Baby Steps

Did you know that 4 in 5 Americans’ mental health has been impacted by COVID-19? That is 80% of the population! Since there is a strong connection to physical and mental health, it is important to take care of both. Now is a great time to take charge of your mental health.

Relationships as an Attorney

Being an attorney can be an extremely demanding job at times and can easily cause strain on your relationships with partners, families, or friends. Continue reading for some tips on how to foster those relationships.

Being a Mother with a Demanding Job

Being an attorney and a mother can be extremely difficult. Finding work-life balance may seem impossible and mother’s may begin to feel guilty for working as much as they do. Continue to read on some tips that can help next time the working mom guilt sets in.

Work-Life Balance as an Attorney

Balancing a large caseload as an attorney while still handling the responsibilities of everyday life can often lead to anxiety and depression. If you are struggling to find balance continue to read for some helpful tips on managing work-life balance as an attorney.

Loneliness and Quarantine

It’s day *what feels like* 598762 of quarantine and I haven’t talked to a single, other adult in eons. It’s time. Desperation has set in. If I stare at my phone for one more minute and don’t talk to another person I might as well just adopt that cute puppy instead…

Mindfulness in the Midst of a Pandemic

As a therapist, people tend to look to me for answers. We ask the questions to gain understanding and help guide and walk with people on their journeys. In the midst of a pandemic, how does that work though?

Pandemic-Related Anxiety

Feelings of increased stress, anxiety, and depression are now a new “normal baseline” for a population finding themselves faced with fear and uncertainty.

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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3 Major Ways to Tackle Stress in Your Life

Everyone agrees: Stress is terrible. It’s the thing that keeps you awake at night and unable to enjoy your day. Sometimes stress helps us prioritize the things that need doing now, but more often than not, it’s a terrible feeling that sucks the life out of you. At its worst, stress can increase your chances of heart attack, harm your immune system, decrease sexual function, and wreck your digestive system. Stress can come from your work, your personal life, or your environment, and it can manifest in a multitude of (not great) ways.

Battling stress is a part of caring for yourself and your body.  How do you get out from under the crushing weight of stress and get your life back on track?

The Art of Self-Care

The best way to combat stress is to practice the art of self-care. Self-care can be hard for a lot of people, especially those with busy lives who are used to putting work and the needs of others ahead of their own needs. Moms are especially prone to struggling with putting themselves first. Self-care is as much a part of thriving as eating and sleeping. It’s caring for yourself mentally, replenishing that spring of mental wellness and energy so that you’re able to do the things you need to do. When you’re busy, schedule time for self-care the way you would a doctor’s appointment.

So what counts as self-care? Anything that leaves you happy, satisfied, and rejuvenated: massages, time spent with a friend or romantic partner, watching a movie you enjoy, or anything that makes you laugh. Examine the things that make you genuinely happy and fulfilled, and when you find yourself lagging, indulge.

Practice Changing the Way You Think

Getting out of a funk is hard to do. When you’re super stressed, it’s easy to fall into a black hole of negative thinking. Practice changing the way you think. If you’re plagued by negative thoughts, flip them around into something positive. It’s hard to do, especially when you feel buried by worry. The more you practice, the more you’ll lean towards positive thinking naturally. You’ll be happier in the long run.

Kick Social Media

There’s a ton of evidence that social media is bad for us. Deleting Facebook from your phone, or drastically reducing your time on Facebook, can lower your cortisol levels (that’s the hormone associated with stress). Increased cortisol can lower your immune system, encourage obesity, and impair memory. Excessive social media use has been linked with anxiety and depression. That’s a lot to put up with just to see what your cousin had for lunch.

Take a 24-hour break from all the noise and pressure from social media. If your hands are still twitching to use your phone, replace Insta with an app designed to help you reduce stress and anxiety. Some apps walk you through mindfulness or meditation. Others help you breathe, or they play soothing sounds.

