11 Ways to Stop a Panic Attack

Panic attacks

Panic attacks are sudden, intense surges of fear, panic, or anxiety. They are overwhelming, and they have physical as well as emotional symptoms.

Many people with panic attacks may have difficulty breathing, sweat profusely, tremble, and feel their hearts pounding.

Some people will also experience chest pain and a feeling of detachment from reality or themselves during a panic attack, so they make think they’re having a heart attack. Others have reported feeling like they are having a stroke.

Panic attacks can be scary and may hit you quickly. Here are 11 strategies you can use to try to stop a panic attack when you’re having one or when you feel one coming on:

1. Use deep breathing

While hyperventilating is a symptom of panic attacks that can increase fear, deep breathing can reduce symptoms of panic during an attack.

If you’re able to control your breathing, you’re less likely to experience the hyperventilating that can make other symptoms — and the panic attack itself — worse.

Focus on taking deep breaths in and out through your mouth, feeling the air slowly fill your chest and belly and then slowly leave them again. Breathe in for a count of four, hold for a second, and then breathe out for a count of four:

2. Recognize that you’re having a panic attack

By recognizing that you’re having a panic attack instead of a heart attack, you can remind yourself that this is temporary, it will pass, and that you’re OK.

Take away the fear that you may be dying or that impending doom is looming, both symptoms of panic attacks. This can allow you to focus on other techniques to reduce your symptoms.

3. Close your eyes

Some panic attacks come from triggers that overwhelm you. If you’re in a fast-paced environment with a lot of stimuli, this can feed your panic attack.

To reduce the stimuli, close your eyes during your panic attack. This can block out any extra stimuli and make it easier to focus on your breathing.

4. Practice mindfulness

Mindfulness can help ground you in the reality of what’s around you. Since panic attacks can cause a feeling of detachment or separation from reality, this can combat your panic attack as it’s approaching or actually happening.

Focus on the physical sensations you are familiar with, like digging your feet into the ground, or feeling the texture of your jeans on your hands. These specific sensations ground you firmly in reality and give you something objective to focus on.

Some people find it helpful to find a single object to focus all of their attention on during a panic attack. Pick one object in clear sight and consciously note everything about it possible.

For example, you may notice how the hand on the clock jerks when it ticks, and that it’s slightly lopsided. Describe the patterns, color, shapes, and size of the object to yourself. Focus all of your energy on this object, and your panic symptoms may subside.

6. Use muscle relaxation techniques

Much like deep breathing, muscle relaxation techniques can help stop your panic attack in its tracks by controlling your body’s response as much as possible.

Consciously relax one muscle at a time, starting with something simple like the fingers in your hand, and move your way up through your body.

Muscle relaxation techniques will be most effective when you’ve practiced them beforehand.

7. Picture your happy place

What’s the most relaxing place in the world that you can think of? A sunny beach with gently rolling waves? A cabin in the mountains?

Picture yourself there, and try to focus on the details as much as possible. Imagine digging your toes into the warm sand, or smelling the sharp scent of pine trees.

This place should be quiet, calm, and relaxing — no streets of New York or Hong Kong, no matter how much you love the cities in real life.

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This Is When to See a Mental Health Professional About Your Anxiety

It seems everyone is talking about anxiety these days, and that’s not a bad thing. Shining a light on mental health helps reduce the stigma that keeps many people from seeking support.

At the same time, it can be hard to know if the worries and racing heart you experience at the thought of, say, meeting new people, is run-of-the-mill stress, or if you’re actually experiencing some level of anxiety and could benefit from seeing a professional.

“I can’t tell you how many people I see who say, ‘I don’t know if I should be coming in here,’” clinical psychologist Robert Duff, Ph.D., author of Hardcore Self Help: F**k Anxiety., tells SELF. “On a broad scale, [talking about anxiety] is positive, but I don’t blame anyone for the confusion.”

Figuring out how serious your anxiety is can be tough because anxiety is a normal and essential part of being a human.

“Anxiety is a reaction to a situation we perceive as stressful or dangerous,” Monique Reynolds, Ph.D., licensed clinical psychologist at the Center for Anxiety & Behavioral Change in Rockville, Maryland, tells SELF. This produces a stress response in your body—specifically, your brain’s hypothalamus triggers your sympathetic nervous system to release norepinephrine (aka adrenaline) and cortisol (a stress hormone) to get you out of harm’s way.

This is actually a good thing when there is a real threat of danger present. “A major part of our brain’s job is to keep us alive, and fear and anxiety are a big part of that,” Reynolds says. For example, the anxiety you would feel at seeing a truck hurtling towards you would make you move from its way more quickly.

But if you have anxiety, that stress response can kick in when it shouldn’t. “You feel very much the way you do when in a dangerous situation…[but] there’s no real danger there,” Duff says. Instead of being helpful, this misfiring of your fight or flight reaction can hinder you.

While a little anxiety can also help you to perform at an optimal level under stress, giving you a burst of adrenaline and hyper-focus to finish a business proposal before deadline or nail that dance number at a performance, living in a constant heightened state of anxiety can be distracting at best and debilitating at worst. When anxious thoughts are interfering with your life and causing you significant distress, that isn’t something you should just chalk up to nerves and push through. That’s something you can get help with.

Anxiety is the most prevalent mental illness in the United States, and it comes in various forms.

Anxiety affects about 40 million American adults each year, according to the Anxiety and Depression Association of America (ADAA). But it’s not as cut-and-dry as saying that anxiety is simply when you feel nervous all the time. This mental health condition comes in many forms.

