The New York Times

By Pooja Lakshmin

May 29, 2020

New and expecting moms are facing pandemic-related fears on top of social isolation.

After going through a harrowing bout of postpartum depression with her first child, my patient, Emily, had done everything possible to prepare for the postpartum period with her second. She stayed in treatment with me, her perinatal psychiatrist, and together we made the decision for her to continue Zoloft during her pregnancy. With the combination of medication, psychotherapy and a significant amount of planning, she was feeling confident about her delivery in April. And then, the coronavirus hit.

Emily, whose name has been changed for privacy reasons, called me in late-March because she was having trouble sleeping. She was up half the night ruminating about whether she’d be able to have her husband with her for delivery and how to manage taking care of a toddler and a newborn without help. The cloud that we staved off for so long was returning, and Emily felt powerless to stop it.

Postpartum depression and the larger group of maternal mental health conditions called perinatal mood and anxiety disorders are caused by neurobiological factors and environmental stressors. Pregnancy and the postpartum period are already vulnerable times for women due in part to the hormonal fluctuations accompanying pregnancy and delivery, as well as the sleep deprivation of the early postpartum period. Now, fears about the health of an unborn child or an infant and the consequences of preventive measures, like social distancing, have added more stress.

As a psychiatrist who specializes in taking care of pregnant and postpartum women, I’ve seen an increase in intrusive worry, obsessions, compulsions, feelings of hopelessness and insomnia in my patients during the coronavirus pandemic. And I’m not alone in my observations: Worldwide, mental health professionals are concerned. A special editorial in a Scandinavian gynecological journal called attention to the psychological distress that pregnant women and new mothers will experience in a prolonged global pandemic. A report from Zhejiang University in China detailed the case of a woman who contracted Covid-19 late in her pregnancyand developed depressive symptoms. In the United States, maternal mental health experts have also described an increase in patients with clinical anxiety.

In non-pandemic times, as many as 14 percent of women will suffer from pregnancy-related anxiety, which refers to fears that women have about their own health and their baby’s over the course of pregnancy and delivery, and up to 20 percent of women will experience postpartum depression.

Samantha Meltzer-Brody, M.D., M.P.H., who is the chair of the department of psychiatry at the University of North Carolina at Chapel Hill and the director of the Center for Women’s Mood Disorders, said, “The natural vulnerability of this major life transition is exacerbated when you just have sort of global anxiety, and things like going to the grocery store to pick up diapers suddenly become a much more anxiety-producing event than it ever was before.”

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Dr. Meltzer-Brody explained that the higher levels of stress in perinatal women increase their risk for developing a clinical disorder, such as perinatal depression or anxiety.

In my clinical practice and in a Covid-19 maternal well-being groupI co-founded, women have voiced their fears about a number of possible distressing scenarios: delivering without a support person; being one of the 15 percent of pregnant women who is asymptomatic for Covid-19 and facing possible infant separation; and recovering during a postpartum period without the help of family or friends to provide support. There’s also grief about the loss of a hopeful time that was meant to be celebrated with loved ones.

Pregnant women and new mothers must also deal with the constant low-grade panic that comes with making decisions that have no specific medical guidelines, such as: What should I do if I have other kids at home and the only person who can help me is a grandparent who is at high risk? What kind of precautions should I take if my partner is a health care worker? Is it OK to send my kid back to day care? Without clear right answers, the mental load of these decisions defaults to mothers.

IDEAS.TED.COM

May 26, 2020 / Judson Brewer MD, PhD

When you’re anxious, one of the best things you can do is slow down and focus on your breath. But what can you do when you’re so anxious or worried that this doesn’t work or simply feels impossible to do?

Below, I’ll share a simple but effective trick that brings in more of your senses and helps cut through the anxiety so you can access more calm and focus.

But first, a quick look at the science behind worry and anxiety. 

There’s a part of your prefrontal cortex — the thinking and planning part of your brain — that is called the dorsolateral prefrontal cortex, or dlPFC for short. It is toward the front and side of your brain. The dlPFC has been shown to be important for working memory; basically, it holds information for you to use right now. You rely on it when someone tells you a phone number and you repeat it to yourself as you prepare to dial, or when you take mental note of the items you need to pick up at the grocery store in the next few minutes.

If you’re really worried about something, that worry thinking takes up space in your working memory. You can compare your dlPFC to the RAM of your computer. If your computer has a lot of RAM, you can run a bunch of programs at the same time. If it doesn’t have that much, it gets slower as you use up the space, signaled by the spinning wheel of “Hey, you are overtaxing me right now.” Eventually, it crashes if you keep pushing.

So how can you free up that space and get your brain working more effectively?

Mindfulness practices can get your thinking brain back online, but doing them can sometimes be really challenging. You might try to bring your awareness to your breath or your feet, but if your working memory is filled with worry thoughts, this effort can feel forced or just not enough to help your mind and body calm down.

So here’s a little exercise to use to reboot that RAM in your brain: It’s called five finger breathing. 

Step 1: Place the index finger of one hand on the outside of the pinky finger on your other hand. As you breathe in, trace up to the tip of your pinky, and as you breathe out, trace down the inside of your pinky.

Step 2: On your next inhale, trace up the outside of your ring finger, and on the exhale, trace down the inside of your ring finger.

Step 3: Inhale and trace up the outside of your middle finger; exhale and trace down the inside of your middle finger.

Step 4: Continue finger by finger until you’ve traced your entire hand.

Step 5: Reverse the process and trace from your thumb back to your pinky.

Five finger breathing is great, because it brings several of your senses together at the same time. You’re watching and feeling your fingers while you’re paying attention to your breath. This not only requires awareness of multiple senses (seeing and feeling) but an awareness of multiple locations in your body (your two fingers, your two hands and your lungs).

When you’re able to use up your RAM with multi-sensory and multi-location awareness, you can forget what you’re worrying about, even if it’s for a few moments. As you do this, you’re also calming your physiology down, so if those thoughts come back, they won’t be as convincing because they won’t have the same emotional tone. Without that arousal, they have less weight behind them and they’re easier to let go of or not react to.

If you have children in your life, I encourage you to teach them five finger breathing. Then, practice together. You can do this before each meal, before nap time, before bed or during other transition points within the day.

If you notice that you’re starting to get worked up during the day, take a moment to express how you’re feeling. You could say, “Oh, I’m a little stressed right now.” Then enlist your kids’ help, which will empower them, and ask them: “Can you help me calm down by leading me in a five finger breathing?”

If you don’t have kids or live alone, no worries. Just let your inner child help and guide you.

This article originally appeared in Elemental.

Watch Judson Brewer’s TEDMED Talk here:https://embed.ted.com/talks/judson_brewer_a_simple_way_to_break_a_bad_habit

ABOUT THE AUTHOR

Judson Brewer MD, PhD Judson Brewer is the Director of Research and Innovation at the Mindfulness Center and associate professor in psychiatry at the School of Medicine at Brown University, as well as a research affiliate at MIT. As an addiction psychiatrist and expert in mindfulness training for treating addictions, he has developed and tested novel programs for habit change, including both in-person and app-based treatments for smoking, emotional eating and anxiety. Based on the success of these programs in the lab, he cofounded MindSciences, Inc. to create app-based versions of these programs for a wider audience. He is also the author of the book The Craving Mind. 

