focus on fitcat the facts in this context at this time. We want to address cognitive distortions, particularly personalization. If I have anxiety that something's going to happen on my watch and if something happens, it's all my fault, that's Personalization. Let's look at this, and I will use the example of somebody who's in hospice care. For example. They're in hospice care. They've. You've already been told that they've got less than six months to live. So if they pass away on your watch, it's not your fault. It's just that was their time. But we can personalize it. We can say, I should have done something different. I should have all or nothing, thinking, I'm either going to get this 100% perfect or I'm going to be a failure as a parent. Well, if you're a parent, you know you're not going to get it 100% perfect. But we do our best, and children, thank God, are super resilient. We need to check ourselves and recognize, yeah, I've got room to grow. I've got room to learn. And there are some things that I'm doing well and catastrophizing. If this happens, it will be the end of the world. If my child gets addicted to drugs, my life is over. It will be the end of the world. They're going to overdose and life is going to be unlivable. No. Could that happen? Yeah, anything's a possibility. But. But let's back up. You found out that Junior decided to smoke some marijuana at a party. That's a far cry from being hooked on drugs and overdosing. So before we catastrophize, let's look at the facts in this context and this time and recognize what we can do. Anxiety. Fear is that feeling of being disempowered and unsafe. The interventions are designed to help you recognize where you have power, understanding you don't have power everywhere, but recognize where you have power and take steps to embrace that power. You also can define your rich and meaningful life as far as that anxiety is concerned. Every morning before you get up and start your watch, define your rich and meaningful life. And each morning decide how you're going to work toward it so you don't lose yourself. How are you going to use a little bit of your energy today? You know, maybe 15 minutes while the kids are napping or while Meemaw's sleeping or whatever it is to connect with people that are important to you or do something that's important to you. A hobby, an experience, whatever. You may not be able to do a lot of it, but a little bit is a whole lot better than nothing. If I crochet for 20 minutes, I'm going to get some done and I'm Going to be plugging away, making baby steps toward getting that project done. If I don't do it at all. Yeah. Then I'm not making any progress towards something that is important in my life. Another emotional issue is anger. Now remember, anger and anxiety are both stress responses. Anxiety is fear. And when we approach a situation and we feel like we are unsafe or powerless, we may become fearful and freeze or run away, or we may become angry and try to fight and try to change it and try to fix it and try to control it, or trying to address that sense of lack of power and lack of safety. People can be angry at the situation. I'm angry. I'm a caregiver. You know, if you were, you may say, I'm a caregiver for this person and they have cancer or Alzheimer's, and I'm angry about that. Yeah, you have every right to be. You didn't have any control over it. And most of us don't like it when things happen that we've got no control over. So we. It's a human emotion to be angry at the situation. You may not be able to change the situation. So that goes back to what we talked about earlier, figuring out, am I going to carry around this anger like a boulder on my back, or am I going to use my energy to take control of the aspects of the situation that I can control. For example, spending time with my loved one who has Alzheimer's when they're having their lucid moments, trying to really engage with them during that time, not ignoring them when they're not lucid, but really cherishing those moments when they're lucid, really spending quality time with them, knowing that it's coming to an end quicker than we'd like that we can do. We may be angry at other caregivers, and we talked about that a lot last week in interpersonal issues, but we can be angry at them because they're, in our opinion, not doing it right, whatever right looks like to us. Or maybe they're not helping enough. And it's important that we communicate to other caregivers what we need from them as so we aren't feeling like they're not doing enough and that we also allow them some latitude if we ask for their help. We also need to allow them some latitude to do it their way. They may take care of your children. If you need a break from your kids, you've had them, they're on summer break, and you just need. Or. Or they're very young, you just need an hour to Be able to take a shower by yourself and, you know, maybe even take a nap for 20 minutes. You're just like my kingdom for some respit. And your sister comes over to help out, and she sits the kids down in front of the television and says, all right, you know, Auntie's here if you need something. She pumps them all full of sugary foods. They love it when Auntie comes over. They get screen time and sugar, and you can get angry at them. It's like you were supposed to come over and take care of them, not just park them and sugar them up. But Auntie came over and did what you needed. Auntie gave you rest. Is it the way you would have wanted? Obviously not. However, we need to give them some latitude. And last week we talked about, do you need to be right or do you need to have help? Do you need them to do it your way or do you need to have them get it done in a safe, sound way so you don't have to do it? Picking our battles is another way to say that is really important. Holding on to anger that Auntie came over and was supposed to take care of the kids