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The Diary of a Diabetes Psychologist

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Motivational StairsI have lost count of the times people with diabetes have said to me, “I would love to change my behaviour around diabetes, but I just have no motivation.” They know what they should be doing to care for their health, but they cannot seem to summon up the how. So when I tell them, “You are one of the most motivated people I have ever seen,” they tend to stare at me in utter disbelief! But then I explain. They are motivated to do all sorts of things in life:

  • Watch the latest film at the cinema.
  • Devote some time to engaging in an enjoyable pastime or hobby.
  • Pet their cat or dog.
  • Eat a delicious meal in the company of loved ones.
  • Go on holiday.

I am confident there is not a single person reading this who finds that the concept of ‘motivation’ enters their mind when they are thinking of doing these fun activities! In fact, the average person would be ready, willing, and eager to get started and feel the enjoyment that these events bring.

The crucial difference with these things is they are a short-term route to good feelings and instant pleasure. The problem with health-promoting activities such as exercising, eating healthily, or testing your blood glucose, is they often do not result in pleasure in the short term — instead working up a sweat is uncomfortable, the salads are more boring than the chips, and testing your blood glucose is more pain than it is worth.

No one feels motivated to do something if the costs seem to outweigh the benefits. Go to the gym in the evening or spend a cosy night in front of the television? I am sure you can see what I mean!

Here are my top tips for staying motivated with any aspect of your diabetes health care:

  1. Link an activity that feels like a struggle with one that naturally feels effortless.

    You could:

    • Test your blood glucose and then phone or e-mail a friend you love to chat to straight after.
    • Plan your exercise so it’s immediately followed by watching your favourite TV programme.
    • Make the doctor’s appointment you have been putting off for months just before you sit down with you morning tea or coffee, and make a rule that you can’t have one until you’ve done it.
    • Stick to your healthy eating plan for three days and reward yourself with a visit to your favourite museum, gallery, park, or shop.
  2. Imagine, and keep imagining, how great you will feel once you’ve accomplished your goal.

    Whether it is losing a certain amount of weight, getting to the HbA1C level you are aiming for, or in a regular routine of exercising more. Having a photo, picture or object that symbolizes or is a reminder of your goal can be effective when you feel like you are losing motivation, perhaps because your goal is taking too long or the results seem too slow.

  3. Kindness Statement.

    Keep your inner voice kind and supportive. It is so easy to find yourself talking to yourself in a negative way, and even worse, listening to it. Form a kindness statement that you find motivating and remind yourself of it often. Examples may be, “If this was easy, then everyone would be doing it!”, “Only I can change my life. No one can do it for me”, “Change is challenging but each day I’m moving closer to my desired goal.”

  4. Remind yourself of successes you have achieved in the past, and how you can transfer this experience to your current goal.

    Keep a success journal and track all of your successes, no matter how small and in whatever area of life you like. Examples could be: learning to drive, making a new friend or nurturing an existing relationship, learning how to use a computer, raising your child, having a successful work meeting, learning a new recipe, mastering a new skill, planning a holiday or family day out — you get the idea!

You might like to think back over times you have changed in the past and fill in the following worksheet.

Example Worksheet: Learning From Change

  • Change I want to make.
    Lose one stone in weight by avoiding snacking between meals.
  • What is your main reason for making this change?
    Feel fitter, look better, be healthier
  • Thinking over times you have made a health change in the past, how did you do it?
    Cut out sugar in my tea — ensured I didn’t have any in the house, kept reminders by the kettle.
  • What helped you to stay on track?
    Telling others of my plans, talking to other non-sugar takers and seeing what their experiences were like.
  • What things got in your way?
    Going to a friend’s house — had to remember to tell her I no longer took sugar.
  • Which strategies were the most successful?
    Using a sugar substitute when I really fancied some sweetness.
  • How will you respond to the urge to go back to an old behaviour?
    Remind myself of how good it will feel to succeed this time, distract myself with an activity.
  • How do you expect to feel when you have succeeded?
    Fantastic!
  • What might you miss about your old behaviour?
    Having a cake with tea when I meet a friend. I could plan to buy myself a non-food treat instead, e.g., a magazine or a new product I have not tried before.
  • Have you told people about your plans? If not, why not?
    No, will tell my partner and ask her for support.
  • Can you think up some responses you can give if tempted to stray from your plans?
    “I’m really enjoying feeling more in control of my health.”
  • Are there any friendships that may be affected when you make this change?
    Mum might be a bit miffed if I don’t eat snacks she has made when I visit her. I could always ask her to wrap it up and tell her I will eat it later, or share it with my partner.

