Transcript Supporting Individuals in Achieving Lifestyle Changes

Sinead Boyce MSc, CNS
Cognitive Behavioural Psychotherapist
health is a state of well-being in
which an individual realizes his or her own
abilities, can cope with the normal stresses
of life, can work productively and is able to
make a contribution to his or her
community” (WHO, 2010).
 “Mental
well-being is not the absence of
emotions, but it is your ability to understand
the value of your emotions and use them to
move your life forward in positive directions”
(Colby, 2010).
 “Everyday emotional well-being also involves
identifying, building upon, and operating
from your strengths rather than focusing on
fixing problems or weaknesses. The better
you are able to master your emotions, the
greater your capacity to enjoy life, cope with
stress, and focus on important personal
priorities” (Colby, 2010).
 “Emotional
 Psychological
resistance to change
 Resistance to change is the action taken by
individuals when they perceive that change is
a threat.
 Changing or Adapting?
We change circumstances
whenever possible, but
adapt whenever necessary.
 Resistance
to change
 Psychological resistance to insulin (Gherman
et al,2011)
 Anxiety - Fear
 Self esteem
 Non Compliance
 Risky Behaviours
 There
does appear to be a link between
diabetes and the incidence of depression,
however, what the link is has not been fully
proved as yet.
 In recent years, the two conditions do seem
to be more common together, but it should
be remembered that diabetes is not the only
chronic condition where depression occurs.
 Psychological Resistance
 Anxiety, Self Esteem, Obsessive traits
 The
lifetime prevalence for depression is
17.1 percent (Kelly et al 2009)
 These rates increase with comorbid medical
illness and the acuity of illness.
 The prevalence of depression in adult
patients with type 1 and type 2 diabetes
suggest that the presence of diabetes almost
doubles the risk of comorbid depression.
 20% more likely to experience anxiety
 NICE (2009) 90% of psychological adaptive
disorders treated in primary care
Anderson et al 2001& Ali et al 2006 Diabetic Medicine
 Wakefield
et al (2007) who argue that up to
25% of people diagnosed with depression may
in actual fact be experiencing normal
sadness in the context of their experience
e.g diagnoses of diabetes.
 Therefore
it is not surprising that by 2020
depression will be the second leading cause
of disease burden (World Health Organisation
(WHO), 2010).
 When
people in society are exposed to
advertisements, media attention and news
stories regarding depressive symptoms they
can confuse depression with normal sadness
and monitor themselves for such symptoms
and therefore reframe their own experiences
of sadness as signs of mental disorder and in
turn seek professional help for their
experiences.
Many people will find that the diagnosis of
diabetes has a profound effect on their feelings.
 This may cause many emotions to surface
including:

anger

denial

guilt

frustration

loneliness

sadness

depression

confusion
(diabetes.co.uk)

