Of the 5.5 million military caregivers across the United States, nearly 20 percent care for someone who served since the terrorist attacks of Sept. 11, 2001. Military caregivers experience more health problems, face greater strains in family relationships and have more workplace issues than non-caregivers (RAND, 2014).

Sen. Elizabeth Dole noted the importance of this duty in a July 4, 2014, message: “Let us band together again to support our military, help our veterans in need and lift up our hidden heroes caring for the wounded at home.”

In the same spirit, Samueli Institute created “The Caregivers Companion” to give these hidden heroes the resources they need to start their own path to health and wellbeing. It’s easy to say that it’s important to take care of yourself, but the real question is: How? And what does that mean? This guide begins to answer these questions.

For the past 15 years, Samueli Institute has worked to uncover how healing happens among individuals, communities, the military and health care systems. This guidebook is based on the resulting research, as well as the expertise and personal experiences of our staff, which includes retired service members, medical doctors, psychologists, nurses, and most important, caregivers, who currently or previously provided care to their own loved ones who were wounded, fell ill or were injured in the line of duty.

As a military caregiver, you have a unique set of needs and great strengths that help you navigate your journey. Caregivers face a constantly evolving role that changes with the health and needs of your loved one. You may deal with false and/or real expectations and feel a roller coaster of emotions associated with them. Being a caregiver is a long journey, often with unforeseen and unique barriers. As such, self-care is essential to your health and wellbeing as well as that of your loved one.

You may feel overlooked by the professionals caring for your loved one. You may feel alone and unable to talk to your care recipient about how the situation makes you feel. And perhaps you feel misunderstood by friends, family and coworkers.
This guidebook is here to support all military caregivers no matter your relationship to the person you are caring for or when they served. You are husbands and wives, parents and children, friends, relatives and acquaintances. Upon the illness or injury of an active-duty or reserve service member, military retiree or veteran, you unexpectedly stepped into this new role for which you may feel unequipped. You may not call yourself or see yourself as a caregiver. But if a wounded, injured, ill or disabled service member or veteran relies on you for day-to-day physical, behavioral or emotional needs, then you are a caregiver and this book is here to remind you that you are not alone on this journey.

So often you hear that it’s important to take care of yourself. But for caregivers like you, who spend so much time and effort caring for someone else, how is that possible and what does it mean? Another important group of individuals reading this book are those coping with the loss of their loved ones. As survivors and Gold Star ¹ spouses or parents, self-care is also important as you create a new and different life for yourself.

This guidebook is based in science and in the personal experiences of caregivers. It walks you through the four areas of your life that are key to being at your best: your sense of self, the choices you make, your circle of support and your interactions with the outside world. Read it when you have five minutes here or there, or whenever you need to take a moment for yourself.
This guidebook will help you to find healing rather than a cure. Cure means that signs and symptoms of disease or injury are gone. That is not always possible. Healing is an ongoing process of recovery, repair and renewal. It is an inside-out personal process, a lifelong commitment that builds your capability to live fully.

In addition to the resources in this guidebook, there are videos, fact sheets and journaling exercises online. Visit SamueliInstitute.org/ Caregiver for more information and to download the journaling companion.

You are the caregiver, not the curegiver.
—SIEGEL & YOSAIF

When most people think of self-care, they think of exercise and eating well. Those are two important topics that will be covered in the next chapter, but the core of wellbeing comes from how you feel about yourself, your life and your relationships.

Your Sense of Self

Who you are at your deepest level includes the thoughts, feelings and wishes that come from the mind. It also includes your spiritual life and having a sense of meaning or purpose. Those caring for a loved one can lose that sense of self. Even as you love and want to help your service member or veteran, you may feel that your whole life is bound up in the illness or injury.

Acknowledging that who you were before and who you are now may not be the same can be a painful process. The goal is to work toward accepting your new self as a complete person who has grown from your experiences.

Be Empowered by Your New Role

Each day comes with new challenges that test and build your resilience. Resilience does not mean bouncing back to become the same person you were before. Instead, you transform into someone better, stronger and more aware than you ever were before.

Caring for someone else teaches you soft skills, such as compassion, love and empathy, as no other experience can. You also learn practical skills such as time management, patient advocacy, listening and communication skills, and many others.

Many caregivers don’t give themselves credit for these new experiences. This can lead to a devaluing of what you do each day. Instead of seeing what you don’t or can’t do anymore, give yourself credit for your resilience. This can create new meaning in life and work—something critical to balance in mind-body-spirit.

Spirituality and Healing Presence Journaling:

For many, spirituality, faith and religion are central parts of who they are. They can influence how you cope with trauma and loss. They help you find happiness and meaning within rather than from external influences such as money, belongings, work, fame or food, which may leave you feeling empty, lost and alone.

The same mind-body practices that help you develop a sense of spirituality can counteract stress and its harmful effects. The most important thing to know when it comes to mind-body practices is that there is no single right way; these practices go through cycles of popularity. However, all have the same intended effect of breaking the train of everyday thoughts. What works for someone else may not work for you.

Consider these factors when picking a mind body practice:

• Physical Energy — Do you enjoy being active?
  • If yes, consider a moving meditation like Tai Chi, Qi Gong, yoga, walking and running, or an active meditation like art therapy or journaling
  • If no, consider breathing techniques, meditation (transcendental meditation) or mindfulness-based stress reduction, loving-kindness meditation, progressive muscle relaxation, etc.
• Self vs. Practitioner-based — Practices such as acupuncture or massage require making time to see an outside practitioner. For some caregivers, that time out can be relaxing, while others may find it stressful to go to one more appointment. Some practices require nothing more than your attention and a few seconds (breathing, mantra repetition). And there are various others that, once learned, can be practiced on your own, such as acupressure, Reiki, yoga or Tai Chi.
• Time — Consider what fits into your schedule. Do you have 30 seconds? Five minutes? An hour? There is a mind-body practice for every moment.
• Belief and Conviction — Choose a practice and terminology that fits into your belief system. Whether you call it making time for prayer, meditation or quiet reflection, what’s important is that you are practicing self-care. It is not important to be convinced that the practice will work for you. However, it is important to set your skepticism aside and look at it with a spirit of experimentation. Often taking that first step is the hardest, though the most important.

Try to schedule this time regularly. Knowing that you have time set aside just for you can be helpful.

Stress and the Body’s Response

Not all stress is bad. Small amounts of stress can increase focus and performance. However, too much stress has an opposite effect on the body, leading to a decrease in efficiency and increase in anxiety. A regular mind-body practice activates the capacity within you that counteracts the harmful effects of chronic stress.

“Over time, continued strain on your body from routine stress may lead to serious health problems, such as heart disease, high blood pressure, diabetes, depression, anxiety disorder, and other illnesses.”
— NATIONAL INSTITUTE OF MENTAL HEALTH-2016

The “no pain, no gain” mindset does not apply to stress. Pushing through may lead to physical and mental burnout. Your stress response can get stuck in the “on” position and you need to learn ways to reset it. Stress regulation skills can help you to recover faster from stress and increase your tolerance for challenging experiences.

Take Action: Commit to developing a mind body practice.

Healing Intent

Healing intention is a conscious choice to improve your health or the health of another. It includes belief in improved wellbeing and the hope that a desired goal can be reached. Belief and hope set the stage for healing to occur.

Developing healing intention includes awareness, intention and reflection.

Awareness

You may frequently hear from friends or family: “How’s your [ill or injured] spouse or loved one?” But you may rarely hear: “How are you?” You may be very aware of how your service member or veteran is feeling but less aware of how you are feeling.

Awareness addresses the question: “How do I feel?” It helps you learn what your body is telling you and to connect what you think about to who you are.

You can become aware of your body’s subtle signals such as changes in energy level or mood. Bring these thoughts and feelings to your conscious mind. This allows you to change behaviors that don’t contribute to your health and learn new skills to change your automatic responses. Physical symptoms are messages from your body telling you how it is doing and what it needs.

Some turn to active practices like jogging, yoga, or even repeating a centering word. Others use religious prayer, practices, and services. You can also just take a few moments to be quiet or to meditate.

Intent and Intention

Once you know how you feel, it’s essential to know what you want. For those whose lives have diverted from what they had planned, this can be challenging. But it’s essential to rebuild this knowledge so you can work toward creating new goals and plans that may be different but are also meaningful and fulfilling.

On a spiritual level, once you connect with your inner self, you can direct your intention to bring this sense of peace and healing to yourself or others in your life.

Reflection

The story you tell yourself about your life is powerful. This self-story can be a way to help you understand the central themes of your life and help you find meaning in them. When your sense of meaning in life is altered, it can lead to feelings of distress. Regaining that sense of purpose—even in or despite suffering—is vital for health in your body and mind.

