By Barry J. Jacobs, AARP, Nov. 2023
Strategies to observe and stop harmful behavior in its tracks. During my caregiving years, I worried. A lot. My mother had poor balance and fell frequently, and I worried she would get hurt. She was having early dementia and was confused about her medications, and I worried she would experience an adverse drug reaction. I fretted that she did not eat properly or manage her money well or spend enough time with other people. I worried endlessly, often needlessly, except for the few occasions when the worrying was warranted.
Why did I worry so much? Partly it is a lifelong, inborn habit; I come from a long line of highly expert worriers. Partly it was that I felt totally responsible for her as her primary caregiver. Nothing bad could happen to her, I said to myself. Not on my watch. I was not going to let her or any of my family members think I was an inept caregiving son. I brooded continuously about all the possible things that could go wrong and then tried my best to control them to prevent my mother from suffering.
Is this normal? Most other caregivers do not worry as much as I did. They know there are limits to how responsible they can be for the care receiver. In the wise words of the Serenity Prayer, they accept the things they cannot change. I tried to realistically accept that I could not be there to catch my mother each time she lost her balance and fell. Knowing that, though, did not stop me from worrying.
Worry does have its positive purposes. It puts us on guard for danger, prompts us to take steps to prevent bad things from happening and prepares us to act quickly when they do. But there is a word for too much worrying: anxiety. One shorthand definition of anxiety is “uncontrollable worry.” It is more common than depression. The minds of anxious people flit about from worry to worry before often looping back to the first thing they worried about and repeating the cycle. That brings them no closer to solving the problems they are ruminating about. We can say their thinking has become overrun by worries.
Being anxious does not improve caregivers’ performance. To the contrary, anxiety makes it more difficult for them to take in new information from care receivers’ doctors or case managers and then respond appropriately. It gives caregivers racing thoughts that keep them up at night. It detracts from their quality of life. Yes, caregivers will inevitably worry and for good reasons. But to be as effective as possible, they should take steps to avoid becoming anxious. Here are ideas for how.
Distinguish worry from anxiety
Worry is usually reasonable. Anxiety is always excessive.
For example, the night before one of my mother’s 10 a.m. medical appointments, I would worry about getting her up, dressed, groomed and fed in the morning to make the appointment on time. I knew she was a world-class slowpoke. If I became anxious about it the night before, however, then I would think of practically nothing else but how hard it would be for me.
I would “catastrophize,” assuming she would not want to wake up or go to the doctor and would protest that I was rushing her. (I certainly was rushing her.) I would be up half the night worrying about how the next morning would go and then awaken grumpy, which did not help me be the good caregiving son. When my anxiety was most severe, ironically, I might even oversleep myself. Then we would certainly miss her appointment, to my endless chagrin.
Observe your thoughts
The best strategy for avoiding anxiety is to step back and observe your own thoughts to better judge whether your worries are reasonable or excessive, and then try to keep the challenges in front of you in proportion — i.e., avoid making mountains out of molehills.
One way is to keep a diary of whatever is on your mind. You can then read what you have written a day or a week later and have a clearer idea of whether the worries you were experiencing deserved as much brain space as you gave them. Another is to ask for feedback from a trusted friend or partner. There were many times when I would share my caregiving worries with my wife (a fellow psychologist), and she would point out how I was going overboard. Our conversations also prompted me to do other things for anxiety, like more physical exercise and identifying and analyzing my anxious thoughts using cognitive behavioral therapy.
Consider treatment for anxiety
When anxiety is so severe that you cannot self-correct, then it is time to consider some of the many effective available treatments. Most mental health therapists can teach behavioral techniques, such as cognitive behavioral therapy (which is based on observing your thoughts) or mindfulness practices that reduce uncontrollable worry. Most primary care providers routinely prescribe proven anti-anxiety medications.
Caregiving will never be worry-free. But caregivers can recognize and control anxiety, do a better job and feel happier in the process.