You may use this article on your website, or for your own e-zine; however, there's one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist chartered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit www.PositiveDiabetes.com.

How can someone who only sees you once or twice a year for roughly 15 minutes at a time really ‘get’ what your experience of diabetes is like? Perhaps I am being a little controversial but I believe that, although you might expect them to, the diabetes doctor, nurse, or dietician can’t. However, here’s something you may not have thought of — they are not really there to.

Let me explain. Of course your healthcare team wants you to be in control of your diabetes and be in good health. They are passionate about helping you to manage the delicate balance between food, medication, and activity, so your blood glucose control is just right. This is fantastic — it is where their skills and expertise lie and they can advise you based on their expert knowledge of the inner workings of the human body.

However, as committed and as dedicated as they are, they are not your psychologist, your counsellor, or your friend. They aren’t there to help you work on the other ‘inner workings’ of your body — your emotions. That’s why there can be a disconnect between your experience of being heard in your diabetes appointments. It’s thankfully becoming more and more recognised that managing diabetes takes an emotional toil as well as a physical one. Government health guidance is calling for greater access to psychological therapies. Yet, a recent survey in the UK showed that less than one third of Diabetes Centres have access to specialist psychological services (Diabetes UK, 2008). There are just not enough Clinical Psychologists to go around unfortunately!

Potential Challenges in the Patient — Healthcare Professional Relationship

Common experiences of relating to healthcare professionals from the patient perspective are:

  • Feeling rushed.
  • Being patronised, unintentionally or otherwise.
  • Not being ‘heard’.
  • Feeling misunderstood.
  • Not feeling free to talk about what is really of concern, e.g., that diabetes is getting you down.
  • Feeling scolded or made to feel like a ‘bad’ patient.
  • A pressure to lie about your blood glucose results or other health behaviour.
  • Feeling the healthcare professional is an ‘expert’ and can’t be disagreed with.
  • Not attending health appointments at all and avoiding healthcare professionals entirely.

Some common challenges from the healthcare professional’s point of view are:

  • Not having as much time to spend with patients as they’d like.
  • Feeling pressure to be the ‘expert’.
  • Feeling at a loss to know how to help.
  • Working within an environment with scarce or stretched resources.
  • Team conflict amongst colleagues.
  • Working to meet government targets, which prioritise ‘hard’ data such as blood glucose levels of their patients over ‘soft’ data such as psychological wellbeing or quality of life.
  • Realising they are not able to fully appreciate the lived experience of diabetes (being an ‘expert’ rather than an ‘expert by experience’).
  • Having to maintain the caring role at work when experiencing personal challenges in their lives outside of work.

How does it feel to read these two lists? Do any of them resonate with your experience or surprise you? Just viewing the relationship from the perspective of the ‘other’ can be helpful.

There are practical steps you can take today to feel more in control of this relationship. Here are the three P’s of improving your relationship with the individuals in your healthcare team:

  1. Plan: The first step is to plan for your appointment. Think back over the last month. What has confused you, or surprised you, or encouraged you, or frightened you about your diabetes? What are the three things you would like to know or say to your health professional?
  2. Participate: The second step is to be an active participant in your appointment. Polonsky (1999), suggests using the ‘ABC’ of effective communication to aid you:
  • Assertiveness: express yourself with confidence.
  • Brevity: speak as briefly as you can, staying to the point at all times.
  • Clarity: express yourself clearly, using short sentences and simple words.