Meaning and purpose help you deal with turbulent emotions such as loss and grief, hope and despair, and joy and sadness. They allow you and your loved one to accept the new normal, find a sense of wellbeing within it, and control your outlook.

Journaling, creative writing, art therapy, peer-mentoring, and chaplaincy services may be helpful as you reflect on questions of who you are and who you are in relation to being a caregiver.

Mindfulness

“It’s not that mindfulness is the ‘answer’ to all of life’s problems. Rather, it is that life’s problems can be seen more clearly through the lens of a clear mind.”
— JON KABAT-ZINN, “FULL CATASTROPHE LIVING”

Many people think of mindfulness as being in a calm, Zen state. And it can be. But more realistically, it’s about being at your best. Mindfulness means being aware of what your mind is up to in each moment but not getting caught up in or controlled by your thoughts. It can help to remind yourself: “My thoughts do not control me.” Mindfulness is shown to improve symptoms of depression, post-traumatic stress, decrease chronic pain, and improve quality of life.

Some specific skills that caregivers can use to cope with stress and anxiety are positive thinking, a learning mindset, and living in the moment.

Positive Thinking

Positive thinking changes anxiety into opportunity. It builds a healthy self-esteem and self-value. Building these skills can keep you from doubting your decisions and being down on yourself during the ups and downs of caregiving:

• Start each day with the intent to learn something new.
• Give yourself permission to be wrong.
• Start a gratitude practice.

Living in the Moment

As you work toward being aware of your thoughts and feelings, notice how much of your day is spent thinking about the past or the future. Thoughts of the past can keep you from being present and making the most of this day.

Many caregivers experience extreme worry and fear when looking too far ahead. Knowing that you are not alone in these feelings can help. Spend a few moments in a mindfulness practice of your choice. Or connect with other caregivers in an online support group.

Trust Your Inner Guidance

How often do you ignore what your gut is telling you? You may think, “I should call a friend for support,” but decide not to because it’s late. Or think, “I wish I could reschedule those plans,” but attend to them anyway and regret it later.

Over time, as you become mindful of your thoughts and feelings you will begin to trust your inner guidance. You may notice that when you follow your instinct you feel better. On the other hand, when you fall back into old patterns of holding back and doing what you think you should, you feel worse.

Being mindful of your emotions is an important part of self-care. What you feel affects your ability to make healthy choices.

Set a Self-Care Goal

What is one realistic goal that you can set today to improve your relationship with yourself?

Self-care is survival. It’s not thinking about yourself more. It’s thinking more of yourself.
—GAIL SHEEHY, CAREGIVER AND AUTHOR

As a caregiver, you spend most of your time thinking of and acting for others. This makes it hard to shift the focus back onto you. It can even feel selfish. Yet self-care is critical to surviving and even more so to thriving. Each time you fly on an airplane, you are told to put on your own oxygen mask before you help others with theirs. When you are your best self, you can share that with your family.

“7 of 10 deaths are from preventable chronic diseases.”
— HEALTH AFFAIRS, NOLTE AND MCKEE, 2008

Living a healthy life is one of the key things you can do to achieve and maintain wellbeing. How you eat, move, relax and connect to others all play major roles in healing your body, mind and spirit.

If making healthy choices was tough for you before your loved one’s illness or injury, it may seem nearly impossible now when the stakes are higher.

Drive to Change

The problem lies not in knowing what you should be doing, but rather in taking action to actually lose pounds, stop smoking, take a walk and take time out to relax—even if it’s just for 30 seconds.

Reframing how you think about making healthy choices can be helpful. Instead of being a punishment, can you find pleasure in a new healthy habit? Perhaps give yourself a reward. Making a small change, such as drinking water instead of a sugary soda or finding a buddy to walk with once or twice a week can help support change.

“Just for today, do the next right thing and good things happen.”
— DR. GEORGE CEREMUGA

While serving as the Chief of the Integrative Holistic Medicine program at Fort Belvoir Community Hospital, Capt. George Ceremuga, DO, had a saying: “Just for today, do the next right thing and good things happen.”

Good lifestyle choices in diet, physical activity, stress management and social connections, as well as eliminating or limiting tobacco and alcohol use, improve overall health and reduce the impact due to chronic illness and mental disease. ¹

The choices you make today matter. And today’s choices determine the choices available to you tomorrow.

Eating, Drinking and Cooking

Water, Water Everywhere

Your service member or veteran was trained in the importance of hydration, and it’s important for you, too. The human body is made up of 60–70 percent water, so you are what you drink. Even if you don’t sweat, your body still loses water every day that must be replaced. Water intake impacts weight loss, muscle fatigue, skin health, kidneys, bowel function, and more. Carrying a bottle of water with you everywhere you go may help you remember to drink more often. Also, try to drink a glass of water with every snack and meal instead of another type of beverage. Flavored sweet drinks rarely contribute to better health.

Food is Fuel

The physical burden of caregiving can take a toll on your body. Eating good whole foods can help you stay at your best. A healthful anti-inflammatory diet like the Mediterranean diet, with a focus on vegetables and fruits, a few whole grains, and an occasional small portion of animal protein, will keep your body powered up.

It can help to focus on adding good whole foods rather than depriving yourself of things that don’t contribute to better health. An added bonus: since vegetables and fruits contain mostly water, they will increase your hydration levels.

Consider the following when focusing on food:

• Instead of thinking about what you shouldn’t eat, start with what you can add to your diet. A low-fat diet with moderate protein, high fiber, whole grains, and at least five servings of vegetables and fruits a day is best for your health.
• Try keeping a food journal either on your phone or on paper to track what you eat throughout the day. We are often not aware of what and how much we eat. Some mobile apps help with this and offer motivation to choose a healthier diet.
• Foods with sugar, corn syrup, artificial sweeteners, and unhealthy fats have been linked to heart disease, cancer, and diabetes. High-fiber diets can lessen some of these effects.
• Eating too much and not exercising are the usual causes of obesity, but they are not the only ones. Especially in times of stress, the problem may be not eating enough or not eating during the day. This can starve the body and affect the body’s metabolism—your body’s ability to burn calories.

Your health care provider or a dietitian may be able to help you design a healthy eating plan and set realistic weight goals to keep you healthy.

Why We Eat

As important as knowing what to eat is knowing why you eat. For some, food can be a subject loaded with meaning and emotion. Food is family, tradition, comfort, and sometimes even used to self-medicate. When food and/or alcohol are used to fill an emotional void or to quiet or dull negative emotions, it may lead to overeating or unhealthy choices. It can be easy to overeat or consume alcohol out of stress, anger, depression, anxiety, frustration, or loneliness.

Build a Positive Relationship with Food

Being healthy is not just about making good food choices. It’s about having a positive relationship with food. As with other relationships in your life, it’s important for your relationship with food to be a healthy one.

Having a positive relationship with food involves some key shifts in thoughts and behaviors:

• Become aware of why you are eating.
  • Ask yourself: Am I physically hungry or am I eating to comfort, de-stress, please myself or others, or counteract boredom or loneliness?
  • If you aren’t hungry, try to recognize the triggers and temptations that prompt you to eat. (See Mindful Eating.)
  • Be hopeful and trust that you can overcome any challenges that you are facing. You may be trying to counter years of unhealthy behaviors, so be patient with yourself. If you make an unhealthy choice, treat yourself with love and kindness.
• Accept that the food rules of your past may no longer be needed or helpful for you anymore. For example, we are often told as children to finish everything on our plates. Give yourself the OK to no longer be a member of the “clean plate club.”
• Understand that you are a unique person with your own needs and challenges. Don’t overdo the food rules. Learn to trust your hunger and listen to your sense of fullness. (See Hungry? Scan for Signs.)
  • Comparing your habits and your body to others around you or in the media may be harmful.
  • What you see in magazines and on TV is not always true. If you struggle with a healthy body image, it may help to limit your exposure to unhealthy body images in the media.
  • Set positive health goals. Weight loss goals can seem unrealistic or not doable. Be positive, even in how you talk about food. Thinking of your food as a “diet” or “bad” adds judgment. Changing your language can help. Instead of seeing sweets as bad, see them as a treat. Allowing yourself a treat from time to time may prevent you from feeling starved and ready to quit.

Mindful Eating

Too often, because of the stress of daily life, food is eaten without even a thought. It’s easy to eat what’s in front of you without attention to whether you are hungry or when you become full.

