Living With Stroke Emotions, Roles and Relationships Trainer: Prior to conducting this training workshop, it is essential that you become familiar with both the facilitator manual and participant manual for the Living with Stroke (LWS) program. It is also vital to have a good understanding of the Facilitator Training Workshop materials and the way that the content and the exercises are designed to explain and build facilitation skills. Two trainers, or a trainer plus an assistant, are required to conduct this workshop effectively. To avoid confusion between this workshop and the LWS program, the individuals participating in the workshop are referred to as facilitators and the individuals participating in the LWS program are referred to as participants. Similarly, the training is referred to as a workshop, whereas LWS is referred to as a program. As you conduct this workshop, it is crucial that you engage the facilitators by modelling the facilitation approach you are teaching the facilitators. Therefore, wherever possible, break up the content review with questions asking for personal experiences and with examples from your own facilitation experience. Sample questions are provided for many areas, but you may wish to develop your own examples or questions as you prepare for the workshop. The more interactive the session and the more relevant the information to the facilitators, the easier it will be for them to understand the principles and the process involved in facilitation and to develop confidence in leading LWS. Facilitator Training Workshop, 2007

Topics Module 1: Understanding stroke Module 2: Physical changes and challenges Module 3: Swallowing and nutrition Module 4: Cognition, perception and communication Module 5: Emotions, roles and relationships Module 6: Reducing the risk of stroke and moving forward

How are you doing on the goals you committed to?

EMOTIONS

Emotions A stroke has significant EMOTIONAL CONSEQUENCES Both STROKE SURVIVORS and CAREGIVERS often feel a flood of emotions after a stroke Adjusting to a stroke is really an emotional journey

Emotions These emotions include: ANGER, SADNESS, GRIEF, and FEELINGS OF LOSS (loss of abilities, loss of independence) May also feel ANXIOUS, OVERWHELMED, STRESSED, and UNABLE TO COPE with all the changes and necessary adjustments after a stroke

We will discuss Anxiety Anger Depression Positive outlook

Anxiety includes Worry Fear Trouble sleeping Irritability or anger Inability to concentrate

Anger

Anger

Anger

Anger

Anger

Anger

Anger Frequent feelings of sudden intense ANGER can increase your risk of stroke Talk to your healthcare professional if you have frequent feelings of anger and are having trouble dealing with it

Depression Depression is common after stroke Half of all survivors and about a third of caregivers experience depression Men and women show depression differently Signs of depression are more common in women

Depression may include: Decreased motivation Less enjoyment of life Indecisiveness or poor concentration

Depression may include: Change in appetite Disturbed sleep Low energy and fatigue

Depression symptoms Typically these symptoms last longer than two weeks and usually start at least three months after stroke

Facts about depression Depression is NOT just unhappiness or “a bad day” Depression is a real condition with a biological basis in the brain Depression is a normal reaction to a major life change Depression is not a sign of weakness

Facts about depression The sooner depression is identified and treated the better the outcome Antidepressant medications are an important tool to treat depression You cannot become dependent or addicted to antidepressant medications

Depression and pain Depression and pain are often associated Pain can cause or worsen depression Similarly, depression can worsen pain

Caregivers Caregivers have also experienced the stroke and its effects as a major life change Caregivers may be struggling to meet new responsibilities and roles while coping with their own emotional response to stroke As a result, caregivers have an increased risk for depression

Geriatric Depression Scale The Geriatric Depression Scale (GDS) is a clinically useful indicator of depression Heart & Stroke Living with Stroke Participant Manual page 71

Geriatric Depression Scale Handout page 35

Treatment of depression Depression can slow your recovery Treatment for depression can help you recover from stroke Treatment should never be regarded as giving in or giving up Treatment of depression is an investment in your overall health

Positive outlook

VIDEO: Emotional Issues

Have you experienced any of the feelings or attitudes mentioned in the video?