Generalized anxiety disorder (GAD) is characterized by having excessive worries and fears for months, according to the National Institute of Mental Health (NIMH). Per the ADAA, GAD affects 6.8 million U.S. adults each year. Panic disorder involves spontaneous bouts of debilitating fear known as panic attacks, along with intense worry about when the next attack will come, according to the NIMH. Per the ADAA, it affects 6 million American adults each year. Social anxiety disorder (also known as social phobia) happens when you have a marked fear of social situations in which you might be judged or rejected, as well as avoiding these situations or experiencing symptoms like nausea, trembling, or sweating as a result.

Then there are other issues that are closely related to anxiety, like obsessive-compulsive disorder, which involves intrusive thoughts and urges, and posttraumatic stress disorder, which happens when people have a prolonged stress response to harrowing situations.

These are just some of the various anxiety and anxiety-adjacent disorders out there. That these issues can present in myriad ways can make it even harder to know if what you’re experiencing is anxiety that could benefit from outside help.

“Some people feel they can control their anxiety, some feel it’s something they ‘should’ be able to manage, some feel shame, some fear they might be ‘crazy,’ and others downplay how much their anxiety is impacting them,” Reynolds says.

If anxiety interferes with your daily life—whatever that might look like to you—that’s reason enough to see a mental health professional.

“When your world starts to become limited because of anxiety, that is a good signal that it’s time to seek treatment,” Reynolds says. “What is it doing to your life, your relationships, your sleep, health, work, and ability to learn and pursue things that are important to you?”

This “functional impairment,” as Reynolds calls it, can show up in different ways in different people. Is anxiety making you avoid doing things with loved ones because you’re too nervous to go outside? Do you skip school or work out of fear of what people may think of you? Can you not get enough sleep because you’re up all night worrying about the next day? Is your anxiety over certain tasks, like paying bills, leading to procrastination so extreme it comes with consequences, like getting your lights turned off?

Keep tabs on whether you’re blowing up at people, too. Anger and irritability can sometimes be a sign of anxiety. “We often forget that fight or flight includes ‘fight,’” Reynolds says. “If you have a shorter fuse or are always on edge for triggers, it could be related to anxiety.”

So, too, could physical issues. “We think of ourselves as these disembodied heads floating around,” Reynolds says. “We forget that there is a big feedback loop between the nervous system and the body.” Every part of you, from your head to your stomach to your feet, has nerves to regulate important processes, which is why your sympathetic nervous system’s stress response can be so far-reaching. You even have an entire nervous system reserved for gastrointestinal function, known as your enteric nervous system, which may help explain why there’s such a strong link between issues like irritable bowel syndrome and anxiety.

Constant fatigue can also kick in if your anxiety is in overdrive. “The physical reaction to anxiety, by nature, is supposed to be short-term. The body is supposed to come back down to baseline,” Duff says. “But a prolonged period of anxiety depletes your resources and exhausts you.”

“If your anxiety is bothering you and you are suffering, you deserve to get help,” Duff says. That’s true whether or not you think your anxiety is serious, whether or not you think you meet diagnostic criteria you read online, and whether or not your friends and family treat your anxiety with the weight it deserves. And if your anxiety is getting to the point where you’re worried for your safety, call 9-1-1 or the National Suicide Prevention Lifeline (it’s available 24 hours a day, seven days a week at 1-800-273-8255), or go to the emergency room, Reynolds says.

Seeing a therapist can be anxiety-inducing on its own, but it’s worth it. Here are a few ways to make it easier.

Knowing what to expect at your first therapy session may make the experience less scary. Although every professional is different, you’re likely to get a lot of questions at the first visit. Ultimately, your psychologist or therapist’s goal is to learn what troubles you’re having so that they can create a plan to help you build the skills you need to address your anxiety.

They’ll also want to figure out which kind of therapy best matches your needs. Different forms, like cognitive behavioral therapy, which aims to help people change negative thought patterns, work for different people.

Since the cost of therapy can be prohibitive, know that there are resources to help you find affordable treatment, like the National Alliance on Mental Health’s HelpLine at 1-800-950-6264. The HelpLine is available Monday through Friday, from 10 A.M. to 6 P.M., and you can explain your specific situation to the staffer or volunteer who answers. They may be able to refer you to local organizations that offer more affordable treatment. You can also try the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator tool, which can help you find mental health providers who take various forms of insurance, offer payment assistance, or use a sliding scale. Resources like GoodTherapy also allow you to limit search results to therapists who use sliding scales.

And don’t stress about meeting some arbitrary threshold of anxiety for your appointment to be worth the effort. “Somebody with anxiety [may] think there is a risk to seeing someone. ‘If I go and don’t have an anxiety disorder, there’s something bad about that,’” Duff says. “That’s not true. If you are suffering and seeing some of these signs, that’s enough.”

It may be that all you need is a few sessions, or you may meet weekly for months or years based on your goals. Your psychologist or therapist might decide medication would help you live your healthiest, happiest life, or just having someone to talk to might work for you. Also, if you decide you’re not really into the person you’re seeing but you still want help, there’s absolutely nothing wrong with trying someone else, Duff says.

Ask yourself what kind of life you want to live and what’s holding you back from achieving it, Reynolds says, adding, “If there’s anything related to fear and anxiety, it’s a great sign that maybe you need support around those things.”

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Smiling Depression: What You Need to Know

What are the symptoms of smiling depression?

Someone experiencing smiling depression would — from the outside —appear happy or content to others. On the inside however, they would be experiencing the distressful symptoms of depression.

