En español | "I worry about him constantly,” the 70-year-old woman said during a recent therapy session while fretting about her husband, who is in a nursing home dementia unit. “How do I know he won't get coronavirus there?"
"I can well understand,” I said empathetically, but then added, “As long as we're in this pandemic, I don't think you are going to be able to stop worrying about him.” In my mind I was considering how I could help her not worry less but worry more productively.
Caregivers have plenty to be fearful about nowadays, including contracting the coronavirus, feeling isolated at home, getting food and medications, and coping with financial strain. Those worries are normal and expected; it would be surprising if a caregiver wasn't worrying during this time of crisis. Evolution has equipped human beings with built-in worry capacity for reasons of survival — to fix our attention on pressing problems and then spur us to try to remedy them.
But when the tendency to stew escalates so much during stressful times that worries dominate caregivers’ thoughts, disturb their sleep and detract from their ability to enjoy life, we call it something else: anxiety. Unlike worry, anxiety isn't normal; it's a problem that clouds our thinking and diminishes our abilities to perform at our peak. In its more severe forms, anxiety is debilitating and requires treatments such as medication and psychotherapy.
How can family caregivers use worry productively to better face the pandemic but not cross the line into anxiety? Here are some ideas.
Worry, but don't ruminate
Thinking about worrisome challenges is not a problem; thinking about them constantly is. Ruminating cows chew their cud for hours; likewise, ruminating caregivers chew on the same worrying thoughts again and again, without getting any closer to a solution. The thoughts torment them, especially at bedtime when they can't turn worrying off enough to relax and fall asleep.
It's usually about as helpful to tell anxious caregivers to just quit worrying as it would be to tell them to cap a high-pressure fire hydrant. Instead, a tried-and-true, if somewhat paradoxical, psychological technique is to encourage caregivers to worry more — but only at certain times. So rather than trying to distract themselves from their worries by forcing their mind to focus on other things, caregivers should schedule at least an hour each day to fret as much as they possibly can. During that time they should keep a highly detailed journal in a notebook or Word document about whatever is troubling them. But, here's the key: At the end of the hour, they need to put the notebook away or close the file and turn their attention to more immediate concerns. This act of “brain-dumping” worries allows caregivers to circumscribe them to those “worry hours” and gain a greater sense of control over their thoughts in general.
Worry, but don't “catastrophize”
It is realistic to worry about the coronavirus's impact on the country's public health and economy. It may not, however, be realistic for a caregiver to worry that her entire family is in imminent danger of being wiped out by COVID-19 because she forgot to wear a mask when she went to the pharmacy three weeks ago. Anxious caregivers tend to “catastrophize” — that is, fear the worst-case scenario in every situation even though the probability is low that anything catastrophic will happen. To tamp down this mindset, caregivers need to reflect on their worries and ask themselves two questions: How realistic is this worry, really? How helpful is it to dwell on worrying about this low-probability possibility? If a worrying thought is neither realistic nor helpful, then it should be given less attention.
Harness worry's energy
Worrying makes us more alert and ready for action. This increased energy can be used for effective problem-solving. During the “worry hour,” caregivers can not only dump their worries and then assess them for realism and helpfulness but also ask themselves another important question: Which of my worries are and aren't within my power to solve? Those that aren't should be assigned for more venting. But those that are should prompt caregivers to begin generating ideas in their journal about how these worries can be addressed. What steps can a caregiver take to make a difference in reducing these concerns? What does she need in order to take those steps? In this case, the caregiver could contact the nursing home and ask what measures the staff are taking to combat the coronavirus. She could also ask what the plan is for the nursing home to communicate important information to both residents and families on a regular basis. This should catapult her into an action mode in which she uses all her will, talents and determination to help herself, her care recipient and her family members fight against this present scourge.
Barry J. Jacobs, a clinical psychologist, family therapist and healthcare consultant, is the co-author of Love and Meaning After 50: The 10 Challenges to Great Relationships — and How to Overcome Them and AARP Meditations for Caregivers (Da Capo, 2016). Follow him on Twitter and Facebook.