This is especially true for the high-speed lives of service members, veterans and their families. Keep these tips in mind:

• Eat slowly. Most meals are consumed in an average of 7 to 11 minutes. Fast eating can lead to overeating. The body doesn’t have time to cue your brain that you are full. For those eating with service members or veterans who were trained to eat quickly, slowing down can be a challenge. Putting your fork down between bites will help. If you are struggling with eating speed, try to focus more on enjoying the meal rather than just slowing down.
• Eating includes all the senses—taste, touch, smell, sound and sight. Paying attention to the multi-sensory experience of eating is called eating mindfully. Mindful eating can help with a healthy lifestyle.
• Tune into your sense of fullness. Eating mindfully also requires learning your sense of fullness. Be alert to your body’s subtle clues rather than waiting for a bellyache. If something is so delicious that you want to keep eating, try saying, “I can have more later if I’m full. I don’t have to eat it now.”

Meal Planning and Mealtime

Meal planning can be good for your budget, your stress level, and your waistline. Knowing in your mind what you’re going to eat or having snacks on hand can help and make mealtime less overwhelming.

Meal planning can be especially helpful for your service member or veteran if they are dealing with certain health issues like diabetes or blood glucose problems, cholesterol, blood pressure, and weight. They may need to take medications at certain times throughout the day, either with or without certain types of food. This can make having a meal plan essential. Planning ahead also taps into predictability and control, which can ease the stress associated with post-traumatic stress.

Prepare Plan B

Allow for flexibility. Don’t forget the value of having ingredients on hand for easy pantry or freezer meals if you don’t have time to stop off at the store for fresh ingredients. Have an idea of where you can stop for a healthier take-out option if an appointment or workday runs long.

Recognize Your Patterns and Hurdles

Are you so hungry that you grab a snack on your way home before mealtime? Try having a piece of fruit, a bag of healthy popcorn, or a handful of nuts on the way home so you aren’t ravenous when you walk in the door.

Are you too tired to make the healthy meal you’d planned, so you find yourself ordering pizza multiple times a week? Maybe having more easy meals like sandwiches or soup on the schedule would help. It’s important to have realistic expectations for yourself in meal planning.

Meal Planning Tips

• Try to shop only once a week. The time you take in planning your meals before you head to the grocery store may result in fewer trips to the grocery store and drive-through. Running into the store to pick up an item can lead to over-buying and more stress.
• Cook as you like. Do you like using the crock pot in the morning? Cooking a week’s worth of meals on Sunday? Using the freezer? Cooking out of the pantry? Don’t fight your cooking style. Cook the way that works for you.
  Keep healthy food on hand. Having your pantry, fridge, freezer, and cabinets stocked with healthy foods makes it easier to cook and eat healthy.
• Involve your children so they will be more likely to eat and help with meal prep. If they can see the meal plan, it will cut down on the questions of “What’s for dinner?” or “What can I eat?”
• Don’t start the plan from scratch. Begin with a two-week or one-month rotation of your favorite recipes and add a new recipe occasionally.
• Make sure your plan is realistic. Plan for occasional take-out.
• Look for meals that include similar ingredients to avoid waste and cut down on prep time.
• Consider starting a small, manageable garden. Use pots on the balcony for easy-to-grow herbs or vegetables. This provides a chance for children to learn and get involved.

Your healthy changes can have a ripple effect on your family as well. Children see their parents as their biggest role models. Be what your children should be.

Meals planned, prepared and shared together at home tend to be healthier and more balanced than meals eaten at restaurants or on the go. Meals eaten out are often fried or highly salted. Plus, soda and other sweetened beverages are usually consumed more often when eating out. But there are more benefits to eating together than just health.

Meals Bring Family Together

In a busy family, it isn’t always possible to eat together every day. But when you can, making time for family dinner is good for the mind, body and spirit. Eating meals as a family several times a week can help children get better grades. Also, children who eat regular family meals tend to use less alcohol or illegal drugs.

Family meals help foster a family bond, feelings of belonging, security and love. This is especially important during times of change. Eating together builds a sense of tradition that can last a lifetime.

Family Traditions and Health

Family traditions can affect your ability to make healthy choices. Becoming a caregiver may require a shift in some family habits. It’s an opportunity to re-think your previous standard operating procedures and to develop healthy new traditions like taking a walk after a shared meal.

Move More!

Being a caregiver can take a tremendous toll on your body. The physical burden of caregiving can be affected by stress and lack of sleep. Motion is a lotion: Exercise can help both your body and your mind to work more smoothly.

At least 30 minutes a day of exercise is important.2 Ask your doctor for ways to move more and for advice on how much exercise is right for you, especially if you are trying to lose weight or have certain physical conditions.

Movement in the Moment

It can sometimes help to see exercise as something to include throughout your day. When your caregiving and other commitments make it impossible to visit the gym, focus on adding movement in the moment.

Your doctor or a physical therapist may be able to give you a list of exercises and stretches to do throughout the day when you have a few minutes to spare. Can you do leg lifts or ankle circles while waiting in a doctor’s office? Might you park farther from the store to get a few more steps in? Use the stairs instead of the elevator. These types of activities add up.

Walking provides many of the same health benefits as running and might be a shared activity done with your service member or veteran.

Recharge at Night

Many caregivers struggle to get the optimal seven to nine hours of sleep that are necessary to rebuild your body. Sleep impacts many areas of life including your overall health, pain level, memory, weight control and even your mood and outlook.

Can You “Catch” a Sleeping Problem?

Sleeping can be especially challenging if your service member or veteran has sleep disturbances, including insomnia, restless leg syndrome, grinding or clenching teeth, sleep apnea and sleepwalking. Sleep disturbances are common in people who have experienced a traumatic brain injury (TBI).

Consider these common tips for sleeping:

• Establish a wind-down routine with quiet soothing activities for the hour before bedtime.
• Go to bed and wake up at the same time each day—even on weekends.
• Have a dark, electronics-free room.
• Avoid caffeine, nicotine, alcohol and sugar several hours before bed.
• Exercise during the morning or early afternoon.

When these tips aren’t enough, it may be time to reach out for help.

Sleep problems can be caused by a host of problems, including physical changes, breathing problems, medication, pain, depression, substances such as alcohol, caffeine and nicotine, and stress or inactivity. As a caregiver, you may find it difficult to sleep if you are always on edge or worrying about your loved one. That’s why talking to your care provider about any issues you or your loved one is experiencing is important. They may also help you to optimize the hours of sleep that you are able to get.

Learn more about sleep resources at SamueliInstitute.org/Caregiver

Making Time for Joy

Even in the most difficult of situations, choosing to feel grateful can help you deal with the challenges of being a caregiver. Focusing on gratitude prevents helplessness and hopelessness from taking over. Forgiveness of self, God, your family and your wounded warrior can help you deal with blame or regret.

Instead of spending your mental energy worrying about what you can’t control, spend it finding moments of joy:

• Dream new dreams. You may have had to put past dreams aside, but that doesn’t mean you can’t come up with new ones. Focus on new goals and dreams that you can work toward.
• Find a creative outlet for emotions. Self care is as simple as picking up a coloring book and some colored pencils or working on a puzzle. Tapping into a creative outlet can serve a dual purpose of releasing emotions and experiencing the joy of art. Whether it’s music, crafting, sewing, drawing, journaling, scrapbooking or photography, creativity has many benefits.

“Art therapy helps people resolve conflicts, improve interpersonal skills, manage problematic behaviors, reduce negative stress and achieve personal insight. Art therapy also provides an opportunity to enjoy the life-affirming pleasures of art making.”
— AMERICAN ART THERAPY ASSOCIATION

• Look forward to the future. Maintaining a sense of hopefulness is critical, especially if your service member or veteran feels hopeless. Finding meaning and purpose in life can lead to happiness. Have something to look forward to. Plan a respite break, a vacation or a full day away from caregiving.
• Keep inspiration on hand. Whether phoning a friend, visiting a place of worship or carrying uplifting quotes or readings in your wallet, tap into a source of inspiration to help you get through the rough patches.
• Say yes to things that make you happy. Join the walking club. Accept a friend’s invitation. Stay connected with people who recharge your battery, provide respite and make you feel good. Pick up something you used to enjoy like reading fiction, knitting or doing woodwork.
• Laugh and play. Try a game night at home, play fetch with your pet, do a crossword puzzle or listen to a comedian on TV. Laughter/humor and play can reduce stress, boost your energy and help you connect with others.
• Don’t compare your life to others. Allow your life to be unique.

Balance During a Crisis

In the first phases of caregiving, you may always feel rushed. Family caregivers of severely wounded loved ones may even feel guilty about leaving the room or taking 30 minutes to run to the grocery store.

In the face of a crisis, it’s important to give yourself permission to walk out of the hospital or rehab center for 15 minutes to get some air, go home and take a shower, have an uninterrupted meal without rushing back to the hospital. This type of self care in the moment will keep you healthy and ready for the long haul.

Creating Balance for the Long-Term

Later, as some of the grief and loss sets in, balance is equally important to keep feelings of depression from taking root. Caregivers often feel stuck in “crisis mode”—dealing with one thing after another, always waiting to see what comes next. Breaking the cycle of constant urgency can allow for new routines.