Depression affects everyone differently and has a variety of symptoms, the most distinguished being deep, prolonged sadness. Other classic symptoms include:

  • changes in appetite, weight, and sleeping
  • fatigue or lethargy
  • feelings of hopelessness, lack of self-esteem, and low self-worth
  • loss of interest or pleasure in doing things that were once enjoyed

Someone with smiling depression may experience some or all of the above, but in public, these symptoms would be mostly — if not completely — absent. To someone looking from the outside, a person with smiling depression might look like:

  • an active, high-functioning individual
  • someone holding down a steady job, with a healthy family and social life
  • a person appearing to be cheerful, optimistic, and generally happy

If you’re experiencing depression yet continue to smile and put on a façade, you may feel:

  • like showing signs of depression would be a sign of weakness
  • like you would burden anyone by expressing your true feelings
  • that you don’t have depression at all, because you’re “fine”
  • that others have it worse, so what do you have to complain about?
  • that the world would be better off without you

A typical depressive symptom is having incredibly low energy and finding it hard to even make it out of bed in the morning. In smiling depression, energy levels may not be affected (except when a person is alone).

Because of this, the risk of suicide may be higher. People with major depression sometimes feel suicidal but many don’t have the energy to act on these thoughts. But someone with smiling depression might have the energy and motivation to follow through.

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7 Tips for Disciplining a Depressed Child

Depression doesn’t just affect adults, it also affects millions of children and adolescents.

Some of the symptoms that accompany childhood depression include irritability, social withdrawal, and low energy. Children with depression may also struggle to manage their behavior.

In 2013, 11 percent of 12- to 17-year-olds experienced a major depressive episode. Many younger children are also diagnosed with depressive disorders, such as persistent depressive disorder or disruptive mood dysregulation disorder, every year.

Children with depression may require a slightly different approach to discipline. Here are seven tips for disciplining a depressed child.

Work With Your Child’s Treatment Team

If you suspect your child has depression, speak to his pediatrician or a mental health professional. Depression is treatable, but without appropriate intervention, it may get worse. Treatment may include therapy, parent training, or medication.

Work with treatment providers to learn about the steps you can take to best support your child’s mental health. Inquire about the specific strategies you should use to address behavior problems like non-compliance and disrespect.

Establish Healthy Rules

All kids need rules, but children with depression sometimes require specific rules that support a healthy lifestyle. A depressed child may want to stay up late and sleep all day, or he may want to spend all of his time playing video games because he lacks the energy to play outside.

Set limits on electronics and discourage your child from sleeping during the day. You may also need to create rules about personal hygiene as children with depression sometimes don’t want to shower or change their clothes. Keep your household rules simple, and emphasize the importance of being healthy.

Provide Structure to Your Child’s Day

Kids with depression often struggle to fill their time with meaningful activities. For example, a child may sit in his room all day, or he may put off doing his chores as long as possible.

Create a simple schedule that provides structure to your child’s day. Set aside time for homework, chores, and other responsibilities and allow him to have limited electronics time once his work is done. Children with depression sometimes struggle with sleep issues, so it’s important to establish a healthy bedtime routine as well.

Catch Your Child Being Good

Positive discipline is most effective for children with depression. Look for opportunities to praise your child by saying things like, “You did a great job cleaning your room today,” or, “Thank you for helping me clean up after dinner.” Praise will encourage your child to keep up the good work.

Create a Reward System

Rather than focus on taking away privileges for misbehavior, emphasize to your child that he can earn rewards for good behavior. A behavior chart or a token economy system can motivate depressed kids.

Choose one or two behaviors to work on first—like taking a shower before 7 p.m. If he follows through, let him earn a token or sticker that can be exchanged for bigger rewards, like a trip to the park. Or, provide small, immediate rewards for compliance, like 15 minutes to play on the computer.

Separate Your Child’s Emotion from the Behavior

Discipline your child’s child’s behavior, not his emotions. Don’t scold him for being angry or lecture him about being in a bad mood. Instead, send the message that emotions are OK, it’s what he chooses to do with those emotions that matters. Teach him healthy coping strategies so he can deal with uncomfortable feelings, like anger, frustration, embarrassment, or sadness.

Consider the Implications of Negative Consequences

Children with depression need negative consequences for breaking the rules, but you should choose those consequences carefully. Taking away your child’s ability to socialize with friends, for example, could make his depression worse.

Short-term consequences, like time-out, can be very effective for younger children with depression. Consequences that take place over several days, like being grounded for a week, can backfire because children with depression may lose their motivation to earn their privileges back.

4 Motivational Interviewing Skills for Parents

4 Ways to Help your Child Deal with T1D Management

What Is Motivational Interviewing? It is one of the most effective ways to decrease ambivalence in clients suffering from long-term illness and the incredible burden associated with it. Many of these skills focus on simple bite-size steps that will begin building self-esteem and feelings of hope. Actively practicing these skills can greatly increase the level of success your child feels over time.

1. Create achievable, realistic goals.

Why? When you place too much on someone’s plate and pair it with severe negative downside, you have a solid recipe to create indecision and apathy.

How? If your child is struggling with daily tasks, don’t talk about things like the A1C blood test constantly. Instead, focus on the next meal, day, or week to help create the right habits.

2. Empower your child rather than manage your child.

Why? Success does not mean blood sugar within the desirable range; it means helping your child take active steps required to create the right habits. Exclusively trying to manage your child’s outcome based on good blood sugar or other fact-based outcomes can put a lot of uncontrollable elements onto your child’s plate and ultimately create hopelessness or low self-esteem.

How? As you talk to your child, work to identify areas of pride or success and incorporate asking about these items while you check in on insulin levels or carb intake. Additionally, try to elicit ideas from your child on how to manage a certain situation (e.g. how much to eat or how much insulin to take). This will support their confidence in their ideas instead of always looking to you for the answers.

3. Listen to your child.

Why? Your child has a 24/7 job that they did not apply for and they cannot quit. Creating an atmosphere that allows your child to safely explore conflicts and face difficult realities is critical to successfully managing T1D.

