Episode #164

Caregivers & CBT

Caregiving can be very rewarding but also draining physically, mentally & emotionally.

If you’re a caregiver, how can you use CBT tools to support you during a very challenging time?

If your loved one is a caregiver, how can you use CBT to support them in their difficult role?

Join me, Dr Julie, as we talk about caregiving and how you can use CBT tools to support your own mental and emotional health.

Click to listen now!

 
 

Full Episode Transcript

Hi, it's Dr. Julie. Welcome to My CBT Podcast. I'm a Doctor of Psychology and a Licensed Clinical Social Worker specializing in Cognitive Behavioral Therapy. I'm here to help you bring the power of CBT into your own life.

Thanks for being with me, and I hope everyone's doing well. I'm still coming down for my high after my interview with Dr. David Burns. I hope you guys have had a chance to listen to that. Just really cool information in different CBT tools. There's so many, which is wonderful, and you just gave a really great perspective. And if you haven't listened, definitely take the time. And this one you can also see on YouTube because we had it videotaped as well. So that's cool.

Today, I want to start off with a really great email that is perfect for my topic for today. I received this from a listener, and I wanted to share it with you.

It starts off saying,

“Dear Dr. Julie,

“I was listening to one of your podcasts recently and wanted share something. I have a complicated relationship with my mother. I don't ever recall feeling really nurtured or validated by her.

“Instead, I always felt judged, criticized, or compared to my brother. He was perfect. Me, I could do better or be more like him. From the age of one, my job was to watch over my infant brother. I know this because family members have told me how she would ask me to, quote, take care of my newborn brother so that I would stop crying. I always felt like she was jealous of me or was competing with me for others attention, boyfriend's partners, even family and friends. Even as an adult, whenever she visited me, that pattern continued. Bottom line, I felt parentified and eventually physically abandoned by her as well. She goes on to share a lot of other dysfunctional behavior by her mom as the years went on. And then she shared, My mother is old and frail. She can be very fun to be with, but also draining. I don't see her or connect with her as often as she would like me Why? Because I'm trying to set some healthy boundaries for myself. I want to focus on taking care of myself. I don't want to be sucked into taking care of her needs, especially at a time when I feel I can barely take care of my own needs.

“I'm having some reckoning, I guess, with my own past I find myself feeling very resentful towards her, and so I've created a distance to cope. Of course, all of this is not going well with her. Family members are calling me and texting me and emailing me, urging me to forgive her beyond annoying. Your podcast on forgiveness, guilt, core beliefs, and accepting yourself, and so many more have been extremely helpful during this time. I bring all this up to say thank you. If you have any further insights or recommendations on what I should listen to next, please share. Thank you from your listener.”

So thank you. You know who you are who sent that. And I thought that would be a really great email to share for many reasons, but because I'm also talking today about caregiving. So she's not caregiving for her mom, but her family members want her to forgive and move on and be in her life. So I thought, oh, that'd be a really good email to share. And I think it's a really common issue when we have issues growing up that are never resolved or acknowledged. And then people have these expectations that we're going to be there for that parent when they get older.

And it can be really complicating, really complicating. So I want to share first to start off about what is What are the issues that come up with being a caregiver? There's that term they call about the sandwich generation, which is actually my generation, where my kids are raised now. But a lot of times I'm raising my kids and my parents needed help as well. I never had a caregiver for my dad, but definitely a caregiver for my mom. I have two siblings. My sister definitely did the most. And then there was stress between how much I did, if my brother step in. In so many families I talk to, it's not balanced well between the siblings. Sometimes it is, but many, many times there's one person that really does the most. And again, it can be complicated. But being a caregiver, it can have a lot of effects on you. So it brings up a lot of specific challenges that can affect you emotionally, physically, and socially. And I also wanted to define for you, because one of the tools in CBT is defining terms. And that is, which all the time, really, I'll tell my clients, well, what does that mean when you use that word?

