Care for the Caregiver

caregiver3

By Melanie Trivette

Consider for a moment the number of caregivers in your life. You may first think about professionals: doctors, nurses, social workers, counselors, teachers or hospice workers. You may also see a friend, neighbor, or parent who provides emotional and/or physical support to a relative or person in the community. You yourself may be one, tending to a sick child or elderly parent. The role of a caregiver is not an easy one, yet compassion is a natural response to seeing others suffer. Often the stress of helping or wanting to help can become overwhelming, resulting in ‘compassion fatigue.’

Compassion fatigue is “a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper (1).” Not to be confused with burnout, which encompasses general occupational stress, compassion fatigue can present symptoms of Post-Traumatic Stress Disorder (PTSD) related to indirect exposure to traumatic events (2). These symptoms include, but are not limited to hopelessness, guilt, social withdrawal, and diminished self-care that can lead to negative habits or consequences for the caregiver.

Many caregivers experience compassion fatigue, and letting it persist can have detrimental and debilitating effects on one’s physical, mental, emotional, and spiritual state. Recognizing early signs and symptoms is the first step in managing it. You may already know that you have compassion fatigue, or you may need help assessing your situation. There are online resources available to help you determine your risk, such as this self-test quiz from Compassion Fatigue Awareness Project (CFAP). If you, or someone you know is experiencing or exhibiting signs of compassion fatigue, please consider talking to a licensed professional and trying some of our recommendations below.

Self-Care
One of the first steps toward healing from compassion fatigue is a renewed dedication to self-care. Identifying nurturing, joy-filled practices that help to ‘recharge your batteries,’ and incorporating them into your daily life can have a profound effect in minimizing symptoms of compassion fatigue. Such practices may include exercise, eating well, journaling, dancing, being in nature, meditation and achieving restful sleep. Consider getting an accountability buddy. Often it is easy to say we are going to incorporate self-care into our routine, but it can be the last item on the list, getting less attention than it deserves. Enlisting a friend or colleague as an accountability buddy can be a fun way to approach this new commitment to your well-being (2).

Connect With Others
Compassion fatigue can feel isolating, often presenting as social withdrawal. Seeking healthy relationships that provide the platform for connection and conversation can go a long way to reducing feelings of separateness. Talking about compassion fatigue with a licensed professional, co-worker, and/or support group are also great options. If you are experiencing compassion fatigue in your job, the chances are high that other people in your workplace and community are as well. Gather your resources, such as workplace bulletin boards or support group listings. Try this web site: CompassionFatigue.org

Respect Personal Boundaries
Defining healthy personal boundaries is an additional mechanism for managing compassion fatigue. Maintaining boundaries that promote a healthy work-life balance and checking in with those boundaries on a continual basis can be eye-opening and empowering. Those who do not help themselves first, are in no position to help others. See your personal boundary commitments as instrumental in supporting your role as a caregiver.

When you think about it, do you feel you know what real, healthy boundaries look like? Try these 10 tips from Psych Central to get you on track.

Discover Self-Regulation
Self-regulation may be a concept that you promote to family members, clients, students, and/or patients, but perhaps it is lacking in your own life. Identify methods of self-regulation that suit your lifestyle, such as meditation, breathwork practice, or yoga (3). Incorporate these tools during times of high stress to foster relaxation and build resiliency. See our article on 5 Tips to Be Here Now for simple ways to practice calming yourself.

An important thing to know is that compassion fatigue is a normal experience for many caregivers. Mother Teresa is known to have made it mandatory that her nuns take a year off from their duties every 4-5 years to allow them to heal from the effects of caregiving (4). You can heal from it too. Organizations such as CFAP have made it their mission to help caregivers recognize and manage their symptoms. Included here is a list of resources for those seeking help and support with compassion fatigue:

This blog post was co-authored by Melanie Trivette, Anna Ferguson, and Becca Odom. For more information about the authors, click here.

Please note that these suggestions and tips are based on our opinions, and should not be considered medical advice. If you are seeking to treat a traumatic experience, please consult a licensed mental health professional before engaging in these tips. You can find a practitioner in your area at the National Association of Social Workers web site: www.helpstartshere.org

References:
1. “Did You Know?” Compassion Fatigue Awareness Project. N.p., n.d. Web. 08 Dec. 2015.
2. “Secondary Traumatic Stress.” Secondary Traumatic Stress. N.p., n.d. Web. 08 Dec. 2015.
3. Gentry, J. Eric. COMPASSION FATIGUE PREVENTION & RESILIENCY (n.d.): n. pag. Georgia Hospital Association. Web. 04 Dec. 2015.
4. Hopkins, Debra. “August 1934.” Burnout & Compassion Fatigue (2013): n. pag. My Viewpoint Health. Web. 06 Dec. 2015.