Is aging a dirty word to you? Do you wish that you could stay young forever and enjoy your youth indefinitely? 

If so, you’re not alone. In fact, if the cosmetics industry is anything to go by, everyone is in the same boat. We all want to avoid the specter of old-age and frailty. 

Aging, though, doesn’t have to be negative. For one, it is a sign of success. If your skin is wrinkled and your hair grey, it shows you’re a survivor – you made it through. 

Growing old also provides you with decades of insight you don’t get when you’re younger. It takes time to understand how the whole show works. 

There’s a tendency to see aging as something negative – and in many ways, it is. But there are also positive aspects to it we shouldn’t overlook. 

You Have More Time For Others

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At the start of life, you spend the vast majority of your time working like a maniac, trying to accumulate the resources you need to have a decent quality of life. The problem, though, with working fifty hours a week, is that it takes you away from the things that matter – your friends and family. 

Getting older, however, helps to reverse this process. When you retire, you suddenly have more time to do all the things you never could in your working life. And that means you can invest more time in your relationships – the most motivating aspect of existence for many people. 

You Develop Better Social Skills

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Learning how to navigate the social environment is a massive challenge. Other people are complicated, and so are you. So it takes time to learn the game. 

Once you have several decades under your belt, though, you can gain worldly wisdom. Eventually, you see how the landscape works and are able to run with it confidently. You’re much better able to deal with difficult situations and know precisely what the other person needs to hear. Over time, you become known in your local community for your sensitive, empathic abilities. 

Achieving A Sense Of Accomplishment

Feeling a sense that you’ve accomplished something in your life is difficult when aged twenty. When you hit sixty, though, you’ve had way more time to get done what you needed to do. 

Achieving a sense of accomplishment is something you only get once you pass a certain age. You can watch your children grow up and take on the world, just like you did when you were young. And you can see the effects of your work in the world all over the place. 

You Get Discounts

Despite the fact that you probably have a large pension pot in the bank, you get various privileged discounts when you become a senior. There are discounts all over the place, from medicine to dining to entertainment and transportation. 

All these perks are a way for society to express its collective admiration for people who’ve committed their lives to the good of the people around them. Well – that’s the hope, at least. 

You Have More Time For Civics And Volunteering

When you get older, you no longer have to pursue a career if you don’t want to. Instead, you can change how you use your time, focusing more on civics and volunteering. 

Many in-home senior care providers actively make this a part of their service offering. Being able to dedicate your time to people in need gives your life a strong sense of purpose and fill the days, which can sometimes seem a little empty. 

You Have A Happier Outlook

Over the decades, research has shown that happiness peaks at age twenty and then declines in our thirties and forties, before bouncing back later in life. If you are old, therefore, you are much more likely to feel happy too. 

Why this happens isn’t entirely clear. You would have thought that the younger generation would be the most content since they have their health and vigor. But psychologists believe the reason has to do with an improved ability to deal with hardship. Over the course of their lives, older people develop the skills they need to thrive emotionally, even in situations of adversity. People in their thirties and forties facing issues like unemployment and divorce don’t have the benefit of hindsight. They must go through these things first. 

The perks of getting older, therefore, do exist. Often, it is a question of being grateful for what we have, not angry about things we don’t. 

A blog by Rachel Bustin that you might be interested in. 

Daily Living Aids For The Elderly or Limited Mobility

I’m reposting for the very important month of Alzheimer’s Awareness. Although I don’t have Alzheimer’s, I do have dementia caused from Lyme Diseases. Every day my memory slips a little, some days I don’t notice, this week has been a difficult week. I know from experience with my granny’s dementia stress can play a role in how your day is going. Even as she progressed in her diseases I could tell the stress we felt impacted her in some way.

If I can say anything it’s never argue, there is no winning. Change the subject and that often works. I would sometimes have problems with her not wanting to take her medication and become very angry. I let it go and a little while later came back and said time to take your medication. Most of the time it worked.

Remember once your loved one no longer knows who you are it’s not personal, it hurts like hell but it’s not personal. One of the activities I did at the end of granny’s life was show her photos of her parents. I would hear her call out for her mother sometimes and I hoped the photos would give her some peace.

Above all else, there is no right or wrong way to take care of someone with Alzheimer’s or dementia. There are many things you can do to make their life easier and safer but you can only do your best. As hard as the decision may be, there are times when an Alzheimer’s rated facility is required. It is very difficult to care for someone at home. It’s a full-time job in addition to health care assistance.

Melinda

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By Bethany Bray

Licensed professional counselor (LPC) Ruth Drew oversees the Alzheimer’s Association’s 24-hour helpline, which offers support to those facing the challenges of dementia and Alzheimer’s disease, including families and caregivers. The fact that the helpline receives more than 300,000 calls each year hints at the heart-wrenching issues that accompany a dementia diagnosis, not just for the individual but for the person’s entire support system.

“We receive a wide range of questions, from someone worried about the warning signs of cognitive decline or dealing with a new diagnosis, to an adult son whose mother didn’t recognize him for the first time, or a wife wondering how to get her husband with Alzheimer’s to take a bath. Whatever the reason for the call, we meet callers where they are and endeavor to provide the information, resources and emotional support they need,” says Drew, director of information and support services at the Chicago-based nonprofit.

Professional counselors are a good fit to help not only individuals with dementia and Alzheimer’s, but also those in their care networks, Drew says. Whether counseling individuals, couples or even children, the far-reaching implications of dementia mean that practitioners of any specialization may hear clients talk about the stressors and overwhelming emotions that can accompany the diagnosis.

“People diagnosed with Alzheimer’s and other dementia diseases are going through profound life changes — coping with the realities of an incurable disease that is stealing their abilities and their memories. Counseling offers a place to process the losses, develop ways to cope, and find meaning in their current situation,” Drew says. “Similarly, family members face emotional, physical and financial challenges when they care for someone with Alzheimer’s. It helps to have a safe place to process feelings, get support, learn to cope with present realities, and plan for the future.”

A growing need

“Dementia isn’t a normal part of aging. It just happens that most dementia patients are older,” says Jenny Heuer, an LPC and certified dementia practitioner in Georgia who specializes in gerontology. “There is this stigma that just because you’re getting older, you’re going to get dementia.”

The Alzheimer’s Association (alz.org) defines dementia as “an overall term for diseases and conditions characterized by a decline in memory, language, problem-solving and other thinking skills that affect a person’s ability to perform everyday activities.”

Although many people associate dementia with Alzheimer’s, there are numerous forms of dementia, and not all are progressive. Dementia can be reversible or irreversible, depending on the type, explains Heuer, the primary therapist in the geriatric unit at Chatuge Regional Hospital in Hiawassee, Georgia. Alzheimer’s, an irreversible, progressive form of dementia, is most common, followed by vascular dementia, which can occur after a stroke. Forms of dementia can also co-occur with Down syndrome, Parkinson’s disease, Huntington’s disease and other diagnoses. Research has also linked moderate to severe traumatic brain injury to a higher risk of developing dementia or Alzheimer’s disease years later.

