Dear Readers:

Today’s column continues last week’s discussion about caregiving.

Reader W.R. wrote about his concern for his sister, who is caring for her husband while she is working 30 hours a week. her signs of stress, anger and depression have W.R. and his wife worried. they want to help and aren’t sure how.

It is frustrating to stand by and witness a family member suffering from the responsibilities of caregiving compounded by work demands. Yet, caregiving and work seem to be the norm, with two-thirds of U.S. caregivers working outside the home.

We know that over a long period of time, ongoing stress can jeopardize one’s health. the Family Caregiver Alliance summarizes a substantial body of research about family members who provide care to loved ones and who themselves are at risk. Here are some of the findings:

Approximately 40 percent to 70 percent of caregivers have clinically significant symptoms of depression.

Depressed caregivers are more likely to also have anxiety disorders, substance abuse or dependence problems, and chronic disease.

Caregivers who experience chronic stress may be at greater risk for losses in short-term memory and attention.

About one in 10 caregivers report that caregiving has caused their physical health to get worse.

Studies indicate that caregivers have a diminished immune response, leading to frequent infection and increased risk of cancers. they also have a higher level of stress hormones and a lower level of antibodies.

they are at greater risk than non-caregivers for high blood pressure and heart disease.

Caregivers reported chronic conditions including heart attack, heart disease, cancer, diabetes and arthritis at nearly twice the rate of non-caregivers.

Nearly three-quarters report that they have not gone to the doctor as often as they should and more than half missed their own doctor’s appointments.

These are disturbing facts. Yet, some may be preventable, particularly if one follows tips recommended by the Mayo Clinic.

The first tip is to ask for help, which comes in many forms. Forget about the guilt:

Non-medical home health care: this involves a caregiver, such as a home health aide, who is trained to provide support in bathing, dressing, eating and housekeeping.

Home health care: this type of care involves a skilled professional who provides medical care in the home. These professionals might be registered nurses or certified nursing aides.

Adult day care centers: the centers are designed for older adults who cannot manage independently or who are isolated and lonely.

Respite care: this is short-term care by another, so the primary caregiver can take some time off and rest. the respite person might be a family member, friend or professional who assumes the responsibilities. Such short-term care also is provided by assisted living facilities, nursing homes and hospice inpatient facilities.

Caregiver retreats: These getaways combine respite with peer support and education. the Los Angeles Caregiver Resource Center holds them three times a year. call 818-847-9141, Ext. 108.

A second “big” tip is to find time for physical activity, adequate sleep and eating a healthy diet. These all require focused intention and are not easy to accomplish.

Finally, be informed. the following resources may be helpful:

Caregiver support groups are a great source for advice and encouragement. Consider support groups at Beach Cities Health District, 310-374-3426, Ext. 155, and Torrance Memorial Medical Center, 310-517-4666.

Support and assistance also can come from an online community. Go to

lotsahelpinghands.com, a free, private, Web-based method of organizing friends, family and colleagues into a community that helps with meal delivery, rides and visits.

For a list of agencies that provide home care, contact the Focal Point on Aging, a South Bay information and referral service, at 310-320-1300.

one final resource: “The Gifts of Caregiving: Stories of Hardship, Hope and Healing” (Fairview Press, 2002) by Connie Goldman. the book consists of realistic and inspiring conversations with caregivers, including the late Dana Reeve, wife of the late actor Christopher Reeve; and former first lady Rosalynn Carter.

W.R., thank you for your good question and kudos to you for being a caring friend to your sister. Best wishes in having a positive influence on her caregiving decisions.

Helen Dennis is a specialist in aging, with academic, corporate and nonprofit experience. Send her your questions and concerns in care of the Daily Breeze, 21250 Hawthorne Blvd., Torrance, CA 90503, or e-mail to .

There are very few programs that combine state of the art Anxiety Disorder therapies with comprehensive Eating Disorder treatment. not only do we provide both at Castlewood, in addition, trauma resolution therapies are blended when applicable. we are able to treat the Anxiety Disorder, PTSD, and any resulting Dissociative Disorders all while helping clients challenge their Eating Disorder beliefs and behaviors.

Castlewood’s Approach to Anxiety Treatment

by Erin McGinty, LPC

At Castlewood, we believe in treating the underlying causes of our clients’ eating disorders. many of the clients we treat struggle with anxiety disorders in addition to the significant levels of anxiety they experience around eating disorder-related issues such as food, weight, body image, and so on.

In fact, many of our clients struggled with their anxiety disorders even before the eating disorder appeared; some studies have shown that this is true for as many as two-thirds of people struggling with both of an eating disorder and an anxiety disorder (Kaye et al., 2004).

Clients with anxiety disorders who come to Castlewood typically describe their eating disorder and their anxiety to be intricately linked together. Anxiety is among one of the many contributory factors found to be at the root of eating disorder symptoms, and results in higher degrees of perfectionism, obsessionality, avoidance, and body image dissatisfaction among clients who experience both an eating and anxiety disorder (Kaye et al., 2004). Anxiety is also an emotion that our clients have difficulty regulating without using their eating disorder or self-injury, and therefore becomes a trigger for many self-destructive behaviors.

Clients often have had either treatment exclusively for their eating disorder, or only for their anxiety disorder; many have not had treatment for both simultaneously. given the identified links between the two disorders, Castlewood’s treatment philosophy is that both disorders need to be treated at the same time in order to give clients the best chance at long-lasting recovery.

Castlewood utilizes exposure and response prevention therapy, a specific type of cognitive-behavioral therapy, to treat anxiety disorders. Clients are asked to identify anxiety-provoking situations that they typically avoid altogether or have difficulty tolerating without using ritual or harmful behaviors. we then gradually and repetitively expose clients to these situations, while requesting that they not engage in ritual behaviors to cope with the anxiety or fear that they experience. With this consistent exposure to feared situations, clients allow themselves to see that what they fear will happen in a given situation will not actually occur, and as a result their anxiety about a previously feared situation reduces naturally.

In conjunction with exposure and response prevention therapy, Castlewood also utilizes other cognitive and behavioral therapies in the treatment of anxiety disorders that allows us to challenge belief systems that maintain fears and ritual behaviors, as well as to provide clients with alternative skills to help them in managing their anxiety.

Resources:

Kaye, W.H., Bulik, C.M., Thornton, L., Barbarich, N., Masters, K. & Price Foundation Collaborative Group (2004).

Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161 (12), 2215-2221.

To learn more about how Social Anxiety Disorder impacts Eating Disorder go to:

Social Anxiety Article.