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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 Psychobiological Effects of Caring Dr Mark A Wetherell Reader - - PowerPoint PPT Presentation
The Psychobiological Effects of Caring Dr Mark A Wetherell Reader - - PowerPoint PPT Presentation
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
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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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(ab)normal stress responding
Acute (adaptive) Chronic (maladaptive)
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Short Term Fight-Flight Response
Blood-sugar levels
Mental alertness
Redirection of resources from long term to short term Longer Term Regulation of biological functions
Immune system
Sleep patterns
Growth & repair
Reproduction
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The regulation of biological functions
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Fatigue
Burnout
Exhaustion
Blunted CAR Flatter Slope
Burnout
Bereavement
Unemployment
Chronic Stress & Cortisol Secretion
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Blunted CAR Flatter Slope
Early mortality in cancer
Cardiovascular disease
Metabolic syndrome
Mood disorders
Cortisol Secretion & Ill-health
Chronic pain
Autoimmune disorders
Cardiovascular disorders
Gastro-intestinal disorders
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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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Are caregivers stressed?
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Does it affect health outcomes
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BUT………….
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Age-related declines in biological functioning
Are negative consequences in carers caused by:
The chronic stress of caregiving Senescence
(or a bit of both)?
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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 Newcastle area
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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
Do you forget something that you were told a few minutes before
The memory involved with completing everyday life tasks Prospective Memory: Memory for future intentions
Do you forget appointments if not prompted by someone else?
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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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Minor Health Complaints Perceived Stress
The role of cortisol?
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Perceived Stress
The role of cortisol?
Minor Health Complaints
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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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Perceived Stress Minor Health Complaints
The role of cortisol?
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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
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)
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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
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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Feasibility - Participation
Eligible participants [randomised] 41 21 Non completion 9 4 Completed 12 16 20
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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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Problems
4/12 benefit finders commented on difficulties completing the writing task
“I honestly don’t believe that there are any positive aspects to having a child with autism” “It is really difficult to say how I am affected positively by my son’s condition”
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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)
Social Support Child Problem Behaviours
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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 (e.g., alexithymia) to express emotions (e.g., O’Connor et al., 2008)
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Future Directions
Positive emotions provide a ‘psychological breather’ from stressful experience
(Folkman 1997)
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