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The term sandwich generation is generally applied to adults, mostly women, who are taking care of minor children and their parents simultaneously. Their parents are losing their autonomy, their children’s needs must be met, or their adult children may need financial support. The sandwich generation is taxed mentally, financially, and sometimes physically while they work to meet everyone’s needs. Being in the sandwich generation also contributes to the emotional load for individuals caring for both older and younger family members because they may feel like they exist in two different realities; parents are not technologically savvy and need hands-on computer and phone assistance while kids’ worlds are dominated by technology. And many of these sandwich generation individuals are working or involved with their own career, too.

Additionally, there is the “triple decker” or “club sandwich” generation which is defined as someone taking care of grandchildren to provide support to an adult child while also providing care for a parent. These individuals may be in their 60s caring for toddlers and a parent who is in their 80s. The “open faced” generation is anyone who is non-professionally providing care for an elder.      

Impacts to the rising number of individuals in the sandwich, triple decker, and open-faced generations include the overall increase in life expectancy, people having children later in life, and more young adult children remaining at home or who return. “It’s not surprising that so many people in that age group are experiencing stress,” says psychologist Katherine Nordal, PhD, executive director for professional practice, American Psychological Association. “The worry of your parents’ health, and your children’s well-being as well as the financial concern of putting kids through college and saving for your own retirement is a lot to manage.”  In fact, most days it can be overwhelming.

For individuals who are living in the sandwich generation, taking care of themselves can be low on the list of priorities. However, not taking care of oneself may further impact stress, burnout, and fatigue.  

Strategies to consider for anyone feeling overwhelmed by caring for more than one generation:

• Identify stressors and to what they are related. Are there ways to reduce these stressors such as having a cleaning service come to your house or your parent’s house? Would it be helpful to occasionally hire childcare?   
• Recognize how you manage your stress. Are you using healthy or unhealthy coping strategies? How can you incorporate healthy coping strategies into your day and week? Taking a short walk or having coffee with friends can boost your mood.
• Make time for what is important.
• Prioritize and delegate responsibilities.
• Build a support network.  
• Make self-care a priority. It is okay to set boundaries for yourself. It is okay to set boundaries for others who are vying for your attention. Setting boundaries does not make a person selfish.
• Take care of yourself day to day making sure you are getting ample sleep, keeping hydrated, and eating a balanced diet.
• Consider ways to lessen your work responsibilities. Can you delegate work tasks or say no to serving on a committee? 
• Use paid time off to recharge.
• Look for support groups that relate to what you are managing. Attending a support group for caregivers of individuals with dementia can provide an outlet for you as well as give helpful suggestions.
• Find senior care for parents. What would help ease your need to support your parents? 
• Seek professional help.
• Above all, be kind to yourself!

While the number of individuals who live in the sandwich, triple-decker, or open-faced generations may continue to rise, being mindful of limitations, ways to engage in self-care, and setting boundaries are strategies to keep in mind. Taking care of yourself affords you the ability to take care of others.

Competency Versus Capacity:

Competency is a term used in forensics and is a legal term can refer to a defendant’s capacity to comprehend allegations against them, such as Competency to Stand Trial, or can refer to a person’s competency to handle their own affairs, such as financial or medical decision making. Competency is a global assessment and a legal determination made in court; it is a judicial decision and is decided by the court, though the court often has a psychologist evaluate the individual to provide information on their abilities and functioning.

Capacity refers to an assessment of an individual’s psychological abilities and has four main dimensions: understanding, appreciation, reasoning, and expression of a choice. Capacity is determined by a psychologist, and is fluid and can change over time. An individual may have impaired capacity for a short, temporary period of time or it may last for longer. For example, individuals with dementia may have fluctuations in their capacity. Additionally, capacity should be related to something specific, for example, you may have the capacity to make medical decisions but not have capacity to make financial decisions.

What Is Dementia?

Dementia is a general umbrella term for loss of memory, language, problem-solving abilities, and other cognitive impairments, that are severe enough to interfere with everyday life. There are many different types of dementia. Alzheimer’s disease is the most common form of dementia; however, other types of dementia include Vascular, Lewy Body, Frontotemporal, and Mixed (a combination of two or more types of dementia).