Do you experience any of these feelings? Happy Depressed Angry Sad Worried Stressed Handout page 34

Do you experience any of these feelings? Lack of energy Tired all the time Difficulties concentrating Loss of appetite Trouble sleeping Lonely Handout page 36

What can you do to deal with depression or mood changes?

How to deal with mood changes Be ENGAGED IN LIFE Stay PHYSICALLY ACTIVE Avoid SOCIAL isolation Handout page 37

How to deal with mood changes Stay in touch with FAMILY and FRIENDS Talk to other STROKE SURVIVORS and CAREGIVERS Handout page 37

How to deal with mood changes Learn about STROKE to help you understand what’s happening Talk to your HEALTHCARE TEAM about your concerns Speak to your doctor about MEDICATION if you think you are depressed Handout page 38

How to deal with mood changes Set GOALS and work toward them to help you maintain a sense of CONTROL, improve your CONFIDENCE and raise your SELF-ESTEEM Take an ACTIVE role in your recovery, one step at a time Handout page 38

ROLES Living With Stroke Trainer: This is a good interactive and thought-provoking icebreaker. Ask each person to answer a question such as the following: What do these quotations mean to you? How do you think they apply to your role as a facilitator? Share your answer first to demonstrate. (Here’s an example: After hearing for a long time about the importance of healthy eating, I was able to change my eating habits because I changed the way I thought of food. Previously, I thought of food primarily as a pleasure. Now, I think of food primarily as fuel for my body. This change in thinking changed my attitude to food and eating and the way I shop for food and cook.) You may wish to have different people answer different questions to introduce some variety and stimulate discussion. Facilitator Training Workshop, 2007

Roles

Did anyone stop working? How did it make you feel? Any positive changes?

Caregiver

Caregiver

Caregiver

Caregiver

Caregiver Caregivers, what are some of the issues and feelings you are experiencing? What do you do to prevent burnout?

Services

Services

Services

Services What services do you use?

VIDEO: Family Support and Caregivers

RELATIONSHIPS Living With Stroke Trainer: This is a good interactive and thought-provoking icebreaker. Ask each person to answer a question such as the following: What do these quotations mean to you? How do you think they apply to your role as a facilitator? Share your answer first to demonstrate. (Here’s an example: After hearing for a long time about the importance of healthy eating, I was able to change my eating habits because I changed the way I thought of food. Previously, I thought of food primarily as a pleasure. Now, I think of food primarily as fuel for my body. This change in thinking changed my attitude to food and eating and the way I shop for food and cook.) You may wish to have different people answer different questions to introduce some variety and stimulate discussion. Facilitator Training Workshop, 2007

Stroke and relationships A stroke can affect your relationship with your: Husband/Wife Brother/Sister Children Friends Others

Relationships A stroke can change your role at home and your relationship with your spouse or children The previous caregiver in the relationship may now require care Some find their need for help embarassing or distressing

Relationships You are dealing with the impact of the stroke as well as the changes in your role and relationship

Relationships The small irritations of daily life often cause more stress than the big events, because they tend to affect the perception of control Everyone needs to feel a sense of control and mastery in life

Relationships Some experience positive changes Many spend more time together and enjoy the resulting closeness Examples: cook together, read together, do chores together

Has your relationship with your family changed in a positive way since your stroke?

Maintaining social relationships After a stroke, people may reduce their social activity because they cannot do things the way they used to If you are prepared to make some changes, there’s no reason to give up social activities

Maintaining social relationships

Maintaining social relationships

Maintaining social relationships

Maintaining social relationships

Maintaining social relationships

Maintaining social relationships

Maintaining social relationships

Maintaining social relationships

Maintaining social relationships

Maintaining social relationships

Maintaining social relationships Meet up at a coffee shop or restaurant Go to the park Go to the movies Handout page 39

Maintaining social relationships Join a community centre Attend your place of worship Join a support group Handout page 39

Can you come up with a goal to deal with the changes that have occurred since your stroke ?

Wellness goal Be physically active Be social Join a group Talk to doctor about medications Other: ________ Handout page 40

Acknowledgements Aphasia Institute Providence Healthcare