Often writing down some bullet points before the appointment can be helpful, covering the main topics of what you would like to talk about. You can then choose to bring them to the appointment with you, or simply have them in mind to recall them.

  1. Partner: The third step is to understand and keep in mind that you and the healthcare professional are equals. Rather than feeling like a passive recipient of expertise, remember you are two adults with an immense wealth of expertise. The healthcare professional has expertise of diabetes and the physical aspects of the condition; and you have extensive expertise gathered through your lived experience of daily life with diabetes. Together, you can share that expertise with one another to work towards the benefit of your health.

You may use this article on your website, or for your own e-zine; however, there’s one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist registered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit www.PositiveDiabetes.com.

Glycosmedia is a free and editorially independent diabetes news service.
It exists to bring the latest diabetes news and information to professionals working in the field
of diabetes, both in the clinic and in research.
Information overload is an overworked and much maligned term, but it is a truism when
considering the increasing proliferation of diabetes news and news resources. The problem
lies in the frustratingly unfocussed electronic news feeds that are available; feeds that
completely lack any intuition of the needs of the busy practitioner or researcher.
In contrast, the content for the weekly Glycosmedia news listing is selected “by hand” and
does not use an automated trawl of the Internet.
As well as being available online, Glycosmedia offers a free subscription to their weekly
newsletter delivered by email.
Subscription to free weekly email newsletter can be found here: http://
www.glycosmedia.com/subscribe.htm
Glycosmedia was launched in June 2008 and at the moment there are over 1,500 healthcare
practitioners who subscribe to this free weekly newsletter.
Glycosmedia also updates their Twitter page here: http://twitter.com/Glycosmedia and this
is done in as close to real time as possible. In a similar way the Glycosmedia RSS feed is
updated with the latest news.
RSS feed: http://www.google.com/ig/add?
feedurl=http%3A%2F%2Fwww.glycosmedia.com%2Ffeed.xml
This RSS feed can be used by the sponsors of Glycosmedia to populate a news page
on their websites, and an example can be seen on the Abbott website here: http://
www.abbottdiabetescare.co.uk/abbott-diabetes-care/latest-diabetes-news
It is also fed into the Young Diabetologists website here:
http://www.youngdiabetologists.org/index.php?option=com_wrapper&Itemid=113
The editor-in-chief of Glycosmedia is Jim Young and he regularly updates their blog with the
latest developments. The blog can be seen here: http://glycosmedia.blogspot.com/
Jim can be contacted on jim@glycosmedia.com
The editorial team at Glycosmedia can be seen here: http://www.glycosmedia.com/
aboutus.htm
Glycosmedia is sponsored by Abbott Diabetes Care, Bayer Diabetes Care, Lilly and Novo
Nordisk.
A link to Glycosmedia can be seen keeping very good company in the Professionals section
of the Diabetes UK website here: http://www.diabetes.org.uk/Professionals/Publications-
reports-and-resources/Links/
Finally, there are some testimonials to Glycosmedia here: http://www.glycosmedia.com/
comments.htm
It has been snowing here in London today and with less than 5 days to go, the Christmas countdown is well and truly on!

As we approach the 25th, days and evenings are full of manic activity for most of us……social events, shopping and eating are all in full swing at this time of year!

All this hectic activity can create excitement, stress and fatigue……or maybe a bit of all three depending on your particular relationship with the festive season!

The idea that relaxation is good for us is not a new one – we hear time and time again that stress is bad for us and we must make time to relax.

But lots of us find the idea of relaxation a complete turn off….images of lyrca clad bodies contorted into the lotus position uttering “Ommmmm” feels so far removed from the reality of most people’s lives….plus that stereotyped image is more likely to make many of us want to break out into a giggle than discover any sort of inner peace!
But don’t be too quick to judge relaxation.