Balancing your work and responsibilities with some “you time” is important. Hobbies can help. Find activities that are fun and rewarding so that you want to do them regularly. They can be anything from walking with friends and playing with your kids to taking your dog for a walk, playing a team sport or going on picnics. Try joining a club or faith-based organization, volunteering in your community or learning a new skill or craft. Living a balanced life can help prevent feelings of burnout.

Nourish Your Spiritual Self

Focus on love and forgiveness—and start with yourself. If you are not loving and forgiving of yourself, it’s hard to inspire, motivate and encourage others.

Meditation techniques such as loving-kindness meditation can help address anger and emotional pain. It is a practice that is used to address feelings such as shame, guilt, fear, chronic pain, a lack of sense of support and difficulties with other people. Learn more at SamueliInstitute.org/Caregiver.

Try a loving kindness meditation and see how it makes you feel.

Time Management

The first piece of advice to finishing your to-do list may be surprising. Take a nap, meditate, go for a walk. Taking 20 minutes to practice self-care makes you more productive and able to do everything else. When you feel good in mind, body and spirit, you are a better caregiver. With this in mind, move your own physical and mental care up on the priority list and get help with or release some of the other items.

Additional tips include:

• Prioritize. Do what’s most important and let the rest go. Don’t feel like you have to do everything at once. Bite off manageable chunks of larger jobs.
• Do what you can and don’t stress about the rest. Find shortcuts that work for you. If you don’t have time to clean the whole kitchen but you feel better with a clear counter, just de-clutter and let that be enough. Repeating “Perfection is overrated,” or “Good enough is great,” may ease your mind.
• Simplify and combine your efforts. Make fewer trips. Group appointments when possible. See if you can do weekly blood draws closer to home. Fill prescriptions when they are ready to prevent running out at the last minute and taking an extra trip.
• Acknowledge that the day will not go as planned and take a breath. Getting upset won’t help you or your care recipient.

Breathe

Caregivers live high-stress lives. Seemingly, everyday activities fuel anxiety and fear. A ringing phone can trigger feelings of panic. Checking on your wounded warrior in the morning may begin a string of “what ifs.”

Various breathing techniques and mobile apps can teach you to use the breath to self-calm. The breath triggers changes in the body’s nervous system that help you better manage stress. Deep breathing techniques have been found to help reduce feelings of anxiety and stress in service members with post-traumatic stress and improve performance in emergency personnel.

Put one hand on your chest and another on your stomach. As you inhale and exhale, your stomach should rise and fall. If not, your breathing may be too shallow.

Visit SamueliInstitute.org/Caregiver for additional information and resources on breathing.

Be Aware of Contagious Behaviors

Caregivers sometimes take on the post-injury symptoms or qualities of service members or veterans. A formerly outgoing and social person may notice symptoms of hypervigilance or checking exits upon entering a restaurant, even when not with their service member or veteran.

Sen. Elizabeth Dole noted in a commentary for the Elizabeth Dole Foundation: “Those caring for individuals suffering from [post-traumatic stress] and TBI become hyper alert for potential triggers. They must be sensitive to what may cause mood swings, anxiety attacks or angry outbursts. In many cases, the caregivers become more sensitive than the veterans themselves. Veterans may only occasionally react to triggers, while caregivers put up their guard with every potential risk factor. This is a real and debilitating phenomenon facing our caregivers—many for the rest of their lives.”

If her description resonates with you, remember that you aren’t alone in this—reach out for help.

It’s also OK to feel joy during the difficult times. You may think: “How can I feel happy when my loved one is in pain?” It’s important to let this guilt go and focus on how you feel. Taking on someone else’s suffering doesn’t help you or them.

Dealing with Unhealthy Behaviors

Let’s face it, we all do things that we know are not healthy. What is important is that these behaviors don’t become habits. Once they do, they are very hard to break and sometimes require professional help.

Groups can help you—your church, community center, doctor and online support groups. The important thing is to develop awareness of your behaviors and seek help. If you are a very private person who is hesitant to share personal issues, taking that first step in seeking help is most difficult. Perhaps having someone you trust to join you will make it easier.

Use your healthy relationships to find support to manage unhealthy behaviors before they become a habit. Break bad habits so they do not become addictions. Find healthy habits to fill the void left when ending the bad habits.

Practice a Healthy Lifestyle

Healthy behaviors can enhance your wellbeing. They prevent and treat disease. Making good food choices, exercising, coping with stress and avoiding unhealthy behaviors are important to lifelong health and wellness.

Set a Self-Care Goal

What is one healthy behavior that you would like to add to your life?

Sometimes our light goes out, but is blown again into instant flame by an encounter with another human being.
— ALBERT SCHWEITZER, NOBEL PEACE PRIZE WINNING PHILOSOPHER AND PHYSICIAN, (1875-1965)

People are social beings. Relationships with others and your role within your community provide a sense of belonging, care and support. Positive relationships can also be good for your health and that of your wounded warrior. Love and support reduce stress, boost your immune system, improve quality of life and prevent isolation and depression.

Positive relationships refuel you, especially when your tank is low. These are called healing relationships and typically include trust, honesty and compassion. If a relationship leaves you running on fumes, consider options to protect you and the relationship. It is possible to learn skills that improve the relationship’s quality and boost its ability to heal.

Your Caregiving Relationship

As a caregiver, your relationship with your service member or veteran is a chief relationship in your life and it may seem that everything else depends on this connection. Ensuring it is a healing relationship is essential. Infusing it with healing involves acknowledging how the relationship has changed, moving beyond the past, shifting roles and responsibilities, reconnecting in love, looking forward to a different joyful future and retaining your sense of self.

Acknowledge the Past

Whether you are caregiving in a marriage, as a parent, as a friend or as a neighbor, the relationship does not spring from a blank page. It grows out of chapters that have come before it. This can make it hard not to get caught up in the vision of yourself and your wounded warrior before the illness or injury occurred.

To move forward in healing, it’s important to acknowledge that what was before may no longer apply, but there is an after, and it can be a happy one.

Thinking of what life was before the injury may involve times of heartache. Many people only refer to grief when a loved one has died. But sometimes in becoming a caregiver, the grieving process plays a role as you work through the changes in your life. You may grieve past memories, former dreams that may never be or that the person who left for war wasn’t the same person who returned. You may even grieve the loss of your old life and who you used to be.

Moving through the grief process can help you redefine who you are and what that relationship is. Some find this process healing.

The five typical stages of grief are denial, anger, bargaining, depression and acceptance. However, this is not a linear process. Not everyone experiences all five of these feelings and they can occur in any order, in addition to other feelings. What’s important is to acknowledge the role of grief in healing, know that it is normal and that there are resources to help. Community resource centers, your health care providers and your chaplain can point you in the right direction.
— DAVID KESSLER/ELISABETH KUBLER-ROSS

Shifts in Roles and Relationships

When a parent becomes a caregiver of an adult child, or when a previously independent service member must rely on his or her spouse or friend for care, it requires a shift in roles and relationships. Calling it a role reversal is too simple and not accurate. There are complex emotions, duties are in flux, and roles are not clear-cut. Re-establishing and relearning one’s appropriate role may be messy to muddle through. These roles change based on the service member or veteran’s stage in his or her healing process.

A person’s injury may be at odds with their formerly independent selves. This can stir up anxiety, resentment and even anger. These jagged feelings are natural reactions that you can work through with the help of professional or personal helpers. Eventually, with help, patience and work, these intense responses can lead to a renewed sense of self and peace.

To ease the tension, acknowledge that it is part of the process of being in a caregiving relationship. The transition requires honesty, transparency and recognizing that it is a time of learning. Mistakes or missteps may be made along the way.

Sometimes even if you do everything right, you may still need help during the times of change. Coping with it alone may cause you to feel even more estranged. Reach out to those in both your formal (health providers, counselors, chaplains) and your informal (family members, friends, support groups, community groups) circles of support.

Redefining Intimacy

Intimacy is about being emotionally close to your loved one. It allows you to let your guard down and let him or her know how you really feel. Intimacy is also about being able to accept and acknowledge his or her feelings.

After taking on the role of caregiver, it may become necessary to redefine and rebuild intimacy to develop an effective and caring relationship in which both people feel respected and loved. Your loved one’s injury might have physical, emotional and/or psychological effects that affect intimacy.

For example, changes in a person’s interests, personality, mood, patience, self-control, self-worth or self-image may change how he or she connects with others.

Consider These Tips to Develop Intimacy:

• After an argument, explore the deeper feelings behind the anger, hurt or anxiety.
• Improve your communication.
• Be positive about what you have. Share what you like and love about the person, even if he or she already knows.
• Make time to get to know your loved one anew.
• Talk to a medical professional about the effects of the person’s injury and identify the connection to your intimacy concerns.
• Create realistic expectations with the help of your support group or medical team.
• In marriage, re-learn non-sexual ways to demonstrate affections when necessary.
• Tap into courses and counseling.

