Caring for Caregivers, Part 4 - Thinking for a Change

"In our first three blogs, we discussed where irrational beliefs may have originated to provide you with some context as to why some caregivers end up having tremendous anxiety and react to stress in an unhealthy manner," said certified elder law Attorney RJ Connelly III. "In our final blog on Care for Caregivers, we are going to examine ways to begin changing our irrational belief system using an ABC method, called cognitive restructuring, and a downloadable workbook that can help you make these changes."

Epictetus' Insights Have Answers

The understanding of how our beliefs create problems for us is nothing new. As humans, we are fallible and always have been. In fact, this was understood dating back to the early Greek philosophers. Central to understanding this is the ancient psychological insight of Epictetus, a Greek Stoic philosopher who said, “What disturbs men's minds is not events but their judgments on events.”


Just what makes Epictetus so special? He was born a slave over two thousand years ago in what is present-day Turkey. Some say he had one of his legs badly maimed by one of the slave owners who beat him. This led to a life-long limp that did not deter him from having a happy and complete life. Shortly after Nero's death, he started teaching philosophy in Rome for 25 years, until the emperor Domitian banned all philosophers from Rome. He fled to Greece where he taught his brand of philosophy until his death.

What made Epictetus different was his type of philosophy - he was not theoretical, living in a make-believe world of his own creation, but instead sought to make his philosophy workable for the most common man - and applicable to real-world problems and situations. His words served as inspiration for many people caught in tricky situations or enduring challenging times.

"Epictetus...was not theoretical, living in a make-believe world of his own creation, but instead sought to make his philosophy workable for the common man - and applicable to real world problems and situations."

One of his most famous followers in the modern-day was vice-admiral James Stockdale, who was a prisoner of war in Vietnam for over seven years. Stockdale was placed in leg irons, unable to move around in his cell.

James Stockdale

During this time, he remembered that Epictetus had a disabled leg from the abuse of a slave master yet still looked at this rationally, stating, “Sickness is a hindrance to the body, but not to your ability to choose unless that is your choice. Lameness is a hindrance to the leg, but not to your ability to choose. Say this to yourself about everything that happens, then you will see such obstacles as hindrances to something else, but not to yourself.” Epictetus' teaching allowed Stockdale to look inward and draw inspiration from the philosopher's reality-based words. He later went on to be the running mate of Ross Perot in the 1992 Presidential race.

Epictetus' Insights on Reality

Epictetus believed that nearly all external events are beyond our control; therefore, we should accept whatever happens calmly and dispassionately. Given that, let's look at some of his major teachings.

There are some things you can control, but most things you cannot. Focus on what you can change and let the rest go...

This is the basis of our caregiver series. Once you begin to accept this and believe this to be true, you are certainly on your way to living a happier life. For instance, you can't control how dementia may progress in the person you are caring for, or the illnesses he or she may get, but you can control the doctor's appointments, when meds are given, and setting up times to discuss progress with family members.

Let go of the unchangable

You have little control over external events, for instance, lightning strikes your home, and it burns to the ground. What you can control is how you will go about rebuilding it, calling the insurance company, and making plans for a place to live while waiting for the rebuild. What this means is that you focus only on things that you have the power to control. To worry about the fire and the lightning is something that cannot be changed. Let it go and move forward.

If you keep this at the top of your thought processes, your focus naturally turns to what is important and away from unhealthy worrying or scapegoating others. If you make plans around things that you can control and something occurs to disrupt that plan, take a breath, put it into perspective, and develop a new one (see some tools later in this blog).

Stop wishing for things you have no control over...

Most things in our lives are out of our control, so to wish for something that you have no way to obtain will only end up with frustration and stress. For instance, to wish that an unhelpful sibling would assist in taking care of your mother with dementia only sets you up for disappointment, especially after you had been told no more than once.

Therefore, you must be your own genie in the bottle. Only wish for those things that you yourself can make come true. Never, ever desire something that depends on the actions of others, otherwise, you will eventually be disappointed. But even those things that you may be able to make come true, keep those wishes within your reach. Don't wish to own an ocean liner but wish for a two-week cruise.

What disturbs our minds is not events but our judgments on those events...

So, you get upset because a family member says they cannot help, and you start getting mad, yelling, and throwing items against the wall. Did this help you in any way? The event is over, you can't change the words you heard.

Was anything accomplished by screaming?

What you want to do is channel this energy into the future. Begin to think of ways to help yourself, maybe by calling a home health agency, or asking another family member. You might judge your family members as lazy and worthless, but they could have their own issues and problems as well. And if not, carrying a grudge gets you nowhere. Take that energy in a positive direction.

And let's briefly touch on your judgment of the event. So, your family member tells you they can't help, do you take it personally, see yourself not being worthy of assistance? Do you feel they are judging you as not being able to "handle" the caretaking duty and then you take the stance that you won't ask for help just to prove you can do it -- no matter what? Both are self-defeating behaviors that set you up for anxiety and frustration.

Take a breath, do not read anything into the situation, channel that energy to finding other solutions to the problem. Any other use of your time is wasted and non-productive.