Heuer, a member of the American Counseling Association, recalls a client she counseled who was diagnosed with Alzheimer’s prior to age 62. She had lived with a husband who was violent and physically abusive toward her, and the client’s caregivers wondered if she had suffered a brain injury that contributed to her early onset Alzheimer’s.

Heuer notes that other conditions can lead to an assumption or misdiagnosis of dementia. For example, a urinary tract infection (UTI), if left untreated, can progress far enough to cause confusion in a client. Once the UTI is diagnosed and treated, the confusion can dissipate. In addition, excessive alcohol use, depression, medication side effects, thyroid problems, and vitamin deficiencies can cause memory loss and confusion that could be mistaken for dementia, according to the Alzheimer’s Association.

“There’s so many [other] things to rule out,” Heuer says. “Doctors try to rule out every other health issue before they diagnose dementia.”

The complicated nature of dementia only reinforces the need for counselors to do thorough intake evaluations and to get to know clients holistically, Heuer says. Counselors should ask clients about anything that has affected or could be affecting their brain or memory, including medication use, stress levels, past physical trauma or brain injury, depression, sleep patterns, exercise and other factors.

The World Health Organization (WHO) reports that roughly 50 million people worldwide currently have dementia, and nearly 10 million new cases develop each year. Alzheimer’s disease-related dementia may contribute anywhere from 60% to 70% of that overall number, according to WHO.

Alzheimer’s is the sixth-leading cause of death in the United States, according to the Centers for Disease Control and Prevention. The Alzheimer’s Association estimates that 14% of people ages 71 and older in the United States have some form of dementia. A recent report from the nonprofit estimated that 5.7 million Americans of all ages were living with Alzheimer’s-related dementia in 2018, the vast majority of whom (5.5 million) were 65 and older. Close to two-thirds of Americans with Alzheimer’s disease are women, according to the association.

These numbers are only expected to increase as the U.S. population ages and the baby-boom generation reaches retirement and later life, Heuer notes.

The U.S. Census Bureau projects that in the year 2034, the number of Americans 65 and older will, for the first time in history, eclipse the nation’s number of youths under age 18. By 2060, close to one-quarter of Americans will be 65 or older, and the number of people older than 85 will have tripled.

“Aging issues hit home for counselors across the board,” Heuer says, “because we are all aging, and many are caring for aging parents. … I invite other counselors to join me in working with this population. [Alzheimer’s] is the sixth-leading cause of death. That sounds very morbid, but it’s only going to go higher. More and more people will be diagnosed. With the aging baby-boom population, there’s someone around every corner [who is] going to be impacted by this disease.”

Caring for the caregivers

There is an obvious emotional component to caring for a loved one affected by memory loss and the other aspects of dementia, but there is also the burden of assuming management of the person’s practical tasks, such as financial planning and keeping up with medical appointments. The stress of it all can affect the person’s entire network, says Phillip Rumrill, a certified rehabilitation counselor in Ohio whose professional area of expertise is clients with disability, including dementia.

“Dementia affects the whole family system, and possibly for generations. The person [with dementia] needs help, yes, but [so do] their spouse, children and entire family system. That’s critically important [for counselors to be aware of] when you’re dealing with dementia,” says Rumrill, a member of the American Rehabilitation Counseling Association, a division of ACA. “There is a tremendous amount of burnout that comes with being a dementia caregiver.”

Witnessing a loved one’s memory and abilities decline can cause caregivers to feel sad, frustrated, exhausted, overwhelmed, hurt, afraid and even angry, says Matt Gildehaus, an LPC who owns Life Delta Counseling, a private practice in Washington, Missouri.

“The caregivers and loved ones are often the hidden victims of dementia. They can become completely overwhelmed as the role becomes all-encompassing,” says Gildehaus, who counsels adults facing a range of challenges, including aging-related issues and dementia. “Taking care
of someone can easily become an identity that gets affirmed and reinforced until it comes at nearly the complete expense of self-care. When being the caregiver for someone with dementia overtakes their life, the caregiver’s emotional and physical health frequently begin to decline.”

Each of the counselors interviewed for this article asserted that clinicians should, first and foremost, emphasize the importance of self-care with clients who are caregivers to individuals with dementia. Counselor clinicians can ask these clients what they are doing for self-care, help them establish a self-care plan if needed, and connect them with local resources such as support groups and eldercare organizations.

It is also important to encourage clients to ask for help from others when they are becoming overwhelmed, says Rumrill, a professor and coordinator of the rehabilitation counseling program at Kent State University in Ohio, as well as founding director of its Center for Disability Studies. If clients mention having a loved one with dementia, counselors should listen carefully to make sure these clients are taking care of themselves and processing their feelings related to the experience.

Connecting clients to support groups and other resources can be vital because many families feel lost and isolated after their loved one receives a dementia or Alzheimer’s diagnosis, Drew notes. “This isolation can increase throughout the journey as caregiving demands intensify, especially if they don’t know where to turn for help,” she says.

Families may also experience emotions that parallel the grieving process as they witness the progressive loss of the person they knew. Caregivers might even find themselves with hard feelings emerging toward their loved one, particularly as they try to handle the frustrating behavior challenges that Alzheimer’s and dementia can introduce.

“The disease can be very deceiving because one day the person may be very clear, and another day they’ll be confused. Caregivers can feel [the person is] doing things on purpose, just to push their buttons,” Heuer says. “I often ask if the person was aggressive or called [the client] names before they were diagnosed. Most often, the answer is no. Then I explain that it’s the disease, not the individual” prompting the behavior.

Gildehaus, a member of ACA, has seen similar frustrations among clients in his caseload. “I often help caregiver clients by providing a safe place for them to share the things they don’t feel they can share with family and friends,” he says. “For caregivers, there are three tools I focus on using: therapeutic silence, empathic listening, and normalizing what they often describe as ‘terrible thoughts.’ These … can be ideas like, ‘They make me so angry,’ ‘I dread going to the nursing home some days’ or even ‘Sometimes I secretly hope they don’t live for years like this.’”

Rumrill notes that clients caring for a loved one with dementia may need a counselor’s help to process how the disease has disrupted roles within the family. He experienced this personally when caring for his grandmother, who lived with dementia for years before passing away in 2009 of stomach and liver cancers. Rumrill, who held power of attorney for his grandmother’s financial affairs, had to adjust to taking care of someone who had taken care of him throughout his life. It felt like a role conflict to have to begin making decisions on his grandmother’s behalf while still trying to respect her wishes, he recalls.

“It’s changing roles: They used to take care of you, and now you take care of them,” Rumrill says. “There is an odd juxtaposition when a child is telling a parent what to do. It can be hard [for the older adult] to accept when it’s coming from the younger generation. The roles have switched, and no one got the memo.”

