When Things Get NUTS
Stress is the body’s natural response to a demand, change, or challenge. It can be physical (e.g. pain) or psychological (e.g. being stuck in a traffic jam). When examining psychological stress, Dr Sonia Lupien developed the N.U.T.S. Model of stress (learn more Here). According to this model, psychological stress contains at least one of these four ingredients: novelty, unpredictability, threat to the ego (our sense of identity and competence), or low sense of control.
In the context of dementia care, this model I find this model extremely helpful. It allows me to better understand what may be stressful for both the person living with dementia and you as the care partner.
When Stress Shows Up for Both of You
Imagine your loved one refusing to take their medicine. You have informed the GP, and all tests have been made to rule out medical reasons, such as pain, for the refusal, yet your loved one continues to refuse them. As a care partner, you might catch yourself thinking:
- “What will happen if my loved one doesn’t take their medicine?”
- “When Debbie gives them, he accepts to take them...”
- “Will he be sent to a nursing home because of that?”
These thoughts reflect unpredictability, threat to the ego, or low sense of control — three of the four N.U.T.S. ingredients.
On the other hand, your loved one may feel:
- This is new (they don’t remember ever needing medication before)
- It’s unpredictable (they don’t understand what the medication is or why it’s needed)
- It threatens their ego (they never needed meds before, they’re not sick)
- Their sense of control is low (it feels like they don't have a choice)
Understanding these ingredients helps reveal unmet needs and guide more effective responses. But in the heat of the moment, analysis can feel impossible.
This post shares ways to address stress when you are in the middle of it and don’t have the energy to look into the N.U.T.S.
1. Let Go of the Agenda
While sticking to your plan feels urgent, if you’re getting nowhere, it may be worth pausing before it turns into a power struggle.
Staying in the room repeating the same prompt while your loved one repeatedly refuses is likely to sour the mood and won’t necessarily lead to success. In this moment, letting go of the agenda — even temporarily — can help.
2. Notice What’s Going On — Without Judgment
Whatever you are feeling is OK.
You are allowed to feel angry, sad, disappointed, or frustrated.
Take a moment to acknowledge the feelings and how they show up in your body.
You are a good person. You are doing the best you can. You are safe.
3. Bring Safety to the Brain
When stress takes over, problem-solving becomes nearly impossible.
Creating a sense of safety helps the brain shift out of threat mode.
Here are some ways to do that:
- Belly breathing
- Physical activity
- Laughter
- Thinking of something or someone positive.
This could be a fun memory, or a person you love, or a future event to look forward to - Noticing 5 pleasant things around you - use any of your senses
Small grounding moments can reset your nervous system enough to re-engage more calmly and problem-solving.
4. Set a Plan B, C, D,...
Once you feel a bit more grounded, begin exploring alternatives. Here are examples of questions that may help:
- Is this annoying, risky or dangerous?
- What is in my control?
- Can someone or something help me?
Setting one or multiple plans can help you gain a sense of control and predictability. If one doesn’t work, you can simply go to the next idea.
5. Implement Your Plan B
Now that you have a plan B, it’s time to implement it.
Give yourself the time you need to feel ready.
And remember:
You’ve got this.
For more information....
Blog post: The N.U.T.S. Model: A Practical Way to Understand Stress
Blog post: Could It Be Stress? One Way to Look at Challenging Situations
Centre for Studies on the Human Stress: Here
Buy the book Well Stressed: Manage Stress Before It Turns Toxic on Amazon HERE
Listen to one of Dr. Lupien's talks on YouTube HERE
This article provides general information to support well-being for people living with dementia and their care partners. Every individual is different, so please adapt suggestions to what feels appropriate for your situation. If you are unsure about safety, medical concerns, or care decisions, consult a qualified healthcare professional. This article is not medical advice and does not replace professional assessment or care planning.
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