Skip to content

Dr. Jen's Diabetes Diary

The Diary of a Diabetes Psychologist

Archive

Tag: Jennifer Nash

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.

Many people embark on weight loss efforts full of enthusiasm and hope for their new regime, and then lose heart when life gets in the way. My advice is different. Embrace the odd slip or two. Actively expect it. Any change in life is usually a process of two steps forward and one step back. In addictions recovery, these backward steps are known as ‘lapses’ — the times when the old, familiar ways of being are the default action we opt for. Sometimes this can be very unconscious (for example your colleague offers you a biscuit with your tea and you take one simply because that is what you have always done).

It is important to be able to distinguish between a lapse, a relapse, and a collapse.

A lapse is one singular event in which you deviate from your desired goal. An example of a lapse is having a bad day at work or an argument with your partner. You reach for your usual comfort food — crisps or chocolate perhaps, and afterwards, or even while you are still eating, you think, “Why am I doing this?” That is an example of a lapse. Yes, you have made an unhealthy choice; however, you can limit it to just one bad decision, get back on track, and continue.

A relapse is a whole sequence of lapses strung together. Many people have a very polarised view of success and failure. They are either totally on the plan or totally off it. One lapse becomes, “I have messed up once so I might as well give up for today.”

Then one written off day can easily become two, until before you know it you are back to where you started. This is a ‘collapse’.

The important part is to keep perspective and pay attention to your behaviours over the course of the week, not just focussing on a single day in isolation. Remember that the weight has taken a long time to become part of you, so it is likely to take time to be free of it.

If you are interested in learning more about how to gain greater control over your eating, mindset, and the way it affects your life and health, then get your copy of my Positive Diabetes Home Study System. This easy to use guide gives you everything you need to immediately get more control over your diabetes, with a focus on helping you to implement new habits, build momentum and create lasting change to produce the results you want. 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.

Sharing food with others has been a way of celebrating, bonding, and commiserating for centuries. However, one thing that doesn’t get talked about much is how difficult it can be to say no to people when it comes to food choices. One of the reasons you may be uncomfortable saying no is because you do not want to be seen as rude or ‘different’ because you have diabetes. Also, food can be a way of conveying love, care, and affection, and all these layers of meaning can make it even harder to say no. Here are my top three tips for asserting yourself.

  1. Acknowledge you are not being rude: Do this by simply saying, “thank you”. For example if your friend offers you a slice of cake, you might like to say, “Thank you for your offer but I don’t fancy any cake right now.” By communicating both parts of the message (you are grateful she is thinking of you, and saying you don’t want it) you can feel more comfortable and confident in what you really mean.
  2. Use ‘I’ statements: Can you sense the subtle difference between these two responses? “Thanks I don’t really want any cake right now.” and “Thanks but cake really isn’t good for me.” Using “I” in your statements subtly conveys you are taking responsibility for your thoughts and feelings. This allows less space for unhelpful responses such as, “Go on, one bite of cake won’t hurt you!”
  3. Recommend a more suitable action: Shape the behaviour of the person to whom you are responding. If your host is offering you some food you don’t want, you could respond with, “Oh thank you it looks lovely. I can’t manage any just now but I would like another piece of fruit/top up of my drink.” This has two benefits. You are enabling the host to be the host (hosts want to give you something!) and you are taking control of the interaction, not allowing their agenda to get you off track of yours. Alternatively, you can distract the person with, “Oh, not for me thank you; but do tell me about your beautiful/interesting [insert something you have noticed — flowers, painting, dress etc.].

If you are interested in learning more about how to gain greater control over your diabetes and the way it affects your life, then get your copy of my Positive Diabetes Home Study System. This easy to use guide gives you everything you need to immediately get more control over your diabetes, with a focus on helping you to implement new habits, build momentum, and create lasting change to produce the results you want. 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.

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.