Counseling sessions for couples and families can also serve as safe spaces to talk through the stressors and disagreements that come with caregiving, Rumrill and Heuer note. Counselors can serve as neutral moderators to facilitate conversations about tough subjects that clients may be fearful of or avoiding outside of sessions. This can include talking over logistical or financial issues, such as dividing caregiving tasks or assigning power of attorney, and harder conversations such as when and how to move a loved one to a care facility.

Counselors who work with couples should be aware of the intense stress that providing care for someone with dementia can put on relationships, Rumrill adds. Home life can be turned upside down when one member of a couple’s time and attention are devoted to caregiving. This is especially true if the family member with dementia moves into the home. Tasks that used to flow easily, such as unloading the dishwasher or taking the kids to sports practices, can become points of contention. Challenges that the couple successfully navigated before — from budgeting to parenting issues — can become more pronounced and complicated as caregiving puts extra strain on the couple’s time, emotions and finances, Rumrill says.

It’s an unfortunate reality, but counselors working with clients who have dementia or their families also need to be watchful for signs of elder abuse, including financial abuse, Rumrill says. Dementia patients and their caregivers are also at higher risk for issues such as depression, anxiety, suicidal ideation, and substance use and abuse (which may be used as a coping mechanism).

Listen and validate

Clients who have dementia can get a variety of needs addressed in counseling sessions — needs that will change as the dementia progresses.

In the early stages of dementia, counselors can help clients process their feelings and fears about the diagnosis, as well as work toward accepting and adapting to the changes that are coming. In the middle to latter stages, clients may benefit more from reassurance and validation from a counselor, as well as occasional redirection and calming techniques.

Heuer recalls a client whose husband had recently been placed in a memory care facility because of Alzheimer’s disease. The client — whom Heuer calls “Anne” for the purposes of this example — was dealing with pre-existing depression, which was the initial focus of the counseling sessions. Heuer and Anne also discussed Anne’s relationships with family members and the various changes she was facing, which included moving because of her husband’s placement in the memory care facility.

According to Heuer, Anne harbored a great fear of losing her own memory, and over time, her memory did in fact begin to deteriorate. She would acknowledge the decline in counseling sessions as she and Heuer talked about its impact on Anne’s life. Later, as Anne’s dementia progressed, Heuer shifted her work to focus more on fostering Anne’s feelings of safety and connection. “The interesting part of working with Anne is she never mentioned the word dementia. I heard about her diagnosis from family and caregivers,” Heuer recalls.

“As her memory declined, I would reflect her feelings [in counseling],” Heuer says. “Then there were sessions where Anne would spend the majority of the time talking about how she had been traveling on a train and had just gotten off the train. Frequently, she would share the story as if it was the first time she was telling it to me.” Heuer says one of the best suggestions she has been given for working with clients with dementia is to show them the same level of patience and attention regardless of whether they are telling her a story or sharing a memory with her for the first time or the 10th time.

“Anne also had hallucinations [in the latter stages of dementia],” Heuer says. “She had moments of clarity where she knew they were hallucinations and questioned her own sanity. I had no magical cure or answer. I would try and imagine how I would feel if this were happening to me and [then] tapped into empathy and the core foundation of person-centered therapy.”

Most of all, individuals with dementia need a counselor to simply “be present and listen,” adds John Michalka, an LPC with a solo private practice in Chesterfield, Missouri. He specializes in working with clients who have mood disorders related to chronic illness, including dementia.

“Patients living with dementia often tell me they just need their loved ones to stop nagging them and making them feel like the things they are doing are intentional,” says Michalka, an ACA member who has personal experience caring for a loved one with dementia. “The patient isn’t forgetting on purpose. The patient has enough to deal with without being made to feel like a burden as well. It always amazes me how simple and unselfish the patient’s request is when it comes to what they need: just simple love, understanding and patience.”

The following insights may be helpful for counselors who treat clients with dementia. Some of the guidance may also be relevant to share with clients who are family members of or caregivers to a person with dementia.

>> Correcting versus agreeing: Patients in the memory care unit where Heuer works sometimes come up to her and say, “It’s so good to see you again!” even though they have never met her before. Over time, she has learned to read clients and think on her feet to respond appropriately to remarks that aren’t based in reality.

For caregivers, deciding whether to correct a person with dementia or go along with what the person is saying can become a daily or even moment-to-moment struggle. Heuer says her decision to validate or correct is often based on how likely the person is to become agitated or aggressive. But empathy also comes into play. “I try to put myself in their shoes. How would I feel if I were seeing a friend I hadn’t seen in a while? It really comes down to meeting them in their emotions.”

Some clinicians may call the practice of validating or going along with a client with dementia “therapeutic lying,” Heuer says, but “I call it ‘molding the information’ and doing what it takes for them to feel calm and safe. …We have to adapt to them because they are not able to adapt to us. It is as if they have a different inner world, and we have to meet them in their world.”

Michalka says he also finds validation therapy helpful for easing anxiety in clients. With clients who are dementia caregivers, he often emphasizes that what is going on in the mind of the person with dementia is their reality.

He recalls one client who was beginning to panic because they saw someone in their room. “There was no one in the room, but the patient’s experience or perception of a stranger in their room was real,” Michalka says. “A natural reaction for most caregivers would be to correct the patient. In doing so, we are challenging the patient’s perception of reality. This typically will only escalate the patient’s anxiety and, in doing so, escalate the loved one’s or caregiver’s anxiety.

“Imagine if you saw a stranger in your room, and when you [try] to tell someone, they proceed to tell you, ‘No, there [isn’t].’ Would you not become more and more agitated as you try to convince them [and] they continue to challenge your reality? Instead, we should validate their experience by asking if that stranger is still in the room. Then, one would empathize with the patient by validating how scary that must have been, but now the stranger is no longer there and they are safe. After which, the patient’s attention should be redirected to a more pleasant thought or situation.”

>>  Considering the whole person: Working with clients with dementia “takes you out of your comfort level because you have to become very creative in how you interact with [them]. It’s not the type of counseling that you learn in a textbook,” Heuer says. “Your ability to counsel and work with these individuals goes well beyond the knowledge you gain about counseling in your master’s [program].”

Heuer encourages clinicians to learn more about who clients were before their dementia diagnosis — what they did for a career, what their hobbies were, their likes and dislikes. Counselors can ask clients directly for this personal information or seek details from their family members. Learning these personal details can help to better inform counselors’ interventions and help form stronger connections with clients, Heuer says. “Tapping into what made them happy as a human being [without dementia] may be therapeutic for them,” she adds.

For example, a client who loves baseball may be comforted and more responsive while watching a televised ballgame or flipping through an album of baseball cards with a counselor. A client who was a teacher or a banker might find comfort writing in a ledger. Even clients with late-stage dementia can respond when their favorite music is played, Heuer notes.

She recalls one client who had previously worked in business and would sometimes think that his caregiver was his secretary. When this happened, the caregiver would “take notes” for him by writing on paper. “It doesn’t have to make sense, but to them it may make sense,” says Heuer, whose doctoral dissertation was on the lived experiences of individuals with early stage Alzheimer’s disease.

