caregiving get inside the body? Can we do anything about it? Dr - PowerPoint PPT Presentation

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

The effects of stress Psychological morbidity Physical disease STRESS Disease progression Cognitive deficits

How does stress get ‘inside the body’? Nervous Endocrine System System Other Systems Cardiovascular, Immune, Digestive, Reproductive

Nervous & endocrine pathways STRESSOR Corticotropin Releasing H ypothalamus Hormone (CRH) S ympathetic Nervous System P ituitary Gland Adrenocorticotropic A drenal Gland Hormone (ACTH) M edulla Cortex

The nervous system pathway A drenaline

What does adrenaline do? Initiation of the Fight-Flight Response Increased:  Heart rate  Blood pressure A drenaline  Redirection of blood to muscle / organs Responses that help to cope with short-term threatening situations

The endocrine system pathway C ortisol

So what does cortisol do? Maintenance of the Fight-Flight Response C ortisol Increased :  Sensitivity of cells to Adrenaline & Noradrenaline  Blood-sugar levels  Mental and physical alertness  Resources to immediate threat

A crazy example

The roles of cortisol (ii) Longer Term Regulation of biological functions  Immune system  Sleep patterns  Growth & repair  Reproduction

The regulation of biological functions

The consequences of caregiving stress Psychological morbidity Chronic Physical disease STRESS Disease progression Cognitive deficits Nervous Endocrine System System Other Systems Cardiovascular, Immune, Digestive, Reproductive

Our Programme of Research

First hand evidence

What do we do? Carers recruited through support groups and word of mouth in North East Questionnaires ฀ ฀ ฀ ฀ Endocrine Measures Diurnal cortisol Demographic characteristics Distress (stress, anxiety & depression) Minor ill-health complaints Immune Measures Social support and evaluation C-Reactive Protein Childhood problem behaviours

Greater Psychological Distress Perceived Stress p < 0.01 Depression Anxiety p < 0.01 p < 0.01

Reduced Social Support p < 0.01

Reduced Social Support Appraisal Availability of confidants p < 0.01 Self esteem Belonging Favourable comparison to others Opportunity to interact with others p < 0.01 p < 0.01

Greater ill-health in caregivers Minor Health Complaints p < 0.01

Greater inflammation C Reactive Protein p < 0.01

Stress & Memory Chronic ↓ Cognitive functioning STRESS - Attention / processing - Problem solving - Recall & verbal memory - Medication schedules - Appointments - Feedback on condition

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

Everyday memory deficits in carers

BUT – is it the same for everybody?

Child Problem Behaviours, Stress & Health Perceived Stress Minor Health Complaints

Does anything help?

Social support as a stress buffer Perceived Stress Depression Anxiety

Social support as a biological buffer Minor Health Complaints C Reactive Protein

Does it just affect parent carers?

More depressive symptoms in siblings

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)

Expressive writing The process of writing or talking about personally stressful and traumatic events Intervention Control Experimental paradigm (James Pennebaker) Description Personally of day’s traumatic Writing for 15-20 mins events event(s) on 3-4 consecutive days Be expressive and emotional Be factual and non-emotional

Expressive writing  Reductions in depressive and anxious symptoms (Lumley et al., 2007)  Increasing self-esteem (O’Connor et al., 2010) Improved mood and reduced fatigue (Wetherell et al., 2005)   Improved physical well-being (Kelley et al., 1997)  Improved immune function (Petrie et al., 1995) Adapted to run in people’s homes (Wetherell et al., 2005 )

Problems Problematic for individuals with stressful daily events e.g., through debilitating illness, caregiving responsibilities Alternatives Use a more ‘neutral’ control task e.g., unemotional description of pictures

Problems Better suited to previously experienced, unresolved events …not ongoing chronic stressors Benefit finding  Caregivers who find ‘benefits’ amidst their stressful role are more motivated to seek out social interaction (McCausland et al., 2003)  Positive association between benefit finding and social support in caregivers (Packenham et al., 2004)

Written benefit finding in caregivers

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

Method Baseline assessment 3 x 20 minute writing sessions (participant called before and after) 1 month 3 months

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

Feasibility – Intervention integrity Linguistic analysis

Feasibility – Intervention integrity Perceived emotional content

Efficacy - Psychological distress Anxiety Depression

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)

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)

Someone that can….

Future Directions Helping people get from… to here here

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)

Acknowledgements Thank you for listening Dr Mark A Wetherell mark.wetherell@northumbria.ac.uk @HealthPsychUNN @DrMinkster