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By ºìÌÒÊÓƵ¸ßÇåappÏÂÔØ social worker Marylynn Tackett

What is stress?

We live in a fast-paced culture where change, and the pressure to react and accept change quickly, is a constant fact of life. Stress is a normal reaction in our bodies to things that require us to modify our usual patterns of behavior. Stress heightens our awareness, makes us more alert and prepares us to deal with dangerous situations.

For most of us, becoming a caregiver to a person with kidney disease can be a stressful change. It is easy to feel overwhelmed and unable to cope.

While it may not be possible to avoid the stressful situation of being a caregiver to someone with renal disease, we can learn to cope with stress in a healthy way. All of us can learn to control the way we react to stress and change how stress affects us.

Warning signs of stress

It is important to recognize the physical, emotional and behavioral signs that our bodies send when we are in stressful situations, such as caring for someone with end stage renal disease (ESRD). If we recognize these signals early, we can take the action needed to minimize the harmful effects of prolonged stress.

Physical signals

• Inability to sleep or sleeping too much
• Weight gain or loss
• Feeling tired all the time
• Change in posture—walking with your head down or with a stooped posture
• Chronic headaches, neck pain or back pain

Emotional signals

• Anger
• Frequent crying spells
• Inability to think clearly or concentrate
• Excessive mood swings
• Feelings of sadness that don’t go away

Behavioral signals

• Withdrawing from usual activities and relationships
• Quitting or changing jobs frequently
• Becoming more impulsive and over-reacting to things
• Using alcohol or drugs to feel better

Coping skills and techniques to deal with stress

If you find yourself feeling some of the signals listed above, read on. Many, or possibly all, caregivers, family members and friends who are closest to a person with a chronic health condition may show some signs of stress at one time or another. The good news is there are ways you can care for yourself as well as your loved one with kidney disease.

Modify your behavior patterns

• Become more assertive—share your expectations with other caregivers, friends, family, etc.
• Seek out others for support and assistance—don’t be afraid to ask for help from others, including ºìÌÒÊÓƵ¸ßÇåappÏÂÔØ team members. 
• Make time for, and focus on, your positive social and family relationships.
• Continue physical activity—walking program or other activity as you are able.
• Take time to reward yourself—have some fun.
• Laugh—it is the best medicine. Read the funny papers or a humor book, watch a comedy program or movie and look for humor in any situation.
• Be flexible—learn to prioritize and to let some things go.
• Eat healthy, avoid tobacco and excessive use of alcohol
• If something is wrong or overwhelming in your life, seek out the advice of others—family, trusted friends, clergy or social workers

There are several relaxation techniques that may help relieve the stress of caring for someone with kidney disease. Below are just a few. They are best done sitting comfortably in a chair, or lying flat on bed or on the floor. Try some of these and if they work for you, or if you find others that are helpful, be sure to share them with other caregivers and patients. Everyone could use a little less stress in their lives.

Two-minute relaxation

• Concentrate on yourself and your breathing. Take a few deep breaths, exhaling slowly. 
• Mentally scan your body. Notice areas that feel tense or cramped. Quickly loosen up these areas and let go of as much tension as you can. 
• Rotate your head in a smooth, circular motion once or twice (STOP if any movements cause pain).
• Roll your shoulders forward and backward several times. 
• Let all of your muscles completely relax.
• Recall a pleasant thought for a few seconds.
• Take another deep breath and exhale slowly. You should feel relaxed.

Mind relaxation

• Close your eyes. Breathe normally through your nose. 
• As you exhale, silently say to yourself the word “one,” a short word such as “peaceful” or a short phrase like “I feel quiet.” 
• Continue for 10 minutes. 
• If your mind wanders, gently remind yourself to think about your breathing and your chosen word or phrase. 
• Let your breathing become slow and steady.

Deep breathing relaxation

• Imagine that your abdomen is a balloon. 
• Inhale slowly and deeply imagining that you’re blowing up the balloon, and then slowly exhale imagining you’re deflating a balloon.
• With every long, slow breath, you should feel more relaxed.
• Continue for a few minutes, or longer, if you have the time.

Guided imagery

• Guided imagery is a technique that involves focusing on a particular visual image, sound, taste, touch or smell to create a specific physical reaction—in this case relaxation. Focus your mind on some sensory factor that pleases or relaxes you (the smell of baking cookies, petting a silky dog, the ocean at sunset) and try to recreate and enjoy that feeling.
• Also called guided meditation, it is a form of mind-body therapy that can bring about deep relaxation and positive focus, the state of mind and body most conducive to healing.
• Guided imagery can also be used to release tension, anxiety and stress.

Biofeedback

• Biofeedback helps a person learn stress-reduction skills by providing precise, immediate information about muscle tension, heart rate and other vital signs.
• It is used to learn total body relaxation and to gain control over certain physiological functions that cause tension and physical pain.
• Talk to your doctor or social worker about biofeedback to find out if it will help you and ask for a referral to a qualified biofeedback therapist.

It is possible to cope with the stress we encounter in our daily lives. As someone who provides care for a person with a chronic health condition, it is important to remember to take care of yourself. Check for the warning signs of stress listed in this article from time to time, and use the tips and techniques when you find yourself feeling stressed. In addition to helping the caregiver, these tips can also be very helpful to those who have chronic kidney disease.