Learning Objectives:

1- List 5 stages of emotional adjustment to

diabetes.

2- Describe the 3 components (A-B-C’s) of

Cognitive Behavior Therapy.

3- Describe the “four pronged” approach to

diabetes care.

I. 5 Stages of Emotional Adjustment

Originally, these stages were developed to describe stages of grief, but it can be expanded to describe stages of diabetes acceptance.

Disclaimer: Not everybody goes through these stages, nor do they necessarily go through the stages in this order.

5 Stages of Emotional Adjustment

A. DENIAL (“Dia-Denial”)

Denial is when somebody doesn’t want to

acknowledge their diagnosis. A person may

feel overwhelmed with feelings of anxiety

about the future, that they cope by ignoring

the facts.

5 Stages of Emotional Adjustment

Is this your client? “Debbie Denial”

She generally ignores her diabetes.

How can “ostrich policy” help?

Sticking your head in the sand and hoping it goes

away.

5 Stages of Emotional Adjustment

B. ANGER

Anger is the direct result of a person’s thoughts,

not of the event.

“Anger is only one letter short of danger.”

Eleanor Roosevelt

5 Stages of Emotional Adjustment

Is this your client? “Angie Anger”

Asks “Why me?” and thinks “This is so unfair!”

It would be better to direct her actions toward

managing her diabetes and not being angry at

it.

5 Stages of Emotional Adjustment

C. BARGAINING

Bargaining is when a person makes a desperate

plea (usually to a higher power or to a

healthcare professional) how they will change

their life, in exchange for taking away the

diabetes.

5 Stages of Emotional Adjustment

Is this your client? “Barry Bargainer”

Makes a deal to be “good” from now on.

Help your client to focus on living as a person

who happens to have diabetes, rather than

seeing themselves as a victim of diabetes.

5 Stages of Emotional Adjustment

D. DEPRESSION/DIABETES DISTRESS

Clinical depression is defined by symptoms that

have lasted more than 2 weeks.

IF the depression is unrelated to diabetes, the

person should consider seeking professional

treatment with a licensed clinical psychologist

or clinical social worker.

5 Stages of Emotional Adjustment

Symptoms of clinical depression:

• Persistent sadness, such as feeling “empty”

• Feeling a loss of joy in your life

• Changes in appetite

• Sleep difficulties

• Feeling fatigue or loss of energy

• Feelings of worthlessness or excessive guilt

• Difficulty with attention and concentration

• Recurrent thoughts of death or suicidal thoughts

5 Stages of Emotional Adjustment

DIABETES DISTRESS

Diabetes distress arises from living with the

emotional burden of diabetes self-

management and blood sugar control.

There are 4 main areas of distress:

5 Stages of Emotional Adjustment

• Emotional burden

• Physician-related distress

• Regimen-related distress

• Interpersonal distress

Diabetes distress can be managed and reduced

using cognitive behavior therapy.

5 Stages of Emotional Adjustment

Is this your client? “Dee Dee Depression”

She cries at the mere mention of the word

“diabetes.” She feels hopeless that she will

ever be able to manage her diabetes.

Diabetes educators can teach depressed clients to

accept diabetes and how to cope with it. They

can be empowered to manage their diabetes!

5 Stages of Emotional Adjustment

“T L C Therapy: Talk, Listen, Counsel”

• Talk: the talk part is educating about diabetes

management

• Listen: the listen part is being quiet and let the

client’s feelings be heard

• Counsel: the counsel part is teaching the

coping strategies of cognitive behavior therapy

5 Stages of Emotional Adjustment

E. ACCEPTANCE

Acceptance is our goal. Helping people with

diabetes to accept their diagnosis of diabetes

and make lifestyle choices that keep them

healthy and happy.

5 Stages of Emotional Adjustment

My story of diabetes acceptance:

Living successfully with type 1 diabetes

for 42 years.

II. The A-B-C’s of Cognitive Behavior Therapy (CBT)

The basic idea of CBT is that the way a person

thinks about an event is directly related to

how a person feels about the event.

• If the thoughts are negative, the feelings will

be negative.

• If the thoughts are positive, then the feelings

will be positive.

The A-B-C’s of CBT

A. ANTECEDENTS

An antecedent is the event which is not within a

person’s control – such as having diabetes.

The A-B-C’s of CBT

B. BELIEFS

1- Irrational (unreasonable) thinking

2- Rational (reasonable) thinking

The A-B-C’s of CBT

C. CONSEQUENCES

1- Negative feelings

2- Positive feelings

The A-B-C’s of CBT

• People with diabetes who experience denial,

anger, helplessness, and diabetes distress are

less likely to practice good self-care behaviors,

which could then negatively impact their A1C.

• When using CBT, the goal is to challenge

irrational, unreasonable thoughts so that the

patients can better manage their self-care and

improve their blood sugar management.

The A-B-C’s of CBT

Revisit your clients:

• “Debbie Denial” – an example of “Minimization”

• “Angie Anger” – an example of “Should”

statements

• “Barry Bargainer” – an example of “The

Fortune-Teller Error”

• “Dee Dee Depression – an example of “All-or-

nothing Thinking”

III Spiritual Approach

Spirituality can be defined as:

Experiencing the presence of a power or force

and experiencing a closeness to that presence.

