The Pandemic Sandwich Club – Reframing the Signs of Overwhelm in Middle-Aged Female Caregivers

By April Boyce



“I don’t know how to start.”


I hear that all the time from the people I work with. Folks with ADHD regularly struggle with task initiation, and after discussions we often find that the root cause of their struggle is stress induced overwhelm. The five domains of stress and Self-Reg are corner stones of my ADHD coaching practice and often provide clarity and understanding to a person who has felt ineffective and worthless for a long time. ADHD symptoms are often magnified when a person is struggling with a variety of different stressors in their life. Through conversation, it is often revealed that the client has been experiencing stress across all of the domains over a long period of time, but because no one stressor is identified as the catalyst for their overwhelm, signs and symptoms are ignored, and alternative explanations are provided for their perceived failures.


I call this the snowball effect. Dr. Shanker often references the arousal scale, and how people have both positive and negative stress in their lives. We all go up and down this arousal scale every day as we engage in tasks and seek to overcome challenges we are presented with. Sometimes the signs of stress are small and very hard to detect. We have lots of strategies that we activate unconsciously to make ourselves feel better. In my case, this included giving in to unhealthy eating habits, ignoring exercise, playing games on my iPad, and binge watching far too much on Netflix. Interestingly, we don't tend to pay attention when these behaviors are occurring, but it's easy to witness them in others. It is only when we are close to allostasis (no amount of comfort food helps prevent emotional overload) that we become aware of the snowball effect we are experiencing. Unfortunately, often by the time we are aware we have reached the “tipping point” we have established patterns of behaviour that require extensive amounts of time to reprogram.


When you are both a parent, and a caregiver to aging parents, there are a multitude of stressors that you face on a day over day basis. However, it is difficult to give yourself permission to pay attention to what you are experiencing, as you are too busy caring for the needs of others to address these small and ever-increasing demands. Recently, I have experienced this myself, when one of my in-laws faced a health scare. This was far from the only stressor I have been coping with over the last few years, but it was my tipping point, forcing me to slow down and ask myself the very important questions, why this and why now?


Over the last two years, many of us have experienced stress in new and unfamiliar ways, as we struggled to adapt to a constantly shifting landscape during this global pandemic. Women in their midlife have had to take on an increasingly complicated and important role during this time. As mothers, we have watched our children miss important milestones, such as graduations, but we’ve also watched them struggle with anxiety and isolation during prolonged periods of separation from their peers. Our role became one not just of parent, but also companion, as we worked to help them coregulate during a time of tremendous upheaval. In contrast to this, we have also lost contact with our own parents as we attempted to keep them safe during a time when being close to your loved ones meant putting them in danger. Trying to meet their needs from a distance, while also not being able to rely on the dyadic relationship that had always been a pillar in our own self-regulation plan, created new and invisible stressors for this sandwich generation of caregivers.


When I became aware that I was near my own tipping point, I turned to Self-Reg to examine what stressors might have brought me to this place. What “silent stressors” had I not acknowledged before, that might have snowballed? It was clear to me that the pandemic was indeed a factor, however I had been through heavy stress situations before, and this was quite different. I needed to reframe what I was experiencing in order to be able to approach it in a healthy and downregulating fashion. I broke down the experience using the five domains of stress, and this is what I learned.


Biological Domain - Women experience symptoms of what is known as perimenopause as many as 10 years prior to full menopause. As hormone levels fluctuate, women experience things such as poor sleep, mental fog, hot flashes, weight gain, body aches and pains, and increased anxiety, amongst others. Although we all know this is coming, it often takes us by surprise, and we ignore these symptoms, as they are subtle and often come and go. I noticed five or more years ago that I was increasingly tired at the end of the day and had less patience to deal with small things that came up. I found myself paying more attention to my worries over physical health issues, and this slowly began to drive me up the arousal scale.


Emotion Domain – This domain was/is directly impacted by what is going on for me in the biological domain (Dynamic Systems theory in action). The more that I became aware of the biological changes I was experiencing, the more anxious I became. I also became more responsible for the emotional wellbeing of my children and parents during the pandemic, which meant more frequent movement up and down the arousal scale, as I worked hard to help others coregulate. My ex-husband (with whom I still have a great coparenting relationship) was also diagnosed with advanced cancer just before the pandemic began. Although I am in reasonably good health, his illness created another worry for my children that I had to support them through. This also magnified my anxiety over the stressors I was experiencing in the biological domain. My parents and in-laws also had serious health crises just prior to or during the pandemic. Constant worry about the wellbeing of all those I am “responsible for” meant that when I put my feet on the floor in the morning, instead of being at the lowest level of the arousal scale, I was already a 5/10, leaving me less distance to travel upwards as I took on a normal day.


Cognitive Domain – As we become more emotionally aroused our executive functions (EF) in the prefrontal cortex become harder to access. Dr. Russell Barkley breaks EF down into six different clusters.

  1. Organizing, prioritizing and activating for tasks

  2. Focusing, sustaining and shifting attention to task

  3. Regulating alertness, sustaining effort and processing speed

  4. Managing frustration and modulating emotions

  5. Utilizing working memory and accessing recall

  6. Monitoring and self-regulating action

If we also struggle with other cognitive stressors such as learning disabilities, this domain is incredibly energy depleting. Just paying attention to my daughter as she talked to me about yet another video she had been watching on YouTube, was exhausting! Add to that I have a job that requires I be completely present during every client interaction, means that by the end of the day I simply had no energy left to help my father, who was in lockdown in Montreal, figure out his remote control via Facetime.


Social Domain – We use social engagement as our first line of defense when dealing with stress. The pandemic meant that people were unable to engage with friends/peers in healthy stress relieving behaviours. Sandwich caregivers spent a great deal more time doing online school with their children and engaged in social activities that normally would have been filled by other young people. Supporting our parents as they learned how to Zoom, stream television, and discuss their personal health and home needs, became another job caregivers had to fill. It’s important to note, that as adults, we also need our peers to help us self-regulate. Jobs moved online, trips to yoga class or an occasional lunch out with a friend, were abandoned as we simply had no time, energy, or opportunity to meet those social needs for ourselves.


Prosocial Domain – As Stuart tells us, “Stress overload shuts down the very systems that enable us to experience “cognitive empathy: not just being affected by, but aware of what someone else feels. When social engagement shuts down, ancient systems run the show: systems that predate the Social Brain relying on aggression or escape to deal with threat.”


The pandemic and the constant caregiving I provided, led me to experience compassion fatigue. Empathy simply didn’t have a place in my incredibly full agenda, but the fact that I was not able to draw upon my own naturally overflowing tank of empathy, led to feelings of guilt and moral conflict. It was in this moment, when I realized I had reached allostatic overload, and it was time to reframe what was going on.


Being a member of the Pandemic Sandwich Club has required me to reframe my own feelings and behaviours. Rather than being angry that I’ve gained the pandemic 20 lbs or can tell you the story line to hundreds of hours of television dramas thanks to Netflix, isn’t a failing on my part, or anyone else who belongs to this esteemed group. Helping to coregulate the needs of those closest to us during this incredibly scary time, was an honour and a privilege, but it makes sense that we are tired and need some self-care. So please excuse me while I go sit and watch season 9 of Grey’s Anatomy and eat some popcorn under a weighted blanket. I have a date with my parasympathetic nervous system tonight, and I am okay with that.

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