and all she did was park them in front of the TV and sugar them up. And your spouse comes home and you vent at them about it and you're just still walking around six hours later angry that Auntie did that. Is that using your energy effectively to move toward your rich and meaningful life is keeping your anger ramped up about how Auntie cared for the kids. They were safe. They were pretty happy, too. How Auntie cared for the kids is holding on to that anger. That's keeping your stress response up here. That's bombarding your stress receptors. That is contributing to creating imbalance in your nervous system. That's not what you want. That's not going to help your burnout. Obviously, you can have a discussion with Auntie about next time you come over, you know, thank you so much. I desperately needed a shower. Thank you so much. And the next time you come, come over, you know, I'll have a bunch of activities for you to do for. For the kids to do with you because they really love their coloring books or playing with Legos or something. I don't know. You may. If you want them to do it a certain way, you may have to give them some guardrails that says, this is what I want you to do. Something in this realm or. Or no screen time, no sugar. Other than that, free reign. You know, maybe they go to the park. I don't know, you may get angry at the caregivee for being difficult or being needy. Even patients that we have as counselors, sometimes we can get a little frustrated with patients who want us to fix it and they want us to fix it yesterday. Number one, we can't fix fix it. We can help them fix it, but we're not able to change them or change another person. We can help them figure out how to deal with it. Sometimes, especially if you're working with somebody who has a trauma history and disregulates a lot, they may be calling your office a lot between sessions too. And that can be exhausting sometimes and you have to learn how to set limits. You may be angry at the caregiver for, quote, doing this to themselves. And again, I'll share my experience so there's no HIPAA issues. My both my parents died of cancer. Both of my parents likely got cancer or what have you, in part at least because they were heavy smokers and heavy drinkers. And was there a part of me that was angry at them for that? Yes. Was there a part of me that was angry? My, my father, bless his heart, he made a decision at some at one point that he was going to continue to smoke even though he was on chemotherapy. And I'm like, daddy, really Daddy. But that was his choice. And yes, I was angry, I was frustrated, but it was his choice and it was not. I didn't have the power or the to control his life. You may be angry at the caregiver for past issues and you need to pick your battles, figuring out how to manage that. If you're working with, and this is obviously usually if you're working with somebody who is an older adult, you know, a parent or a grandparent or a great aunt or something that you're taking care of. And maybe you had issues in the past, but now it's time for you to take care of them. And you may feel resentful or angry that they did that to you and you're still holding that anger. It's important to figure out what to do with that. You may be angry at yourself. It's that guilt we talked about for not being perfect. Who's perfect? Facts in this context at this time, who do you know that's perfect? Importantly, recognize again what you do do well. Wow, lots of doo doos there. Recognize that you're not perfect and focus on what you are doing well, what you can learn and accept with compassion that you're not going to be perfect. That's just unrealistic. And if you expect yourself to be perfect, you're setting yourself up for guilt and anger and misery. You may be angry at yourself for being judgy. And it's easy, especially when you start feeling burned out, to get judgy about the caregiver. You shouldn't have done that. Or you're just being nasty and feeling sorry for yourself. And then you think to yourself, wow, you. You hear yourself in your own head, and you're like, wow, that's awful judgmental. That's horrible of me. So now I feel guilty for being judgmental. Hayes calls it dirty discomfort. But ultimately, you're feeling angry at yourself for being angry at somebody else. And you're piling on these emotions like layers of an onion, which doesn't give you the full weight of it. Think of it. Each emotion is another rock in that backpack. And then you start getting angry at yourself for being impatient and irritable. Yes, it happens. We don't have to act on it. We can learn how to pause before we act. I remember when my kids were little, pushing the stroller through Target one day, or not the stroller, the buggy through Target one day. And they were happy and they were chatty and they were high strung, and I was exhausted and. And I just kept walking through the, pushing the thing, looking for what I needed, trying to get out of there as quickly as possible, saying to myself, God grant me patience, over and over again. Because I recognized that I was being impatient. They weren't being bad. It was me. And so I was choosing to take a pause, and instead of getting irritable with them, you know, letting that feeling come out as behaviors, I chose a different route. In terms of interventions. We need to recognize that anger is a reaction to fear of rejection, of vulnerability or loss of control. It's a feeling that's designed to alert you that there might be a threat, just like a smoke alarm, and give you the energy to examine and address the situation. It is important for you to know your anger style. Are you one of those people who just sits there and seethes? What does it look like when you start getting angry? Know your anger symptoms so you can identify. All right, I'm angry. Some people just hold it in and they're just. Eventually they. They're like a pressure cooker and