Signs And Symptoms Of Dementia:

Symptoms of dementia are progressive, which means that signs of cognitive impairment start out slowly and gradually get worse over time. Early symptoms of dementia can include memory loss, difficulties concentrating, difficulties or confusion completing a daily familiar task (i.e., using the microwave or stove), word finding difficulties in conversation, being confused about time and place, or mood changes. Other symptoms can include wandering and getting lost in familiar places, repeating questions, using unusual words to refer to familiar objects, hallucinating or experiencing delusions or paranoia, not caring about other’s feelings, or difficulties with balance and movement.

When Should I Be Evaluated Or Have My Loved One Evaluated?

If you or a loved one are experiencing memory difficulties or cognitive changes, see a doctor to determine the cause. Early diagnosis of dementia allows you or your loved one to get maximum benefit from available treatments and allows you to be provided with recommendations to improve your daily functioning. 

What Are The Appropriate Steps To Being Evaluated?

Oftentimes, the first step is to visit your primary care physician and they can help you find a specialist (i.e., psychologist who tests for cognitive issues such as dementia, capacity areas, or competency areas). Or you can research and find a specialist in evaluating in these areas. Your psychologist can then evaluate your symptoms and determine a diagnosis. If you have a court case related to Competency or Capacity, you can use the report in that case.

What Types Of Evaluations Are There?

Cognitive and neurological tests are available and used to evaluate thinking and functioning. These can include capacity and competency evaluations which help in determining an individual’s ability to evidence a choice, ability to understand relevant information, ability to appreciate the situation and consequences, and ability to manipulate information rationally.This can be done by asking individuals to respond to what they have been told about their medical condition and interventions, and asking individuals to disclose and paraphrase their understanding of the proposed treatment intervention or diagnostic procedure, or court processes, in combination with psychological testing. For dementia, brain scans can also be used to identify problems that cause dementia and identify any changes in your brain’s structure and function.

What Does This Mean If I Am Diagnosed With Dementia?

Being diagnosed with dementia does not mean you are losing your freedom and independence. In fact, there are specific things you can do to ensure this. Early diagnosis can provide time to plan for the future. You can appoint a power of attorney (POA), which involves a legal document that allows someone else to act on your behalf when you cannot. You can plan ahead to appoint a POA to be a substitute decision-maker for medical decisions, finances, etc. POAs can be complicated and having the help of a lawyer can protect against potential abuses. Lastly, if you are deemed to not have capacity this does not necessarily mean you will be deemed to not have competency. Competency is determined by the court and differs from capacity. If you are deemed not to have competency in some area, trusted loved ones can act as POAs for you; while that can be stressful, you can also still live a fulfilling life.

Summary:

• Competency is a legal term that is determined in court and capacity is the assessment of an individual’s psychological abilities and has four main dimensions: understanding, appreciation, reasoning, and expression of a choice.
• If it is determined by a doctor (psychologist, neuropsychologist, psychiatrist) through testing (cognitive or neurological) that you do not have capacity, then this may lead to not having competency in court, however, this is not always the case.
• A diagnosis of dementia which is characterized by memory loss and cognitive impairments, that are severe enough to interfere with everyday life, may impact one’s capacity and it is important to be evaluated as early as possible.
• Appointing a power of attorney as early as possible can help minimize stress related to decision making in both legal and personal domains.
• Psychotherapy can help alleviate any stress you may experience related to this topic. Ask for a therapist experienced in health psychology, aging, and/or dementia.

In today’s fast-paced world, feelings of anxiety and overwhelming stress have become increasingly prevalent, and are often referred to as the ‘common cold’ of mental health. These emotional states not only impact our mental well-being but can also hinder our ability to function optimally in various aspects of life, including work, studies, and personal relationships. However, it’s essential to understand that recovery from anxiety disorders and chronic stress is achievable through the implementation of appropriate strategies and techniques.

