Could It Be Stress? One Way to Look at Challenging Situations

Have you ever walked away from a difficult moment with your loved one and wondered, “What just happened?”

When we talk about challenging situations in dementia care, we often hear that they come from unmet needs. I agree with that. But before we dig into those needs, it’s important to remember that any sudden or unusual change in mental status should always be checked by a medical professional first. Infections, pain, medication side effects, or other medical issues can cause changes in behavior, and they need to be ruled out before we explore other explanations.

Once medical causes have been addressed or excluded, we can turn our attention to the emotional or environmental needs that might be at play. Figuring out what those needs are can be tough—there’s no one-size-fits-all answer. But there are ways to make sense of the situation and find clarity.

In this post, I’d love to share one perspective that’s really helped me both professionally and personally. I hope it helps you make sense of those tricky moments too.

We’ll take a look at the N.U.T.S. Model by Sonia Lupien—a simple framework that explains how stress shows up in any human being, dementia or not. We’ll then explore how it connects to dementia care, with an example that might feel all too familiar: helping someone shower.

The N.U.T.S Model of Stress

We often think of stress as being caused by time pressure. In her book Well Stressed: Manage Stress Before It Turns Toxic, Sonia Lupien (2012) offers another perspective that I find especially helpful when reflecting on our stress and that experienced by people with dementia.

Sonia Lupien’s N.U.T.S. model includes four key ingredients that can lead to stress—and just one is enough to trigger it:

• Novelty – something new you haven’t experienced before
  
  
• Unpredictability – not knowing what will happen next
  
  
• Threat to the ego – feeling your competence is questioned
  
  
• Sense of low control – feeling like you have little or no control over a situation

Knowing these four components when caring for someone with dementia can help prevent situations of refusal by diminishing the stress response (fight or flight). Take, for example, assistance with showering.  

A Showering Example

For most of us, the idea of being assisted in the shower is unsettling; it threatens our ego and lowers our sense of control. The situation may also feel unpredictable and novel to us. While this situation is likely to be stressful, as a care partner you can help decrease the stress created by the situation by providing a sense of safety, control and predictability to the person. 

How you will do this depends on the person, their ability and your relationship with them. Here are some examples:

• Protect their intimacy by having big towels they can wrap around, for instance.
• If they can turn on the shower themselves, let them. If you need to, then ask them to guide you: “Too hot or too cold?”
• Offer choices – sometimes, two options are the most someone can handle.
• Improve predictability by explaining each step in clear, calm language.

Side note: This situation may be triggering for you too. Understanding what part of the process creates stress for you, setting up a plan, as well as a plan B and C will help you feel more prepared and in control before and during the task. You matter, seek help when needed and respect your boundaries. 

Coping with Stress

Knowing the person you care for and spending quality time with them will help you better understand their preferences and routines. This will help create a sense of safety—one where the ego isn’t as threatened, and where control and trust can be nurtured.

Activities such as singing or dancing are great ways to lower stress hormones AND build a strong relationship with the person. If you would like to know more about activities you can try with your loved one to decrease your stress and theirs, let me know in the comments. :)

In my work as a counsellor and consultant, I aim to assist you in decreasing your stress and that of your loved one. Working with me, you will realise that I use this framework as a guide, giving you the tools and knowledge so you and your loved ones don't go N.U.T.S.

Sonia Lupien and her team are experts in the field of stress and I highly recommend checking out their research at the Centre for Studies on Human Stress for more information about the model. You can also have a look at one of her talks HERE. While this talk is aimed for parents, her talk is extremely valuable to understand what is stress and how to cope with it as a carer.