Take Care of Your Body

There’s definitely a connection between mind and body — just ask anyone who has experienced being hangry. When you’re stressed, taking care of your body can absolutely help get you back to balanced. If you’re working under a deadline, you might be tempted to forgo eating healthy for something quick, like vending machine food. Sugar bursts and crashes can exacerbate stress. Take some time to eat food that will give you energy without burning out quickly, like protein.

Physical activity can help you work through feelings of stress. It’s as simple as taking a quick walk to clear your head. A walk can help you calm down, catch your breath, and head back into a stressful job or project with a much clearer head.

Sleep is a powerful tool to relax and unwind. Follow practices that lead to a good night’s rest:

  • Don’t eat before bed
  • Give yourself time to settle
  • Prime your bed for comfortable sleep
  • Keep distractions or stimulating objects (like your cell phone) far away from your bed.

Like a lot of the other suggestions in this article, they’re small changes. Those small changes can lead to a big difference in your life — one that will leave you more relaxed, fulfilled, and able to take on your goals with increased gusto.

 

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Ten Tips to Help You Feel Happier

Happiness is an elusive concept, we all want it but not many of us can define what it actually is and even fewer how to get it.

Unfortunately, a lot of us fall into the trap of the ‘I will be happy when’mentality. It’s an easy fix supported by our own psychology and propagated by the modern world. You end up thinking; ‘I will be happy when I have lost 10kg’s’, ‘I will be happy when I find a partner’, ‘I will be happy when I get that new car’ and so on. The difficulty is that you will be happy briefly, or at least you think you will. But this feeling won’t last long and then you will be onto the next thing that you believe you need to feel happy.

Now, don’t get me wrong, being healthier and finding positive relationships are good goals, but when you anchor your entire life onto the ‘i’ll be happy when’ philosophy you will always be left wanting more and the happiness you seek will likely remain elusive.

I am not promising that trying the following tips will immediately fix everything, but remember that you are the author, editor and viewer of your own life. You choose what you do from day to day. You filter experiences based on what you expect to see and you choose what you focus on and remember. So maybe just try some of these and see how you feel, who knows it could really make a difference, they have to me over the years.

  1. Try something new.

Now this doesn’t have to be big, in fact it can be tiny and in any aspect of your life. Try a new route from work and see what different sights there are, or people you meet. Maybe it will simply turn out to be quicker. Try a new restaurant, try a new activity.  Go big and visit a country you have never been to before, go brave and ask that person out, or end a toxic relationship. Novelty can help reinvigorate you, it can give you new perspectives, new experiences. You may meet new people, who in turn give you new ideas. It can give you new things to consider and talk about. Maybe just try one new thing a month and see what changes.

  1. Start Small

This is really important, people often make the mistake of trying to change everything at once. You set yourself giant targets and when you don’t achieve them in a month you start giving up and feel like you have failed. Instead focus on the tiny wins. If you want to lose weight, don’t think “I want to lose 2 stone”, start some exercise and if you feel a bit better then thats your target. Maybe your clothes feel a bit looser or you have little bit more energy. There is nothing wrong with big bold targets, but don’t measure your progress by it. Instead, break it into smaller goals and celebrate when you achieve them (perhaps not with a cheesecake though).

  1. Count the Good Things

Try this experiment with a friend, when you are somewhere you haven’t been before, ask them to look around and memorize everything that is red. Once they have done that, ask them to close their eyes and list all the things around them that are blue. A lot of people will struggle because they simply haven’t paid attention or focussed on the blue things around them. This is how our minds work. Very simply, we see what we expect to see and remember based on our preconceptions, your mind filters to make it more efficient. Now this is great from a survival perspective however it can cause problems. If we expect to have a bad day we will unconsciously only look for the things that confirm this. If we think we are unlucky we will look for things that prove our bad luck streak. Instead try something very simple, everyday before you go to sleep, think through your day and focus on five good things that have happened. They could be anything from ‘a nice walk in the sunshine’ to ‘meeting someone new’. There are always at least five events you can find that haven’t been awful or disastrous. Try this for a while and you may be surprised how it starts to change your mindset. You will start to look for more and more of the good and likely feel more positive.

