04/02/2014 11:53 am ET Updated May 31, 2014

Only a Breath Away: Relaxation Techniques to Reduce Caregiver Stress

We've all been given the advice "take a deep breath" when experiencing high levels of stress or anxiety, and while that usually does the trick, many of us are unaware of the full health benefits that can come from practicing certain breathing techniques. Family caregivers in particular are prone to experiencing anxiety, chronic pain or sleeplessness, but they may not know that there are plenty of non-invasive, non-pharmaceutical ways to get relief, including deep breathing, visualization and meditation.

These techniques, which aim to elicit a "relaxation response," can be learned on your own, through books and YouTube videos, though one-on-one training from a professional often proves to be the most effective.

If your family member has home care in place, you may be lucky enough to get a clinician who is trained in these complementary health therapies and can work directly with you and your loved one. Amelia Muir, BSN, RN-BC is a Behavioral Health Nurse with the not-for-profit Visiting Nurse Service of New York. She was trained at the Watson Caring Science Institute in Boulder, Colorado, which offers a caring model that focuses on the whole person, rather than just their disease. The model strives to create a healing environment for patients and families that takes into account both the physical and spiritual self. In her work as a behavioral health nurse, Amelia's counseling sessions can sometime become stress-inducing as patients relive difficult experiences and memories. The training Amelia underwent enables her to share her knowledge of meditation, mindfulness and positive thinking with her patients, who can immediately see results as their breathing evens out, and blood pressure lowers.

While this may sound a bit "hokey" to some, there is some hard research behind the use of these techniques for reducing stress. For example, most of us are familiar with the "flight-or-fight" response identified nearly 100 years ago by Harvard physiologist Walter Cannon. He defined a "stress response" (SR), a set of involuntary physiological alterations that include increases in heart rate, blood pressure, respiration rate, and metabolic shifts that liberate energy. But more than 30 years ago, cardiologist Herbert Benson characterized another physiological state, the relaxation response (RR). The RR, which can be voluntarily elicited, is associated with decreases in oxygen consumption, respiratory rate, and blood pressure, along with an increased sense of well-being. 1

Many people can elicit the relaxation response on their own--through exercising, engaging in a hobby, or practicing their religion. We sometimes call this "getting in the zone" or "getting those endorphins flowing." For those living with multiple comorbidities and who take multiple medications, including those in managed long-term care, like VNSNY CHOICE, this relaxation technique can be life-changing when financial resources to see a special therapist or attend a community workshop are not an option. The problem for family caregivers is that they often feel that they cannot find the time to engage in such activities, particularly if it means they'd be leaving their loved one alone in order to do the activity. It falls upon their caregivers to manage these tasks while also prioritizing time for themselves for the sake of their own health and well-being. We also have to be realistic that the caregiving years pose unique challenges on a person's time and freedom. Techniques to reduce stress and improve well-being will be best utilized when they can be done in the home.

Blood pressure reduction is one of the most consistently observed changes during studies of the relaxation response.2 A 2008 study at the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital in Boston, MA, showed that patients utilizing the relaxation response were able to eliminate an antihypertensive medication while maintaining adequate blood pressure control more easily than those who did not use the RR.3 Lower blood pressure is indicative of a body relaxing, both physically and, hopefully, psychologically.

So what can you expect from a nurse practicing a complementary health therapy? According to Ms. Muir, the first thing she does when working with a family caregiver under stress is listen to what is making them feel overwhelmed. Then she asks what they are doing to manage their stress. "More often than not, they are not doing anything productive. Either they're too exhausted, or they can't get out of the house to participate in enjoyable activities. They may be substituting unhealthy behaviors -- such as smoking, watching TV, overeating, or arguing -- which ends up making them feel worse. So I teach them strategies they can do in the house, things that don't require a lot of energy at the start." For example, breathing exercises.

When we are anxious or angry the stress response causes us to breathe quickly and shallowly. Rapid, shallow breathing can in turn lead to a racing heart, increased tension and interrupted sleep. Improving shallow breathing through focused efforts to calm and deepen your breathing can be very calming. You can do this for five minutes or even just one minute, and you can do it on a regular schedule each day, or any time you feel anxiety creeping up.

Madelina A. is a caregiver for her brother who has Parkinson's disease and arthritis. Their relationship has always had a lot of conflict, and for Madelina, this is the hardest part of being a caregiver -- spending a lot of time with someone you don't easily get along with. "The physical tasks of caring for him don't bother me very much. But when he complains about his life, or about what I'm doing, or how I'm managing the house, it makes me feel this is all not worth it."

Ms. Muir introduced Madelina to breathing and visualization exercises and encourages her to use them every day when she first gets up, but especially when she starts to feel the conflicts with her brother heating up. "I tell her, don't wait until you're about to snap. Go in the other room as soon as possible, and start your breathing." Madelina has learned that deep, slow breathing really calms her, and she's learned how to visualize positive outcomes in her caregiving. "While I wouldn't say I've become a master at meditating, it does help me to visualize myself as a competent caregiver, and to be mindful that that my brother is fighting with me because he feels vulnerable, dependent and afraid. Sometimes, this is all I need to get through an afternoon."

Ms. Muir tries to cultivate mindfulness in family caregivers. A buzzword you may have heard, mindfulness is simply being aware of what is actually going on at the moment, and reacting appropriately to that reality rather than some What-If scenario. "Many people fear what MIGHT happen and get bogged down by the worst case, hypothetical, scenario. But the reality they are facing today, or the pain they are actually experiencing at the moment, is tolerable. So I tell them to ask themselves -- rate your back pain at this very moment. Don't allow your memory of your back pain, or your fear of what it could be, to influence that rating. Often, when they really examine what they are experiencing, it helps them relax."

So if you're experiencing symptoms such as depression, anxiety, chronic pain or fatigue, consider complementary therapies -- breathing exercises, visualization, and meditation, as one more tool in your toolbox, rather than lashing out or taking a pill or a drink. Adopting strategies to manage stress at home will enable you to continue to provide necessary care for your loved one for the long-term.