Decide to fix the problem, not pointing fingers at others for your misfortune

In today's irresponsible society, people tend to blame others when their life choices or other circumstances turn out less than positive. This is only counterproductive. So, you made a choice to become a caretaker for a loved one, and things may not be going well. To blame other family members only serves to increase anxiety and pile-up resentments. Instead, consider ways to make the best of what you have.

Accept the fact that you are responsible for this choice and no one else. Even if you have been "thrown" into the role, you are there, so make the best of it. Do some homework, check out senior centers, investigate what programs may be available for your loved one, and those that can provide you with support.

"Accept the fact that you are responsible for this choice and no one else. Live your life and not the lives of others, stop trying to guess what another would do and make your own decisions..."

Take matters into your own hands, grab the bull by the horns. Live your life and not the lives of others, stop trying to guess what another would do and make your own decisions if they refuse to help. On the other hand, don't take credit for the victories of others. Epictetus warned against being elated at the excellence that you did not achieve. Let me tell you a brief story.

As a supervising clinician at a hospital program in Boston, our team dealt regularly with clients who presented with suicidal thinking. A new clinician was assigned a client who was threatening to suicide. The pair met and the client appeared to let go of his suicidal thoughts. The new clinician began to tell others that she had "saved his (the client's) life" with her intervention. The following day, the client had completed suicide through an intentional overdose of fentanyl. She was devastated.

I met with her the following day and told her a lesson I had learned from a well-respected and wisdom-filled clinical psychologist, the late Dr. Paul Gerson. He asked me this question years before, "if you are willing to take credit for saving the life of a suicidal individual, are you also willing to take responsibility if that person takes his life?"

What Dr. Gerson succeeded in teaching is this -- individuals are responsible for their own choices, both good and bad. All we can do with others is give them the tools they need to help themselves, and then let them do the best they can. If they fail, they can come back for more help and if they succeed, then they can be proud that they did it themselves. Even failing and coming back for help is a victory of sorts, because the individual has embraced failure and is looking for help to try another way. Taking responsibility and making good choices is what we want others and ourselves to do. And one other thing, never want more for others than they want for themselves, because if you do, you are involved in a fool's errand.

Don't seek instant gratification, it's a road to a bad end...

Smoking cigarettes to deal with stress, spending inordinate amounts of time on social media where everyone has a perfect life, and even gossiping, are evils that must be avoided. All these things give the brain easy hits of dopamine and a short-term feel good, but eventually, the damage they cause is sometimes irreparable.

Avoid instant gratification -- in any form

In our society today, many people lack the willpower to overcome such temptations. Instead, they fall into the trap of instant gratification. They look for the effortless way out, smoke a cigarette rather than go to a caretaker support group, go on Facebook, and read how Jim and Jane travel around the country while they are taking care of an elderly parent (in reality, Jim and Jane are in debt up to their ears). But we like to compare ourselves to others and at times become envious. In the end, seeking instant gratification has adverse consequences, including stress, anxiety, and frustration.

So how can you avoid taking the route of instant gratification? Instead of thinking of the momentary pleasures that a cigarette would provide, or posting a negative statement on Facebook to "vent" (another quick lesson from Dr. Gerson, "if you are going to vent, make sure you also have some solutions in mind, otherwise venting without plans to make things better adds fuel to the fire that will only grow bigger and out of control with nothing to extinguish it.").

Think of what is good for you overall, how much better you will feel when life stabilizes once again, and you were able to refrain from these non-productive actions. And even better, you might not have burned bridges by your hasty post or comments condemning other family members.

Reframe your thinking. Instead of challenges, think of this event as a learning opportunity...

Even the most unpleasant events have opportunities. For the person whose home had burnt down because of a lightning strike, one could say that the home needed extensive plumbing upgrades anyway that needed to be done before the next insurance inspection, so nature just made it happen sooner. Or even more philosophically, the event helped the family learn to pull together in a crisis and adjust to an extremely negative circumstance, a life lesson that all will carry on in the future. In other words, look hard, an unseen benefit can always be found even in the darkest circumstance.

Now back to irrational belief systems and making changes.

The Need to Succeed

We have goals. We want to accomplish them. We want to succeed. Be it in our career of choice, a relationship, caregiving, school, etc. But for some, possessing an irrational belief system can block them from achieving their goals leading to frustration and unsuccessful outcomes. Make no mistake about it, these beliefs are entrenched and difficult to replace but we can begin to change the way we perceive events and respond to them. But it takes practice, practice, practice.

Think about that for a second (or two, remember to respond and not react). As we discussed earlier, we have learned things in our lives that are ingrained within our minds. Every experience we now have is run through those filters we have put into place. As a result, we have a set of beliefs that govern our lives. Although most of these beliefs are rational and based on reality, others are irrational and cause bad choices leading to self-defeating behaviors.

Mostly subconscious, these beliefs determine how we respond, and in many cases, react to life. When an event triggers off a train of thought, what we consciously think depends on the general beliefs we subconsciously apply to the situation.

