Janet Cromer's journey as a caregiver to her husband began with a traumatic event—a heart attack on an airport tarmac. In a little over an hour, Cromer's husband, Alan, had lost the ability to read, write, walk and talk. All memory of his life, marriage and family were wiped clean.

The following seven year odyssey took Cromer, a psychotherapist and author of, "Professor Cromer Learns to Read: A Couple's New Life after Brain Injury," and her husband on a rollercoaster ride of highs and lows.

Like many caregivers, Cromer waged constant war against anxiety, and was harried by battles with depression and emotional fatigue.

"Family caregivers of the elderly have many reasons to feel stressed," she says.

Between managing the medical, financial and emotional aspects of taking care of a loved one, there never seems to be enough time in the day, or energy in the caregiver.

Much attention is focused on the overall concept of caregiver stress, but little consideration is given to the nuanced nature of how different types of pressure cause varying physical and mental reactions.

Diverse stressors in the caregiver combat zone

The most common manifestations of caregiver stress—according to Robert Motta, Ph.D., director of the Child and Family Trauma Clinic at Hofstra University—are compassion fatigue and burnout, spawned by chronic feelings of anger, sadness, anxiety and guilt.

But, if a caregiver is exposed to a jarring traumatic experience (i.e. witnessing a loved one drop dead of a heart attack, or seeing them struggle with an excruciating ailment) they may develop symptoms of Post-Traumatic Stress Disorder (PTSD)—an anxiety disorder marked by flashbacks, nightmares and hyper-vigilance that strikes after a person experiences a traumatic event.

Though commonly associated with survivors of disasters and veterans returning from the front lines, PTSD can also strike those tussling in the trenches of caregiving.

"The sudden loss of a loved one is similar to experiencing death in war," says Motta.

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Seeing an elderly loved one fall down the stairs, or caring for a someone who is prone to angry, violent outbursts can also result in a post-traumatic stress response—a heightening of the "fight or flight" reaction to trauma—which may eventually lead to full-blown PTSD, according to Cromer.

Front-line survival strategies

Though not a victim of PTSD herself, Cromer did struggle with depression while caring for her husband.

Some of her most harrowing experiences occurred when her husband's confusion and frustration manifested in dangerous outbursts. "His unpredictability put me on edge," she says. "He soon forgot his behavior, but I had to actively calm myself to keep us both safe."

6 Strategies to Prevent PTSD and Manage Stress

  1. Scan yourself for symptoms: "Recognize the symptoms (of PTSD) and get help early," advises Cromer, who credits her ability to overcome depression while caring for her husband to a willingness to seek out professional assistance. Symptoms of PTSD include: reliving a traumatic event in ways that interfere with daily life (i.e. flashbacks, nightmares, intense reactions to circumstances that mirror the dangerous event), being easily excitable, feeling emotionally numb or detached and having trouble recalling the specifics of the traumatic event.
  2. Assemble your strike team: When caring for an aging loved one, few things are as important as a social support team that has your back. According to Motta, having a group of friends and family members that you can vent to is invaluable. Support groups, both in-person and online, are a great way to find people who understand what you're going through and who can offer advice and a shoulder to lean (or cry) on. Cromer, who co-founded a support group for people families affected by brain injuries, has first-hand knowledge of the benefits of social support. "The group provided me with understanding friends and updated skills for our ‘new normal' life. Over time, I learned valuable lessons about my own strength and resilience, and how to ask for, and accept, help."
  3. Don't forget your body armor: Whether it's praying, punching a pillow, meditating, tai chi, yoga, or journaling, engage in some form of stress reduction behavior every day. Even just ten minutes can lower your anxiety and clear your mind, says Cromer. Self-care is a crucial piece of the caregiver health maintenance puzzle. Implement a ‘no excuses' policy when it comes to engaging in practices that promote your physical, mental and emotional wellbeing. Eat right, exercise often and take time every day to do at least one thing you love.
  4. Defend your borders: One of the trickier aspects of taking care of a loved one is learning how to set the proper boundaries. "Don't do anything for the sick person that he or she can do for themselves. Do not let anyone bully or threaten you," says Cromer.
  5. Beware of friendly fire: As a caregiver, it's vital that you avoid adopting your loved one's emotions and anxiety. Feeling too much of your loved ones' pain can cause you to develop an often overlooked source of angst called, "secondary traumatic stress." An example of secondary traumatic stress would be a daughter who is taking care of her mother with terminal cancer. When changing her mother's nightgown, the daughter is forced to see the bed sores that refuse to heal. The daughter can practically feel the pain of the wounds, though there is nothing she can do to help heal them.
  6. Have an exfiltration strategy: Cromer advises being honest, proactive and realistic when it comes to what kind of care you can (and are willing to) do. "The time may come when the level of care required will be beyond your capabilities without endangering your health or relationships," she says.

Courage and perseverance helped Cromer and her husband cope with his injury and its consequences. It was a struggle, but eventually they were able to re-define their relationship and find meaning—even sometimes joy—in their new reality.

Their journey together ended in 2005, when Alan passed away.

Cromer now travels around the country, speaking about and advocating for caregivers and the struggles they face.

Her ultimate advice for people taking care of an ailing loved one: "Appreciate that you are human and give yourself credit for all of the wonderful forms of care you provide."