How? Show empathy, and then communicate your empathy. As a parent raising a child with T1D, it can be easy to hyper-focus on the next blood sugar reading or meal. Simply saying, “That makes sense. I can see how frustrating that would be.” can go such a long way.

4. Roll with Resistance.

Why? Managing T1D can be extremely discouraging. Your child might do everything right and still have a high blood sugar reading at the next meal. Helping your child understand that managing T1D is a roller coaster and not every blood sugar reading will be in the desirable range will help tremendously.

How? Normalize your child’s experience: “You ate the right amount, took the correct dose of insulin, and you still have high blood sugar. That happens all of the time.” Also, spend your mental energy on controlling what you can control and let everything else run its course.

 

These tips are helpful and supported by research but can be incredibly hard to implement consistently. If you ever need help or want someone to talk to, give us a call at (612) 223-8898 or schedule an appointment here.

Improving Treatment Adherence for Type 1 Diabetes

Despite all the advances in medical science and technology, there is still no cure for diabetes. A person with diabetes has to live with it and manage it all their life. The challenge, of course, is being diligent and consistent with diabetes management. Type 1 diabetes is challenging to manage because it is so comprehensive. Research shows that the adherence rate for chronic conditions is about 50%. Despite extensive studies and research, that number has not changed significantly over the past 3 decades.

What is adherence? How does it apply to people with type 1 diabetes? How can a person with type 1 diabetes improve their adherence? And how can mental health professionals help? These questions were answered by Dr. Katherine Fan, a psychiatrist and pediatrician, at the 2016 Asian Outreach Day. Dr. Fan spoke with attendees about the factors that affect a person’s short and long-term dedication and commitment to managing their diabetes. Here’s a recap of her talk:

Asian Outreach Day, Dr. Katherine Fan discusses factors that affect treatment adherence

What is Treatment Adherence?

Adherence is the active, responsible, and flexible process of self care and self management with a goal of overall health and wellness. An adherent patient strives to achieve good health by working in close collaboration with health care staff, instead of simply following rigidly prescribed rules.

In the context of type 1 diabetes, adherence can also be known as “collaborative diabetes management”, “patient empowerment”, or “self care behavior management”.  It can be useful to break down diabetes adherence into a number of areas:

  • Glucose monitoring
  • Administration of medication / insulin
  • Dietary intake / carb counting
  • Physical activity
  • Follow up visits

This may help the patient, medical care providers, and support system prioritize and focus on which parts to work on.

Also, it is important to distinguish between Adherence and Compliance. Compliance implies a paternalistic relationship between and patient and his/her doctor. The patient takes a passive role in diabetes management, simply following doctor’s orders and doing what they say. On the other hand, adherence is more of a partnership between a patient and his/her doctor, as well as his/her support network. In fact, the patient is an active participant in planning and management.

 

Factors Impacting Adherence

What makes a person with diabetes more or less likely to adhere to their diabetes management plan?  There are 4 main types of factors that diabetes adherence:

Treatment and Disease Characteristics

Complexity of treatment: The more complex the regimen, the lower the adherence rate. For example, if a patient has to take 10 different kinds of medication, 4 times per day, it is difficult to integrate this routine into daily life.

Duration of disease: The more chronic the illness, the lower the adherence rate. This may seem counterintuitive, but patients who have been diagnosed longer actually tend to have lower adherence rates than those recently diagnosed. Managing a condition over long periods of time may lead to a more casual attitude, or it may lead to burnout.

Delivery of care: Diabetes care can be delivered a number of ways: via a multidisciplinary team, a single general-care provider, or community treatment, to name a few. Research has shown that patients with diabetes seen specifically for their diabetes received more counselling on diet and adherence than patients with diabetes seen for an acute illness.

Intra-personal factors

Age: The teenage years tend to be hardest time to stick to a diabetes management plan. In contrast, parents of young children with diabetes are more likely to be adherent.

Self-esteem: Research has shown that high levels of self-esteem are related to high levels of adherence to physical activity regimens, adjustment of insulin doses and dental self-care

Self efficacy: Self-efficacy is defined as an individual’s belief in their ability to succeed specific or accomplish a task. A healthy sense of self-efficacy can play a major role in approaching goals, tasks, and challenges. The more a patient is able to advocate for him and herself, the better the outcome.

Stress: Stress and emotional state is also correlated with treatment adherence. The less stresses a person experiences, the more likely he or she will adhere to diabetes management.

Comorbid conditions: A comorbid condition is one that occurs at the same time as another illness or condition. Comorbid conditions such as depression, alcohol abuse, eating disorders, and others can adversely affect diabetes adherence. This effect is not limited to mental conditions: physical comorbidities also tend to lower the adherence rate of diabetes.

Inter-personal factors

Patient-provider relationship: The better the relationship between a patient and his or her provider, the higher the patient’s adherence rate will be. Patients and providers who communicate with each other tend to have improved relationships.

Social support: The benefits to have a social network for a person with type 1 diabetes are well known. Greater social support means better levels of adherence. For children and teens with type 1 diabetes, great parental involvement also means better levels of adherence.

Environmental factors

Stressors:The more stress a person has in their life, the harder it is to prioritize and manage diabetes

Conflicts: People with diabetes are as multifaceted as everyone else. Frequently, they are called upon to choose between giving attention to diabetes self-management or to some other life priority. They can face time pressures and social pressures during school events, work events, family events, holidays, and more.

Lifestyle factors: A person’s lifestyle can directly affect their diabetes adherence levels. Are they sedentary or active at work? Do they work long hours? Do they travel a lot? How much time do they spend in front of the television? Do they have a hobby?  Different circumstances require individuals to adjust and maintain their diabetes management.