Can you explain that what actually means to me? Because one word can mean a lot of things to different people, right? So the word that I came up with that wanted to define to start off this podcast was the word burden, because a lot of times people see caregiving as a burden, and it has such a negative connection to that word. So I was like, Okay, what's the actual definition of burden? And it means a heavy load, right? We see it. I think we interpret it, our society, as a burden is this pressure we get when somebody depends on us, when we're in their presence or what their needs are, can be a burden. But a burden is really a heavy load, a lot of hard work, and it can be difficult. It can cause excessive difficulty, hardships, or stress for you. So it's hard to be comfortable, I think, with this word, but I've said to clients, even though you love your parent, it can still be a burden. And it can be something that you really honor and are grateful that you can be there for them. It can be both, right? You can be sad and you can be happy at the same time, right?

We have so many emotions. And I think it's important, sorry, to be comfortable with saying, Yeah, it is a burden. It's difficult. It can be a heavy load sometimes. It does affect me on different levels. It doesn't mean I don't want it. It doesn't mean I don't like the person. But yeah, let's just be... Oh, no, it's not a burden. That's my mom. No, that was a burden. There were things that were burdensome about taking care of my mom, but also I'm grateful that I could be there for her also. And I think it's supernatural, too. As a parent, you always, Oh, no, I don't want to be a burden. I don't want to be a burden when I'm older. I remember my dad telling me when I was a kid, we go to the VA hospital for some of his medical care. And as a little kid, I'd walk in there. It was a little spooky. People were missing limbs and wheelchairs. And my dad's like, Oh, When I'm sick and I need more help, just drop me off at the VA. And I'm like, What? I would never drop you off at the VA.

But he didn't want to be a burden, which I love my dad, and he was a great father, and I appreciate that. And I feel the same with my kids. I don't want it to be a burden to my kids. So I think we can use it when we say, I don't want to be a burden. But if we actually say the situation, the person is burdensome, it's negative, but it's not. It's okay. And anyways, I just wanted to not to go on and on. But I wanted to define that because that is part of what's going on. When you become a caregiver, it is a heavy load and it is a lot of work, and it can be excessively difficult, and it can cause you hardships, and it can cause stress for you. And let's just be real and let's just honest. I think we can be more real with ourselves. We can do the other things I'm going to talk about that are important for you to get through this time in your life when you are being a caregiver. So let's first talk about the emotional strain. So it is chronic stress, right?

You have this constant vigilance and responsibility towards someone else that can lead to long term stress. A lot of people feel guilt. People feel guilty for for taking breaks, for feeling frustrated, for not doing enough. Remember, the definition of guilt is you did something wrong. So if you're feeling guilty, ask yourself. And taking breaks and feeling frustrated, you're not doing anything wrong. You're just being human. Anxiety can come in, right? You worry about the care that you're giving to your loved one. You're worried about their health. You're worried about what the future looks like, what needs they're going to have, and of course, what crises may come up. So that's anxiety, right? Worry about the future, not knowing the outcome. You can also feel depressed emotionally, right? You lose your freedom. It can be socially isolating, and the exhaustion may lead to you feeling depressed, sad, having a really low mood. So that's all normal. That's the emotional strain that being a caregiver can... That's how it can affect you. You can also get burned out. Just the exhaustion from sustained caregiving demands can burn you out. You can have an emotional detachment or reduced empathy over time because it's so exhausting and the things that come with this burden, this difficult job that you have, especially if you don't have enough help.

If the person you're caring for has dementia, they don't remember asking for things, ask for things over and over, they can be difficult, not on purpose, but it's just part of the aging process. And when you have dementia, that you can just get burned out. And you can also feel trapped without an end in sight. So these are really strong issues that come out that can really get you burned out. And you also can have physical health problems. You can have issues with your sleep, you can feel fatigued, you can have an increased risk of chronic illness due to your stress. You can also end up with injuries from lifting or assisting the person who isn't very mobile. So it can affect you physically as well while you're trying to help them. There's also a strain on your role and your identity because that can change. So shifting from spouse to child to sibling to full-time caregiver altars your personal relationships. That's a real thing. And difficulty maintaining a personal sense of self outside of the caregiving role can be very difficult, even though it's really important, which we will talk about, of course, using your CBT tools, how to keep that balance.