5 Practical Tips to Be Here Now: Decreasing Dissociation

Be Here Now. You may have seen those words on a bumper sticker, heard them in a yoga or meditation class, or even picked up the book of that name by Ram Das. How have these three words, intentionally placed beside another become so mainstream? Perhaps it is because, in today’s society of multi-tasking, the words “be here now” remind us that the present moment is a gift. A gift that when consciously acknowledged has the potential to offer clarity, peace, grounding and perspective.

Anxiety about the future or worry about the past may rob you of the ability to thrive in the present moment. It also may hinder you from understanding the concept of being in one place at one time. In traumatic experiences and memories, there is another form of disconnection from the awareness of here and now, called dissociation. Dissociation is ‘a coping mechanism used to create distance from emotions, cognitions, or somatic symptoms, (1)’ and often causes a separation between one’s physical self, the external environment and cues of danger. In this blog post, we offer five practical tips to decrease dissociation and increase connection to the present moment.

IMG_16745. Find your Feet

One of the key factors of dissociation is the feeling of separateness from the body. By intentionally focusing the mind on the physical aspect of grounding, you can increase present-moment awareness and potentially increase the feeling of being safe and supported. (1)

Our Tip: For this exercise, you may have your eyes open or closed, and you may be standing or seated with feet on the ground. It can be really helpful to do this practice without shoes or socks on, so that you can feel more sensations in your feet.

Bring your awareness to your feet. Wiggle your toes. Feel your feet on the ground, firmly planted. Notice any differences between the right and left foot. Shift your weight from side to side. Often swaying or rocking can have a calming effect on the nervous system, which can also help to increase a sense of awareness and focus in the present moment. Try to then place equal weight into both feet. Wiggle your toes. Connect to the ground beneath your feet, understanding that you are supported by the earth and by your physical body. Notice textures or colors, whether you are standing inside or outside, the temperature of the ground or air around your feet. Notice as many interesting details as you can about the world around your feet.

4. Orienting Practice

We all have orienting mechanisms within our bodies and minds. These mechanisms are what tell us where our bodies are in relation to space. Often times we are using these mechanisms in a Fight-Flight-Freeze response to stress. For example, if we are in the woods and there is a mountain lion, these are the mechanisms we would use to tell ourselves where we are in relation to that mountain lion. The more we can strengthen these mechanisms in a calm state, the more we can increase our ability to access them in a time of need and therefore begin to increase the body-mind connection more effectively. (2)

Our Tip: Here is an orienting exercise you can practice to increase your body’s awareness of where it is located in space, in a calm state. Any time you feel like you want to “check out” or are getting scared or triggered, feel free to practice this skill to help orient yourself to the present moment and self-regulate when needed.  

Calming Forward Folds: Start in a position where you feel comfortable. You can be sitting, standing, or lying down. As you inhale, place your hands at the top of your thighs, then run your hands down your legs (front or back) as you exhale. Inhale, slide the hands back up the legs. Repeat as many times as you like. Notice the sounds, sensations, etc. of this movement. Bring as many of your senses into this practice that feel comfortable and supportive.

3. Breathing Practice

Breathing is essential to life, yet we often go through our day unaware of our breath. The only time we typically become conscious of our breath is when it is shallow or small, or when there is an increase of demand for it. Certain breathwork, or pranayama practices, are specifically helpful in creating a calming experience in the mind, and a grounding presence in the body. Focusing on our breath is an excellent way to “be here now,’” because the breath is the one companion we have with us from the moment we come into this world until our last. (4)

Our Tip: If at any time you feel anxiety during this practice, return to your normal breathing.

First, begin to notice your breath. Try not to change anything about it. Just notice. Are your breaths shallow, or are they deep? Do you breathe through your mouth or through your nose? After several moments of observation, consider closing your mouth (if it was open), and breathe solely through your nose. Does it feel easier or more difficult? If you choose, continue nasal breathing, and noticing the qualities of your breath (1).

Another way to start a breathing practice is to notice belly or chest breathing. As you breath in and out, does your chest or belly move? Do they both move? If most of your breath is in your chest, try shifting it to your belly. With chest breathing there is less capacity for air in the lungs so when we can breathe in our bellies we can get a fuller, deeper breath.