>>  Redirecting: When working with clients in the middle to latter stages of dementia, techniques that prompt a change of focus are invaluable. Redirection can keep these clients from becoming upset or escalating to aggression, Heuer says. For caregivers, this technique might involve engaging the person in an activity that they used to enjoy or simply asking for help with a task, such as folding laundry or setting the table.

“Redirection really comes into play when an individual is exhibiting behaviors such as agitation, fear, anger or paranoia,” Heuer explains. “Normally, there is something in their environment that is triggering them. An example we often observe and hear about is an individual [who] is wanting to go home. In essence, they want to feel safe and are looking for something familiar. Redirection is a technique that refocuses the individual’s attention in an effort to therapeutically calm them and make them feel safe.”

Heuer mentions a woman who was wandering in the care facility where Heuer works and feeling a strong urge to leave. The woman was getting agitated and escalating to the point that staff members were going to medicate her. Heuer stepped in and asked the woman if she wanted to take a walk. The woman agreed and soon calmed down as she and Heuer walked together and chatted.

With dementia, behaviors often manifest out of the person’s worry about their own safety or the safety of loved ones, Heuer notes.

“We all have that need to have a sense of purpose. Just because someone has dementia, they’re not less human. They have similar needs but have a different way of communicating them. Usually, there is a need behind every single behavior they’re displaying,” Heuer says.

>> Working through grief: Individuals with dementia and their loved ones often experience a range of grief-related emotions, from denial and avoidance to sadness. Counselors may find it helpful to use grief and loss techniques with these clients, Rumrill says.

Watching a loved one with dementia decline and seemingly change into a different person can feel similar to experiencing that person’s death or loss, Rumrill says. In the case of his grandmother, even her vocabulary and the way she spoke changed. She began using profanity and other words that Rumrill wasn’t previously aware she even knew. When she became angry, Rumrill says she would “go off” on people, which she never did prior to her dementia diagnosis.

“There’s a tremendous sense of loss that can go with that. The person you knew and loved isn’t there [any longer],” he says. “I was grieving the loss of who [his grandmother] was and also grieving with her over her loss of independence.”

Feelings of loss can also resurface for clients with dementia who are widows or widowers, even if they have previously processed their partner’s death. Dementia can reaggravate the person’s feelings of grief and sadness or even ignite feelings of anger toward a deceased partner for leaving them to go through their dementia journey alone, Rumrill says.

Family members and caregivers may experience repeated cycles of grief as their loved one’s dementia or Alzheimer’s progresses, Michalka adds. “Each time the loved one living with dementia progresses to the next stage, the client [a caregiver or family member] in some ways repeats the grieving process. They now are experiencing another loss. It is as if they have lost their loved one once again,” Michalka says. “It is extremely difficult for many clients to have mom or dad not know who they are or simply not remember their name. The client loses their loved one many times during the progression of dementia. At a minimum, the client loses the person their loved one once was, and then once again upon the passing of the loved one.”

>> Focusing on strengths: Clients with dementia are likely to be saddened by the anticipated or actual loss of their abilities. A counselor can help these clients flip their perspective to focus on what the person can still do, Heuer says. She often uses the words strengths and challenges, not weaknesses, during conversations about what the client is still able to do and enjoy.

For example, a client with dementia may no longer be able to maintain a garden outdoors, but gardening supplies and planter pots can be brought to the person inside so they can still get their hands in the soil. “Activities can change as the disease progresses,” Heuer notes.

>>  Using “tell me about” prompts: Gildehaus says that narrative therapy can be a helpful technique with clients who have dementia. These clients often respond well to storytelling prompts, even as their memories fade. It can be therapeutic for clients with dementia to share memories and, in turn, to feel heard and understood, he explains.

Similarly, Heuer uses reminiscence therapy with clients with memory loss, asking individuals to talk about their careers, families, and other favorite memories. It is not helpful, however, to frame questions by asking clients whether they remember something, she stresses. Instead, counselors can use gentler “tell me about” prompts to spur clients to open up. For example, instead of asking, “Do you remember your parents?” a counselor would say, “Tell me about your parents,” Heuer explains.

Rumrill notes that group work can be very helpful for caregivers or family members of people with dementia, especially to prevent or ease burnout. Motivational interviewing, cognitive behavioral techniques, and rational emotive techniques can also help clients process the changes and stresses that come with having a loved one with dementia. But Rumrill urges counselors to use whatever techniques they find to be most helpful to and best suited for the client.

Dementia is “no more stressful than any other life issue that brings people to counseling; it’s just different,” Rumrill says. “It has unique features that need to be understood to help. Marshal all the coping reserves you can to help the client.”

>>  Offering empathic listening: Gildehaus notes that professional counselors’ core skills of listening, empathic reflection and normalization can go a long way for clients dealing with dementia.

“In my experience, clients struggling with dementia need someone to listen to them for understanding without confronting them, trying to argue with them, or trying to fix them,” Gildehaus says. “Normalizing frustrations and fears related to memory challenges and aging also helps clients feel less defective.”

When working with clients who have dementia, Gildehaus says his primary objective is to offer a nonjudgmental environment in which these individuals can share their frustrations and fears. “My efforts are focused on providing an interaction where they feel heard and understood without feeling questioned or having someone trying to talk them out of their ideas,” he says.

This came into play this past summer as Gildehaus faced a tough conversation with a client who needed to give up her right to drive because of cognitive decline. “This was very hard for her,” he recalls. “She argued that she did not drive far, that she had not had any accidents, and that she didn’t care if she died in an accident. She became very emotional — tearful and angry. I listened empathically, validated her truths, and reflected her logic and feelings. Then, I asked if she wanted her lasting legacy to be causing someone else’s injury or death. She agreed this was not what she wanted. We then explored options and resources that would allow her to maintain her freedom and active schedule without driving. We talked about local taxi services, friends who were going to the same activities [and could give her a ride], and the obvious solution became allowing her home health care provider to drive her most of the time.”

Still human

Individuals with a dementia diagnosis often feel as if they’ve been labeled as damaged goods, “deemed incompetent and unable to do anything for themselves,” Heuer says. The empathy and support that professional counselors are capable of offering these clients can go a long way toward changing that mindset, she asserts.

People with dementia “are still capable, still human, and they have emotions,” Heuer emphasizes. “There is an immediate stigma attached to someone [with a dementia diagnosis] that they aren’t able to do anything for themselves, and that’s often a source of frustration. There is an assumption that they’re helpless. But they will say, ‘I need help.” … They will let you know. What they need from counselors — and everyone else — is the recognition that they are still a person and still human.”

****

Counselors as caregivers

Despite a career as a helping professional, Phillip Rumrill found himself feeling “inadequate” when it came to caring for his grandmother as her dementia progressed. He admits that he learned how to manage “through trial and error.”

The professional objectivity that allows practitioners to help others process issues in counseling simply isn’t there when it comes to caring for their own loved ones, says Rumrill, a certified rehabilitation counselor and a professor and coordinator of the rehabilitation counseling program at Kent State University.

