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Dr. Jen's Diabetes Diary

The Diary of a Diabetes Psychologist

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Archive for January, 2013

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.

Eating a Hot DogDo you ever find yourself feeling down, unhappy, or restless, and before you know it, you are eating something you hadn’t planned to? If so, you’re not alone. “Emotional eating” or “comfort eating” is really common, both for people with and without diabetes. As an attempt to feel better (temporarily at least) it’s okay to use food like this some of the time. However, when food starts to feel like it controls you, rather than you being in control of food, and particularly if you have weight to lose, it can be helpful to consider your eating behaviour from a different angle. What is your ‘relationship’ with food? This article will help you understand the way you relate to food and diabetes weight loss is not just a simple formula of “eat less and move more”. There are numerous reasons why the relationship you have with food may be complex and these can be divided into biological, psychological, and social factors.

Biologically, we are fighting against our evolutionary history. Our bodies have evolved to store food in times of plenty to sustain us in times of scarcity and this is at odds with our modern day lives in which food is more than abundant. Our bodies simply haven’t caught up with our contemporary western world.

Psychologically, the connection between emotion and food is one that is established from birth, from the very first time you cried and your mother comforted you with milk. As you grew up, you may have been given sweets to cheer you up after the upset of hurting yourself, or been cooked your favourite dinner when you’d fallen out with a friend. Food is not just a fuel; it has been conditioned as a soother of emotions for as long as you can remember. So now when you’ve had an argument with your partner, or a bad day at work, there can be an impulse to reach for food as a way of calming, distracting, or comforting yourself.

Further, being able to limit food intake to maintain a socially desirable slim body shape is valued in today’s western societies; therefore, eating choices aren’t just made on nutritional content or taste but are complicated by their connection to personal sense of self-worth.

Socially, shared eating experiences are a way of bonding, celebrating, and showing love within our families and communities. Births, deaths, marriages, and all occasions in between are marked by food. Family members may offer food (and keep offering, long after we’ve said no thank you!) as a substitute when it is difficult for them to express love through a hug or saying “I love you”.

So fast forward to the diagnosis of diabetes and you are suddenly required to sharply focus on food and be thoughtful about changing or limiting previously enjoyed food choices. Your doctor, nurse, and dietician will tell you healthy eating is one of the crucial elements of optimal diabetes control; but given the link between food and emotions, it’s hardly surprising that encouragement by healthcare professionals to cut down on fatty sugary food is sometimes difficult to implement.

You know in your head what you should be doing, but it’s hard to break away from the conditioning and pattern of food as an instant route to pleasure, distraction and satisfaction.

However this pattern can be changed. The goal is to reach a place in which you can make a decision about whether or not to eat when you are feeling emotional, rather than it just being an automatic response. An important point to remember is that everyone — of every shape and size — can use food to deal with his or her emotions, and occasionally it can be fine to use food in this way. The danger is when food becomes the only way to deal with emotions. The next article in this series will examine strategies to help you gain control over your eating, the central role of your thoughts in eating behaviour, and how authentic emotional expression can help.

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.