Dr. Selchen is a Staff Psychiatrist and Director of Education at Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre.

Stress affects everyone. Where does yours stem from?

I don’t think my stressors are significantly different from a lot of folks. In no particular order, there’s work. As a psychiatrist, there are a lot of people who rely on me, especially throughout this pandemic, so being present and available can be challenging. I have other roles; I’m a husband and father, and I want to support my family through the challenges they are facing. So stress comes from having enough time in the day to attend to those people and things that are meaningful to me, along with the other things that get in the way.

Would you describe yourself as a calm person?

I don’t know if I’m calm by temperament, but I’m calm but cultivation. I am an “earned” calm. My professional focus is on people’s mental health and wellbeing. One of the selfish benefits of this job is that I can help myself as much as others, and I wouldn’t be authentic in my work if I didn’t do that.

So what does that look like for you?

Especially during the pandemic, I’ve been mindful to keep track of my relationships, so making time for people and checking in on them. I carve out time every day for meditation practice. I do yoga. I’ve also been doing martial arts for years and have a black belt in karate. It’s been great for physical, mental and spiritual health. I also have a Netflix practice.

Tell me more about your Netflix practice!

I’m human, I watch television. My kids are big into the Marvel cinematic universe so we all love that. During the pandemic, it was hard not going to movie theatres, so we translated that into family movie nights.

Part of your role is teaching mindfulness. It seems like such a big abstract idea.

For many people, mindfulness has become synonymous with calming the mind and emptying it of thoughts. To be honest, that’s not how I would define it. Mindfulness is really about the relationship we have with what we encounter and our life experiences. The people, the sights and sounds and events around us and within us; the physical sensations that move through our bodies, the thoughts that move through our minds and the emotions we are experiencing. So it’s really a question of how do I relate to those things? Am I relating in a way that’s adding more stress, or am I relating in a way that lets me work with the challenges? A lot of what I do is helping people unlearn what they thought mindfulness was all about.

How hard is it to practice what you preach?

There is a real difference between embodying and modelling. Modelling is about putting on a behaviour that I want you to have, but it’s deliberate and not necessarily authentic. It’s about playing a part. Embodying is really living a behaviour; the more we can do that, the more authentic it is, the more meaningful it becomes for us and the more impactful it is for others. When it comes to taking my own advice, embodying good habits and behaviours is what I try to apply into my own life.

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Answer: I must admit that if you’ve been reading my blog on a regular basis, the good news is few and far between. So before I dedicate a blog to the important topic of caregiver stress, let’s concentrate on what might be the positive and even enjoyable aspects of caregiving.

As you might expect, the study of the positive aspects of caregiving has received little attention in the research related to Alzheimer’s disease and dementia. My colleague at Sunnybrook, Dr Carole Cohen, has been one of the pioneers in this area, studying the topic for over 20 years. What has become apparent, is that being able to find and focus on the positive aspects of caregiving has important outcomes including reducing caregiving stress, improving emotional status, and possibly reducing the likelihood of institutionalization. Dr Cohen has determined that being able to find at least one positive aspect to caregiving is present in about three quarters of caregivers.

So what do caregivers identify as being positive or enjoyable about caregiving? Responses include having the love and company provided by the patient, feeling the relationship has been strengthened by the caregiving, enjoying pleasant interactions with the patient, improving the relationship with the patient and other family members, sharing past memories, feeling accomplished and proud in the role of a care provider, being able to fulfil a duty, obligation, or responsibility, being able to make proactive decisions, and being gratified by the fact that their care is leading to the avoidance of institutionalization. For some, the small daily moments of smiles, laughter and joking is enough to keep caregivers going.

Does finding pleasure in caregiving lead to less burden and stress, or does less burden and stress lead to greater ability to find pleasure in caregiving? The answer is probably both. Less caregiver depression and fewer behavioural problems exhibited by the patient have been associated with more positive caregiver experiences, but being able to spend less time assisting the patient with basic activities of daily living has also been associated with more positive caregiver experiences. Some researchers have noted that being able to find pleasure in overwhelmingly negative experiences can be an excellent coping technique for caregivers. Other research has described the importance of the “search for meaning” of the experience as being a positive and necessary activity for caregivers.

While emphasizing the positive aspects of caregiving is important and potentially beneficial for both patients and their caregivers, there is a possible downside. Some caregivers may be convinced that they are the only ones who can adequately care for their loved one with dementia. This may impede getting the extra care they need from community sources, and/or lead to refusal to institutionalize, even when it might be in the best interests of the patient and their caregiver.

As a Memory Doctor, I believe it is one of my responsibilities to act as cheerleader for the caregivers of my patients. I always try to emphasize what a great job they are doing and how they are ultimately ensuring that my patient has as good a quality of life as possible. I can’t always convince them that caregiving is enjoyable, but I can usually help them to feel a sense of mastery and satisfaction in their role.