Socio-economic status: The economically disadvantaged and ethnic minorities may find it particularly challenging to visit healthcare providers or to live a healthy lifestyle. They may have limited access to fresh fruits and vegetables, small living spaces. Their schools may not provide opportunities for physical activity. What’s more, financial constraints may prevent them from going to a gym. Those factors, combined with their local climate, may make regular exercise challenging.

 

The Diabetes Adherence Team: What can we do?

There are four kinds of players on any diabetes management team: the Patient, the Parents (or family/friends), the Physician, and the Environment. All players have a role to play in diabetes adherence. When each “player” contributes in a positive way, it leads to better adherence and better outcomes. Here are tips on how each team player can work to enhance adherence and wellness:

The Patient

It takes a team to manage diabetes, but adherence starts with the patient. As the person with diabetes, you’re going to be living with your body for a long time, so take care of it! Here are some things the patient can do to make diabetes adherence easier:

  • Be informed and understand your condition. Understand what it does to your body, and understand the complications that can occur if one does not manage the condition and stick to the plan.
  • Identify your strengths and future goals. Don’t see diabetes as something that defines you, but something that is a part of you. You cannot change it but you can manage it.
  • Stress proof your life. Work on areas such as sleep, nutrition, exercise, hobbies, mind-body exercise, healthy coping strategies, and more. Also, develop a support network of family, peers, school, religion, and/or support groups.

The Parents

Parents (and family) play a huge role in enhancing adherence. Here are some things parents can do to help their child with T1D:

  • Understand the developmental needs of your child and recognize where they are. Remember, each child is different! At any given age, a child may be a different levels with respect to cognitive, motor, social-emotional, and physical skills.
  • Be informed and stay involved. Invest in your relationship with your child! Additionally, help your child be informed and involved. Help educate your child’s school, as well as caretakers, friends, and family.
  • Balance “take control” and “letting go”. We all want to be there for our kids, but we want our kids to take responsibility and be independent so that when they leave home, they can take care of themselves.
  • Create a supportive home environment. Avoid judgement words such as “good” or “bad” sugar/A1C. Instead, use phrases like “in or out of range”.
  • Foster a positive attitude about the condition.
  • Model self care. Kids learn by watching!
  • Focus on incentives, not threats or fear tactics. Consequences are for behaviors that you want to stop, while incentives are for behaviors that you want to foster.
  • Don’t be shy about asking for professional help!

The Physician

Physicians play an important role. A physician who can help enhance adherence is one who:

  • Keeps it simple and simplifies treatment regiments as much as possible
  • Makes sure patients understand the consequences of non-adherence
  • Connects with the patient in a way they understant
  • Enhances patient communication via phone, text, etc..
  • Leaves bias out of the relationship and avoids judgement. Patients already feel shame and guilt, and when they feel judged, it negatively affects the doctor-patient relationship.

The Environment

Some environmental factors are difficult, if not impossible, to control, so focus on things that you can control. For example, you may not be able to enhance access to health care, but you can provide diabetes awareness and education. You can educate not only yourself and your family, but also the broader community. Parents can help educate their children’s school teachers and friends. Adult patients can start support groups online and in real life. Technology can also improve diabetes awareness and education.

 

The role of Mental Health Clinicians

How can mental health clinicians help patients achieve overall wellness?

  • They can support the patient and the patient’s family, not just during diagnosis, but throughout their journey.
  • Acceptance is the first step towards adherence. Mental health clinicians can help patients work on accepting their condition and coping with it.
  • Mental Health Clinicians can help the patient process some of the emotional factors that come with diabetes: anger, fear, guilt, shame, stress, sadness
  • They can facilitate communication and conflict resolution, between you and parents and friends, between doctor and patient
  • They can help identify other emotional disorders that can complicate diabetes management, such as depression, anxiety, eating disorders, or substance abuse.

Mental health clinicians can provide treatments such as cognitive behavioral therapy, motivational interviewing, behavior modification plans, or family therapy.  Diabetes affects the mind as well as the body. Mental health is an important step towards the journey to your best self. Never be afraid to ask for help from a mental health professional!

 

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Family relationships and Type 1 diabetes

A diagnosis of Type 1 diabetes can affect the whole family. It’s important to listen to, and communicate with, all members of your family – especially any other children – and get help and support if you or anyone else needs it.

Sibling rivalry

While you’re getting to grips with your child’s diabetes, it’s easy to forget about the needs of your other children. But, they, too, will be affected by their sibling’s diagnosis. They may feel that their brother or sister is getting special treatment, worry that their sibling will get really sick or be scared that they’ll develop diabetes themselves.

Rivalry and jealousy are common in most families, and a child with diabetes can cause upset between siblings. In the early days, after diagnosis, it’s only natural for you to be anxious and focus your attention and care on your child with diabetes. But, regular hospital visits, attention to diet and everything else that goes with diabetes has a longer-term impact on all the family.

Advice for coping with sibling rivalry

  • Try to listen to both sides equally and be sensitive to their claims that it’s ‘not fair’.
  • Be clear about what you expect from each of them.
  • Try to give them the same amount of attention.
  • If you feel it’s appropriate, get siblings involved with diabetes management, so that they feel part of it.
  • Try not to put family life on hold.

Separated parents

It can be a challenge to manage a child’s diabetes when they go from one home to another. Whatever your feelings about your ex, the two of you need to work together to make sure your child’s diabetes is well managed.

  • making sure both of you learn about managing your child’s diabetes from your paediatric diabetes team – second-hand information can be confusing or inaccurate
  • how you’ll keep each other updated about any changes to your child’s treatment or routine
  • how you’ll involve new partners.

Lone parents

As a lone parent, you may have particular difficulties because all the pressures fall on you alone.