General principles of breathwork state that extending the exhale can have a calming effect on the nervous system, while extending (or lengthening) the inhales can have an energizing effect on the body. Since there is never a ‘one size fits all’ answer, we encourage you to experiment with these practices to see what works best for your mind-body connection.

2. Yoga Practice

The practice of yoga has a way of helping us feel our bodies in the present moment. The body can give us real-time feedback about what is needed and appropriate at any given time. There are several poses that specifically aid in grounding and connecting, thus decreasing the feelings of dissociation.

Our Tip: There are many different styles of yoga that can be practiced to help ground and regulate in the present moment. Here are a few principles of Yoga for Trauma practices that can be a helpful place to start when learning new poses to increase awareness skills and decrease dissociation: (4)

  • Use repetitive, rhythmic movements along with mindful breathing practices to help regulate the nervous system.
  • Practice movements that involve coordinating opposite parts of the body in specific sequences to increase neuroplasticity.
  • Move mindfully into and out of each pose – transitions are key to pain-free yoga.
  • Using breath as a check-in for pain management/triggers/symptoms/etc. Ask yourself, ‘What is my breath doing in each pose? How can my breath be a tool to keep me in the present moment with my physical/mental/emotional experiences?”

IMG_14971. Practice Yoga Brain Games

Throughout our lifetime, our brains become accustomed to what we do and how we do it. Often, many of the things that we do on a daily basis, seem to be performed automatically, and without our conscious effort. Challenging our brain with exercises that are different from our normal routine not only builds new neural pathways in the brain, it also aids in bringing the present moment into our awareness. There are several types of brain games, ranging from crossword puzzles, to using your non-dominant hand to brush your teeth, or driving home a different way. (3) We have created a few Yoga Brain Games you can try as well.

Our Tip: Tip Tap Fingers (4): Begin to tap the tips of each finger with your thumbs, in no particular order. Then start with your right thumb on your right index finger and your left thumb on your left little finger. Begin to tap each fingertip until you end up with the right thumb on right little finger and left thumb on left index finger. Repeat this tapping back and forth several times. Practice with eyes closed, or try walking, talking or counting while doing the exercise to increase the mental challenge.

This blog post was co-authored by Melanie Trivette, Anna Ferguson, and Becca Odom. For more information about the authors, click here.

Please note that these suggestions and tips are based on our opinions, and should not be considered medical advice. If you are seeking to treat a traumatic experience, please consult a licensed mental health professional before engaging in these tips. You can find a practitioner in your area at the National Association of Social Workers web site: www.helpstartshere.org

References:

  1. Emerson, David, and Hopper, Elizabeth. Overcoming Trauma through Yoga: Reclaiming Your Body. Berkeley, CA: North Atlantic, 2011. Print.
  2. Walker, Julian. Awakened Heart, Embodied Mind: A Modern Yoga Philosophy Infused with Somatic Psychology & Neuroscience. N.p.: n.p., 2013. Print.
  3. Beck, Melinda. “‘Neurobics’ and Other Brain Boosters.” WSJ. The Wall Street Journal, 3 June 2008. Web. 05 Nov. 2015.
  4. Odom, Becca and Ferguson, Anna Yoga for Trauma Manual. Asheville, NC, 2014. Print

5 Ways to Improve the Quality of Sleep

Written by:  Melanie Trivette,  500 hour certified yoga teacher

Can you recall a time when you got out of bed to start the day without having a restful night’s sleep? Perhaps you couldn’t fall asleep in the evening despite being exhausted. Maybe you fell asleep quickly, but awoke only a couple of hours later feeling wide awake. Or you could have been tossing and turning all night long, never reaching that deep, restorative sleep state.

If you have experienced any of these sleep disturbances, you’re not alone. The National Institute of Neurological Disorders and Stroke reports that, “At least 40 million Americans each year suffer from chronic, long-term sleep disorders each year, and an additional 20 million experience occasional sleeping problems.” (1) While it is of utmost importance to seek professional, medical advice for chronic, long-term sleep disorders, making some simple adjustments to your day can improve the quality of sleep each night. Here are our top five tips to get you on your way to a sound night’s sleep.

  1. Create a Bedtime Routine

Eating, exercising, and working on a computer too close to bedtime can disrupt your natural ability to fall asleep. Information from sleep experts, including those at the National Sleep Foundation, reveals that creating a bedtime routine that involves winding down can promote an easier transition to sleep. (2)

Our Tip: Aim for a three hour window between when you finish vigorous exercise or eat a heavy meal, and when you go to bed. In the hour before bed take a bath/read a book/listen to soft music, and practice the other 4 tips below to ease into a great night’s sleep.

