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Living with a long-term condition such as diabetes can be exhausting. Quite frankly, it’s relentless; no holidays, no days – wait no, minutes… off, and no-one can do it for you. So, you can be forgiven for having times when you just want to give up; diabetes burnout is a very real issue that many of us are likely to face at some point. Managing diabetes 24/7 is probably enough to make you feel stressed from time to time, but add in the rest of life’s everyday challenges such as work, family, kids, commuting, social events etc., etc., and sometimes it can feel a bit much. This article is going to introduce you to some simple strategies and techniques that you can use to manage those feelings of stress.
Basic Stress Management
Google “stress management” and you get 27,000,000+ results. Most of these websites give you some straightforward tips and guided self-help for managing the common symptoms of stress, so I’m also going to start there. However, if you’ve tried most of these and they don’t quite cut it, I’m going to include some more detailed strategies in the second half of this article. First, the basics. Get these things right and you’ll be on the right track to psychological well-being.
If you’re getting all the basics right but and still struggling, try some techniques based on the theory of Cognitive Behavioural Therapy (CBT)
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy was developed in the 1960’s and 1970’s (Beck, 1963), and is currently one of the most used psychological therapies in the UK. It tends to be the “go-to” model for tackling common mental health problems such as depression and anxiety, as well more complex difficulties such as an obsessive compulsive disorder or post-traumatic stress.
The basic model of CBT is that situations trigger thoughts; these thoughts trigger emotions, behaviors and physical responses. So, for example, let’s say you had some not-so-good HbA1c results. You might experience thoughts of “I can’t manage my diabetes, it’s too difficult” leading to feelings of anxiety, hopelessness, and this could lead to avoidance and further poor management.
CBT uses diagrams (known as formulations) to help people see these “vicious cycles” of thoughts, feelings, and behaviors which maintain those feelings of stress – see below for an example:
The Power of Our Thoughts
Imagine you are at the gym, and someone comments on your technique during an exercise you’re not 100% familiar with. What might you think? What emotions might those thoughts produce? There could be multiple responses to this, depending on who you are or what your current mental state is, despite the situation being exactly the same. For example, you might think:
These thoughts have the potential to completely change our emotional state, and potentially ruin the rest our gym session!
The Power of Our Behaviour
The way we act and what we do has a huge impact on how we feel and react to situations and therefore has the potential to maintain some negative emotional states. Let’s go back to my earlier example of someone making a comment about your technique. How you respond in that situation could impact your day or even your week. Imagine that this situation had triggered the thought “I’ll never get this right, I may as well just quit now” leading to feelings of sadness and hopelessness, how might you spend the rest of your session or your subsequent sessions? For some, this might be a real knock to them; they might leave the gym immediately and avoid going back for a while for fear that they’ll see that person again. As shown below, this just perpetuates the cycle; it reinforces the thought which makes the behavior more likely to continue, and we all know how hard it can be to get started again with a good routine after a bit of time off!
Someone else in the same situation might act very differently; perhaps they start chatting to the person, maybe ask for a quick demo and before they know it, they have a new gym buddy. This shows that two people in the exact same situation can have very different outcomes depending on how they think about it and how they behave. So, what can you do about it? Let’s start with those thoughts.
One of the biggest challenges I have when helping people change their thoughts is getting them to realize that their thoughts are not facts. I’m going to repeat that… YOUR THOUGHTS ARE NOT FACTS! Just because you think that guy thinks you don’t know what you’re doing, that doesn’t mean that he does! The most common response I get when I tell people I’m a psychologist is “Oh cool, do you know what I’m thinking?!” The answer is a big fat no, and I can guarantee that you don’t know what I’m thinking either.
Now that we’re clear that none of us are mind readers, let’s look at ways to make those thoughts more realistic. The key here is realistic. I’m not going to convince you that positivity is the cure to all stress, actually, sometimes our negative thoughts are right and we need to pay attention to them. However, sometimes we’re too harsh on ourselves and tend to overestimate the negative.
The first thing you need to do is try to identify the thought, this can be easier said than done. Often people state their feelings instead of their thoughts. If you’re struggling with this, try to imagine a difficult situation and pay attention to the monologue in your head. Once you’ve got some ideas of what you were thinking, pick one thought that you have regularly. Now, I want you to take that thought to court. Imagine you had to prove to a jury that this thought is 100% true, and you can only do that through evidence. And I do mean evidence, not just more negative thoughts and opinions. I’ve given an example below.
|“I’ll never have a good HbA1c”|
|Evidence For||Evidence Against|
|· My latest result was XXX
· I had a high reading this morning due to XXX
|· My previous results have been XXX and XXX
· I can get more help with this – I can ask my GP
· I can test more to help my control
· XXX told me that they struggle with this too
It can be difficult to think of evidence to disprove your thought; if it was easy, you probably wouldn’t have had that thought in the first place. Take some time to really think about it, and imagine what you would say to a friend in the same situation – would you be so harsh with them? Once you’ve got a good list of evidence, review your thought…is it still 100% true?
Once you’ve started to avoid things, it can be really difficult to break that cycle and face what is making you anxious. For some, changing the behavior is way easier than changing the thoughts, and if we look back to those vicious cycles, it really doesn’t matter where you try to break it. If you think behavior is the way for you, try these tips.
Unfortunately, the only way to get past avoidance is to go through it, and getting the motivation for that can be tricky. Have a look at my other article on motivation for extra tips to get started.
Stress affects everyone at some point in their lives, and even those who look like they’ve got it completely together are going to have rough patches. However, if you feel that your stress levels are getting out of hand, do visit your GP. For the purposes of this article, I’ve very much simplified the theory and techniques, but going through a course of CBT in depth with a trained therapist can provide you with the extra skills you might need to manage stress. There are great (and often free!) therapists around that can help you out, and loads now offer an online service if you can’t get along to your GP practice regularly.
If nothing else, remember that:
About The Author
Dr Abigail Nancarrow is a Clinical Psychologist working in neuropsychology and mental health in South West London / Surrey. She has lived with T1D for 14 years and is passionate about supporting people living with long term conditions to improve their psychological well-being.