Your community of care can help you with the right balance and establish goals.

The Healing Power of Touch

Whether it’s holding hands or resting your head on someone’s shoulder, we have all experienced the healing power of touch. There are complementary and alternative healing practices called Reiki, healing touch and therapeutic touch that make the most of the healing power of touch.

These are gentle, non-sexual healing practices in which a person places their hands lightly upon themselves or another to evoke healing.

Benefits include:

• Reduced stress.
• Release of pain or discomfort.
• Emotional calming.
• Deep relaxation.
• Heightened wellbeing.

Some medical institutions even offer these services from volunteers or nurses. Ask your care provider if these are available in your area.

Goals for Success

Each family or individual defines success differently. Paying attention to the idea of goals and celebrating achievements may be helpful on your journey. It is powerful to say, “We hit the goal we were reaching for!” They may be small or incremental, but they lead to feelings of pride and motivation for the next step.

The recovery process works best when both the caregiver and the wounded warrior are on board for the recovery process. However, you can only control yourself and your own actions. The recovery process is a careful balance of accepting reality and working toward change. In the beginning, the service member or veteran may be dealing with a lot of anger. As time moves on, it’s important for the service member or veteran to learn to cope with the anger in a healthy way.

Your medical team may provide advice about what is practical to make sure your expectations are realistic. A caregiver support group may also have ideas on what are appropriate milestones to work toward.

As a caregiver, you learn to deal with the moods and feelings of others. Self-care is important because it can be easier to deal with the emotions of others when you are healthy and taking good care of yourself. Once you are in a strong and healthy place, you will be better able to be in a healthy relationship.

Coping with Anger

Caregivers must cope with two sources of anger: your own anger and that of your wounded, ill or injured warrior. Your service member or veteran may have learned some coping skills in an anger management training including improving self-regulating or self-relaxation skills, communication and problem-solving skills. Those same skills can help you cope, too.

When dealing with the anger of your loved one, see if these strategies help:

• When a discussion begins to escalate, stop the fight and agree to come back to the topic when you’ve both calmed down. Make an appointment to talk. Say, “I’m getting upset, can we talk about this in two hours when we’ve calmed down?”
• If your loved one starts getting louder, speak quieter and slower than you normally do. This allows you to hear and understand better, tapping into the body’s natural self-regulating ability.
• Take three deep breaths. This will help you to calm, but it subconsciously forces the other person to do so as well. Like yawning, breathing is contagious.
• Use non-threatening body language. Uncross your arms and stand or sit at an angle so you aren’t directly confronting the other person.

At times, external help is required. That’s when it’s time to reach out to your circle of support. Professionals are well trained to help you deal with your anger and the anger of your care recipient.

Retain Your Sense of Self

Somewhere on the journey of providing care for their loved ones, many caregivers find that they have lost themselves. “Three years ago I was someone else. Now I don’t even know who I am.” When so much of your time is focused on your care recipient, it can be easy to lose your sense of self. Who are you? What do you enjoy?

When you step forward to care for a service member or veteran, your own needs, wants and thoughts don’t disappear, but they can get lost. It’s a role that you didn’t plan for, have little or no training in, and that seems to change everything. Despite the changes, you are still an individual outside of your caregiving role. It’s important to be aware of yourself, your interests and your needs.

Explore Your Joy

Keep the feeling of being lost at bay by exploring your own interests when you have a moment. If you liked crafting, can you pick up a simple crochet or knitting project while in the doctor’s waiting room? Rediscover the joy of reading fiction.

You may find that taking a moment each day to think about what makes you happy helps center you. Many caregivers feel a sense of guilt: “How can I feel happy when my loved one is in pain?” It’s not only OK to still feel happy during this time, but your happiness may also help your loved one to feel better. Even wearing a favorite colored top or taking time for a massage can brighten your spirits.

Moods and attitudes are contagious, so it’s important to acknowledge how you feel versus how your service member or veteran feels.

How Your Care Recipient’s Feelings Affect You

Other people’s moods are as contagious as the flu. Society values empathy or sharing in a person’s feelings, but that is not always healthy. Taking on another person’s pain or moods can leave you feeling drained. As a caregiver, it’s important for you to be at your best, and that includes being aware of your mood and how the moods of others affect yours.

Develop protective approaches that work for you. Here are some examples:3

• Imagine a protective barrier around yourself, perhaps a caring light or a warrior’s shield blocking the negativity.
• Try to react with positivity rather than being drawn into the negativity being aimed at you.
• Take a moment to pause, breathe or walk away if you begin to feel affected.
• Manage your overall stress level. This helps you to be less reactive and less aroused by outside negativity.
• Balance out the negativity by spending time with a positive friend. Let their happiness be contagious and refill your tank.
• Find an appropriate place to vent.

Venting

Venting your thoughts and emotions is appropriate at times to release tension rather than bottling it up inside. However, some ways and places to vent are more helpful than others. See if any of these work for you:

• Get out a piece of paper and write for 10 minutes without stopping. You can even pretend that you are talking with a person.
• When venting to a person, be sure to do so with someone that you aren’t upset with. It should be someone you trust and with whom you are on good terms. Choose someone who is supportive and helpful rather than enabling negative emotions. Give the person a heads up that you just need to vent.
• Exercise. Physical activity can release chemicals in the brain that relieve stress and tension. Consider yoga, Qi Gong and Tai Chi as well as other personal self-care practices.
• Breathe. Since it’s impossible to be stressed and relaxed at the same time, use breathing techniques to calm down.

Setting Boundaries

Part of maintaining your sense of self is to set boundaries. Setting up boundaries is an important part of self-care. A boundary is how much access others have to your heart, time and energies. It is a protective fence you build around yourself that allows you to monitor the impact of others on you.

Leaving yourself too open can leave you bruised and battered by comments, moods and opinions of others. But staying closed up can leave you isolated and locked up inside yourself. Finding the right balance takes time. It is a process. Set boundaries in your own time frame, and only when you are ready. Counselors can help you with protecting your heart, freeing yourself from the need to please others and learning to say no when appropriate.

Learning to establish healthy boundaries can help you in all your relationships, whether it’s with your care recipient, family, friends, neighbors or coworkers.

Widen Your Circle of Support

Developing a healing relationship with your care recipient is important, but don’t ignore the rest of the world. As priorities change and social clutter fades, continue to build and maintain relationships that will help you thrive over the years to come.

With all the new responsibilities that you now have, it can be easy to feel like you are alone. You may feel like you are shouldering the weight of the world. Instead, try to see yourself as a coach. Bring together and guide a circle of support around yourself and your loved one.

Redefine your community and examine who might play a role. Don’t forget to recruit your full community: family, friends, co-workers, friends and community resources.

Create a collaborative team of successful caregivers through the following:

• Develop a shared family calendar.
• Introduce others into the circle of support early so the care recipient feels comfortable with others rather than you always having to step up.
• Recognize who can give help. Set limits on or let go of those who are chronically unhelpful.

Ask for Help on Your Terms

Being independent is important; being too independent can lead to burnout. Asking for help is a sign of strength, not weakness. Being a super hero can be isolating and lead to exhaustion.

There are things that people can do for you to lighten the load, such as getting the oil changed in your vehicle, doing laundry or helping you with errands. When you see how broad your circle of support really is, it becomes easier to divvy up tasks so they don’t become overwhelming or burdensome.

The following also may help:

• When asking for help from others, use “I” statements. Rather than saying, “You never help!” Instead try, “I feel burnt out; I need help with the chores.”
• Don’t let a molehill become a mountain. Caregivers often find themselves doing things that they have never done before. Regular tasks like taking out the trash, maintaining the car, sorting through the mail, mowing the lawn and changing the light bulbs can all add up. Consider tapping into your circle of support for help. Although you can do these items, not doing them allows you freedom to spend more time doing what you value—spending time with family and attending to self-care.
• Arrange regular breaks.
• Say yes when people offer to do things for you. Give them the gift of accepting what help they can offer—even if you feel you should be able to do them yourself.
• Tap into programs that offer much-needed respite care.

When to Ask for Help

How do you take on the job of caregiving while keeping your life as whole as possible? How do you keep your spirits up for the long haul without becoming exhausted—emotionally, physically and spiritually? It may be time to reach out if you experience:

• Emotional triggers like anger, fear, resentment, guilt, helplessness, grief. (Talking about these difficult feelings can help you to deal with them.)
• Signs of depression or anxiety (crying spells, loss of sleep and appetite, significant weight changes, irritability, restlessness, difficulty concentrating and making decisions, persistently sad, anxious and empty feelings, thoughts of suicide).
• Feelings of being burnt out (feeling tired even after resting, increased feeling of resentment, new or worsening health problems, difficulty concentrating, neglecting responsibilities, withdrawal).
• Difficulty maintaining balance in your life—no longer participating in activities that are important to you.
• Difficulty sleeping.
• Difficulty taking care of your own health care needs.
• Substance abuse—using alcohol and drugs to escape.
• Thoughts of self-harm.

