Psychological Strategies to Overcome Diabetes Depression

1. Take Notice of Your Thoughts

Becoming aware of your thinking styles and the thoughts that you regularly have are an important part of managing the frustrations caused by living with diabetes. Start to become more mindful of the thoughts you are having before, during and after you notice yourself feeling dissatisfaction or stress. Thoughts can be very fleeting and learning to notice them rather than respond to them automatically is a valuable skill. Get into the habit of writing your thoughts down so you can begin to discover which of them are helping you and those that are not.

2. Challenge Those Thoughts that Don't Empower You

Once you have begun to notice the thoughts you are having, you can start to evaluate them. Take each thought in turn and ask yourself:

*Is thinking this way helping me?
*Are there other ways of thinking about this situation?
*If a friend told me they were thinking this way, how would I respond?

Over time you will begin to notice those thoughts that fail to support you and you can start replacing them with more constructive thinking styles.

3. Practice Mindfulness

Mindfulness is a commitment to live in the moment. For many of us, our conscious lives are focussed in the past - on memories or regrets, or in the future - on anxiety or uncertainty about what's to come. But in reality the only moment we truly have is the one occurring right now, so mindfulness encourages people to focus on this and 'let go' of thoughts of the past and future. It involves paying attention to our internal and external experiences, emotions and behaviours - without necessarily trying to change them. It can be as simple as noticing the sensation of your hands against the paper you are holding, or noticing your breathing. It can feel strange and difficult at first but with practice it can lead to a more peaceful experience of daily life. Furthermore, research studies
have demonstrated that individuals with diabetes who regularly engage in mindfulness practice notice a positive impact on their blood glucose control.

4. Define Your 'Ideal Me' Narrative

Having diabetes isn't fair and it is very normal to have hopeless and despairing thoughts about your diagnosis such as, 'Why Me?'. You may feel that your life isn't turning out the way you would have wanted - that the 'Narrative' or story of your ideal self is very far from that of your actual self. What is the difference between these two Narratives? Make a list of each:

'Actual Me':
* Who am I now?
* What is my life like?

'Ideal Me':
* What did I expect to be?
* How would I like things be?

Is there any evidence of the 'Ideal You' in your daily life now? Could you take steps to increase the amount of 'Ideal You' in your life in the following week? What are three things you could do differently?

5. Seek Solutions

Often we get caught in a negative cycle of thinking about our problems and difficulties. To some extent this is natural, however when it becomes the only way of responding to distress it can become a negative spiral of low mood. Even when things are bad and everything feels like it's going wrong, there are days when things aren't quite as bad. Start noticing what is different about these days. What thoughts are you having, who are you seeing or not seeing, how much sleep, healthy food, exercise, alcohol, cigarettes, interesting conversations, fun, have you had or not had? Start noticing this for a week and see if there are any patterns. Do more of what helps you and less of what doesn't.

6. Seek Out Inspiring Role Models

Having role models that inspire can really help you to capture the essence of the direction you want your life to go in and the results you want to achieve and diabetes-related role models are no different. Finding inspiring examples of people who have flourished despite their diabetes can provide a real sense of hope when things are difficult. This might be someone you have met though a Diabetes Support Group or Education Programme, or someone in the public eye such as a celebrity or athlete with diabetes. If you can learn from them about what keeps them positive and how they cope when things inevitably get difficult you can start to think about how you can do things differently. Who knows, maybe you will be a role model one day!

7. Set Inspiring Goals

Goals are an important part of achieving everything in life. Even if you don't feel you are the sort of person who sets yourself goals, you do so without realising - even something as simple as the decision to make a phone call is a goal! Your diabetes life is no different - what are the top three diabetes-related goals that would make a difference in your life if you achieved them? It might be writing down your blood glucose results, snacking on a piece of fruit rather than a packet of crisps or going for a brisk walk rather than getting the bus. Pick the easiest and break it into smaller, mini goals, and take a step towards reaching it today!

8. Reward Yourself!

Making goals can feel like the easiest part. Following through on the actions you need to take in order to reach them is the tough bit. Humans need rewards to do everything in life - even as children it was the reward of praise or attention that helped us learn good behaviour. What are some rewards that would motivate you when you'd made progress towards a diabetes-related goal? Make them little and often rather than extravagant and infrequently. Be creative, they don't have to cost any money!

9. Learn How to Survive Setbacks

Setbacks are inevitable in life. Pursuing a more positive diabetes life involves a process of change and like all change, it wont occur in a linear, straightforward fashion - in contrast it will often feel like taking two steps forward and one step back! This is normal, the crucial step is to keep going when setbacks occur. Noticing your successes and riding through the setback can be all you need to do - look back and see how far you've already come. What success have you already achieved in meeting your diabetes-goals? Doing something nice for yourself - planning a treat or asking a loved one to surprise you with a reward, can help you get through the more difficult days.

10. Seek Support

Having support in the form of family, friends and loved ones who can help you through your day to day struggles with diabetes is a real asset. However, not everyone has this support, or feel that a source of support outside their immediate network would be more beneficial. Making contact with a Healthcare Professional, particularly someone who is familiar with the demands of managing life with diabetes, can be a real source of hope and relief when things get tough. Seek assistance in this way if you feel it might help you - you might like to make an appointment with a Diabetes Psychologist, see the Resources Box for further information.

And Finally... Have Fun!

Many people with diabetes are stressed and overwhelmed - life can feel quite bleak at times. But remember that life can be fun, rather than something to be endured. There will always be some stresses in life - but you don't need to delay enjoying life despite them. Make the decision to think about the things you love in life, and start to live a more positive diabetes life... starting today!

Dr. Jen Nash, The Diabetes Psychologist, is a Clinical Psychologist who has had type 1 diabetes for over 20 years. She understands first hand the psychological impact that the demands of managing diabetes can cause.