You can also have a lot of tension in relationships, the family conflict I mentioned earlier over caregiving responsibilities, and then strained in friendships and romantic relationships due to the lack of time or emotion availability you have for them. You want all these... You want the family support, you want your romantic relationships, you want your friendships. They're more important now than ever, but you're not as available, and that can cause the strain. It's a lot to balance here. It is a lot. Then let's talk about the financial and your work challenges. You can lose income from reduced work hours, the high cost of medical care, equipment, or modifying your home. Where's that money coming from? Some parents might have it to say, here, do what you need. Here's my bank account. Pay for what you need to get the help and how you need to modify the house. And some parents don't have any money and it's coming out of your pocket and you're not getting much from the insurance company. So it's a lot to think about. And then your disruption in your career. Maybe you're getting ready to be promoted and you're like, I don't think I can take on that extra responsibility and be able to care for my parent home.

I don't have enough support. So what am I going to choose? And then that's that vicious cycle of now I feel some resentment, now I'm feeling burned out. This is a burden. It's taking away from me everything I've worked for, but I want to be there for my parents as well. And when you have a lack of support, again, you're going to feel isolated when you don't have adequate help. And sometimes people have a really hard time asking for or receiving help, asking for that assistance you need. Oh, I can do it. Or maybe the person, your caregiver is like, Well, I don't want anybody else in the house. And they're trying to manage when you're taking care of them all the time. That we need to have some healthy boundaries to say, No, mom or dad or whoever you're taking care of, I need this extra help. I need to bring this person in. I need some respite care. You need to be able to work with me so I can have a little bit of break so when I come back, I can be in a better place and not get burned out.

So it's important for you to say, Am I willing to ask for help and receive it? And are there any barriers to that happening with the person I'm caring for? And I have to have a discussion with whoever you're caring for if that's coming up as well. And you really don't want to feel isolated. That's going to go back to feeling depressed and anxious and all these other things that I've been talking about. Those are really the main issues that you may be dealing with as a caregiver. So I talk about the emotional strain, the burnout, the physical health problems, the strain in your role and your own identity, tension and relationships in your life, financial and work challenges, and also the lack of support. So if you identify with any of these, I really would encourage you to reach out and get some help and support. There's so many different organizations in each community that can help with caring for the aging. If your person you're caring for is a specific medical illness, like say if it's cancer, the Cancer Society has a lot of resources. Whatever illness it is, if you reach out to a specific group, a lot of times they can give you resources, as well as you call your insurance company also and see and ask for a case manager, and then they can help you with resources as well.

So you want to just start asking questions and being open, and then you can decide what works for you and what doesn't and what do you need. So let's start talking also before I get into CBT. One other thing I want to talk about was if you're caring for someone with dementia, because it can be really emotionally taxing, it can be physically demanding and mentally draining. Just being around someone with dementia, not even if your caregiving, can be draining because you really need a lot of patience. They're not trying to be difficult or frustrating or even annoying. They don't remember. And they're frustrated. A lot of times people that are starting to get dementia, they can still remember and they know they're not remembering, and it's very frustrated and scary, so you need a lot of empathy. So it's really important first to understand what is dementia, right? It is progressive decline. So I'll I'll just talk a little bit about it, but it is a progressive decline, dementia, including Alzheimer's, and it causes that gradual loss of memory, reasoning, and ability to perform your daily tasks. That's just a basic definition. The behavioral changes that come with that within that person is they can have mood swings, they can get confused, they can be aggressive, and wandering is very common.

You might be at a store and you might say, Hey, Mom, go grab milk. I'll meet you over here. And you never see your mom again. And so you have to go find her, right? Or just stay right here. I'll be right back. And you go back and they've moved already. And you're like, oh, my gosh, where are they? So there's lots of different things that can happen. And we have to have understanding, just like we'd want to have understanding if we ever end up in their position. So the challenge is being a caregiver with someone who has dementia is the emotional stress. And what I'm talking about is you're going to be grieving the loss of the person as you knew them while you're still caring for them. That is really hard, really hard. Especially if it's a parent and they've been like your rock to now see them need you, it's a big deal. It's not like, Oh, yeah, well, this is life. This is aging. It's still really hard. Just a really quick side note, and it's not even about dementia, but I remember when I was in college, my dad had, I believe it was shoulder surgery.

