The Psychobiological Effects of Caring 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
(ab)normal stress responding Acute (adaptive) Chronic (maladaptive)
Short Term Longer Term Fight-Flight Response Regulation of biological functions Blood-sugar levels Immune system Mental alertness Sleep patterns Redirection of resources from Growth & repair long term to short term Reproduction
The regulation of biological functions
Chronic Stress & Cortisol Secretion Flatter Slope Blunted CAR Fatigue Burnout Burnout Bereavement Exhaustion Unemployment
Cortisol Secretion & Ill-health Flatter Slope Blunted CAR Chronic pain Early mortality in cancer Autoimmune disorders Cardiovascular disease Cardiovascular disorders Metabolic syndrome Gastro-intestinal disorders Mood disorders
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
Are caregivers stressed?
Does it affect health outcomes
BUT………….
Age-related declines in biological functioning Are negative consequences in carers caused by: The chronic stress of caregiving Senescence (or a bit of both)?
What do we do? Carers recruited through support groups and word of mouth in Newcastle area 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 Do you forget something that you were told a few minutes before Prospective Memory: Memory for future intentions Do you forget appointments if not prompted by someone else?
Everyday memory deficits in carers
BUT – is it the same for everybody?
Child Problem Behaviours, Stress & Health Perceived Stress Minor Health Complaints
The role of cortisol? Minor Health Perceived Stress Complaints
The role of cortisol? Minor Health Perceived Stress 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
The role of cortisol? Perceived Stress Minor Health Complaints
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 Experimental paradigm Control (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 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 - Participation Eligible participants [randomised] 41 21 20 Non completion 9 4 16 12 Completed
Feasibility – Intervention integrity Linguistic analysis
Feasibility – Intervention integrity Perceived emotional content
Efficacy - Psychological distress Anxiety Depression
Problems 4/12 benefit finders commented on difficulties completing the writing task “I honestly don’t believe “It is really difficult to say that there are any positive how I am affected positively aspects to having a child by my son’s condition” with autism”
Bringing it all together Parent carers of children with autism….. Have higher levels of psychological distress Borderline caseness for anxiety and depression 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) Child Social Problem Support Behaviours
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 (e.g., alexithymia) to express emotions (e.g., O’Connor et al., 2008)
Future Directions Positive emotions provide a ‘psychological breather’ from stressful experience (Folkman 1997)
Acknowledgements Dr Brian Lovell Helen Elliott Chris Liu Our parent-carer participants Thank you for listening Dr Mark A Wetherell mark.wetherell@unn.ac.uk @HealthPsychUNN @DrMinkster
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