“All of this stuff that you know about professionally goes out the window when you experience it personally,” Rumrill says. “You may have helped a client who is dealing with this, but it’s not the same when you’re going through it yourself. … You may think that because you have expertise in helping others you might know procedurally what to do, but it’s just different when it’s affecting you on a core level. You can arm yourself with information, but it’s going to be very different to be going through it on your own.”

Although it may not come easily, counselors who have loved ones with dementia should heed the same guidance they would give to clients in the same situation, including keeping up with their self-care and asking for help when needed.

After his grandmother passed away in 2009, Rumrill collaborated with two colleagues, Kimberly Wickert and Danielle Dresden, who also had cared for loved ones with dementia, to write the book The Sandwich Generation’s Guide to Elder Care. Their hope was that their insights might help other practitioners who were facing similar challenges. “You can’t be [your] family’s counselor,” Rumrill says. “Sometimes you have to shut off your professional side and deal with the humanity of your own experience.”

John Michalka, a licensed professional counselor and private practitioner, says he and his wife experienced a range of issues — from stress to anxiety to grief — while caring for his mother-in-law. Michalka’s mother-in-law, who had vascular dementia, moved in with Michalka and his wife in 2013 when she was no longer able to care for herself.

“I took a hiatus from work, and for the last two years of her life, I cared for her until she passed [in January 2015],” he says. “I watched my wife, as a daughter, struggle with pain and grieving during every step down of the disease, from [her mother] forgetting our names to [us] becoming absolute strangers. For me, I was the caregiver and did my best to suppress the emotion. To say the least, caring for anyone living with dementia can be extremely difficult. At least it was for me.”

****

The Alzheimer’s Association has a wealth of information on dementia and Alzheimer’s disease, including nuances of the diagnoses and resources for living with or caring for a person who has been diagnosed. Call the association’s 24/7 helpline at 800-272-3900 or visit alz.org (click the “Help & Support” tab for links to online and local support groups).

Also, the U.S. Administration on Aging offers an eldercare services search tool at eldercare.acl.gov. Resources are also available from the Dementia Action Alliance (daanow.org) and the Family Caregiver Alliance (caregiver.org).

****

Contact the counselors interviewed for this article:

• Matt Gildehaus: matt@lifedeltacounseling.com
• Jenny Heuer: jenheu77@gmail.com
• John Michalka: john.michalka@cvcstl.com
• Phillip Rumrill: prumrill@kent.edu

****

Read more

Check out an extended Q+A with licensed professional counselor Ruth Drew, the Alzheimer’s
Association’s director of information and support services, at CT Online: ct.counseling.org/2019/12/qa-helping-clients-affected-by-dementia/

****

IDEAS.TED.COM

May 18, 2020 / Michael Bungay Stanier

This post is part of TED’s “How to Be a Better Human” series, each of which contains a piece of helpful advice from people in the TED community; browse through all the posts here.

I caught up with a friend of mine a while ago. She’s smart, she’s brilliant, and she’s talented.

After we did the usual warm-up chitchat, she looked at me and said, “Michael, you’re a good guy. I need your advice.”

My advice monster was delighted.

She started telling me what was going on, and I started to pretend to listen because, quite frankly, my advice monster already knew exactly what I wanted to tell her.

Finally, she finished so I was able to share my brilliant advice —  — and make no mistake it was brilliant. But my advice went nowhere; my advice monster had sabotaged the conversation.

All of you know your advice monster. Somebody starts telling you about something. Even though you don’t really know the situation or the people involved and you certainly don’t have the full context, after about 10 seconds your advice monster is like, “Oh, oh, oh, I’ve got something to say here.”

The problem isn’t with giving advice. Instead, the problem is when giving advice becomes our default response. There are three ways that advice giving goes bad.

The first issue with advice giving is that we’re often solving the wrong problem. We get seduced into thinking the first challenge that shows up is the real challenge — but it almost never is.

The second issue is that our advice is not nearly as good as we think it is. If you’re thinking to yourself, “No, no. My advice is magnificent,” I suggest you watch a video on cognitive bias. It will explain we think we’re amazing at things even though we aren’t.

The third issue with giving advice cuts a little deeper. If you have an advice monster — and if I can be clear, we all have an advice monster — holding the responsibility of having to have all the answers and save the person and save the day is exhausting, frustrating and overwhelming. And for the person who’s on the receiving end of your advice monster, they’re getting the message that they can’t figure this out by themselves, which cuts away at their sense of confidence and autonomy.

We’re constantly feeding our advice monsters, and they’re insatiable. As soon as somebody starts talking, your advice monster looms up and goes “Oh, I’m going to add some value to this conversation, yes I am!” You need to learn to tame your advice monster, and in order to tame it, you have to understand it.

As it turns out, your advice monster has three different personas.

I call the first persona “Tell It”. Tell It is the loudest of the three, it’s convinced you the only way that you can add value is to have all the answers. Because if you don’t have all the answers, then you fail.

The second persona is subtle; it’s called “Save It”. Save It has put its arm around you and said, “Your only job is to rescue everybody — don’t let anybody stumble, struggle or have a difficult time. If anybody struggles at all, you fail.” Parents might recognize that one.

The third of the personas — and the sneakiest of the three — is “Control It”. Control It has convinced you the only way you win is to maintain control at all times. If anybody else takes over control, even just a little bit, then you (and they) will definitely fail.

Now there’s something that connects all three of these personas. In that moment when your advice monster is speaking, it’s saying that you are better than the other person and that they’re not good enough. But it’s not only the other person that is diminished; you are, too. You’ve lost that connection to your humanity, to your empathy, to your compassion, and to your sense of vulnerability.

To tame your advice monster, what you want to do is replace your advice-giving habit with a new habit: Staying curious. It’s as simple — and as difficult — as that.

Questions are the kindling of curiosity. Let me share with you the three questions that I wish I’d asked my friend when she said she wanted my advice.

The first question is: “What is the real challenge here for you?” This recognizes that neither of you know what’s going on at the start of a conversation. It repositions you to help the other person find the really important issue, not provide them with a fast, wrong answer.

The second question is “What else?” This holds the insight that the first answer your friend will give you is never their only answer and it’s rarely their best answer. This will help you go deeper and further on any question you ask.

The third question is a difficult question, but it’s so powerful: “What do you want?” When a person can get clear on what they want, it becomes their foundation for action. When they know what they want, they get to step towards that with autonomy and confidence.

When you’re able to stay curious, you begin to empower people not by giving them the answer but by helping them find their own answer, and not by rescuing them but by helping them find their own path.

This article was adapted from a TEDxUniversityofNevada talk. Watch it here: https://www.youtube.com/embed/Kl0rmx7aa0w?version=3&rel=1&fs=1&autohide=2&showsearch=0&showinfo=1&iv_load_policy=1&wmode=transparent

ABOUT THE AUTHOR

Michael Bungay Stanier is the founder of Box of Crayons, a learning and development company that helps organizations transform from advice-driven to curiosity-led. He is also the author of the bestselling book The Coaching Habit. Before founding Box of Crayons, Michael held senior positions in the corporate, consultancy and agency worlds. He has lived and worked in Australia, the UK, the US and Canada.