And in between classes, I went to go visit him. And my dad was my rock, an athlete, just always a strong man, emotionally, physically, everything. And I remember him saying, Hey, could you just get that washcloth for me? He just washed my back for me. And I was like, Oh, sure. And I got so anxious seeing him needing me in that way. I didn't think about it. I'm just like, Oh, yeah, I'm going to come visit you, dad, in the hospital. And to see him in a weaker state. I was only about 20 years at the time, but it was really hard for me to see that because I always just depended on him. So to actually take care of a parent that you've really depended on, and now you're grieving their loss as they're there and you're taking care of them is a lot of emotional stress. Again, burnout, as I said earlier, it doesn't hurt to repeat, but the high risk for anxiety, depression, and the physical exhaustion. Caring for them as well often limits your social and personal activities. You're managing their medication, their finances, their safety, their doctor appointments. I hear a lot about that, right?

Just managing that is a full-time job. Do you take your medicine? Oh, yeah. And then you see the pills are on the counter. Or when did you take them last? I don't know. It's a lot, right? Those of you out there listening that are in the midst of this understand what I'm talking about. The physical strategies is keeping a routine. You You want to keep consistent schedules to reduce their confusion. You want to really simplify communication. You want to use short sentences, yes or no questions, so they're not having to think and reason through it. The environmental safety, you want to think about removing any hazards, locks, labeling rooms, keeping some schedule, say, with the medicine. I'm just giving you a couple of strategies if that's what you're looking for here. And really break down your tasks. Rather than doing everything, break things down for yourself as well as the person with dementia. So it's just easier for both of you guys. And again, protecting yourself as a caregiver with someone with dementia. You really need to use respice care. You can use adult day programs, and you can share the duties among friends, family, anyone willing.

So as a friend that might know your parents, say, Hey, I'll come over and hang out with them for an hour so you can go do an errand or take a nap or for a walk. Anyone that's willing to help that you feel comfortable with, just say yes. I love that. I'd really appreciate it. And also, support groups are out there for you as caregivers. They've been around for a long time and you just need to seek out. Again, that's maybe where a case manager could help you find that. You want to maintain your own health, your sleep, staying connected socially as much as you can, setting boundaries. It's not selfish to limit what you can do. I always talk to you guys about setting boundaries. It's so important. And the last thing I just want to address before I get into the CBT tools is it's really important when you need to consider a higher level of care. I know so many times the person you're caring for is like, Oh, I want to be here at home. I want to pass away here at home. And people get really caught up in that, and it may not be the safest thing for them, and it might not be what's best for you.

And it's a really hard decision. But when safety becomes unmanageable, if your health is deteriorating, when you need supervision 24/7, those are times that you need to start talking about a higher level of care, even though you don't want that. We had to do that for my mom. None of us wanted to, but we couldn't take care of her 24/7. And it's a real expense to bring people in. So she had to go to nursing home, which was really difficult. I still hate thinking about it, to be with you, but she needed 24/7 care and we had to make that decision. So there's a lot of things to think about. So how are we going to use our cognitive behavioral therapy tools to help us through this time? So especially when it's long term and intensive, like I've been talking about and talking about how it can be emotionally, physically demanding, your CBT tools can help you manage your stress, prevent burnout, right? We're not looking to manage burnout, we're looking to prevent it and really maintain a healthier thought pattern while you're supporting your family member or others. As always, you want to identify your hot thoughts.