  • who you can call if you need help
  • who can help you in an emergency
  • who can support you when you’re struggling emotionally
  • who can babysit when you need time off
  • involving siblings in your child’s care, being careful not to give them too much responsibility.

Extended family

When your child is diagnosed with diabetes, it’s natural for grandparents, aunts and uncles, etc to be as upset and worried as you are. They may be in constant contact, asking for updates or how they can help – or they may leave you alone to concentrate on your child.

Advice for dealing with extended family:

  • Keep one person up to date. This person can then update everyone else: group texts and emails work well for this.
  • Ask for the help you need. Perhaps you’d like someone to look after your other children, do a bit of shopping for you or walk the dog? People often want to help, but don’t know what to do.
  • Think about the future. Your family will be living with Type 1 diabetes from now on, so how can your extended family best support you? If your child is used to staying over with relatives, it’s important that they still do so. If grandparents and other family members are worried about looking after them, try involving them in your child’s diabetes care. You could also bring them to clinic appointments to help them learn more about diabetes and ask questions for themselves. Most of all, be honest with them, tell them how you feel and ask them to help you keep your child’s life as normal as possible.

Is Type 1 diabetes hereditary? Will my other children get it?

Research has shown that Type 1 diabetes is caused by a combination of genetic and environmental factors. If one family member has Type 1 diabetes, there’s a slightly increased risk of another family member developing it, too. But, many people diagnosed have no family history of diabetes. It’s natural to worry that your other children will also develop Type 1 diabetes, but try not to let this worry affect you too much. Talk to your diabetes team or contact theDiabetes UK Carelinefor support.

Diabetes support for you and your family

If you’d like some diabetes help, you can:

 

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Type 1 Diabetes and Your Relationship: How to Address Common Challenges

Managing type 1 diabetes can take a physical, emotional, and financial toll on your relationship, whether you’re dating, married, or in a long-term partnership. Although every relationship has challenges, there are some issues that can seem especially tricky when you have a chronic condition like type 1 diabetes.

A qualitative study published in March 2013 in Diabetes Care found that people with type 1 diabetes and their partners feel that the condition impacts their relationship, posing both emotional and interpersonal challenges — and that partner support is a vital source of support for those living with the condition.

If you find that your type 1 diabetes has taken a toll on your relationship, there are steps you can take to help reconnect with your partner and get back on track.

Common Relationship Challenges

Here are some common issues that people who have type 1 diabetes and their partners may face, as well as tips to help address these concerns and maintain a healthy relationship.

Lack of support Diabetes requires many daily management tasks. If your partner isn’t aware of what all those tasks are and why each is important, it can be difficult for them to support you, says Mark Heyman, PhD, a certified diabetes educator and the founder and director of the Center for Diabetes and Mental Health in Solana Beach, California. “I encourage people to educate their partner or have a healthcare team who can help educate their partner about each step in managing type 1 diabetes. Your partner needs to be able to offer support — not only when you aren’t feeling well, but also in the day-to-day,” he says. “That means support in making healthy choices when it comes to eating, exercise, and other activities. It can be really hard to manage type 1 diabetes when you feel like you’re all on your own.”

Feeling micromanaged On the other hand, you may sometimes feel like you’re receiving too much support. It may seem like your partner is constantly asking you about how you feel and what you ate, and monitoring your every move. “It usually comes from a place of caring and not always knowing how to help,” says Dr. Heyman. In those cases, it’s important to let your partner know what’s helpful for you and what’s not helpful, he says.

“For example, you might tell your partner, ‘It’s really not helpful for you to be looking at my blood sugar numbers all the time and commenting on them. What would be more helpful for me is if we could plan time this weekend to take a walk together or prepare a healthy meal,’” says Heyman. “That does two things: It helps you set boundaries with your partner around how they interact with you about your condition, and it also gives them a concrete way to help you manage type 1diabetes, which can help relieve some of the anxiety your partner may have,” he says.

Lack of spontaneity Because type 1 diabetes involves a lot of planning, it might feel like there isn’t enough spontaneity in your relationship. While it may feel counterintuitive, doing a little planning in advance can help you be spontaneous. “Having supplies packed and ready to go can help if a last-minute trip or fun activity comes up,” says Heyman. Keep extra insulin and anything else you might need in a bag, he suggests. “If you want to take off on a weekend road trip, it’s nice to know you can just grab that bag and have everything you need to stay healthy,” he says.

“If one of you would like to be more spontaneous, ask the other person, ‘What can we do together to make you more comfortable with that?’” he says. “You may be amazed at the ideas that can come about if one of you just asks the question.”

Intimacy challenges A study published in May 2018 in International Journal of Environmental Research and Public Health found that people who have type 1 diabetes may be at an increased risk of sexual disorders. Communication is key in helping with these issues, says Heyman. “You have to let your partner know how you’re feeling, just as in any relationship,” he says.

“Lots of things can impact the desire for intimacy. There are times when you just don’t feel well. Maybe there are fears about having low blood sugar while you’re being intimate,” he says. The more you can communicate about what you’re experiencing and what your partner may be able to do to help, the better. “Being able to talk about it may lead to increased intimacy; often communication can make you feel closer to your partner,” says Heyman.

Financial strain The cost of managing type 1 diabetes can vary, but according to the American Diabetes Association, people who have diabetes spend approximately $9,600 a year on diabetes-related medical costs. This may include anything from doctor visits to medications and supplies. These extra expenses can add stress to your relationship. Communicating and planning are key, says Heyman. “Have a really frank conversation about your financial health and what your goals are. How does diabetes impact this? How can we manage it?” he says.