Caregiver Support

If you’re like most family caregivers, you aren’t trained for the challenges you now face, and you probably never anticipated you’d be in this situation. But there are places you can turn to for caregiver support including:

• Family members or friends who will listen without judgment.
• Your church, temple or other place of worship.
• Caregiver support groups at a local hospital or online.
• A therapist, social worker or counselor.
• National caregiver organizations.
• Organizations specific to your family member’s illness or disability.

“The capacity to care is the thing that gives life its deepest significance and meaning.
— PABLO CASALS

In order for you to maintain your capacity to care, it is essential for you to receive the support you need. If you do not take care of your own needs, you may begin to feel distracted, burned out or overwhelmed by the daily routine of caregiving. Learning to manage your stress and responsibilities as a caregiver is the first step to take care of you.

Communication Is Key

Being aware of your communication style can reduce misunderstandings among family members, health care providers, employers, friends and your care recipient. Honest and open communication is key to the healing relationships that you are working to build.

Although we all communicate daily, we rarely see that what we say and how we say it affects how we are heard.

You probably already know that most communication has little to do with what you say. Your stance, posture, breathing and even your muscle tightness all relay a message—as does the tone, speed and volume of your voice.

Focus on Listening

When you listen, focus on both verbal and nonverbal messages. Here are some tips for active listening:

• Maintain appropriate eye contact for your culture.
• Paraphrase to confirm you understand what the other person is saying. Don’t jump to conclusions.
• Ask questions to clarify
• Try not to think about what you are going to say next; it’s more important to be attentive, even if it means there is a thoughtful pause before you talk.
• Affirm their comments and offer encouragement by nodding, saying yes or say things such as “tell me more” or “I understand.”
• Listen to disclaimers (maybe, but, mostly, usually, probably), as they are typically followed by new information.
• Give your care recipient time to form a response; try not to interrupt.
• Avoid distractions such as TV or pets so you don’t have to compete for attention.

Especially in high stress situations, the more you can encourage the other person to talk, the more you can understand what they are trying to share with you. Encourage conversation to continue through active listening.

Speaking Your Mind Mindfully

Honest communication is vital. It can be important to voice feelings or fears that may seem unthinkable. When they go unspoken they can fester and lead to angry outbursts, withdrawal or resentment and guilt trips that drive a wedge in the relationship.

Here are some tips to ensure open channels of communication:

• Relax and breathe.
• Go into difficult conversations with a goal. Example goals include: Be honest and direct; express feelings and thoughts; find common ground or create harmony. (Do you need to ask for help? Address the way they have been treating you or the person you provide care for. Raise a concern.)
• Treat the individual with dignity, respect and courtesy.
• When offering assistance, do not insist or be offended if your offer is not accepted.
• Ask if it’s a good time to talk so you begin the conversation on the right foot.
• Make appointments to talk.
• Don’t be afraid to say “I don’t know,” or “Let me check.” You can be clear about the limits of your authority or ability to respond to a person’s needs or requests.
• Be mindful that symptoms of TBI and post-traumatic stress may fluctuate and are influenced by many factors; there may be periods of ease and comfort as well as more challenging times.
• Support, patience and understanding go a long way. Be generous with these. ⁴

Focus on “I” Communication

“I” versus “you” messages are the foundation of positive communication.

“I” messages:

• Help you take ownership of your own thoughts and feelings.
• Make you explore what you really think and feel.
• Increase your chances of being heard.
• Help keep conversations positive.

“You” messages may make a person feel uncomfortable and attacked. They may make a person stop listening, withdraw or fight back—none of which resolve the question or concern.

Example:

“I” message: I can take John to his appointment on Wednesday. Can we talk about Friday? I need help then.

“You” message: You need to take John to his appointment on Friday since you can’t take him on Wednesday.

Good communication skills build strong relationships. For more communication tips and specific advice on communicating with someone who has experienced a TBI or is experiencing post-traumatic stress, visit: SamueliInstitute.org/Caregiver.

Creating Healing Groups

Whether it’s a school, workplace, church or community organization, you are part of many groups that impact your ability to care for yourself and others. Seeking out and being involved in groups that are healthy and have positive healing qualities supports your health and wellbeing.

Healing groups:

• Promote open and honest communication.
• Create a climate of trust and personal responsibility.
• Inspire a sense of belonging.
• Allow you to make decisions that affect you in a positive way.
• Focus on learning rather than blame.

Support Groups

The best emotional and practical support and advice often comes from others who have experienced something similar. That’s why caregiver support groups provide such great help. They can speak to your fears, know what you need even before you do, help you tap into existing resources and begin to see hope, joy and potential in the new path.

Military caregiver support groups provide support that differs from that of friends or even professional counselors. Support groups provide a sustaining emotional boost along with group problem solving and idea sharing.

Some also find comfort in giving advice that aids in the transition and healing of another family in a similar situation. Being able to assist another validates your personal sense of purpose and adds meaning to your experiences. It is also a reminder that you are not alone in this journey.

Support is available online, in person and even on Pinterest. Visit SamueliInstitute.org/Caregiver for a list of resources.

(Un)Helpful Advice

Family and friends want to provide comfort, but most people don’t know what to say. During stressful times, you may be more vulnerable and sensitive to comments. Comments made with good intentions can hurt, minimize feelings or underestimate the problem. Whether it’s “I know how you feel,” or “Everything happens for a reason,” all caregivers have heard phrases that rub them the wrong way.

Dealing with insensitive people or comments in a productive way is part of caring for yourself because it helps you manage your stress.

Here are three ways to handle insensitive comments:

• Remind yourself that people often mean well but make such comments due to ignorance and fear. When people can’t relate, they may resort to trite comments and minimize the situation or feelings.
• Try to direct them to resources or educate them to show them in a kind way why that is hurtful to you.
• It’s especially important to keep up your self-care. When your tank is full, it’s easier to handle insensitive comments.

Ever-Changing Process

Becoming a caregiver comes with surprise and shock. It is outside the gates of normal, and you are not following the roadmap you expected. Many days it can feel like there is no roadmap. Rather, it’s a series of detours that can be painful and scary. When coping with an illness or injury, families want predictability and stability. But the process of healing is dynamic and ever changing. The unexpected nature of the process often generates a sense of being adrift without an anchor.

Caregiving is a roller coaster. One doctor’s appointment may have you plunging into sadness, but two days later another more hopeful prognosis may boost you to a false high. Setbacks feel like a sucker punch. Your wounded warrior may go in for a simple procedure and be back in the hospital for weeks. You may become depressed as your life gets turned upside down once again.

Navigating the Phases of Healing

Each person’s experience will be different and involves many transitions. Each phase of the process includes different types of medical treatments, changing care providers and perhaps new locations and levels of support. Fear and anxiety begin the moment you are notified of your loved one’s illness or injury and reappear at each following transition. Each shift adds to the unknown of what’s expected. The unknowns challenge your ability to grasp what lies ahead. Always being in limbo makes it hard to have confidence in your decisions.

Stabilization

This phase begins at the point of injury or diagnosis. Medical care is the top priority at this time and helplessness and the fear of the unknown is overwhelming. Stabilization ends when the ill or wounded warrior is discharged from the hospital and moves to a treatment facility, Fisher House or back home.

Rehabilitation

Once stabilized, the service member or veteran moves into the rehabilitation phase. In addition to medical treatment, rehabilitation may require inpatient or outpatient care and may include treatments such as physical therapy. Focus begins to shift to healing the mind, body, spirit and family. During this phase you may take on additional tasks.

Reintegration

Reintegration requires another shift in focus. It is when decisions are made to either return to full duty or separate from the military and return to civilian life. Even when returning to military service, your loved one may need to retrain for a new military job. During this phase you may need assistance as your service member transitions from active or reserve status to veteran status. Separating from the military can change your support system, especially if you are moving away from a community or military base where you had social ties and resources.

The reintegration phase comes with its own challenges for you and your loved one as you may feel alone and abandoned. A specialized care team may not be there to help you navigate the recovery and show you what resources are available to you. Some find this “finding your way” phase to be the most challenging, as well as the most promising.

Although there are some commonalities in the healing process, there is no “typical” tale. Different circumstances include:

• Whether your loved one was wounded in combat, fell ill or was injured in the line of duty.
• Military status—active duty, reserve, retired or veteran.
• Service branch—Army, Navy, Air Force, Marines or Coast Guard.
• The severity and nature of your loved one’s injuries.