Maybe one of your hot thoughts as a caregiver might be like, you might tell yourself, I can't take a break or I'm selfish or something goes wrong and I'm not there, it's all my fault. Hot thought, hot thought, hot thought. Remember your hot thoughts or thoughts aren't 100% true, right? So you want to recognize these Automatic thoughts, identify if they're hot thoughts, and then, of course, challenge them. So doing your thought records is super important. Right there in the moment, you want to practice them enough on paper so that in that moment, you can say, Okay, why am I so stressed? Because I'm thinking If I go take a walk and my friend's watching my mom and something happens, it's going to be all my fault. Hot thought. I need to go take that walk. It's going to be okay. You also want to reduce any guilt and perfectionism. As a caregiver, you may feel you must everything perfectly, which is not possible. And you want to replace these rigid beliefs you have with more balanced ones, right? So a new belief, new thought could be doing my best is enough and I'm allowed to rest.

I always say progress, not perfection. Especially as a caregiver, I think you're always going to come up with, You know what? This works better than what I did last week, right? Or when I asked my parent this, they seem to understand better. I'm going to do that. I'm going to share with others, this is how you want to ask questions, right? And knowing doesn't have to be perfect. And if someone else has an idea, be open to that and goes, oh, I know how it works. I know how my parents are. Oh, okay, what did you do? What have you learned? Right? Yeah, I'll try that. Let's see how it works. So it's not about being Perfect. It's about learning new ways to address whatever issues come up. Sometimes every day is different, and you don't have to feel guilty about anything. You don't try to be perfect because that's not going to help anything. You also want to manage your anxiety and your catastrophic thinking. So worrying about whoever you're caring for, worrying about their future or their health can just be overwhelming. And we want to stop those spiraling hot thoughts that we have by using are evidence and also focus on what do you have control over.

People get anxious when they're focusing about what they don't have control over, and you want to be able to know the difference. What can I control? What can't I control. If I can't control this, do I need some help? Do I need some resources? Is there something I can do? Maybe not. What can I control is the way that I think, identify my health thoughts, use my tools, take care of myself with sleep, eating well, moving your body, getting exercise every day, getting help in, those things I have control over. I can't control that the dementia is going to increase. I can't control if my parents are going to get their This is going to get worse. But I can manage along the way how I take care of myself and the care I give to them. And that's really important. You don't want this catastrophic thinking because that's just going to put you down that rabbit hole, right? Also, as a caregiver, a lot of times you may withdraw from activities due to feeling so tired or again, feeling guilty. So you really want to think about behaviorally, what am I doing? Remember, I tell everybody it is Cognitive behavioral therapy, CBT, not just cognitive therapy.

What am I doing behaviorally? And even though I'm tired, I don't have to go out and dance with my friends. But maybe I say, I could take a short walk with you. That'd be good. And not to let that guilt like, Oh, I can't leave. I can't leave. I have to always be here. Or if your person, your caregiving for, Oh, please don't leave me. I only like you being here. I only like you feeding me. I only like your meals. Don't let that take control of you. It's like, I appreciate that you like my meals. I I appreciate you like me taking care of you, but I also need other people to step in so I can continue to do that for you. Remember, as I said earlier, definition of guilt is I'm doing something wrong. So that's something to ask yourself when you're feeling guilty. Am I doing something wrong? A lot of times you realize, I'm not doing I don't have anything wrong. That's just this emotion I'm going to because it's just ingrained in me. But it's important that behaviorally I'm doing things for myself. So you want to intentionally schedule things that you find pleasure and meaning in.

For your own mental health so you can continue to be there for the person that you want to be there for. Also your problem solving skills, right? Cbt includes lots of problem solving, right? You want to have some structured approaches to break those overwhelming tasks that you have to address when you're caregiving and make them more manageable. I talk to a lot of people about action plans. If you're using the mind over mood book, action plans are in chapter 10, and it helps you think about about what could possibly go wrong in this situation and what am I going to do if that happens? So now that I have a plan, I can feel a little less anxious. So if there's something coming up, I'm trying to deal with myself or for the person I'm taking care of, what would be my action plan? So I'm thinking of possible problems and possible strategies. So I'm not going in just hoping things will go well because hope is not a plan, but you want to have some real cognitive steps to take going forward. And one last The next thing I want to say is just using mindfulness and stress regulation.