Sometimes there can be resentment if one of you feels “stuck” in a job you don’t like because you can’t afford to lose your health insurance. Talk about the situation and brainstorm together, suggests Heyman. “Is there a solution that can be agreeable to everybody, and if not, can you find a compromise?” he says. Bottom line: Staying healthy is critical to living your best life.

Dealing with low blood sugar When you’re experiencing low blood sugar, you don’t always act like yourself, says Heyman. “You may become aggressive or defiant,” he says, which can be concerning, medically dangerous, and stressful. “It’s helpful for couples to set rules around how they’re going to deal with an episode of low blood sugar — before it happens,” he says.

Sometimes you may be in the middle of a low blood sugar episode and not realize it, or think you’re just fine and your blood sugar will correct itself, he says. Developing rules that are “non-negotiables” are a good idea.

“For example, if your partner thinks your blood sugar is low, agree that you’ll check it. If your partner sees that your blood sugar is low or if you’re exhibiting signs that it is, agree to take the snack they offer you without question,” he says. “Agreeing and sticking with rules like this can go a long way in easing tension and letting your partner know that their concerns are heard and you’re going to be okay,” says Heyman.

Find Support — for Both of You

Your partner needs to understand that sometimes you just don’t feel well. “High blood sugar doesn’t always feel good and low blood sugar is not only dangerous, it just doesn’t feel great,” says Heyman. “That can be a hard thing to communicate to people; diabetes can be a very invisible disease. Someone may look fine even if they’re not feeling well, and explaining what the different symptoms feel like can be challenging.”

Seeking social support, either in person or online, where you can get other couples’ perspectives on what these things are like and how they handle them, is a good idea, says Heyman. “Online communities are a great source of support,” he says. Beyond Type 1 and Type One Nation are two helpful resources for people with type 1 diabetes.

“Diabetes can be overwhelming and frustrating. You can experience lots of emotions that go along with that,” says Heyman. Having a partner you can count on and who can understand and empathize can go a long way.

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Anxiety + Diabetes

WRITTEN BY: Kristi Caporoso, MSW, LSW

State(s) of Fear

Anxiety has become one of the most commonly diagnosed mental illnesses in the United States. It seems everywhere you turn, someone is talking about it. Whether it’s their child or themselves that are afflicted, everyone and their mother seems to suffer from some level of anxiety. There has been a particular uptick in the level of anxiety reported in children and adolescents. While mental health professionals are trying to put their finger on what exactly is contributing to this – technology, political climate, homework – you don’t have to dig deep to find a reason for increased levels of anxiety in those living with Type 1 diabetes. To begin unpacking this issue, first let’s take a look at what the “A” word actually means.

What is anxiety, exactly?

A certain level of anxiety is healthy – necessary, even. It is what prevents us from engaging in dangerous behaviors, and what keeps us motivated to accomplish the things we need to do. The dictionary definition of anxiety reads as follows: “distress or uneasiness of mind caused by fear of danger or misfortune.”1 When this distress gets too high, or is disproportionate to the situation provoking it, the person tends to suffer from anxiety instead of benefitting from it.

Some of the more common forms of anxiety disorders are:

Generalized Anxiety Disorder (GAD)

A prolonged state of worry or tendency to worry about any and everything. GAD can have physical manifestations, such as GI problems and difficulty sleeping.  Someone living with GAD will have a tendency to view everything through a lens of anxiety, and be bombarded with “what-ifs?”

Panic Disorder

Panic disorder can occur after a person experiences one or multiple panic attacks, and is living in constant fear of the next one occurring. Everyone experiences panic attacks in different ways, but the most common symptoms are shortness of breath, feelings of impending doom, de-personalization (that feeling when you are floating outside your body), and heart palpitations, to name a few.

Social Anxiety Disorder

Basically what it sounds like, social anxiety disorder is when people experience extreme discomfort and anxiety around other people. This anxiety is rooted in the fear of what others think of you, or of embarrassing yourself or looking foolish.

Diabetes & Anxiety

T1D and anxiety are made to exacerbate one another. The fears and thought patterns that fuel anxiety are inherent to managing diabetes. On the flip side, struggling with anxiety can wreak havoc on your blood sugars. The more time I’ve spent working with and trying to pick apart anxiety disorders, the more I’ve realized how counterintuitive diabetes management is to anxiety levels.

What ifs

Running through the back of every anxious mind is a pestering whisper of what if? “What if I die?” “What if I embarrass myself?” “What if I fail?” These persistent questions can be crippling. However, when managing diabetes, it is often necessary to ponder what if. For example, I am about to pre-bolus for my dinner on my way home, but what if I get stuck in traffic? I am preparing for a run by adjusting my dosage and snacking, but what if it rains?

At the forefront of diabetes management is planning. Unfortunately, planning often invites what ifs, and what ifs can easily manifest into anxiety. When you are living with anxiety, it is often difficult to differentiate between rational or helpful what ifs and irrational, detrimental ones. Considering the rain or traffic while planning your insulin dosage can be productive, while repetitively pondering the possibility of going low and passing out during your exercise routine is not.

Living in the present

Similarly, planning for diabetes care can interfere with being present in the current moment. In recent years there has been growing evidence of the efficacy of mindfulness-based stress reduction (MBSR) and meditation for treatment of anxiety2. Much of our worry is rooted in what may or may not happen in the future. But it is hard to focus on the present moment and often difficult to be spontaneous when you’ve got insulin on board (IOB), sensors with downward-pointing arrows, and a fixed amount of juice in your handbag. Even the actual practice of meditation can be interrupted by alerting insulin pumps and CGMs. As mentioned above, diabetes management involves a lot of planning. And a lot of planning means a lot of future-oriented thinking.

