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Depression, Anxiety and Stress Symptoms in Family Caregivers

When Worries Become Anxieties for Caregivers
Along with caregiving can come stress and anxiety while taking care of a loved one.
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After my mother was hospitalized twice in two months for falls, I found myself consumed with worrying about her. The worries were various and boundless. When my cellphone kept buzzing one day with calls and texts while I was in an important work meeting, I worried that someone was urgently trying to reach me to say she'd fallen again. Or perhaps, I fretted silently, she'd been found wandering outside. Or maybe she had accidentally burned her apartment building down. Even as I faced my boss impassively, my mind was frantic with realistic and unrealistic concerns.

After the meeting, when I was finally able to check my phone, I found that my worrying had been unwarranted. The messages were about other matters; my mother was fine. It was then that I realized I was suffering something more disruptive and uncontrollable — rampant anxiety.

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How do we distinguish the two? When stressed, it is normal for us to worry about potentially bad outcomes. As uncomfortable as worrying feels, it is the way many of us think through and plan for future contingencies. When all turns out well, we feel relieved.

Anxiety is what we experience when the worries are so numerous and intense that we can no longer think clearly. Our minds become fixated on worst-case scenarios and overwhelmed by feelings of fear and helplessness, even when real danger has passed. We have difficulty making decisions or interacting with our loved ones calmly. Our bodies, too, may suffer symptoms, such as palpitations, tremors and tense muscles.

Anxious caregivers, for all their good intentions, are often hobbled by their fears. But fear can be reduced to normal, manageable worries if we are willing to approach our anxiety as a treatable condition. Here are some ideas how.

Nagging worries are bothersome, but we can push them away and focus on other things. What clinicians call "anxious ruminations," on the other hand, are troubling thoughts that we can't stop mulling over for very long no matter how we try to distract ourselves from them. Such ruminations cause us to be preoccupied and inattentive during the day and keep us awake for hours at night. They greatly detract from our enjoyment of living. If you recognize your experience in this description of anxiety, then it is time to seek help in order to become a happier and more effective caregiver.

Start by visiting your primary care physician to seek an evaluation. She will ask you about how much of your time you spend worrying, the effects on your sleep, mood and concentration, and the impact on your ability to perform your duties as a family caregiver. If your symptoms are persistent and uncontrollable, she may diagnose you with generalized anxiety disorder and recommend behavioral, cognitive and/or pharmacological treatments.

One of the best behavioral treatments for anxiety is the same as for general physical health — aerobic exercise. This kind of exercise — such as brisk walking, swimming, bicycling, Zumba class — causes our body to release natural substances called endorphins into the bloodstream that help soothe us and improve our moods. Other beneficial behaviors include daily relaxation regimens — for example, breathing exercises, yoga and meditation — that calm us not only immediately afterward, but for the rest of the day.

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A popular form of psychotherapy called cognitive therapy teaches us that it's the thoughts we characteristically think (and not necessarily the situations in which we find ourselves) that lead us to anxiety and sometimes depression. For example, if we are overly pessimistic or self-critical ("My mother is going to fall again, and it will be my fault that I didn't prevent it"), then we may be more predisposed to blaming ourselves and worrying. By observing and critiquing these negative thoughts, we can curb unrealistic assumptions and reduce our anxiety.

Your physician may prescribe an antianxiety medication to take every day or on an as-needed basis. Such medicines are generally safe and effective but, like all treatments, may have side effects. They are not heavy sedatives to sap your energies or "happy pills" to change your personality. Rather, they are tools to provide relief from the incessant rumination.

None of the recommendations above will guarantee you worry-free caregiving. But by reducing anxiety, they can keep the inevitable bumps in the road from seeming like monolithic obstacles. This job is hard enough without intense and unceasing anxiety roiling whatever sense of stability and confidence you've achieved.