A New Normal

A time will come when a new normal arrives. It becomes possible to look forward more than an hour, a day, a week, a year. Until then, mindfulness and self-care will relieve the tension and anxiety.

Emotions and fears are normal and part of the process. Although you may feel isolated, you are not doing this alone. Each shift is a time to redefine and mobilize your circle of support.

Don’t be afraid to seek help with each changing phase. The challenges you face are common and treatable. It’s completely normal to need help from your support team and other caregiver resources.

Set a Self-Care Goal

What is one realistic goal that you can set today to improve your social connections?

Each day is different, and you get up, put one foot in front of the other, and go—and love; just love.
—FIRST LADY NANCY REAGAN

When your focus is on caring for your loved one, the places where you live, care, work and play may fade into the background. But what surrounds you affects your ability to find peace, rest and strength. Your home and workplace, as well as the time spent at the doctor, in the car, outside and in the community can add or subtract from your stress levels.

Have you ever been somewhere that just makes you feel good? These “healing spaces” minimize stress. They bring your family and friends together and they allow you to be at your best. Many things are outside of your power but your physical space is one area of life over which you may have some degree of control. It takes creativity and intention, but you can try to create a space at work or at home that can add to your joy instead of your stress.

Your Home

When you walk in the door after a stressful day at work or at a medical appointment, it can help to return to a place of peace. Your home’s colors, clutter, scent and decor all affect you.

Here are some tips to make your home a place of healing and peace:

• Surround yourself with nature:
  • Natural light
  • Nature views or art
  • Nature sounds
  • Flowers
• Decorate with meaning:
  • Photographs of family and friends
  • Religious symbols
  • Meaningful objects
• Furniture arranged to encourage interaction
• Simplify your life:
  • De-clutter
  • Clean
  • Create quiet spaces for reflection

Each change in life is an opportunity to re-think what’s in your life. Perhaps letting go of items you no longer need would make your home more peaceful. Outer order encourages inner calm.

This may be an area in which you could ask for help from a friend, family or community member. Those in your circle of support may be able to help you make small changes in your home that make a big difference.

As Life Changes, So Does Your Home

When your loved one returns home from a hospital stay, physical challenges may require changes to your home. Your ill, injured or wounded warrior’s care team can help you to prepare your home for the transition from inpatient care to home care. Additions or adaptations may include a hospital bed, a walker or wheelchair, a ramp in place of the stairs or a shower stool in the bathroom. To help with moving from room to room, it can help to remove items that may cause falls like excess clutter, area rugs and cords.

In addition to the changing physical needs of your loved one, you are both going through emotional changes that can affect how your home feels to you. Items that once brought you joy may now make you yearn for the past or evoke feelings of anger. Recognize those items and consider replacing them with things that make you feel good. This will be different for each person.

A Restful Bedroom

Having a dark, clutter-free bedroom at night is a great way to help improve your sleep. You can purchase inexpensive blackout shades or curtains if streetlights keep your room too bright. Surround yourself with comfortable bedding that feels the best against your skin.

Colors Matter

Choose colors to suit your mood. Reds, oranges and yellows energize and stimulate, while other colors (blue, green and violet) evoke feelings of peace and restfulness.

Experiment with Scents

The sense of smell has a powerful connection to the brain. What you smell can stimulate feelings of wellbeing, improve your mood, relieve stress and clear your mind. Experiment with scents in your home. What makes you and your loved one enter a room and breathe more deeply?

Talk to your care provider about using aromatherapy. If you or someone in your home is pregnant, has asthma or a chronic lung disease, your doctor may want you to avoid certain essential oils.

Muffling Sounds

Sounds can be stressful or soothing. Experiment with playing music to set a mood or block out disturbing noises like street traffic. Carpets, curtains and soft fabrics absorb sound while hard surfaces amplify them.

Light Your Day and Night

Warm, natural light is soothing, while fluorescent or overhead lighting can be harsh. To create a feeling of warmth and intimacy, try lower, warmer lights. Put ceiling fixtures on a dimmer, especially over a dining table. Wall sconces and side lamps can help.

Get Help to Purge the Clutter

Those dealing with crisis situations may not have time to do the normal purging that keeps a home clear and clutter-free. Not being able to do the typical spring and fall cleaning can lead to an unintended hoarding-like environment. This contributes to anxiety and can be unsafe for those with mobility challenges.

On the Road

If you feel like you live in your car, make it a positive place. Small changes like keeping the inside of your car clean and trash-free might make the traffic jam less stressful. Here are a few more ideas for making car rides more pleasant:

• Consider adding an air freshener or car diffuser. Scents of lavender or vanilla relax, while orange or eucalyptus energize.
• Turn “wasted” car time into a time of learning or rejuvenation. Play an interesting podcast.
• Take a few minutes to repeat a positive or motivating thought to focus attention and interrupt the stress response. You can say a religious or spiritual prayer or an affirmation. Affirmations are positive thoughts that you can say daily in a repetitive way to help you to change your mindset and stay positive during unbearable and challenging times.
• Play music to set your mood.

Your Work

For some, being a caregiver is a full-time role. Others return to work outside the home after a span of full-time caregiving. Still others become caregivers in their retirement. Some provide part-time care. But all who work at least part time while providing care to a service member or veteran face unique challenges in taking on a dual role of worker and caregiver.

The changes needed to maintain a positive workplace may go deeper than décor and clutter. Life as a caregiver can be unpredictable. Demands on your time can take you away from the office more than your boss and coworkers would like. Even if they are trying to be sensitive to your situation, this sensitivity may run out over time. You may be wondering how to manage the demands of work with the growing needs at home.5 A support group can help you to answer the following questions:

• How can I share my caregiver experiences at work without showing weakness and vulnerability?
• How can I share caregiving challenges with my coworkers when I don’t want them to think my productivity and performance will suffer?
• How much of what I’m going through should I tell people at work?

Communicating With Your Boss

Learning new communication skills may become necessary. Some of the skills you have gained in communicating with your care recipient may be helpful when speaking with your boss. You may need to ask for more time off, schedule flexibility or changes in your job responsibilities or workload.

Here are some tips for communicating in the workplace:

• Think about what you hope to communicate. Write down all the topics you wish to share with your boss before the conversation so you feel prepared.
• Be clear about what you want or need from your boss in a way that is assertive rather than aggressive.
• Rehearse what you want to say. Practice in private or with someone in your circle of support.
• Use “I” statements, such as, “I need to leave at 5 o’clock to pick my child up from aftercare,” instead of “you” statements, such as, “You always make me stay late.”
• Communicate regularly with your boss to develop and maintain a comfortable relationship.

Work-Related Stress

The additional caregiving responsibilities may have required you to set aside work-related goals and dreams. Perhaps your work provided you with a sense of identity, purpose or self-esteem and now you feel a loss of meaning. Stress can build as you may have had to change or leave a job, face a loss of income or manage a tighter budget.

But the changes are not all bad. Recognize the new skills you have learned as a caregiver. The challenges you have overcome in your life as a caregiver may make you more flexible at work. You may not sweat the small stuff as much. You may feel like a stronger person and be better able to prioritize. You may be proud of all you are now able to accomplish during the day.

If a change of work becomes necessary, give yourself credit for all the new skills you have gained as a caregiver and showcase them in your job search.

Connecting with Nature

Spending time out of doors can be good for your mind, body and spirit. Take time out to watch a sunset or find a green space to eat lunch during your work hours. Working in or simply enjoying a community garden can help you connect to the earth.

If gardening is not an option for you, try walking in a local park or green space. Listen to the sounds of a fountain, watch birds in the trees or visit some other natural setting.

When dealing with the stresses of a busy life, it’s easy to tune out to the plants, animals and the natural world. Whether you live in the city, country or somewhere in between, be aware of the life around you. You can do this through artwork that depicts scenes of nature, a view of green and sky through a window or an online video of waves crashing along the shore.

In your own life, pick out and create spaces that involve all of your senses and promote feelings of peace, safety and connections with others. Another way to connect with nature is to track how changes in nature affect you, your mood, your weight and your energy level.

Being aware of these things can help you to make the best decisions. You can even try to change your perception of the situation. For example, if you find yourself becoming depressed or sad during rainy weekends, try to see the beauty in the raindrops or make something you love to do a rainy-day only activity. (You might even begin to look forward to them!)

Although bad weather can make you feel down, nature frequently provides positive images for meditation. Just as winter turns to spring, one’s self-healing capacity can move from sickness into health. The restorative quality of nature and your own body is an important image to hold onto throughout your journey.

In the Community

Whether it’s a school, workplace, place of worship or community organization, you are part of many groups that impact your life. Being involved in groups that are healthy and have healing qualities supports your health and wellbeing. These types of healing groups allow you to participate in making decisions that affect you. They promote open and honest communication, create a climate of trust and personal responsibility and inspire a sense of belonging.