Checking

Much like planning, with diabetes checking is essential. Checking you blood sugar, checking your IOB, checking your low supplies. But for someone with anxiety, checking can spiral into an obsessive ritual. People suffering from obsessive-compulsive disorder (OCD) have certain rituals they perform to quiet obsessive thoughts that repeatedly run through their mind. Because checking is so essential for diabetes management, it’s easy for someone susceptible to anxiety to fall into a pattern of over-checking. Picture this: you feel anxious about going low, check your sensor data and see no downward arrows. You feel a temporary wave of relief. But moments later, those thoughts recur. They get louder and louder in your head, until you have to check your sensor again – still no downward arrows. You see how this can fall into a negative thought-behavior cycle.

Where do we go from here?

Fortunately, much like type one, anxiety is manageable. But it takes work. If you feel like anxiety is interfering with you or your child’s everyday life, consider seeing a therapist. There are many therapists who have experience working with people with chronic illness. And if they don’t, BT1 has a helpful guide to teach them about type 13.

Where to start: finding a therapist

Your primary care doctor or pediatrician may have some referrals. Or, if you feel comfortable, ask around. It’s more than likely that many people in your life see a therapist and you have no idea. Or, if you have private insurance, you can try calling the “Member Services” number on the back of the insurance card and asking for referrals to local in-network behavioral health providers. There are also many ways to locate a therapist online:

If you have Medicaid (or Medical, or your state’s equivalent), your state’s Division of Mental Health and Addiction Services should have resources for local community mental health centers that accept this insurance. Your therapist or primary care doctor will also be able to suggest if you should consult a psychiatrist. A psychiatrist can prescribe medications for behavioral health concerns.

While diabetes and anxiety may make a great pair, you don’t have to constantly live at their mercy. As you learn to accept and manage your anxiety, you’ll learn how to live well with it. It won’t be easy, and there’s a lot of trial and error. Of course, having type one means you’re used to that! And always remember, you’re not alone in this.

REFERENCES

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Diabetes Burnout

WRITTEN BY: Mark Heyman, PhD, CDE

Have you ever felt like you are just “done” with diabetes?

Are you sick and tired of doing everything you’re supposed to do, but feel like your blood sugar is still out of control? Do you feel like you don’t care anymore about managing diabetes and want to just give up? If any of these things sound familiar, you may be experiencing diabetes burnout.

Diabetes burnout is a state in which someone with diabetes grows tired of managing their condition, and then simply ignores it for a period of time, or worse, forever. Unfortunately, diabetes burnout is common, and most people with Type 1 diabetes (T1D) have experienced it at some point in their lives. After all, if you have T1D, you have to be “on” 24/7, and as much as we would like one, there are no breaks. People who experience diabetes burnout aren’t necessarily depressed and are certainly not lazy. In fact, almost everyone with diabetes, even those experiencing burnout, want to live long healthy lives. But sometimes diabetes can feel overwhelming and folks can get burned out from all the hard work.

What does diabetes burnout actually look like? While it may look different in people, there are some common signs and symptoms. These include:

  • Strong negative feelings (e.g., overwhelmed, anger, frustration) about diabetes
  • Feeling controlled by diabetes
  • Isolation, or feeling alone with diabetes
  • Avoidance of some, or all diabetes management activities and being unmotivated to change this behavior

If you have T1D and are feeling burned out, please know that there is hope! Diabetes is hard work, and until we have a cure, it will continue to be hard. However, there are some thing you can try that can help you overcome, and even prevent, feelings of burn out.

Manage your expectations

People with T1D tend to be really hard on themselves. They expect a lot from themselves, and when they don’t meet their own expectations, it can be frustrating. Anyone who lives with T1D knows that it is almost impossible to do everything “right” all the time. And even if you do everything “right”, your blood sugar can have a mind of its own and do some crazy things. If you expect perfection, and perfection is not possible, it’s normal to want to give up. Instead, try cutting yourself some slack. It’s ok to strive for perfection, but it’s important to cut yourself some slack sometimes and be ok with slipping up. And remember that sometimes, having wacky blood sugars is part of having diabetes.

Take small steps

Diabetes takes a lot of hard work and sometimes everything can seem overwhelming. When things get overwhelming, you may not even know where to start. Instead of tackling a big task all at once, try breaking it down into small steps that you know you can accomplish. For example, telling yourself you want to reduce your A1C from 8% to 7% may sound like a Herculean task. However, if that is your goal, identify the specific things you can do today to get there. For example, you can check your blood sugar at least 4 times a day and count carbohydrates at every meal and take insulin to cover. Taking small steps can make achieving big goals seem a lot more obtainable.

Get support

Feeling like you’re alone in your life with diabetes is a big risk factor for diabetes burnout. With diabetes, isolation is one the biggest risk factors for becoming burned out. If you feel that nobody understands what you are experiencing or that you are the only person with diabetes that feels this way, life with diabetes can be a lonely place. While feeling supported does not make T1D go away, it can make it easier to live with. Getting support, encouragement and empathy from others can be a critical part of staying motivated to manage your diabetes. Sometimes the people in your life may not know what kind of support you need. Be clear with these people what would be most helpful and what you want them not to do. Remember that other people with T1D can also be a great source of support. These are the folks who know exactly how you’re feeling, because, at some point, they have probably felt the same way. If you don’t know anybody else with T1D, there are resources that can help. Many communities have meet-ups for people with T1D and there is an active diabetes online community on social media.*

If you feel burned out with T1D, you are not alone. Just remember that many people have overcome their burnout and are able to live long, happy and healthy lives with T1D. If you are experiencing diabetes burn out and you feel like you can’t deal with it on your own, it’s important to get help from a mental health professional who understands diabetes. Talk to your endocrinologist to see if s/he can recommend one in your area.

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