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Tag: emotions

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.

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.

Woman Eating DonutDid you know your environment plays a hugely important role when you are trying to change your eating habits? In our evolutionary past we had to seek out food, so there was a natural delay between thinking about food and being able to consume it, now it is everywhere we turn! So much of our everyday lives are done habitually, on autopilot. Think of some of your daily routines — how you shower, get to work, what you eat for breakfast — nine times out of ten you do these in pretty much the same way every day. That is because our brains, as wonderful as they are, have a limited processing capacity and they are designed to create shortcuts to make the demands less arduous. Imagine if you had to concentrate fully on exactly what to do and in which order each time you had a shower!

Spend some time thinking about the ways your environment sabotages your eating goals. Perhaps you keep sweets, nuts, or chocolates on the coffee table and you find yourself snacking on them while you are watching television in the evenings. Maybe your route home from work is past a fast food restaurant that you can ‘drive-in’ to get something to tide you over until dinnertime. It could be you have many unhelpful foods in your kitchen at home. Therefore, when you are hungry, it is too easy, convenient, and tempting to reach for these rather than take a moment to think about an option that might be better for you. Think now about the different environments you find yourself in regularly that sabotage you, and make a note of them here:

Environments that have a tendency to sabotage me:

Environmental Triggers Rate 0 – 10 
   
   
   
   
   

Now you have a clearer sense of the environments that sabotage you, you can start to address them. Rate each on a scale of 0-10, where 0 is it rarely affects you and 10 is it affects you most frequently and most badly. Pick the one that affects you the most to start with, as this will have the greatest impact the quickest. Think about how you can change your environment to support you. Here are some ideas to help you:

  • Store foods you find tempting out of reach and out of eye sight (e.g., in the top cupboard of your kitchen rather than on the counter top).
  • Avoid buying the foods you find tempting in the first place, if they are not at home, it takes a lot of effort to get them.
  • You may want to find a different route home if the food places you pass are too appealing.
  • If you know a vulnerable time is the evening, you may want to rearrange your plans so you’re occupied. You could go for a walk or phone a friend.
  • In restaurants, you could ask the waitress not to bring you the bread bowl; or you could ask for an alternative option to snack on that is lower in calories.
  • Perhaps you snack while preparing your meals, in which case pre-prepared vegetables, etc., may be an effective way of breaking this habit (you can always return to preparing your own when you have shifted this habit).
  • Engage in doing something active with your hands, which means you cannot reach for the food. This could be doing your nails, mending or fixing something, knitting, playing a game on your phone, doing a crossword puzzle etc.

Remember, there are no rights or wrongs with this process. You are simply making small shifts to the habits you have formed that are no longer truly serving you. Treat it like an experiment. All ideas are good ideas at this stage and you can stop the ones you do not find helpful and keep the ones you do. Even if you do not make any practical changes right now, just the simple act of gaining insight into how your environment is hindering you is hugely valuable. It enables you to view your situation from a more realistic point of view — showing you the times when you are not at fault, rather your environment is. This helps you to separate some of your tendency for self-criticism and self-blame. At least if you do continue to eat the snacks on the coffee table, you are doing so with your eyes wide open. Knowledge is empowering and just the increased awareness can translate into different actions over time. List below your own ideas of how your environment triggers you and what changes you can make to help you.

Changes I can make to my environment:

Environmental Triggers Changes I Can Make 
   
   
   
   
   
   

If you are interested in learning more about how to use Cognitive Behavioural Therapy to overcome your struggle with diabetes, then get your copy of my Positive Diabetes Home Study System. Life is too short to keep struggling on your own. I know, I’ve been there. I’d love to help you too.

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.

Can you recall the moment you were diagnosed with diabetes? Perhaps it has been a very recent experience and is still fresh in your mind; or maybe it was a number of years or even many decades ago. Dealing with diagnosis is a process not an event, so you may be surprised to learn that it can be as relevant as those who have had diabetes for many years as it is for the newly diagnosed.

Regardless of the time that has elapsed since diagnosis, try to put yourself back to that moment now. Where were you? What was said to you? How was the news conveyed? What was the first thought that entered your head? Who was the first person you told? What were your feelings and reactions in the days and weeks that followed learning the news?

Following diagnosis, it takes time to emotionally accept this new way of life. Accepting a chronic illness has similarities to accepting the death of a close friend or family member — it takes a lot of time and you may find yourself forgetting momentarily, and then experiencing a sinking feeling when the reality hits you. The ‘non-diabetic’ part of you feels like it is gone. You will need time to mourn your loss.

Below is an outline of the stages of grief, first described by the therapist, Elizabeth Kubler-Ross. Do you recognise any of the descriptions in your feelings towards diabetes?