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Going through cancer treatment during the holidays can completely change your perspective during what should be one of the happiest times of the year. Patients and families struggle with how they can celebrate when they or someone close to them is coping with cancer. Patients wonder if they will feel well enough to enjoy the holidays when they going through radiation treatment, receiving chemotherapy or recovering from surgery. There are questions about whether they will have the energy to participate in family celebrations and worries about what the coming year will bring. While everyone else is moving ahead with holiday preparations and celebrations, our patients are facing a very uncertain future. They may feel pressured (by themselves or others) to carry on with the traditional holiday rituals, even though they may not have the physical or emotional energy to do so.

As the holiday season gets into full swing, here are some tips for families affected by cancer.

Focus on your own well-being.

Whether you are a patient or a caregiver, first and foremost you have to focus on your own wellbeing.  Eat well, ensure that you get your rest — including naps — and stay hydrated. Do not abandon your regular routines to accommodate the hectic holidays as these routines are what have helped you cope so far. Allow yourself to do less than you are accustomed to doing during this season and allow yourself to ask for help, whether that is with picking up gifts or bringing in food or helping with decorating and cleaning.

It’s OK to say no.

Remember that it is OK to say no. You do not have to accept every invitation or accommodate every request.  Most importantly, be flexible and know that, even if plans have been made, you may have to reschedule or change plans depending on how you or your loved one is feeling that day – and let people know that when you accept or offer an invitation.

Plan ahead.

Clinic closures may be a source of stress for you or your loved one. It is important to know what dates the cancer centre is closed over the holidays and who to contact in the off hours if you run into difficulty. Ensure that you have enough of all your prescription medication to last through the holidays

Prepare for questions.

Inevitably, family and friends you see over the holidays may ask questions about your diagnosis and how you are doing. Allow people the benefit of the doubt that their questions are expressions of concern. But know also that you do not need to explain your medical situation or provide any information beyond what you are comfortable disclosing. It may be helpful to coordinate an exit plan with one of your caregivers if you feel their questions or inquiries are becoming overwhelming.

Remember things may be different – but try not to focus on those differences.

This holiday season is not like all the others so do not pressure yourself to make it so. Give yourself the time and the permission to make changes and create new traditions this year that make it easier for you to participate. Instead of making the whole Christmas dinner, offer to host a potluck. Or hand the tradition to a sibling or child.  Try not to focus on what might be missing, on what tradition wasn’t kept, or on what might be different about this year’s holiday season from those in the past. Rather, try to focus on the moment and enjoy your celebration in whatever form it takes. Remember what the holidays are truly about – a time for being thankful and sharing with others.

If you have concerns about how to cope with the stress of the holidays, talk to your health care provider and let them know how you are feeling.  Support is available through the Patient and Family Support Program at the Odette Cancer Centre. Wellspring also has various support programs available.

The post Coping with cancer during the holiday season appeared first on Your Health Matters.

1. Is my stress level is normal?

We all experience stress from time to time, but this stress does not necessarily impact on our day-to-day functioning. This is normal stress. When stress starts to get in the way of our lives (e.g., work, school, relationships, daily responsibilities, social life, etc) or it occurs at level that we find too distressing, that is when we begin to classify the stress as being “maladaptive”. When it comes to the way in which our stress or anxiety affects our performance on various tasks, research shows that having some anxiety can actually be beneficial.

Having some anxiety about how you will perform on a test will likely lead to you studying and taking the time you need to prepare for the test. But, having too little or too much anxiety may actually hinder performance.

2.       What can I do to reduce my stress level?

There are many things that we can do to help manage our stress levels. General self-care is very important when we are experiencing stress. Things like getting enough sleep, exercise, balanced and healthy eating, and social engagement can all help modulate our stress levels. It is also important to make sure that we get a good balance of engaging in activities that make us feel productive (e.g. doing work, paying our bills, chores, etc) and activities that we find pleasurable and fun (e.g. hobbies we like, being with family/friends, playing sports, etc). If you’ve tried these strategies and it feels as though your stress level may still be difficult to manage, it can be helpful to speak to a professional who may be able to provide you with additional strategies to help manage your stress.  We have proven effective psychological and medical treatments for those experiencing more clinically significant stress.

3.       My mom says I should do yoga or take some deep breaths – will that help me feel less stress?

Yoga and deep breathing can be quite helpful for stress. Deep breathing is one type of relaxation strategy that involves taking deep breathes through your diaphragm. Research shows this type of breathing can reduce feelings of anxiety. There are other relaxation strategies that can be helpful as well, such as progressive muscle relaxation. This exercise requires you to tense and relax various muscle groups throughout your body and train yourself to notice the difference between the tensed and relaxed states.

4.       Does exercise help?

Yes, there is research to suggest regular exercise of at least a moderate intensity is associated with improvements in anxiety and depression. To achieve health benefits, Canada’s physical activity guidelines recommend that adults aged 18-64 engage in at least 150 minutes of moderate-to-vigorous aerobic physical activity (i.e. exercise that makes you sweat) per week.

5.       Are there any foods or drinks that might make me feel better or worse?

Eating a balanced and healthy diet can be helpful for managing stress. It is also important to limit use of alcohol and caffeine. Beverages that include alcohol and caffeine can affect our sleep and impact our body’s stress response.

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