Take part in groups that are specific to you or your loved one’s experience. Some of these include:

• Era of Service. Communities for Vietnam-era Veterans may provide a different cultural environment than one for those who served in Iraq and Afghanistan.
• Illness or Injury. Support groups may be specific for those who have experienced a TBI, post-traumatic stress or other illness or injury.
• Relationship to Your Care Recipient. Whether you are a spouse, parent, friend or relative may alter your experience. Connect with those who play a similar role.
• Survivors. Those who have lost a loved one may find comfort surrounded by other survivors or Gold Star Wives, mothers and fathers.
• Survivors of Suicide. Survivors may find comfort by making connections with those who have suffered a similar loss.
• Volunteer Group. Participating in a group that helps others can be rewarding. Your circle will expand and you will enjoy a sense of service from directing your energies to others.

At the Hospital or Other Care Facility

Making the most of your interactions with the medical care system is important. This includes your own health care, communication before, during and after appointments, decreasing anxiety during appointments and accessing integrative care.

Medical Care for the Caregiver

Without proper care, a cough can become pneumonia, a strain can become a fracture and a pull can become a tear. Maintaining your medical care is important to prevent chronic problems and keep you at the top of your game in body, mind and spirit.

Regular dental and medical care is more important now that you’re a caregiver. Identifying what’s in your way of getting medical care can help you solve the problem. At times, attitudes and beliefs can create barriers that stand in the way of caring for yourself. It may seem easier to care for another rather than caring for yourself. For some, not taking care of yourself may be a lifelong pattern. For others, this is a new problem to tackle. You may feel guilty taking the time to attend to your own medical appointment when you feel your loved one needs you. Identifying these thoughts can help you work through these feelings.

You may also benefit from learning certain caregiving skills, such as how to lift or move your loved one. Learning proper techniques may help you preserve your back and avoid injury.

Health Care for Your Loved One

Depending on where your loved one is on his/her healing journey, you may spend considerable time in the hospital or doctor’s office. Making the most of health care appointments can help improve care and lessen stress. Communication both before, during and after a health care appointment can help decrease tension and conflict especially when you and your service member or veteran may have different ideas about what you want to discuss with the doctor.

Consider the following:

Prepare for the Visit – Write down what needs to be covered during the appointment to ensure you don’t forget something important. Bring a list of medications and usage to the appointment. Medication management forms are available online. Bring any notes about symptoms or issues that your loved one has experienced.

Some topics may be sensitive. It can be embarrassing to talk about certain symptoms and upsetting to talk about memory loss or feelings of anger. At times, it may be helpful for each to talk to the doctor separately. Knowing in advance how your loved one wants to handle sensitive topics can prevent miscommunication during the appointment.

Talk about what role your loved one wants you to play in the appointment. Would they rather you sit in the waiting room, or would they prefer you take the lead in asking questions or remain silent?

Having these discussions can make it easier for you to communicate with health professionals so you don’t “betray” the person you are caring for by calling out a problem they weren’t ready to talk about. You may benefit from having a signed consent form for you to discuss issues with providers.

During the Visit—It can be helpful to use a tape recorder for important consults to prevent confusion. Many smart phones have a record function. You and your wounded warrior may hear different things. Taking notes can also help you remember what was said. If confused, ask for a follow-up consult.

Advocate for yourself and your loved one when needed. Clearly express what you need from the doctor.

After the Visit—Check in with your loved one. How did he/she think the appointment went? What do they wish had gone differently?

Decreasing Anxiety

You may not be able to control the stressors that are in your life, but you can learn skills that will prevent the stress from controlling you. Be aware of your breathing. Shallow, upper chest breathing is a sign of stress. Taking 30 seconds to do a deep breathing exercise will trigger your body’s natural relaxation response.

If the sounds of machines cause you anxiety, perhaps you can experiment with how listening to different genres of music makes you feel. Maybe you’d be better off listening to a book on tape or interesting podcasts. Take a moment to be mindful of how each activity makes you feel. Consider how it helps you react to your external environment.

Accessing Integrative Care

Integrative care is medical care that includes the best of traditional medicine, such as procedures and medications, with the best of nontraditional medicine, such as mind body treatments, acupuncture, massage, chiropractic care, energy medicine and others. Sometimes called complementary and alternative medicine, these treatments are best when used with traditional care rather than instead of it.

If you’re confused by all the terms for unconventional approaches to medical care—read on to decide which term resonates with you and learn five important aspects of integrative health care.

According to the National Center for Complementary and Alternative Medicine at the National Institutes of Health:

• “Complementary” generally refers to using a non-mainstream approach together with conventional medicine.
• “Alternative” refers to using a non-mainstream approach in place of conventional medicine.
• “Integrative” combines mainstream medical therapies and complementary and alternative therapies for which there is high-quality scientific evidence of safety and effectiveness.

Integrative care is important for both you and your wounded warrior because it acknowledges the whole person in mind, body and spirit. This type of care can often be practiced without a provider, making these techniques useful in self-care. Some can be learned from a provider and then done at home without additional help.

What Makes Your Care Integrative?

1. You matter. You play a major role in your own care especially treatment decisions. This is commonly called “patient-centered care” or “person-centered care.”
2. It is care of the whole person. By exploring more than just the one part of a person or one issue, it works to solve issues at their core and acknowledges the effect of many factors, including your mind, spirit and environment on your body, and vice versa, your body on your mind and spirit.
3. Your doctor is your partner in care. The doctor-patient relationship is important and is cultivated for comprehensive, continuous care.
4. The body is a self-healing machine. Integrative medicine recognizes that the body heals itself, so first optimizing that self-healing capacity is a priority.
5. Get the best of both worlds. Integrative medicine includes the best of conventional and complementary medicine.

Learn more about the evidence behind integrative care including fact sheets on acupuncture, yoga and art therapy at SamueliInstitute.org/Caregiver.

Your Health Team

Proper health care requires teamwork, with the patient in the center. Your providers should communicate with one another and keep your best interest as the top priority. All of your providers should be on the same page and work to set goals and expectations for your future care.

Set a Self-Care Goal

Wherever you spend your time, make sure that the spaces around you don’t add unnecessary stress to your days and nights. Focus on the spaces in which you spend the most time first and then move on to improve the others.

What is one improvement that you can make at home, work or at the doctor?

Take a moment to reflect on these three pieces of advice on your journey to health:

1. Being a caretaker is a marathon, not a sprint. This makes self-care critical to your resilience in mind, body and spirit.
2. Focus on your breathing throughout your day. Five seconds of mindfulness or gratitude helps to reset your stress response.
3. Ask for and accept help. You are not alone in this. Turn to friends and family, external resources like respite care, non-profit groups, Department of Defense/Veterans Health Affairs support or the resources on SamueliInstitute.org/Caregiver.

You have seen that self-care means the following:

• Regaining your sense of identity.
• Building strong social connections.
• Making healthy life choices.
• Surrounding yourself with healing where you live, care, work and play.

You are on your own unique place on your journey. To make progress you may need to take one step to the side and then another before you can take a step forward. When you are ready, take your next step to improve your own situation.

Too often, we tell ourselves and others that we aren’t caregivers because we feel caregivers have special training and fancy titles after their names. In reality, few people choose to be an informal caregiver—it’s simply what happens when you are drafted to care for those you love while also trying to negotiate the countless other responsibilities in your life.
—ZACHARY WHITE, PHD, AUTHOR OF THE UNPREPARED CAREGIVER BLOG

Contributors

Endnotes

1.  Kvaavik, Elisabeth (April 2010). “Influence of Individual and Combined Health Behaviors on Total and Cause-Specific Mortality in Men and Women: The United Kingdom Health and Lifestyle Survey”. JAMA Internal Medicine 170 (8). PMID 20421558. Retrieved 7 July 2015.
2. Centers for Disease Control and Prevention: http://www.cdc.gov/physicalactivity/basics/index.htm
3. CONTAGIOUS EMOTIONS By Ginger E. Blume, Ph.D. www.drgingerblume.com
4. Adapted from http://www.brainlinemilitary.org/content/2012/05/tips-for-communicating-with-people-with
   traumatic-brain-injury-and-post-traumatic-stress-disorder-.html
5. Questions adapted from: http://www.unpreparedcaregiver.com

Samueli Institute (SI) is an expert in the field of healing, self care, and military resilience. For the last 15 years, SI has worked with partners in the military and Veterans Affairs to help service members, special operators and veterans build resilience and recover from the trauma of war. SI is now leveraging that expertise for a different audience—the 5.5 million family caregivers who are critical to the health and wellbeing of the nation’s wounded, ill or injured service members and veterans. Learn more at SamueliInstitute.org.