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U.S. Pain Foundation

By Jaime Sanders

Google “migraine products” and more than 48 million search results come up. How do you even begin to weed through options to find something that will help you manage your symptoms? Below are several products that have been put to the test by the migraine and headache community, and come out on top.

Note: These products are being provided as additional tools for you to use as you fight to manage your headache symptoms. U.S. Pain Foundation does not specifically endorse any of these products.

Cryotherapy

Migraine Hat
Co-developed by Lisa Jacobson, founder of The Daily Migraine, Migraine Hat is an ice/compression therapy hat made specifically for people who live with migraine and chronic migraine. The Migraine Hat includes two reusable Cryo-Gel Ice Packs that stay cold for four hours, and pulls over the eyes and ears to block out light and sound. The wrap-around design contours to the shape of your head and stays securely in place while allowing you to adjust to your comfort or to target pressure points: bit.ly/migrainehat

The Catalyst Cryohelmet is a tool designed to help alleviate migraine and headache pain and concussion symptoms, as well as promote sleep. The cool packs stay cold for at least 90 minutes when they are frozen solid. They remain flexible so they can be wrapped around the head and neck. The Cryohelmet features moisture-wicking fabric, an insulating neoprene shell that is latex-free, and drawstrings to adjust the fit: cryohelmet.com

Icekap Therapeutics
The Icekap, developed by Andrea Jones, who lives with migraine, combines cryotherapy, heat, aromatherapy, and compression to help alleviate the pain, inflammation, pressure, and swelling caused by migraine. The essential oil component of the Icekap combines the calming properties of lavender with the cooling properties of peppermint. With the adjustable pressure band, users can target the compression of the cap to key areas (occipital, frontal, parietal, or temporal): icekap.ca

Precision-Tinted Eyewear

TheraSpecs
TheraSpecs was developed by Hart Shafer, whose wife, Kerrie, lives with debilitating migraine. The precision-tinted glasses are designed to filter lights from fluorescent lights, computer screens, and bright sunshine that trigger migraine, headache, and eye strain. When worn regularly, the glasses can help reduce the frequency of attacks. The frames are ultra-lightweight and flexible so as to not add any extra pressure to already sensitive areas. Many styles offer wrap-around protection to block and filter light from the sides: theraspecs.com

Axon Optics
Axon Optics provides therapeutic eyewear for migraine and light sensitivity. Founder Bradley Katz, MD, PhD, a neuro-ophthalmologist, studied the pain pathway associated with migraine and photophobia. Through his work, the company developed the SpectraShield FL-41 migraine glasses lens for indoor and outdoor sunglasses. FL-41 improves light sensitivity by blocking out blue and green wavelengths of light, which are thought to be a problem for patients with light sensitivity. Axon Optics also offers glasses for blepharospasm (BEB), as well as indoor sunglasses: axonoptics.com

Protection From Outside Triggers

WeatherX Earplugs
WeatherX is a pressure-regulating device that provides a proactive way to manage weather-related migraine and headaches before they start. At the first sign of headache, you place the devices, one in each ear, for 2 to 4 hours or until symptoms have alleviated. WeatherX includes a ceramic inner filter that regulates air flow in and out of the ear canal, which helps mitigate shifts in weather pressure. It has four rings for a snug, comfortable fit and is made of soft, cleanable, hypoallergenic silicone. A free app can be set up to alert you when weather pressure shifts are happening near you, prompting you to proactively begin using the earplugs: weatherx.com

Aculief
Aculief is a wearable acupressure device that uses your body’s own endorphins to help relieve headaches and migraine attacks naturally. It provides pressure to the LI4 acupressure point, which has been used for thousands of years to provide natural headache and tension relief as well as promote your body’s natural energy: aculief.com

Vogmasks
Vogmasks are unique face masks designed to be reusable and fashionable. These masks are especially useful in blocking many external triggers that often exacerbate migraine symptoms. It provides protection from airborne particles such as dust, allergens, odors, scents, mold, and more: vogmask.com •

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Jaime Sanders is the author of the award-winning blog The Migraine Diva. She is a member of CHAMP (Coalition For Headache And Migraine Patients), and the Headache and Migraine Policy Forum. Jaime works with the Society for Women’s Health Research Interdisciplinary Migraine Network and sits on the Patient Leadership Council with the National Headache Foundation.

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IDEAS.TED.COM

Apr 15, 2020 / Ingrid Fetell Lee

Some people love working from home, and they can’t imagine anything better than a day with their laptop clad in pajama pants. Others miss the structure and the casual chats with coworkers that happen at their offices. Whether you love it or hate it, working remote — for those who can do it; not every job lends itself to this kind flexibility — is going to be common for many of us in the near future due to the pandemic.

For those of you new to working from home, there’s lots of advice out there about how to deal with the pitfalls and stay productive and sane (“Take a shower!” “Don’t spend too much time on social media!”). But from my own experience, working from home can be a real delight if you let it. So I’d like to share a few ideas for creating a workspace and routines that will make working from home a joyful, sustainable experience. And who knows? You might not even want to go back to the office!

1. Take care of your body 

In her book Proposals for the Feminine Economy, Jenn Armbrust offers a series of principles, the first one being: “You have a body.” Sounds simple, but working from home can make it easy to forget about your body’s basic needs. At your office, you probably had an ergonomic desk chair or an adjustable workstation. However, unless you work from home regularly, your workspace may consist of a kitchen table and basic chair.

You don’t need to invest in a whole home-office setup, but rather pay attention to how your body feels as you work from home. One advantage to working from home — as opposed to being in an office — is that you can change positions frequently. Try out lots of postures, whether that’s sitting in a chair, standing at your kitchen counter, relaxing on the sofa, or sitting on a yoga block on the floor with your coffee table as a desk. It took me a long time (and some serious shoulder pain) to realize that the best position for long writing stretches for me is sitting on a backless bench at my dining table. Testing different positions can help you find physical ease faster.

Another thing to pay attention to is movement. You likely do some walking in the course of an office workday — to the office from the train or bus or parking lot, between meetings, to the café for more coffee — and these movement breaks disappear when everything you need is within a couple of rooms in your home. When I first started working from home, I was surprised to find that I sometimes got in fewer than 1,000 steps in a day!

The flexibility of home work means, though, that you can largely move when you want to. Try setting a timer for a yoga or workout to break up a long email session. While writing my book Joyful, I took impromptu dance breaks whenever I was stuck on a section, which cleared my head but would’ve been hard to do in the office. I also started to take a long walk in the park at the end of every day. In the summer, I’d print out the latest draft and take it with me and sit in the shade while marking it up. In the winter, I’d do this at the kitchen island after coming home.

2. Use your commute

How long was your pre-pandemic daily commute? For many people, it can range between 30 minutes to 2 hours (or more), round trip every day. It also really adds up. Even at the short end, that 30 minutes per day adds up to two and a half hours that you’ve now gained per week!