the top comes off. Other people become very passive aggressive or. Or snotty or whatever. Whatever word you want to use. But know what anger looks like for you when it's oozing. And then check yourself before you wreck yourself. Before you interact with people, and ideally, periodically, just throughout the day, check yourself for those symptoms. Am I seething? Am I oozing stress? Am I irritable, or what's going on? Identify what aspects of the situation are within your control. Anger is that fight. You want to fight, you want to control, you want to fix it. Okay, so let's figure out if we're in fix it phase. Fix it mode. What can you control? You can control. You. You can control how you react, how you act to the situation. You can control whether you set boundaries and say, you know what, I need to take a minute. When my son was little and had his gastric reflux, and we've talked about this in, in the other videos in this series, my husband and I would trade off at night, who would walk with him and rock him. And when he would just keep crying, I would feel helpless, I would feel powerless. And I would get angry at the situation, and I would get frustrated that I couldn't get him to stop crying. And I'm just like, oh, please, God, stop crying. And I would start to get angry with him. And then I. I knew it wasn't his fault, and I'm walking with him, but we know that children pick up on that, so. And thankfully, my husband was very supportive and also understood the dynamics. I would pass Sean off to him, and he'd take the pillow with the baby and he'd walk for the next hour. But I knew I was within my control. I knew I could choose to do something different than just being angry. I knew that anger was telling me I needed to make a choice. I needed to do something. The caregiver. What aspects of the caregive are within your control? A lot of times none. Sometimes, especially with smaller children, there are some things that you can do. You can set up rewards, you can set up token economies in a classroom. You can set up structure. There are things that you can do in order to help navigate, direct the caregiving. Put on those guardrails so they behave within certain parameters. Certainly you. That's something you can do, but you can't choose if they're going to decide to jump over the guard rails. And children will periodically do it sometimes just to test to see if you're paying attention and if those guard rails are still appropriate. My son and I know we're. We're getting a little behind, but when he was little, we went to my grandmother's house, and my grandmother had this big TV on a. On a. A pedestal. And Sean knew he wasn't Supposed to touch it. He was 2. It was his second birthday. And he walked over to the television and he promptly looked at me and he said, mommy. And he pointed to the TV and he said, no touch. And I said, right, no touch. And he looked at me and he said, mommy and touched it. And I said, did. Did you touch it? And he said, yes. And I said, okay. He said, mommy, time out. I said, yep, timeout. And he toddled into the room that we were staying in, and he sat down and I went in there a minute later because he was 2, so his timeout was a minute. I went in there a minute later and I was like, sean, what happened? Are you going to do that again? He said, no. He was just checking to see if the rules were the same. You know, he knew that was a rule. He tested it. He tested those guardrails. And I said, you jumped over. Need to rein it back in. And things were fine for the rest of the day. He just wanted to make sure that the rules still applied at Grandma's house. And again, you can identify what aspects of the situation with the other caregivers were within your control. Like I shared in the analogy with Auntie coming over to watch the kids. You can let Auntie know, here are the guardrails. We don't do screen time before such and such time of day. We don't do sugary foods. These are the things that we do do, and that can be really helpful for you when you're working with other people. Instead of identifying all the don'ts, all the things that are out here that you're not supposed to do, identify. These are the things that we do, and that's much more proactive, much more positive. Stop mind reading and expecting mind reading from other people. Don't assume you know what they're thinking. Don't assume you know that they knew that you needed help. Stop it. Talk. Communicate assertively. Don't expect them to read your mind and know what you need. And don't read their mind and assume you know what they're thinking. That just creates a whole world of hurt for most people. And that can be one of the easiest ways to reduce tension in relationships and caregiving. Recognize and address displaced anger at yourself versus the situation or the higher power. If you feel like, you know, it's all my fault, am I angry at me for something that's going on? Am I angry at me or am I angry about this situation and I'm taking it out on myself, I'm blaming myself. Am I angry at the caregiver? Or am I angry at the situation or other caregivers or who exactly or what exactly am I angry at or about? Are you angry at the caregiver in the present, you know, what grandma's doing right now versus the caregiver in the past? I'm angry about what you did when I was 8. You're 88 now, and you know I'm still holding on to that anger. So am I angry about what you're doing right now, or what you did 80 years ago, or am I angry about what you're doing right now? Caregiving? Or am I angry about what another caregiver, like you did 10 years ago? And you can see this for teachers. Teachers can remember how students treated other students in the past, and they can get angry through projection of what's going on there in terms of grief now, remember, grief is anger and depression. Denial, anger, depression, acceptance. You may be losing the person you love either