 To
communicate message
 Anger
 Sadness
 Shame
 Guilt
 Jealousy
 Envy
 Stress
results when something causes your
body to behave as if it were under attack.
 Stress is a physical and mental reaction to
perceived danger. Conditions that seem
uncontrollable or require emotional and
behavioural change tend to be perceived as a
threat
 Whether threat is perceived or imagined
body prepares for survival
 50% perceived stressors
 Fight
or flight
 Resistance
 Exhaustion
 Excessive stress & Diabetes:
 Increasing blood glucose levels
 Inciting string negative emotions
 Impairing sound thinking & decision making
 Tempting compulsive, poor eating
 Logical
Mind
 Emotion
 Wise
Mind
Mind
 Mindful
living – An antidote to stress
 Being aware of what is happening within
yourself and in the world around you. It is
being aware what you are doing and why,
being aware of what is working and what is
not working for you
 A mindful approach to coping opens the way
to using a variety of tools to preventing
avoidable stress & managing unavoidable
stress or change
 Unhelpful
thinking.. The Big MACS
 Impulsive behaviour
 Self criticism – ‘Raggy Doll Club’
(Murphy,2013)
 Is it a worry or a problem? – problem solving,
letting go
 What
are the chances....?
 What is the worst thing...?
 Am I right to think that...?
 The 5 year rule
 What is it worth?
You don’t have the skills for acceptance; you do not know
how to accept painful events and facts.
 You believe that if you accept you are making light of or
are approving of the facts
You believe that if you accept a painful event nothing will
be done to change or prevent future painful events.
 Emotions get in the way (unbearable sadness; anger at
the person or illness that caused the painful event; rage at
the injustice of the world;
overwhelming shame about who you are; guilt about your
own behaviour).
 is
like facing a fork in the road. You have to
turn your mind towards the acceptance road,
away from the rejecting reality road.
 TURNING THE MIND is choosing to accept.
 The CHOICE to accept does not itself equal
acceptance. It just puts you on the path.
STEP-BY-STEP
 OBSERVE that you are not accepting. (Look for
anger, bitterness, annoyance, avoiding emotions,
saying “Why Me” “Why is this happening”, “I
can’t stand this,” “it shouldn’t be this way”)
 Go within yourself and MAKE AN INNER
COMMITMENT to accept reality as it is.
 DO IT AGAIN, over and over. Keep turning your
mind to acceptance each time you come to the
fork in the road where can reject reality or
accept it.
 DEVELOP A PLAN for catching yourself in the
future when you drift out of acceptance.


If we consider that life is like a game of cards. It
makes no difference to a skilled card player what
cards they get. The object is to play whatever hand
they get AS WELL AS POSSIBLE (willingness). As
soon as one hand is played another hand is dealt.
The last game is over and the current hand is on.
For the skilled player the goal now is to be
MINDFUL of the current hand and play it AS WELL
AS POSSIBLE, and then LET GO and then TURN THE
MIND to the next hand of cards. If a player judges
themselves on the last hand and can’t take their
mind off of it (wilfulness), then their ability to fully
concentrate on the next hand is compromised and
they struggle more in playing the game. Our goal
on this programme is to learn to play the cards we
are dealt with in life as best we can!
 1.
Normalise the persons emotional distress in the
context of their life experiences for example
diabetes (normalise is not the same as doing
nothing).
 2.Don’t
medicalise or pathologise their emotional
distress i.e. don’t see their emotional distress in
terms of symptoms only, view it in terms of what
the individual is attempting to communicate to you
through their emotions.
 3.
Have a list of mental health organisations both
voluntary and statutory that may be useful to the
person i.e. low cost counselling, supports groups,
psychoeducation, diabetes support groups, etc
 4.
Cognitive behaviour therapy, interpersonal
therapy, supportive counselling, ACT therapy.
 5.
Pharmacological intervention.
 Stop
 Be
mindful
 Check the facts..ask?
 Unhelpful thinking styles/thoughts, beliefs
about diagnosis
 Validate the valid
 Accumulate positive emotion
 Stress management
 Pros and cons – choice
 Acceptance


Suppose you are taking a hike in the mountains. You know
how mountain trails are constructed, especially if the slopes
are steep. They wind back up and forth; often they have
“switchbacks”, which make you literally walk back and forth,
and sometimes a trail will even drop back to below a level
you had reached earlier. If I asked you a number of points on
such a trail to evaluate how well you are accomplishing your
goal of reaching the mountaintop, I would hear a different
story every time. If you were in switchback mode, you would
probably tell me that things weren’t going well, that you were
never going to reach the top. If you were in a stretch of open
territory where you could see the mountaintop and the path
leading up to it, you would probably tell me things were going
very well. Now imagine that we are across the valley with
binoculars, looking at people hiking on this trail. If we were
asked how they were doing, we would have a positive
progress report every time. We would be able to see that the
overall direction of the trail, not what it looks like at a given
moment, is the key to progress. We would see that following
this crazy, winding trail is exactly what leads to the top.
(Steven Hayes et al 2003)
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