Stage 1: Denial: “This can’t be happening.”

Stage 2: Anger: “Why me?” “It’s not fair.” “How can this happen to me?” “Who is to blame?”

Stage 3: Bargaining: “I’d do anything to turn back time…” “If only I could have done things differently.” “Just let me be okay to see…”

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

Stage 5: Acceptance: “It’s going to be okay.” “I can take control and manage this.”

How to Come to Terms with Diabetes — Learning to LIKE Yourself

LIKE is an acronym for the four steps to better managing diagnosis.

Learn
Educate yourself all you can about diabetes. Becoming familiar with the condition, its new vocabulary and learning about all of the various aspects of managing the condition allows you to integrate it as part of your identity and help you become an ‘expert by experience’. Just as you no doubt needed some element of training or teaching to be able to perform your occupation or learn a skill such as using a computer or being able to drive a car, diabetes is just the same. You now call yourself a ‘driver’, ‘computer literate’, or ‘[insert your job title]’, diabetes is no different. You are likely to have been given some information about diabetes from your healthcare team and this is an ideal place to start in learning the basics of the condition.

However, don’t let your learning stop there. Borrow some books from your local library (join one if you need to!), contact diabetes charities to find out about local diabetes support groups and other useful resources these organisations offer. Obtain all the information you can from your healthcare team and ask them for recommendations of support or resources that other patients have found helpful. If you have Internet access, you could join a diabetes Internet forum run by one of the charities and learn from other ‘experts by experience’ who have been on a similar journey to yours and will be able to offer advice, hope and support, so crucial in these early stages of adapting to the condition. Start wherever feels manageable for you; you could set aside five minutes each day or thirty minutes at the weekend to do this.

Learning all you can about diabetes is not just for the newly diagnosed. When you have had diabetes for many years you may feel like you ‘know it all’ — and in some ways you do — you are an expert of your own body and how diabetes affects you specifically. However diabetes knowledge is advancing at an ever-increasing rate, so do not neglect to keep updated with all the new developments.

Inquire
Ask yourself what you can do to improve life with diabetes. At the top of a blank sheet of paper, write, ‘My life with diabetes could be improved by…” Your immediate response may be, ‘Nothing!’ or ‘If I didn’t have it!’ That is okay, that is the resentment towards diabetes speaking, so there is no judgement in it being your initial response. Nevertheless, I want to encourage you to stick with this question for five minutes (set a timer on your watch or phone if that’s helpful) and see what answers surface. Some things other people with diabetes have found helpful are:

  • Is there an educational course you can attend at your local NHS diabetes service? If you have type 1, then there are courses available to support you with your diabetes care. One of these is DAFNE (Dose Adjustment for Normal Eating) may be useful in teaching you how to alter your insulin requirements in line with your food intake. If you have type 2, a DESMOND course (Diabetes Education and Self-Management for On-going and Newly Diagnosed) can help you to gain greater insight into the management of your health. Chat to a member of your diabetes healthcare team about how to be referred to one of these free courses.
  • Would a dedicated kit bag for your diabetes equipment help you to feel more in control?
  • Or an attractive case with a design that reflects your personality?
  • A particular blood glucose meter that stores and memorises your results?
  • An attractive notebook to record your blood glucose results?
  • A session with a dietician to explore different ways of managing your eating regime?
  • A system for remembering to take your medication or test your blood glucose (e.g., putting a note on your bathroom mirror to remind you, or leaving your medication somewhere you will easily notice them, such as by the phone or next to your keys).
  • Anything and everything that makes life with diabetes a bit easier is worth considering.
  • Get in touch with other people with diabetes, as they are the ones who will really know what you are going through. Although healthcare professionals know their stuff and are well-intentioned, they sometimes can’t quite ‘get it’ (just as it is impossible to truly know what it is like to have lost a child, or be widowed, until you experience this yourself). Connect with others through a local support group, or if you use the Internet, on an online support group.

Kindness
Go easy on yourself and show yourself some kindness. It is common to experience a range of painful and powerful emotions towards your diabetes — as well as the anger and sadness that are inherent in the grief cycle; guilt, rage, regret, and numbness are all unnerving with which to contend. These emotions can feel overwhelming. Try to keep reminding yourself that you have encountered an experience of loss and in the same way as any loss; you cannot expect to feel your usual self straight away. Give yourself permission to feel the whole range of emotions, however know that these painful feelings can and will pass. Formulate a ‘Kindness Statement’, keep it somewhere handy (in your diary, bag, or by your bed) and read it at least three times a day. Ideas might be:

  • “I have a right to feel sad/angry/low/frustrated about diabetes but these feelings will pass.”
  • “I am going through a difficult life event, which will get easier to deal with over time.”
  • “I can choose to do something nice for myself.”
  • “Diabetes is demanding right now, but I have overcome other difficult challenges in life and diabetes will be the same.”