physically through death or going to a nursing home. They're just not there anymore. They're not there for you to take care of. You have no control over that situation anymore. And that can be terrifying. Um, and you can get angry about that, and then you can feel hopeless about it. Then you can get angry again. With children as they grow up and they leave the nest, they fledge. That's supposed to be a beautiful, wonderful thing. But we also grieve it because our role as a caregiver changes. It doesn't go away completely, but it changes remarkably when they move on to their own apartments when they get married. And you may grieve if there's abandonment. If your child or somebody, you know, your caregiver runs away, they just pack up and leave, you know, for whatever reason, either because, well, for whatever reason, they just leave and they're not there anymore. You can grieve the loss of the person you love. When you lose them cognitively through dementia, they lose their memory. They don't recognize who you are. And that's a. Grief is exhausting. Grief takes a lot of energy because you go back and forth between anger and depression. I'm angry. I'm going to try to control the situation. I'm depressed. I realize it's hopeless now. I'm angry that I can't control the situation again. There's got to be something I can do. Now I'm depressed because I realize there's nothing. Know we go back and forth and then I have here ideals. Cognitively, when you're raising your children, particularly as a caregiver Ideally, I think we try to raise them to think for themselves and develop their. Develop independently. And sometimes they choose ideals, they choose beliefs and stuff that are different from ours. And we can grieve that. It doesn't mean we're not bad people for being sad that our, our children didn't embrace the same beliefs that we did. But recognizing that and not trying to continue to impose those ideals, you know, we need to look at where those boundaries are, acknowledge that it hurts when a child rejects something that's important to you, doesn't mean they're rejecting you. They're rejecting the ideals and the loss of the image of the person that you love. We grieve that if we saw this person as invincible and perfect and all of a sudden they're frail, that can really hit home. And we may grieve the loss of that image that we always wanted to have, or the fact that somebody needs you. We have this image of this, especially our children. They need us. They're always going to need us. And then they, they fledge and suddenly they don't need us so much anymore, at least not most of the time. And recognizing that's a normal feeling. Yes, we're on partly glad it's bittersweet. We're partly glad that they're independent and strong. But we're also, there's part of us and that's changing. And depression represents a sense of hopelessness, helplessness, and sometimes exhaustion. We want to recognize the hopelessness of changing parts of the situation. Illnesses, sometimes they're not going to get better. We can help a person live their highest quality of life and have the illness, but we may not be able to heal the illness. We may not be able to fix it. What parts of the situation in that person's life or that being's life that you're caregiving can you change? And the last part of this I have is your anger, your anxiety, or your grief. And I mentioned that earlier, you cannot just suddenly say, I'm not going to have that feeling anymore. That's not how it works. You can choose how to respond to that feeling, but it's almost impossible to stop feeling feelings and exhaustion. We do want to recognize that sometimes when we get depressed, our body is just telling us, you're out of gas, you don't have anything left to give. You've given body, heart and soul. Interventions determine what's causing your depression and what resolution would look like, am I depressed because I feel hopeless and helpless? And what do I have power over? Or am I depressed because I'm just plump exhausted and I don't have any energy to go or some combination. And what does recovering from that depression? What would it look like? Define and chart. That means keep a log of your smart goals. Set goals that are small and specific things that you can accomplish. Maybe in 15 minutes, 30 minutes, they're measurable. You, you can identify did I do it or did I not. They're achievable, something you can do within that period of time. If I say I'm going to knit a cardigan in an hour and a half, that's not achievable. If I say I am going to knit 10 rows in 30 minutes, that's achievable. Relevant. Obviously you want to use your energy for something that's going to help you move toward your rich and meaningful life and have it time limited. Like I said, if you're really burned out, 15, 30 minutes, that actually feels like a really long time. So set goals that you know you can accomplish. So at the end of the day you can look back at your list and you can go check, check, check. I did those things. Sometimes it's even going to be I know I seem like I'm harping on the shower thing today, but for a lot of caregivers, good nutrition and showering just go out the window. That can be one of those things on your interventions that is helping you heal yourself. General Tips Mindfulness Morning mindfulness for grounding and planning Wake up, identify how do I feel and what do I need right now to be my best self to be my best self as a caregiver and plan what can I do to meet those goals, to meet my own needs and, and who else can help me? So morning, you know, kind of get grounded and centered and planned. Plan evening mindfulness. Reflect on your successes. Reflect on what you need to learn and then identify those things that caused you angst throughout the day and decide what you need to do about them so you can let them go so you're not carrying those boulders in that backpack tomorrow morning. Eliminate