Note: A belief in God is not a requirement to

adopt the message of empowerment

Spiritual Approach

• Current diabetes self-management guidelines,

such as those of the ADA, reflect a more

holistic style. Spirituality can be seen as part

of the journey toward becoming whole.

• Religiousness and spirituality have been

shown to improve glycemic control, as well as

lower diabetes-related morbidity and

mortality.

Spiritual Approach

A. Serenity Prayer

God, grant me the serenity

To accept the things I cannot change,

The courage to change the things I can,

And the wisdom to know the difference.

Spiritual Approach

Learning to recognize what is not within their

power to change (their diagnosis)

and to recognize what is within their power to

change (their thoughts and actions)

– and the understanding of both choices –

will result in the wisdom of your clients to accept

their diabetes.

Spiritual Approach

The Other Serenity Prayer

God, grant me the serenity to stop beating myself up for not doing things perfectly,

The courage to forgive myself because I’m working on doing better,

And the wisdom to know that You already love me just the way I am.

Eleanor Brown

Spiritual Approach

B. “Four-pronged” approach to diabetes care

1- Medication

2- Diet

3- Exercise

4- Spirituality

Spiritual Approach

• Elliott Joslin, MD (1869 – 1962) was the first

doctor in the US to specialize in diabetes and

was the founder of today’s Joslin Diabetes

Center in Boston.

• He recognized that managing tight control of

blood sugar could be achieved through diet,

exercise, and insulin and could extend one’s

life and prevent complications.

Spiritual Approach

• Joslin’s approach to diabetes management was

expressed by the “troika,” the Russian word

meaning threesome.

• He created a three-horse chariot to reflect this

philosophy of living with diabetes – the three

horse motif symbolized insulin, diet, and

exercise, which are needed to achieve

“victory” over diabetes.

Spiritual Approach

• In my men’s book MY SWEET LIFE:

Successful Men with Diabetes, one of my

contributing authors took the idea of the

triangular facets of diabetes self-care to a new

level – a square!

• In his paradigm, diabetes management has

four points: medication (insulin), diet,

exercise, and spirituality.

Spiritual Approach

Diabetes care is coming to address the 4 areas in one’s life:

1- Insulin and diabetes medicines help the body.

2- Diabetes educators teach people about blood sugar monitoring, meal plans, and exercise.

3- Ideally, the health-care team also teaches people to manage stress and maintain emotional health.

4- Recently, organized medicine has begun to address the spiritual aspect of self-care as well.

Spiritual Approach

With a positive attitude toward diabetes, your

clients can choose to feel at peace with their

diagnosis and feel empowered to manage their

diabetes self-care.

Spiritual Approach

C. Selected quotes about acceptance and attitude:

• “The primary cause of unhappiness is never

the situation but your thoughts about it.”

Eckhart Tolle

• “If you don’t like something, change it. If you

can’t change it, change your attitude.”

Maya Angelou

Spiritual Approach C. Selected quotes about acceptance and attitude:

• “Change your thoughts and you change your

world.” – Norman Vincent Peale

• “Choosing to be positive and having a grateful

attitude is going to determine how you’re

going to live your life.” – Joel Osteen

Spiritual Approach

C. Selected quotes about acceptance and attitude:

• “I cannot always control what goes on outside.

But I can always control what goes on inside.”

– Wayne Dyer

• “Remember, happiness doesn’t depend upon

who you are or what you have, it depends

solely upon what you think.” – Dale Carnegie

Spiritual Approach C. Selected quotes about acceptance and attitude:

• “Everything is an opportunity. The glass is either half empty or half full. You can choose….it’s the same glass.”

Diane von Furstenburg”

• “What has happened to me isn’t nearly as important as how I decide to respond to it. I choose to grow through adversity.”

Carl Jung

Spiritual Approach

C. Selected quotes about acceptance and attitude:

• “A bad attitude is like a flat tire – you don’t

get anywhere until you change it.” –

Anonymous

• “There is nothing good or bad, but thinking

makes it so.” – William Shakespeare”

Spiritual Approach

Conclusions – Lessons for your clients:

Encourage your clients to choose a positive

attitude. There’s a saying: “You cannot live a

positive life with a negative mind.”

“A negative thinker sees difficulty in every

opportunity. A positive thinker sees

opportunity in every difficulty.”

Spiritual Approach Conclusions – Lessons for your clients:

Diabetes can be managed, not cured. Help your clients take charge of their diabetes. The difference between try and triumph is a little UMPH.

Worrying about the future with diabetes doesn’t take away tomorrow’s troubles. It takes away today’s peace. Teach your clients to be a warrior, not a worrier.

Announcement

I will be retiring as a clinical psychologist and

Certified Diabetes Educator treating the

emotional issues of clients with diabetes……

….Just as soon as they find a cure for diabetes!!

Thank You!

www.AskDrBev.com