Are you in Denial?

                                 

Whether your are newly diagnosed with diabetes or another serious illness,  or you have been told by your doctor that you have high cholesterol and high blood pressure and your well-being is at risk,  when you were first confronted with the diagnoses, you may have responded with feelings of anger.  And actually, feeling angry is a normal response to hearing and learning of a serious diagnosis.  However, ongoing anger is not a healthy response to this new stressor and may keep you from a healthy acceptance of the diagnosis.   The chronic anger may add to your stress levels and keep you from healthy behaviors and self-management.  Finding ways to control your anger is important, then. Begin, by realizing that there are normal and healthy anger responses and there are also unhealthy anger responses.

What is a common and unhealthy anger response and the alternate healthier way of managing your anger?  One of the most common anger responses to having been diagnosed with a serious disease such as diabetes is one of denial.  The denial may be over the actual diagnosis of the disease or the long term and potentially life long aspects of the disease.  One of the unhealthy ways to express the denial is through blame – blaming others, including family members, blaming scientific progress for not finding a cure, blaming the environment, for making your life more difficult.   You may end up lashing out at those who are there to help you the most, including your family and friends.  What is a healthier denial response then?  How can you work through the denial in a way that de-escalates your stress levels,  keeps your anger managed in a healthy manner and includes your loved ones in a supportive role?

First and foremost, admit your denial. Admit to your loved ones and your health care providers and ask for help.  You can rest assured that your feelings are not unique. Denial is one of the biggest hurdles to overcome.  The next step in working through the denial, once you admit to yourself and others, is to work at expressing your thoughts and feelings without denial and blame.  Practice this often and try it out on others.  Eliminate blaming others from your vocabulary.  Work at owning your diagnosis by verbalizing your diagnosis and letting others know of your progress.  You may be surprised to find that by re-framing your language into thoughts and phrases that are free of denial and blame, you will emotionally and psychologically reach a point of healthier anger management and healthy acceptance of your diagnosis.

Where do you want to go?

Have you ever taken time out to really consider why you want to lose weight or get healthier overall, or let go of a substance abuse problem or even change your attitude?   You may experience ongoing demands and stress at work, stress at home, relationship struggles, illness, or financial crisis and rarely or never take time out to contemplate and really pay attention to who you are,what you are experiencing and why you have certain goals, hopes and dreams.  Practicing mindfulness is one way to accomplish a greater sense of self and others and gain a deeper understanding of what really matters to you.  What is mindfulness?  It is an awareness of the here and now, the real-time experiences in your day to day life. It is acceptance and fully attending to whatever happens in your daily life.  It is living each moment and each event as fully as possible, embracing the hope and the despair, the joy and the discouragement, the risks and the fear and as fully as possible.  This is counter to the manner is which most of us have learned to experience our lives.  We live in a society where almost everywhere we look,  the focus is on how to be more, accomplish more, be more successful, be more beautiful, and then be viewed by more as worthy. We cannot easily escape media's over-emphasis of the perceived and highly regarded rewards that accompany looking your best, losing weight, having cosmetic surgery, or undergoing that much "needed" makeover.  Consider this though. The real makeover needs to start from the inside.  Jon Kabat-Zinn, author of the book entitled “Coming to our Senses” reminds us of this: “There is no time other than now.  We are not, contrary to what we may think, “going” anywhere. Even though we may imagine some other future moment as more fulfilling, more pleasant, more rewarding, we can’t really know this."  Instead of living in a dream reality, wake up! Today is your reality.  Embrace who and what you are.  Does this mean you can't hope, dream, want, wish, work toward, strive, commit? Of course not.  You can do all of these things but remain mindful of the fullness and beauty and richness of your current experience.  How to accomplish this?  Practice mindfulness. Practice being in the moment. Practice letting go and accepting and moving on and letting go again and moving on again. Practice mindfulness and remaining in the here and now and experience a more peaceful and less turbulent journey as you pursue your dreams and goals.

The mind-body connection

Current research fully supports the notion that  psychological treatments of people who seek help in a medical setting can make a significant difference in their overall health.  In the 1980's, estimates were that approximately 25% of visits to a primary health care practitioner are for psychological and mental disorders, masked by physical symptoms. This estimate has increased to 30-50% today. And estimates today suggest that more than 60% of emergency room visits involve a psychological component.  We also know that up to 80% of medical patients overall, struggle with various levels of psychological distress. What does this all mean?  Most importantly, statistics now clearly demonstrate that illness is not only physiological and that the psychological component is an important contributor to health, well-being and therefore illness.  The biological, psychological and social are intertwined in a complex and powerful manner.  What can be done?  Physicians and physician's groups need to continue to increase efforts to include psychologists in their treatment plans and willingly refer when the patient might benefit from psychological intervention.  And patients need to increase their awareness of the mind-body connection, examine their own psychological struggles, talk to their health care providers about their physical and psychological status and ask for help and psychological support when they need it.

Why Exercise?

What are some of the psychological benefits of regular exercise?  Results of studies on men, women, children, youth, mid-life and the elderly point to the benefits of overall improved sense of well-being.  Specific studies on the effects of exercise on clinical depression have shown that it is a viable treatment option for some people.  A sense of self-efficacy and confidence is another benefit for the far majority of people who keep up an exercise regimen and get physically healthier as a result. These are just a few of the psychological benefits of regular exercise.

What is it then, that keeps people from exercising? Why not just go out and do it?  The benefits are numerous, from physiological benefits of managing and preventing diseases like diabetes and high blood pressure and cardiac illness to greater quality of life to extending ones' longevity to improving your overall mood, and keeping depression under control.

If you ask most sedentary people why they don't exercise, they may tell you that regular exercise is too hard and they really don't like it!   If you fit in this category, consider re-thinking your attitude.  First of all, replace your idea of 'exercise' with 'activity.'  What activities do you like or did you like before you became sedentary?  Going dancing, playing on a softball team, playing with your children or grandchildren, walking hiking, swimming and gardening  - are all an improvement over a sedentary lifestyle.  Remember that as few as 30 minutes a day of moderate activity - brisk walking for example can not only help you become physically healthier but also  psychologically healthier.

How to start? Identify an activity that you consider to be enjoyable. You are much more likely to keep up the activity if you enjoy doing it in the first place!  Find another person or a group who like the same activity.  Other like-minded friends can help you feel and stay motivated and supported as you work toward your goal of increasing enjoyable activities (and exercise) into your lifestyle. 

How do you cope?

For a person who is struggling with dealing with self-management of their diabetes regimen, trying to lose weight or manage other health related issues, the demands create an ongoing challenge and the need to cope with the stress.  There are numerous researchers who have explored types and theories of coping, with the purpose of wanting to understand how people become 'good copers' versus those who are not able to cope with such demands.  One of these theories or concepts of coping is called the problem focused model (Lazarus). This type of coping involves how the person attempts to change the environment in order to adapt, deal with or change the stressor. Research is this area suggests that for many individuals who tend to cope using a problem focused approach, their sense of psychological well-being is better than those who focus on their emotions.  Additional research has added further understanding to this model of problem focused coping, acknowledging that individuals consciously select and engage in particular coping behaviors, and that individuals also differ in their coping strategies, depending on the stressor.  What kind of 'coper' are you? Do you focus on how you feel, and base your coping strategies on your feelings?  Or - are you a problem focused 'coper' - seeking how you can change your environment so that you feel better?  Whatever approach works for you  - is the most important concept of all.