This comprehensive guide aims to empower individuals by providing a holistic approach to managing anxiety and stress effectively. By exploring a diverse range of evidence-based methods, readers will gain valuable insights and practical tools to cultivate a sense of calm and regain control over their emotional well-being.

Understanding the Nature of Anxiety and Stress

The Physiological Response

To effectively manage anxiety and stress, it is crucial to understand the underlying physiological mechanisms at play. The “fight or flight” response is the body’s natural reaction to perceived threats or dangers. However, for individuals with anxiety disorders, this response can be triggered inappropriately by situations that are generally harmless.

During this physiological reaction, the body releases a surge of hormones, such as adrenaline and cortisol, which prepare the body for action. This can manifest physically through symptoms like increased heart rate, rapid breathing, muscle tension, and sweating. While this response is beneficial in genuinely threatening situations, chronic activation can lead to adverse effects on both physical and mental health.

The Psychological Impact

Anxiety and stress can have a profound impact on an individual’s psychological well-being. Persistent worry, rumination, and negative thought patterns can contribute to a heightened state of anxiety and exacerbate stress levels. These psychological factors can further perpetuate the physical symptoms, creating a vicious cycle that can be challenging to break without proper intervention with a therapist who specializes in anxiety.

Moreover, anxiety disorders and chronic stress can significantly impair an individual’s ability to function optimally in various aspects of life, including work, education, and social interactions. This can lead to feelings of isolation, shame, guilt, and a diminished sense of self-worth, further compounding the issue.

Developing a Comprehensive Approach

Overcoming anxiety and stress requires a multifaceted approach that addresses both the physiological and psychological components. By incorporating a combination of techniques and strategies, individuals can gain a greater sense of control, experience less anxiety, and cultivate resilience to manage any stress and anxiety they do experience.

Mindfulness and Relaxation Techniques

Embracing the Present Moment

Mindfulness is a powerful tool that can help individuals break free from the cycle of anxiety-provoking thoughts and rumination. By cultivating a practice of present-moment awareness, individuals can learn to disengage from unhelpful thought patterns and redirect their attention to the here and now. Mindfulness techniques, such as body scans, breath awareness, and mindful movement, can help individuals develop a greater sense of calm and clarity. These practices promote a non-judgmental observation of thoughts, emotions, and physical sensations, allowing individuals to respond to them with greater objectivity and compassion. Think you can’t learn these? There’s lots of help available! Many apps exist, or a few sessions with a therapist can teach you these techniques! This also holds true for the relaxation techniques we will discuss next.

Relaxation Techniques for Mind and Body

Relaxation techniques are powerful tools for counteracting the physiological effects of anxiety and stress. By consciously engaging in practices that promote relaxation, individuals can activate the body’s natural relaxation response, which can help alleviate symptoms such as muscle tension, rapid breathing, and elevated heart rate.

Some effective relaxation techniques include:

• Progressive Muscle Relaxation (PMR): This technique involves systematically tensing and releasing different muscle groups, promoting a deep state of relaxation throughout the body.
• Diaphragmatic Breathing: By focusing on deep, controlled breaths originating from the diaphragm, individuals can regulate their breathing patterns and promote a sense of calm.
• Guided Imagery: This technique involves visualizing peaceful and serene scenes or environments, allowing the mind to disengage from anxious thoughts and promote relaxation.
• Yoga and Gentle Stretching: Incorporating mindful movement practices like yoga or gentle stretching can help release physical tension and promote a greater mind-body connection.

Cognitive-Behavioral Strategies

Challenging Negative Thought Patterns

Cognitive-Behavioral Therapy (CBT) is a well-established and effective approach for managing anxiety and stress. At its core, CBT focuses on identifying and challenging negative thought patterns and beliefs that contribute to and perpetuate anxious and stressful states. By learning to recognize and reframe distorted or irrational thoughts, individuals can gain a more balanced and realistic perspective on situations that previously triggered anxiety or stress. CBT techniques, such as cognitive restructuring, reality testing, and rational self-talk, can empower individuals to develop a more positive and adaptive mindset. Many therapists are trained in CBT so finding help is easy.