Express Emotion
How can you express and let go of some of the emotion you are experiencing? Can you have a good cry? Talk to a trusted friend? Punch a pillow, do some exercise, write in a journal, or see a therapist? If you are interested in learning more about how to use Cognitive Behavioural Therapy to overcome your struggle with diabetes, then get your copy of my Positive Diabetes Home Study System. Life is too short to keep struggling on your own. I know, I’ve been there – I’d love to help you too.

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.

As a Clinical Psychologist who has lived with diabetes for more than 25 years, I’m here to give you permission to find life with diabetes difficult. The demands of living with diabetes have been likened to a job; in which you work 24 hours a day, 7 days a week, 365 days a year with no break, no holiday, no reward, and no praise. I’m not sure about you, but I wouldn’t stay in a job like that for very long! However, the person with diabetes has no choice but to deal with these demands each and every day, perhaps all the while being told, “It’s only diabetes. What’s the big deal?”

However, you and I know the real story. Dealing with diabetes involves daily challenges, frustrations, and stress. Diabetes doesn’t just affect your body, it affects your emotions and mind too. It’s little surprise then that depression is very common among people with diabetes (two to three times more common in fact). But the good news is there are LOTS of ways to overcome it, too many to mention in this e-zine!

One excellent three-step strategy I ask my private clients to do to improve their mood is to increase the activities that give them a sense of pleasure and those that provide a sense of achievement. To feel good about your life, you must experience these two aspects to your activities, but when you are depressed, both of these are at risk. Depression means you are prone to not feeling like you want to engage in the activities that give you pleasure and tasks that involve a certain level of mastery or achievement tend to feel difficult to do.

So how do you find out which activities bring you pleasure and achievement?

Step 1: Fill in an Activity Diary

You will find an example Activity Diary below. Each hour of your waking day has a slot, for you to fill in everything that you do.

Example Activity Diary

Time Friday Saturday Sunday
6-7am Awake in bed Asleep  
7-8 Shower Asleep
8-9 Commute to work Breakfast  
9-10 Emails Watched TV  
10-11 Meeting with boss Went to the park  
11-12 Report writing Shopping  
12-1pm Phone calls Lunch with sister  
1-2 Lunch at desk Lunch with sister  
2-3 Meeting Internet  
3-4 Typed up minutes Housework  
4-5 Emails Housework  
5-6 Commute home Coffee & phone call  
6-7 Phone call — mum TV  
7-8 Dinner Dinner at home  
8-9 TV Drinks with friend  
9-10 TV Cinema  
10-11 Chores Cinema  
11-12 Read book Home, read book  
12-1am Sleep Sleep  

Your Activity Diary

Time Mon Tue Wed Thu Fri Sat Sun
6-7am              
7-8              
8-9              
9-10              
10-11              
11-12              
12-1pm              
1-2              
2-3              
3-4              
4-5              
5-6              
6-7              
7-8              
8-9              
9-10              
10-11              
11-12              
12-1am              

Step 2: Assess Your Levels of Pleasure and Achievement

Give each activity a rating for both pleasure and achievement. Score the activity on a scale of 0-10, where 0 is no pleasure/achievement at all and 10 is the most pleasurable/challenging task you could imagine doing. So each activity should have 2 numbers P=? and A=? Do not spend time wrestling too much between ratings (e.g., “Am I a 6 or 7?”). Just go for the figure that feels most appropriate.

Step 3: Increase Your Levels of Pleasure and Achievement

To do this, ask yourself the following questions:

  1. Did my activities affect my mood? How?
  2. What activities helped me feel better? Why?
  3. What activities helped me feel worse? Why? Are these activities in my best interest to do?
  4. Were there certain times of the day (e.g., mornings) or week (e.g., weekends) when I felt worse?
  5. Can I think of anything I could do to feel better during these times?
  6. Were there certain times of the day or week when I felt better?
  7. Looking at my answers above, what activities can I plan in the coming week to increase the chances that I will feel better this week?

By being aware of and increasing the levels of pleasure and achievement in your life, you will feel more in control of your mood and the frustrations of diabetes will be less all-consuming.

Are you interested in learning more strategies about how to overcome depression, including the one simple change that will dramatically improve your mood right away? I’ve developed a brand new audio course that teaches you the precise ways you can overcome depression and burnout. To find out more, please register your interest at info@positivediabetes.com and a member of my team will be in touch! Life is too short to keep struggling on your own. I know, I’ve been there — I’d love to help you too.

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.