  1. Add in AromatherapyIMG_1295

Essential oils can be used to promote a good night’s sleep. You can find natural balms, vaporizers, and room sprays that contain any number of essential oils that are known to induce relaxation and calm the nervous system. The University of Maryland Medical Center states, “several essential oils — including lavender, rose, orange, bergamot, lemon, sandalwood, and others — have been shown to relieve anxiety, stress, and depression.” (3)

Our Tip: Sprinkle a couple drops of lavender essential oil on a tissue and place next to your pillow, or use a lavender-scented eye pillow for ultimate relaxation.

  1. Practice Restorative Yoga Asana

IMG_1283This blog would not be complete if it didn’t address yoga’s therapeutic benefit in improving sleep! Certain yoga poses, or asana, are especially helpful in relaxing the nervous system and preparing the body’s systems for sleep.

Our Tip: Try ‘Legs up the Wall’ pose (Viparita Karani) before laying down in bed at night. To practice this pose, lay your hips, back, shoulders and head down on the floor and prop your legs up to the wall. Make the pose as comfortable as possible by placing a blanket/bolster under the hips/low back and a small pillow under the head. If legs completely up the wall is too intense, consider bending the knees and resting your calves and heels on a chair. Comfortably rest in this pose for 10-15 minutes.

  1. Try Relaxing Pranayama

Certain breathing exercises are also extremely useful in calming the mind and initiating the relaxation response. Intentionally slowing down your breathing and creating an exhalation that it slightly longer than your inhalation reminds the body that you’re trying to relax. That helps prepare the mind for falling asleep!IMG_1293

Our Tip: Left-nostril breathing. In yoga, the left nostril is the ‘moon’ channel, and the right nostril is the ‘sun’ channel. Focusing the breath in and out of the left nostril only will produce the qualities associated with the moon channel such as cool, calm, reflective. (4) To practice left nostril breathing, take your right thumb to your right nostril, sealing it off. Then, take at least 5-10 long inhalations and long exhalations through the left nostril only.

  1. Listen to Yoga Nidra

Yoga Nidra, or ‘yogic sleep,’ is a method of relaxation similar to guided meditation. There are several different forms of Yoga Nidra available, but all will systematically guide attention to certain parts of the body with the goal of inviting ease and deep relaxation.

Our Tip: To enjoy the fruits of Yoga Nidra, set aside at least 10 minutes (preferably 20) where you can relax and will not be disturbed. You can lay down wherever is comfortable and listen to a recording of Yoga Nidra right before bed. Many people become so relaxed in this practice that it is common to fall asleep during the recording! If you think you may fall asleep during Yoga Nidra, practice in bed just before going to sleep. (5)

If you have ever had a bad night’s sleep, you know that a lack of quality Zzz’s can lead to increased tiredness, fogginess, and irritability the following day. What you may not immediately experience is that continued sleeplessness can lower your immune response, inhibit cellular repair, and even make you hungrier! Eight hours of sleep a night is optimum for adults, so it is important to be proactive with your schedule and routine to provide enough time for a full night’s sleep. These suggestions can be performed nightly, either by picking a couple of your favorites, or committing to implement all of the tips in your new routine. Don’t forget, some of the tips such as left-nostril breathing, aromatherapy, and yoga nidra can also be practiced in the middle of the night if you happen to wake up and cannot fall back to sleep immediately. We hope that these tips are simple additions to your routine that will help to improve the quality of your sleep. Let us know in the comment section if they are helpful for you!

Sleep tight!

Please note that these suggestions and tips are based on our opinions, and should not be considered medical advice. If you are seeking to treat a traumatic experience, please consult a licensed mental health professional before engaging in these tips. You can find a practitioner in your area at the National Association of Social Workers web site: www.helpstartshere.org
References:

(1) The National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm

(2) National Sleep Foundation sleepfoundation.org

(3) Aromatherapy | University of Maryland Medical Center http://umm.edu/health/medical/altmed/treatment/aromatherapy#ixzz3jr0p0y9N

(4) Yogi Bhajan. Information sourced from http://www.grdhealth.com/yogameditation/leftnostril.php

(5) Soulful Mountain Yoga. Yoga Nidra Recording.

Editors Note: This article was written by Melanie Trivette for Yoga for Trauma. Melanie trained with Hala Khouri in Trauma-Informed Yoga & also trained with Connected Warriors. She has a passion for connecting those in need with the resources to heal and live well.