There is a way to relax that has been demonstrated to be of huge value to those with diabetes.

Research studies have shown that regular practice helps those with type 1 and type 2 better manage their difficult emotions about diabetes and also had a positive impact on their blood glucose control.

Furthermore it is a practice that is incredibly straightforward to learn and implement.

So what is this new form relaxation? It is called ‘Mindfulness’ and is simply a commitment to live in the moment. For many of us, our thoughts are focussed in the past – on memories or regrets, or in the future – on anxiety or uncertainty about what’s to come. But in reality the only moment we truly have is the one occurring right now, so mindfulness encourages people to focus on this and ‘let go’ of thoughts of the past and future.

For those of us with diabetes this can be helpful, for example when we feel regret about ‘bad’ food choices or when we experience fear or anxiety about the future – such as the possibility of developing complications and so on.

Mindfulness involves paying attention to your internal and external experiences, emotions and behaviours – without necessarily trying to change them. This might involve just noticing the thoughts you are having, rather than engaging in them.

Thoughts stream rapidly through our minds and mindfulness encourages us to sit back and “observe” our thoughts, rather than becoming involved in them. As you observe them, you might find your mind calming and the thoughts becoming less stressful. In addition, focussing on something external to yourself, rather than the internal voice of your thoughts can be helpful.

This can be as simple as noticing the sensation of your hands against the paper you are holding, or noticing your breathing, or how it feels to sit in the chair you are in – where is the tension held in your body?

This can feel strange and difficult at first but with practice it can lead to a more peaceful experience of daily life.
So this Christmas, while your ‘mind’ is ‘full’ with festive activity, why not try bringing a new form of ‘mindful’-ness into your life. I’d love to hear how you get on, do email me and let me know: drjen@positivediabetes.com

Warm wishes for a happy Christmas and I’ll see you in the New Year (lycra optional)………!

Can you remember the day you were diagnosed with diabetes? How did it feel? What were the emotions, thoughts and reactions that you had?
 
The experience of being diagnosed with diabetes has been likened to the experience of grief. In the same way as we may grieve for a lost loved one, the diagnosis of diabetes can trigger a grieving for our lost health.

It is common to live life as if we are invincible, rarely considering our health or mortality. However this dramatically changes when we are diagnosed with a chronic health problem; we are suddenly acutely aware that life is not without its limits. We now have to rely on regular medication, make frequent visits to a medical setting and a team of doctors and nurses to keep us well.

The stages of grief were described by the psychologist Elizabeth Kubler-Ross and are outlined below – do you recognise any of them in your feelings towards diabetes?

1. Denial – “This can’t be happening”

2. Anger – “Why me?”, “It’s not fair”, “How can this be happening to me?”, “Who is to blame?”

3. Bargaining – “Just let me see…” “I’d do anything to turn back time…”

4. Depression – “I’m so sad”, “What’s the point?”, “I miss my old life”

5. Acceptance – “It’s going to be ok”, “I can take control and manage this”

Not everyone with diabetes will necessarily experience all of these emotions, or in this particular order. In fact many people oscillate back and forth between a number of these stages for many years, getting stuck at denial, or between anger, bargaining and depression and perhaps small acceptances along the way.

To find out more about how to manage the impact of diabetes, go to my homepage (www.PositiveDiabetes.com) and download your FREE copy of ‘Top 10 Tips for Living a Positive Diabetes Life’ at the top right of the page.

If you would like to learn how to better cope with the impact of diagnosis, the Positive Diabetes Ebook, ‘Diabetes De-Stress’, will teach you the step by step process of how to manage the emotions caused by diabetes, based on evidence based psychological strategies. Find out more here: http://positivediabetes.com/diabetes_book.html

Finally, would you like t o take advantage of a FREE telephone conversation with me to discuss any aspect of managing your diabetes? If so, just email drjen@positivediabetes.com to arrange yours now. I look forward to hearing from you and helping you gain control of your diabetes and your emotional well being.

Warmly,

Jen