Exposure Therapy: Facing Fears with Courage

Exposure therapy is a powerful component of CBT that involves gradually and systematically confronting feared situations or stimuli in a safe and controlled environment. This approach aims to desensitize individuals to their anxiety triggers, allowing them to develop a greater sense of confidence and mastery over their fears.

The process of exposure therapy typically involves:

1. Identifying and ranking anxiety-provoking situations or stimuli from least to most threatening.
2. Developing a step-by-step plan to gradually expose oneself to these situations or stimuli, starting with the least threatening.
3. Practicing coping strategies, such as relaxation techniques and positive self-talk, during the exposure process to manage anxiety levels.
4. Repeating the exposure exercises until the feared situation or stimulus no longer elicits an intense anxious response.

Through this process, individuals can learn to redefine their perceptions of danger and develop a greater sense of resilience in the face of anxiety-provoking situations.

Lifestyle Modifications and Self-Care Practices

Nurturing the Mind and Body

Adopting a holistic approach to managing anxiety and stress involves making lifestyle modifications and embracing self-care practices that support overall well-being. By nourishing the mind and body, individuals can enhance their resilience and create a solid foundation for managing anxiety and stress effectively.

Maintaining a Healthy Diet

A well-balanced and nutrient-rich diet can play a crucial role in managing anxiety and stress levels. Certain nutrients, such as magnesium, vitamin B, and calcium, have been shown to support relaxation and promote a sense of calm. Incorporating whole, unprocessed foods like whole grains, leafy greens, and low-fat dairy products into one’s diet can help ensure adequate intake of these essential nutrients. Additionally, it is advisable to limit or avoid substances that can exacerbate anxiety and stress, such as caffeine, nicotine, and stimulant drugs. These substances can trigger the release of stress hormones, further compounding the physiological effects of anxiety and stress.

Regular Exercise and Physical Activity

Engaging in regular physical activity can be an effective way to manage anxiety and stress. Exercise not only helps burn off excess stress hormones but also promotes the release of endorphins, which are natural mood-boosting chemicals in the body.

Incorporating a variety of physical activities, such as brisk walking, swimming, cycling, or engaging in sports, can help individuals find enjoyment and prevent boredom. Aim for at least 30 minutes of moderate exercise most days of the week, or engage in more vigorous activities for shorter durations, depending on individual preferences and capabilities.

Building Self-Esteem and Assertiveness

Low self-esteem and a lack of assertiveness can contribute to and exacerbate anxiety and stress. Individuals with anxiety disorders may struggle to communicate their needs, wants, and boundaries effectively, leading to a sense of powerlessness and increased anxiety.

To combat this, it is essential to work on building a healthy sense of self-worth and developing assertiveness skills. This can involve engaging in activities that foster personal growth, setting realistic goals, and practicing effective communication techniques. Additionally, seeking support from counselors or support groups can provide guidance and strategies for cultivating self-esteem and assertiveness.

Fostering Supportive Relationships

Social support can play a vital role in managing anxiety and stress. Surrounding oneself with a network of supportive friends, family members, or a local support group can provide a sense of belonging, understanding, and encouragement. Sharing experiences and concerns with others who have faced similar challenges can help individuals feel less isolated and more empowered to overcome their struggles. Additionally, engaging in social activities and cultivating meaningful connections can promote a sense of purpose and fulfillment, which can further contribute to overall well-being.

Seeking Professional Guidance

While the strategies outlined in this guide can be highly effective in managing anxiety and stress, it is important to recognize that some individuals may require additional support from mental health professionals. If anxiety or stress levels become overwhelming or interfere significantly with daily functioning, seeking professional help is recommended.

Mental health professionals, such as psychologists, counselors, or therapists, can provide personalized guidance and evidence-based treatments tailored to individual needs. They can also assist in identifying and addressing any underlying factors contributing to anxiety or stress, and provide ongoing support throughout the recovery process.

It is important to remember that seeking professional help is a sign of strength and a commitment to one’s well-being. With the right support and a willingness to engage in the recovery process, individuals can overcome anxiety and stress, and reclaim a sense of calm and balance in their lives.