So there is something called mindfulness CBT that people teach as well. And the mindfulness is just being mindful, being present, grounding yourself, right? So you can not get so focused and not get stuck with worrying about the future. And also another part that's really important is self-compassion and having good communication. Again, setting healthy boundaries and asking for help, that is part of good communication. And setting healthy boundaries is part of your own self-care and self-compassion. And realize you're one person. And you can't take all of this on yourself. There's research out there that many times after the person you're taking care of passes away, in about three months, caregivers end up in the emergency emergency room, sick themselves. Because think about it, right? As a caregiver, you're just going, going, going, going, going really starts to hit your body. Because you're in this forward motion as a caregiver. It's like, Oh, I need to be well. I got to take care of them. I can't get sick. I can't get sick. And when you don't take care of yourself, you don't have good balance, eventually it's going to hit you. And I've seen it over and over and over again.

And you don't want that to happen. So easier said than done. I always say that you guys, right? Everything I say is easier said than done. But that's why it's important to have some tools so that you can make it more manageable and have good self-care. Again, whatever that looks like. Treat yourself to a massage. If you're like, do a Manny Petties. If you want to go out and shoot the basketball around, go to a movie by yourself. Nobody's talking to you, nobody's asking you. Nobody has any expectations. What is it that will fulfill you, re-energize you? You deserve it a thousand times over if you have taken on the responsibility to care for somebody. It is a big deal. It is a big deal. And you need to show yourself as much love as you're showing the person that you're caring for. It can be a win-win. It can be a win-win. I've had some really happy memories. You can't see me now, but I smile when I think about just some loving and funny conversations I had with my mom when I would visit with her, when I did take care of her before she went to the nursing home, Even when she started to get her cognitive decline, just some funny things she would say or some sweet things.

And that meant a lot to me. And I'm glad I had that time. I know she felt loved and cared for. And that we wanted to do what was best for her. And that was really important so that you don't have any regrets going forward. And maybe you're not in a position at all to care for your parents. And you need to find a place for them to go. That's okay, too. Again, it's whatever fits your situation. I'm not saying you go care for your parents just because they need you. Not everybody can do that. I knew somebody else, too, that was in a really good financial situation. And I remember the brother said, I can take care of them. And the person And with the money, he said, Fine, I'll give you whatever you need to take care of mom and dad. I will financially foot the bill. I cannot do it. I'm busy. I travel, but I want to support you doing it. So there's a million scenarios, right? I know I've also heard of a parent stays in one kid's house for a month, they go to the other kid's house. And then again, many people just go into nursing homes or a boarding care right away.

So no guilt here, no shame, no judging. Okay, just whatever you can do to help out the person that needs some help and get them in a safe place so they can be taken care of. That's what you need to do. And then you figure out, what does that look like for me regarding visiting and what time and phone calls? Whatever it is that is going to work for you is what's going to be best for everybody because then you can be there more for that person. So I hope this was helpful, especially if this is something that's going on in your life or something you think about down the road. What is that going to look like when my parent needs me or my partner or maybe a sibling you need to take care of? I mean, there's lots of different situations or even friends, right? Some people take care of their friends. Remember that beautiful Beaches? If you haven't seen the movie, it's a wonderful movie. And it was about a friend that stepped in to help her friend that was dying. So it's anyone that you choose to take care of that you need to take care of yourself.

Really, really important. So I hope this was helpful. Please share with anyone that may benefit from this as well. As always, you guys know you can find me at mycognitivebehaviouraltherapy.com.

You can follow me on Instagram at My CBT Podcast.

You can see my videos on YouTube under Dr. Julie Osborn, Facebook Dr. Julie Osborn as well.

On my website, you can find my email, all my contact information, and lots of other goodies. I also have a store where you can find lots of fun merchandise associated with the podcast that helps you along on your journey to wellness.

As always, please keep sharing your thoughts, your concerns, your questions. I love hearing from you, and I'll always get back to you.

And as always, especially as a caregiver, make decisions based on what's best for you, not how you feel.