Let us say that you hold the general belief: "To be worthwhile, I must succeed at everything I do." You happen to fail at a relationship or you have a bad day with the person you are taking care of, this event, when coupled with an underlying irrational belief system, leads you to the conclusion: "I’m not worthwhile" leading to feelings of being "less than", meaning you will accept being treated as if you are "less than". In such situations, reaching out for help becomes foreign because you either believe you're not worth being helped or you want to prove you are competent to others.

Underlying beliefs are general, meaning one belief can apply to many situations. If you believe, for example: "I can’t stand discomfort and pain and must avoid them at all costs", you might apply this to relationships, and to life events in general. How do you respond to events when you have these beliefs? You might avoid anything that you believe could create discomfort for you which leads to levels of stress and anxiety because you are either unable or unwilling to communicate your needs because you think you are not worth it.

Does Rational Thinking Make You a Machine?

One of the criticisms of using a rational thought process is that it “lacks emotion”, however just the opposite is true. Rational thought is an emotional regulator. Rational thinking leads to a rational or an appropriate emotional response.

But remember, not all negative emotions are bad for you, but neither are all positive ones. Feeling happy when someone disappoints you could keep you from communicating your feelings appropriately. Similarly, not feeling anxious when presented with a dangerous situation could threaten your very survival. What we are aiming for is to avoid exaggerated reactions of both negative and positive emotions.

The entire point of learning to regulate your emotions and apply a rational thought process to events is to accomplish our goals and to live a good life. It also helps us from overreacting to stress by accepting the reality that most things are out of our control. What we want to understand is that a major obstacle to reaching our goals is our irrational thinking about an event and not the event itself. Events are often out of our control, but our thoughts in response to them are not. In the ABC model, we can see how beliefs lead to emotional and behavioral responses, some appropriate, some not.

A is an activating event. It is what sets off the entire process of irrational thinking. A situation occurs, and you begin to assign value to that situation.

B is your belief system. You now take A and run it through those filters in your brain. If those filters are irrational, you will respond with irrational emotions and choices may be based on those feelings.

C is what you feel. The C is the emotions that arise because of your belief system. Here is this model in table form:

But here's the thing, remember, it's not the event that causes the emotions, it's what you believe about the event that creates your emotions. And if your belief system is not rational, your emotional response will not be rational.

Let’s look at an example of this:

Amanda just had a discussion with her sister, Sue, about helping her father who has early-onset dementia. Sue said she would be there to relieve her at 2:00 pm, it is now 2:30 pm and Sue has not shown up yet. Amanda tries to call Sue but no answer. On the first day after their discussion, she is late. So, Amanda begins the process of irrational thought:

Let’s look at this from another belief that Amanda might have about what is happening:

Let’s explore these two examples. Again, one thing that is evident in looking at this is that A (the event) does not cause C (the behavior or emotion), it is B (the belief) that creates the emotion.

In example one, it is Amanda’s belief that her sister is “not coming and lying” results in anger. In example two, it is her belief that she “needs” someone in her life and without someone, it “would be absolutely horrible”, the result -- anxiety and frustration.

Getting There

The goal is to make changes in your thought processes, helping you recognize your irrational beliefs and change them into rational ones. As a result, your irrational reactions will become rational actions and the outcomes will be much different. This is accomplished through a technique known as “Disputing” (we will now add a D to the table). When you dispute, you are challenging your irrational beliefs, and this is the beginning of change. Let’s return to the earlier examples with Amanda.

Remember that Amanda had a discussion with her sister, Sue, who agreed to help. Sue is late arriving. And the process has started.

Let's look at the belief Amanda has here --- Others must treat me with fairness, kindness, and consideration and in exactly the way I want them to treat me. If they don’t, they are no good and deserve to be punished!

As a result of this belief, we see anger and rage. It's a belief of absolutes. When her sister does show up late, because she had a flat tire or was held up in traffic, Amanda may be in a rage or display passive-aggressive behavior. Either way, her first plan of sharing caregiver duties with her sister may end up being the last one.

But if Amanda learned to dispute her irrational belief, things could turn out much better for her and for her sister. Amanda could say, “Where is it written that people must treat me fairly?” or “Even if she doesn't come, does she deserve to be I deserve to feel this way?”

And now let’s take Amanda’s issue one step further. She has learned to dispute her irrational belief and once she is successful at this, she can now replace this belief with E, Effective ways to think, feel and behave.

Again, let’s return to Amanda one more time and look at effective replacement thoughts:

Does this mean that Amanda will be a punching bag for Sue if this behavior continues? Quite the opposite. By using a rational thought process, Amanda keeps her cool, allowing herself to address the problem rationally without getting upset. At some point, it may not work, but Amanda is learning to take care of her own emotional needs and able to plan for what is needed realistically and not emotionally driven.

My Rational Life

So, does having these tools mean life will be great from this point on and you will never be upset? No, because rational thinking states that we are human and therefore imperfect, and we will all think irrationally from time to time. The goal, however, is to reduce how often this occurs, how long it lasts, and how intense these beliefs are that lead us to poor choices and outcomes.

Reducing these events is the result of developing three basic insights:

  1. We don’t get upset, we upset ourselves by being inflexible in the beliefs th