caregiving get inside the body? Can we do anything about it? Dr [PDF]

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How does the stress of caregiving get inside the body? Can we do anything about it? Dr Mark A Wetherell

Reader in Psychobiology & Health Psychology Registered Practitioner Health Psychologist

Health in Action Stress Research Group

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Psychological morbidity Physical disease Disease progression Cognitive deficits

STRESS

The effects of stress

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Other Systems Cardiovascular, Immune, Digestive, Reproductive

How does stress get ‘inside the body’?

Nervous System Endocrine System

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Pituitary Gland

Cortex

Hypothalamus

STRESSOR

Nervous & endocrine pathways

Corticotropin Releasing Hormone (CRH) Adrenocorticotropic Hormone (ACTH)

Sympathetic Nervous System Medulla Adrenal Gland

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Adrenaline The nervous system pathway

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Adrenaline

What does adrenaline do?

Increased:

 Heart rate  Blood pressure  Redirection of blood to muscle / organs

Initiation of the Fight-Flight Response

Responses that help to cope with short-term threatening situations

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The endocrine system pathway

Cortisol

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Cortisol

Increased:

 Sensitivity of cells to Adrenaline & Noradrenaline  Blood-sugar levels  Mental and physical alertness  Resources to immediate threat

So what does cortisol do?

Maintenance of the Fight-Flight Response

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A crazy example

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Longer Term Regulation of biological functions

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Immune system

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Sleep patterns

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Growth & repair

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Reproduction

The roles of cortisol (ii)

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The regulation of biological functions

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Psychological morbidity Physical disease Disease progression Cognitive deficits

The consequences of caregiving stress

Other Systems Cardiovascular, Immune, Digestive, Reproductive

Nervous System Endocrine System

Chronic

STRESS

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Our Programme of Research

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First hand evidence

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Questionnaires ฀ ฀ ฀ ฀ Demographic characteristics Distress (stress, anxiety & depression) Minor ill-health complaints Social support and evaluation Childhood problem behaviours

What do we do?

Endocrine Measures Diurnal cortisol Immune Measures C-Reactive Protein

Carers recruited through support groups and word of mouth in North East

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Perceived Stress

p < 0.01

Anxiety

p < 0.01

Depression

p < 0.01

Greater Psychological Distress

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p < 0.01

Reduced Social Support

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Appraisal

Availability of confidants

p < 0.01

Self esteem

Favourable comparison to others

p < 0.01

Belonging

Opportunity to interact with others

p < 0.01

Reduced Social Support

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Greater ill-health in caregivers

Minor Health Complaints

p < 0.01

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Greater inflammation

C Reactive Protein

p < 0.01

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Chronic STRESS

↓ Cognitive functioning

Attention / processing
Problem solving
Recall & verbal memory
Medication schedules
Appointments
Feedback on condition

Stress & Memory

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Everyday Memory

Retrospective Memory: Recollection of past events The memory involved with completing everyday life tasks Prospective Memory: Memory for future intentions

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Everyday memory deficits in carers

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BUT – is it the same for everybody?

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Minor Health Complaints Perceived Stress

Child Problem Behaviours, Stress & Health

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Does anything help?

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Social support as a stress buffer

Perceived Stress Anxiety Depression

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C Reactive Protein

Social support as a biological buffer

Minor Health Complaints

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Does it just affect parent carers?

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More depressive symptoms in siblings

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What can we do about it?

If social support buffers the harmful effects of stress ….. ….. Increase social support

BUT… It’s not that easy

Many social support networks are [perceived as] inaccessible

 A lack of alternative care arrangements (Wiles 2003)  A lack of time / too many responsibilities (Gallagher-Thompson et al., 2006)

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Expressive writing

The process of writing or talking about personally stressful and traumatic events

Personally traumatic event(s) Intervention Description

f day’s

events Control Experimental paradigm

(James Pennebaker)

Writing for 15-20 mins

n 3-4 consecutive days

Be expressive and emotional Be factual and non-emotional

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Expressive writing

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Reductions in depressive and anxious symptoms (Lumley et al., 2007)

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Increasing self-esteem (O’Connor et al., 2010)

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Improved mood and reduced fatigue (Wetherell et al., 2005)

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Improved physical well-being (Kelley et al., 1997)

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Improved immune function (Petrie et al., 1995)

Adapted to run in people’s homes (Wetherell et al., 2005)

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Problematic for individuals with stressful daily events e.g., through debilitating illness, caregiving responsibilities

Problems Alternatives

Use a more ‘neutral’ control task e.g., unemotional description of pictures

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 Positive association between benefit finding and social support in caregivers

(Packenham et al., 2004)

 Caregivers who find ‘benefits’ amidst their stressful role are more motivated to

seek out social interaction

(McCausland et al., 2003)

Better suited to previously experienced, unresolved events …not ongoing chronic stressors

Benefit finding Problems

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Written benefit finding in caregivers

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Written benefit finding in caregivers

Feasibility

 Are parent carers able to participate and engage in the intervention?  Is it possible to carry out psychobiological assessments?

Efficacy

 Assess the effects of benefit findings on psychological and physical wellbeing

To conduct a home based, written benefit finding intervention in parent carers

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Baseline assessment

3 x 20 minute writing sessions

(participant called before and after) 1 month 3 months

Method

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People often find positive consequences amidst stressful life events such as improved social relationships, greater sensitivity to family issues and overall appreciation for life/loved ones. You should write about positive consequences with respect to your life, your goals and your relationships. Describe in detail one picture per day without including any personal information or opinions on the images. Focus on the pictures in detail, for example, describe the objects, the colours, the shapes and their positions.

The writing instructions

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Linguistic analysis

Feasibility – Intervention integrity

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Perceived emotional content

Feasibility – Intervention integrity

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Anxiety Depression

Efficacy - Psychological distress

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Bringing it all together

Parent carers of children with autism…..

 Have higher levels of psychological distress  Report lower levels of social support  Experience greater numbers of everyday cognitive failures  Experience greater incidences of minor health complaints  Have elevated levels of inflammation (C-Reactive Protein)

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Bringing it all together

Written benefit finding…..

 Can be successfully employed as a home-based intervention in caregivers  Elicits linguistic outputs and positive emotions associated with improved wellbeing  Shows (preliminary) evidence of improvements in psychological distress in carers

BUT…..

 Not all carers were able to fully engage with the task

Benefit finding does not work for everyone…..

 Inability / unwillingness to express emotions (e.g., alexithymia: O’Connor et al., 2008)

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Someone that can….

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Future Directions

Helping people get from… to here here

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Future Directions

Positive emotions provide a ‘psychological breather’ from stressful experience

(Folkman 1997) Writing about positive emotional experiences… …Improve life satisfaction (Wing et al., 2015) …Reduced health center visits (Burton & King, 2004) …Reduced anxiety / depression in caregivers (Ashley et al 2010) …Reduced health complaints after 2 minutes of writing

(Burton & King ,2008)

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