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Conclusion

Managing anxiety and stress is a journey that may people face these days, and by being persistent, you can decrease your stress and anxiety. By incorporating mindfulness and relaxation techniques, cognitive-behavioral strategies, lifestyle modifications, and seeking professional guidance when needed, individuals can lessen the stress or anxiety they feel, and develop the resilience and coping mechanisms necessary to navigate life’s challenges with greater ease. Remember, recovery is possible, and by embracing the strategies outlined in this comprehensive guide, individuals can reclaim their inner calm and cultivate a sense of empowerment in the face of anxiety and stress, and even greatly reduce the amount of anxiety and stress they experience.

Anger management is a considerably frequent topic in therapy, both in our work with individuals and couples. Some people seek therapy on their own to get help, whereas others are court ordered to address anger management. Anger can cause toxic divisions between people, have partners lacking senses of safety or predictability in relationships, and induce powerful shame and embarrassment in the one who struggles to regulate emotion. Fortunately, people can make significant strides in their relationship to their anger in a relatively short time.

The first key element of working through anger is to openly and earnestly explore what functions it serves in one’s life. It can in fact be an adaptive mechanism at times, and recognizing this normalizes and validates it, undermining some of the resultant shame which can occur when one has problematized their anger. Speaking broadly, there are two general functions it serves with people. First, it serves as a communicator when one feels they are not being listened to (albeit a less-than-skillful communicator). Exasperation in not being heard can lead to a person, purposefully or unconsciously, choosing to increase the volume and vitriol. Second, as Sue Johnson explains in Emotionally Focused Therapy (EFT), it can serve to obscure the more tender, intimate feelings, such as loneliness, fear or hurt. If one contacts and communicates these primary feelings, the protection of anger isn’t as needed in one’s life. Successful working through anger requires a skilled and intentional replacing of these functions.

The next key in approaching anger is simply to allow oneself the space to intervene with it. Buddhist psychologist and meditation teacher Jack Kornfield refers to this as taking the “Sacred Pause.” The hormones associated with anger, testosterone, adrenaline and cortisol, lead to racing thoughts and a sense of needing to declare one’s truth (loudly and forcefully) as it occurs. Taking a moment to reflect, calm oneself into a place of internal stillness, and respond rather than react is critical in this work. Many people are never taught this skill and can make great strides at this when taught in therapy. Once that space has opened up, a gentle breathing exercise such as deep diaphragmatic breathing can be a way to soothe the physiological impacts of the stress hormones. Another way to allow ourselves the opportunity to monitor our feelings and ensure they aren’t hurling us around the room is to be sure to listen with openness and repeat back what we are hearing prior to responding. This can slow down the conversation in a way that we may gain some distance from our habitual triggers.

Cognitive therapy can assist with another important part of managing one anger, which is learning respect for others and for opinions that differ from one’s own. Once a person gains insight into what purpose their anger serves, learns to manage the hormonal rush associated with anger, and becomes a better listener, the next challenge is to not get riled up if what one hears or experiences is not what they want. Mutual respect for others’ right to have a different way of thinking, even if you disagree with it, assists a great deal with staying calm.

Having learned to remain calm and listen, the next step is being able to communicate one’s thoughts and feelings effectively. Building communication skills is thus also important to emotion regulation, because it is easier to avoid becoming angry when you feel confident in your ability to clearly express yourself.

Finally, it can be instructive to inquire into what exactly our triggers really are. A common theme is a lack of control leading to frustration or rage. For these people, there can exist a vicious cycle in which they feel powerless or out of control, become frustrated, and then their emotions themselves dictate their words and choices, which reconfirms this feeling of being out of control (only now it’s their own feelings controlling them!), and an instantaneous negative feedback loop is born.

Through a deeper understanding of anger’s place in one’s life, its birth and how it perpetuates, along with some simple emotional regulation and communication skills, people are able to make significant strides. While people on the other end of someone’s anger feel hurt by it, the anger also takes a toll on the person who is angry… it does not feel good to be consumed with anger. Thus these strides in new anger management skills benefit both the individual and those around the person…everyone benefits!