The key is being intentional about how you use that time. Schedule it in your calendar — it doesn’t have to be at the same time as your commute — just as you would a meeting.

You can also block that time out for free, unstructured time, something most adults don’t get enough of. But then make sure to put tools down when the calendar alert goes off and give yourself space to enjoy it.

3. Create a sensory landscape 

With their dull color palettes, synthetic carpets and humming HVAC systems, most workplaces have a joyless sensory landscape. Add in the noise from open-plan seating, and the fact that many spaces are often too cold or hot, and the typical office can be deeply unpleasant to spend time in, much less get focused work done.

While many of us often see the problem as overstimulation, in fact offices are just as likely to be understimulating. Workspaces have traditionally been designed based on the belief that to maximize productivity you need to minimize distraction, leading to bland, featureless spaces. But research shows that when people in these “lean” workspaces are compared to people working in “enriched” spaces that have art, plants, and more sensorial stimulation, the workers in the enriched spaces are 15 percent more productive. And if the workers have control over the placement of things in their workspace? They’re 32 percent more productive.

When you work from home, you can be like those workers in the study who controlled their own workspace — and create a sensory landscape that works for you. Part of this may mean eliminating unpleasant sensations, by getting noise-cancelling headphones to tune out distracting noises or adjusting the temperature so that it’s comfortable for you.

Also, look for ways to add pleasant sensations into your workspace. Hang up an image that gives your gaze something to rest on while you glance away from your screen. Play nature sounds. Choose a brightly colored mug for your morning coffee.

The senses of touch and smell are particularly understimulated during the hours we’re tapping away at a keyboard, so look for ways to appeal to them. For example, I cover the bench I sit on when writing with a sheepskin, which has a decidedly unofficelike soft texture. I keep a bottle of essential oils on my desk, and sometimes use a diffuser to scent the air.

4. Get some sunshine

One poorly designed aspect of many traditional offices is how little daylight exposure is available in workspaces. For most workers, the only light during the day comes from the dull fluorescents overhead. Yet research shows that workers who get more exposure to daylight sleep better (up to 46 minutes more per night), are less stressed, and are more active during the day. Light regulates key hormones and neurotransmitters, influencing everything from our alertness to stress levels, our immune system to our moods.

In your home, you have more control over where you choose to work, so if possible, choose a space near a window. And if you don’t have much natural light in your space, use lamps to boost the brightness. Just as too much blue light from our screens can keep us up at night, a healthy dose of bright artificial light during the day can also help keep our 24-hour internal clock in sync.

Also, when you used to commute to work, you likely got at least a little sunlight on the way, which you lose if now you jump straight into work first thing. Light has the greatest impact on our circadian rhythms in the morning, so try to go outside for a brief walk before you sit down.

5. Green your workspace

One simple thing to do to make your workspace more joyful is to add greenery. Plants that might struggle in the dim light of an office can thrive in your home, and you gain the extra benefit of getting to enjoy them when you’re not working as well. You don’t have to have as many plants as Summer Rayne Oakes does in her home workspace, but even just adding a few has been shown to reduce stress and restore your ability to concentrate.

6. Make a “get to work” playlist 

One challenge I’ve found in working from home is transitions. It can be hard to stop doing all those home things (emptying the dishwasher, folding laundry, etc.) and get down to work, especially if there’s work you’re avoiding. In fact, many writers joke that their home is never tidier than when they’re working on a book.

One thing that helps is having some sort of ritual that marks a transition into a work session. I have a couple of “Get to Work” playlists that help with this: one for writing, one for email. The playlists always start with the same song, so it becomes like a sonic trigger that primes me to focus.

Other transition ideas might be pouring a fresh cup of tea or coffee, doing a quick stretch, or setting a focus timer (I use the Tide app on my phone).

7. Make snack time special 

A lot of work-from-home guides advise you to take a real lunch, but I confess that when I’m in flow, I much prefer to eat at my desk. This doesn’t mean that I don’t believe in taking breaks, though. As I mentioned above, the most important features of breaks for me are to get outside and to incorporate movement into my day.

I also love a good snack break. We often think of snacks as fuel, but for me, they’re more of a treat. And, as writer Gretchen Rubin has pointed out, treats can help make us feel cared for, energized and motivated. Having access to your own kitchen means that you don’t have to rely on the processed foods that constitute a snack in most offices, nor do you have to eat it out of a bag.

I’m a big fan of cutting up fruit and arranging it in a wheel around my plate, or making little sampler plates from the fridge of pickles, olives and other nibbles. I also make energy balls or banana bread and freeze some so I can have it for a mid-week treat. You’re your own office manager now, so think about what would make you feel cared for and create space for it in your daily routine.

8. Be playful 

Offices have been designed with work in mind, and the prevailing view is that work is somehow the opposite of play. But, as play researcher Brian Sutton-Smith says, “The opposite of play is not work. It’s depression.” Bringing your work home gives you a chance to invite more play into your workflow. And this can start with your workspace.

A playful workspace creates more opportunities for play in your day. These can be small, like the miniature spinning tops I keep on my desk to spin when I get stuck on an idea, or they can be larger, like having a trampoline to bounce on or a hula hoop to play with. Changing out a desk chair for an exercise ball can also bring a sense of play. A giant bowl of Legos or a big puzzle can keep hands busy while your mind is working through ideas.

You can also experiment with adding playful forms of decor, like children’s drawings on the wall, or cute objects for your desk. I put googly eyes on my stapler, for instance. Cute things may even benefit our productivity, according to research out of Japan, by enhancing our ability to focus.

Imagine: If you’d never been to an office before, what would you want it to look like? When you work from home, there’s no reason not to create a space that lets your imagination run free.

9. Pack it up and put it away 

Perhaps the worst thing about working from home is that it’s hard to know when the workday ends. Writer Kevin Roose has found, for example, that remote workers take shorter breaks and fewer sick days, suggesting that boundaries can be an issue. This is even more challenging if you don’t have a dedicated home office space. When your laptop sits on the dining table or your coffee table is covered in stacks of folders, it’s hard to fully feel like you’ve turned off.

This is one reason why I insisted on building in two tiny home offices in our current renovation. I still will probably spend time working at the dining table, but I wanted a place to put everything at night so that I can close the door on it and not be distracted by the things I didn’t get done.

You don’t need a spare room to do this, though. Simply having a basket or closet to tuck your laptop and papers into at night will do the trick. Creating a physical boundary will help you reset your mind and reclaim your home as your home.

This post was originally published on The Aesthetics of Joy site.

Watch her TED Talk now:https://embed.ted.com/talks/ingrid_fetell_lee_where_joy_hides_and_how_to_find_it

ABOUT THE AUTHOR

Ingrid Fetell Lee is the founder of the blog The Aesthetics of Joy and was formerly design director at the global innovation firm IDEO. 

ABOUT THE SPEAKERHailey Hardcastle · Mental health advocateHailey Hardcastle established a network of student activists in order to make schools a better place for those struggling with mental health challenges.