Post on 15-Feb-2018
transcript
Coping with Anxiety & Depression: A Conversation
with a Psychologist/PWDNicole Bereolos, PhD, MPH, CDE
Clinical psychologist/certified diabetes educator/PWD (type 1 x25 yrs)
DiabetesSisters/Diabetes Unconference, Alexandria, VA
October 15, 2017
What we already know.
• Diabetes SUCKS for PWD and those that love them!!
• It takes a LOT of work to try to manage diabetes
• Life, by itself, has too much stress and diabetes is just “icing on the cake”
Diabetes & Depression (Roy & Lloyd, 2012)
• Type 1
• 12%, range 5.8–43.3% vs. 3.2%, range 2.7–11.4% (with vs without type 1)
• 3x higher
• Type 2
• 19.1%, range 6.5–33% vs. 10.7%, range 3.8–19.4% (with vs without type 2)
• 2-3x higher
• Higher in women (with and without diabetes)
What is clinical depression?
• Per DSM-5 (2013)
• Must be present for at least 2 weeks
• Must cause clinically significant impairment
• Must have either depressed mood or loss of interest/pleasure
• And… (5 or more of the following)
• Significant weight loss or gain or changes in appetite
• Insomnia or hypersomnia
• Moving faster or slower than usual
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Diminished ability to concentrate or make decisions
• Recurrent thoughts of death or suicidal ideation
Diabetes Distress
• unique, often hidden emotional burdens and worries that are part of the spectrum of patient experience when managing a severe, demanding chronic disease like diabetes (Fisher et al, 2012)
• Compared to clinical depression, diabetes distress affects diabetes self-management behaviors only
• Aka Diabetes Burnout – William Polonsky, PhD, Behavioral Diabetes Institute, San Diego, CA
Anxiety
• “a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome” – dictionary.com
• Overgeneralization of your physical sensations and/or environment
• Important to first rule out low blood sugar and side effects from medications
• Can have physical and psychological symptoms
• Racing thoughts, sweating, palpitations, increased heart rate, nausea, shaking
Diabetes-related Causes of Anxiety
• Constant focus on numbers – blood sugars, HgA1C, weight, cholesterol, etc
• Being judged on those numbers CONSTANTLY
• The unpredictableness of diabetes – humans prefer control
• Effects of food, stress, hormones, emotions, exercise
• Fear of trying new things, being alone, traveling, etc – getting out of comfort zone
Examples of Health Coping (Kent et al., 2010)
• Fulfilling health care obligations (keeps appointments, takes medication)
• Expressing emotions
• Seeking help; looking for answers
• Demonstrating basic problem-solving skills
• Incorporating physical activity into one's life
• Being proactive
• Demonstrating self-efficacy
• Overcoming barriers
• Having an adaptive coping style
• Being motivated
• Being optimistic
Cognitive Behavioral Therapy (CBT)
Resources for Diabetes Distress
• DOC (diabetes online community; #DOC)
• Dr Polonsky
• Ginger Vieira, PWD
Bibliotherapy
• David Burns, MD
• William Knaus, EdD & Albert Ellis, PhD
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Bibliotherapy
13
National Mental Health Resources
• Agency for Healthcare Research and Quality
• American Association of Suicidology
• American Psychiatric Nurses Association
• *Anxiety Disorders Association of America
• CDC
• *Salvation Army
• *Depressive and Bipolar Support Alliance
• Institute of Medicine
• *Mental Health America
• Mental Health Liaison Group
• National Association for Rural Mental Health
• National Association of Anorexia Nervosa and Associated Disorders
• National Association of County Behavioral Health and Developmental Disability Directors
• National Association of State Mental Health Program Directors
• *1-800-SUICIDE
• National Council for Community Behavioral Healthcare
• *American Counseling Association
• *National Institute of Mental Health
• The National Institute of Alcoholism and Alcohol Abuse
• National Institute on Drug Abuse
• * American Psychological Association
• *SAMHSA
• *Catholic Charities
Personal Moto
• “Which is bigger, you or your diabetes?”
• “Who is in control, you or your diabetes?”
• “Who do you want to win, you or your diabetes?”
Key Take-Aways Simplified
•Balance
•Conversation
• nbereolos@gmail.com