unnecessary stressors. Simplify. Do what you can to reduce the drain on your energy physically, emotionally, cognitively. Make sure you're getting quality, sufficient quality sleep. If you're not, your emotions are going to be much more all over the place. Sleep deprivation causes stress response to increase. It's a fact. So if you don't want to have as many distressful emotions, if you don't want to feel as disregulated, it's important to keep your sleep in check as best as possible. Stay hydrated. Dehydration actually contributes to brain fog and feelings of depression. Eat an anti inflammatory diet. Lots of colors, lots of, you know, vegetables, fruits, those things, Skittles and condiments. They don't count. Make sure there are probiotics and prebiotics, so fermented foods and yogurt and foods that have fiber in them like beans and legumes. Get enough vitamin D and sufficient complete protein, which isn't a big deal for most Americans because most Americans are meat eaters, but. But if you're a vegan or a vegetarian, make sure you're getting sufficient complete protein so your body has all the amino acids it needs. Get blood work done annually to check your thyroid, gonadal hormones, your levels of vitamin D, vitamin B12, whether you have anemia and your blood sugar, because stress, especially chronic stress, can throw all of these out of balance and imbalance in any of these will contribute to anxiety, anger, depression and sleep problems. Behavioral activation. 20 minutes of positive focus. 20 minutes a day, whenever, whether it's at dinner or right before bed, I don't care. Spend 20 minutes focusing on what went right the other three. 23 hours and 40 minutes. Focus on whatever you want. They've shown that that actually strengthens your parasympathetic, your rest and digest nervous system and helps you be more aware of a balance of things. Embrace the dialectics. If you're taking care of grandma and she's frail right now and that scares you, it causes you anxiety. Okay, you know, that part sucks. And the fact that she's with you and she's frail means that she's probably lived a long life. And how wonderful is it that you've had 94 years to get to experience her wisdom and her personality or whatever it is. So embracing the two. Yes, it sucks that she's frail now, but how awesome is it that I was blessed enough to have her in my life for this long? The kids, they make messes, they make noise, they go to school and they bring home illnesses and then we all get sick. It's frustrating, but you wouldn't trade them for the world if yes, you could live in a, in a house, in a life where there was no mess, where you could control the noise and you rarely got sick. But then you wouldn't have the joy of the children. So embracing those things. Also with behavioral activation, the simplest thing, increasing laughter and Joy. Go on TikTok or YouTube, find some videos that make you belly laugh that actually increases oxytocin and endorphins and does all kinds of good things for helping to heal that or balance that nervous system. Work on your distress tolerance skills. Practice grounding imagery. Identify a place you can go if you need to go to your happy place, whatever that place is. When you start feeling stressed, that can help you get grounded. You're not staying there forever. You're just going there until you can downregulate your stress response. Use square breathing or other breath work. Cued progressive muscular relaxation is another really interesting one, because when you first start doing it, you start at the top of your head and you tense and relax muscles and notice the difference between tense and relaxed. And you try to envision the stress moving out of your body as you tense and you relax your muscles. But each time you relax, you say a cue like relax. See how creative I am? But then that cue becomes associated with relaxation in your brain. So eventually when you say relax to yourself, it just happens. Kind of like when you were a kid and you'd be sitting in class and not, you know, bebopping along, whatever, the teacher would come in and she'd say, we're gonna have a quiz. And every muscle in your body would tense up. Well, cute. Progressive muscular relaxation is the opposite way. You have associated the word relax or breathe or blue for that matter, with relaxation. So now when you say blue, you take a deep breath in, you exhale, and you can feel that stress leaving and then unhooking. Recognizing that feelings aren't facts. I have this feeling, I'm feeling angry now. What am I going to do with it? It does. Doesn't have to be part of me. It's not who I am. I am not anger. I am feeling angry. What do I do with it? Develop a prevention or rescue plan to identify your vulnerabilities. What things tend to make you more vulnerable to getting triggered. And then figure out what your triggers are so you can avoid them. When you're vulnerable, if you tend to be more vulnerable, if you tend to be more easily triggered when you're tired, then when you're tired, try to avoid some of those triggers that tend to set you off. Know your symptoms and signs of stress and know your needs. If you're aware of all these things, if you're mindful of these things, you can take proactive steps to reduce unnecessary distress emotions or biochemical reactions to help you regulate your energy to survive. It's that simple. Feelings are not facts and are triggered by assumptions we make based on prior learning. Distressful feelings are not meant to be nurtured or carried. They're designed to propel you to action. Yeah, even depression is designed to propel you to action. Depression is saying we're out of gas or this is hopeless. There's no point continuing to throw energy at it. So your body is telling you something and you got to figure out what you're going to do next. Validate, investigate and remediate based on the facts in this context at this time.