  1. Say no….and yes more

This might sound like contradictory advice, but a lot of us spend a significant amount of time trying to second guess what other people want us to do. We try and make decisions on their wants and needs. We might do this for lots of reasons; we care for them, love them, live with them, dislike them and so on. Instead I want you to make decisions about how you feel and what you want. Have the confidence to say no to things you don’t want to do and yes to things that you do want to do. You may have avoided things in the past as you are worried that friends and family might judge you or it might change their view of you, but it’s not their life! It’s not about being selfish, just recognising that to be a good friend to others you need to first look after yourself and that you are entitled to do what makes you happy.

  1. Read a Book

In a world of social media and access to non-stop entertainment, books have sometimes fallen out of favour. Books give you a window into a different world or another persons life, a glimpse into history, they stimulate your imagination and mind. The focus required to read without distractions is sometimes considered a form of meditation; you can’t half read like you do with some TV programmes, it requires all of your attention. Books have the time to be more descriptive and delve deeper, ask questions that mass media are unwilling to, they can put you in the shoes of another world changing your perspective on life. Books have literally changed the course of history so why not give one a go.

  1. Stop and Meditate

We spend so much time running around thinking about work, family, friends worrying about what we have to do next, dwelling on something we did last week, rarely just stopping and taking in where we are and how we feel right now. Meditation can be practiced in many forms and its worth learning more about it. Essentially though, meditation asks you to focus on the moment you are in now, your place within it and the internal feelings and thoughts going on at that moment. Acknowledge them and then work to find stillness and quietness. Learn to slow down and quieten your mind to stop if from jumping from thought to thought like a over excited animal. Simply give yourself 5 minutes a few times in your day to just stop and look around you, admire the view and really take it in. Ask yourself, where are you now and how do you actually feel?

  1. Exercise

In anything, anywhere and anytime, just do it. Stop worrying about what to do and stop giving yourself the excuse that you have no time. Everyone has 10 minutes to take a brisk walk even if it’s to pick up the kids, 20 minutes for a run, 15 minutes for some Yoga, weights or just some stretching in your living room before you crash in front of the TV. The physical and psychological benefits of exercise are documented on an almost daily basis and finding information could not be easier online. Just start, today, you will not regret it.

  1. Think about your Food

Like with little changes you don’t have to stop eating all your favourite foods (pizza) immediately but perhaps just cut down on some of the worst offenders. You know what they are. Fast food, packaged cheap food full of salt and sugar. Reduce your meat intake for the sake of your own gut and the environment, eat…….some…….greens. It really isn’t rocket science, you just have to eat a balanced diet, there is so much information online and healthy food isn’t that expensive anymore. Now I know this is difficult when you don’t have time or money to cook, but a bag of salad is instant and chicken takes 10 mins to cook. Like above, focus on little changes that you can maintain and see how you feel after a few weeks. It should be no surprise that the food you put into your body can dramatically affect your internal state.

  1. Give

“No-one is useless in this world who lightens the burdens of another” Charles Dickens

Giving money is great and I applaud you for doing it, but also try and give your time. Stop and talk to people and really listen to them. Volunteer for something nearby.  Your time is the most precious resource you have, far greater than money, and spending it to help others is an amazing way to improve the world around you and you will be surprised how good it makes you feel. Give to charity, help others, give anything you can and as much or as little as you want to. There are always people more and less fortunate than you, don’t judge or compare just give.

  1. Spend time with your Friends and Family

There have been numerous surveys over the years conducted with terminally ill patients each one asking them about the meaning of their life, what made them happy and what they wished they could change about how they lived their lives. With each study there are some things that just keep coming up. For a start “I wish I worked more” is never in the list and almost always at the top is wishing they had spent more time with their friends and family. Good relationships are believed to even lengthen your life and none of us can get through this alone.

Remember though people come and go into your life, don’t be afraid to make new friends or say goodbye to toxic relationships. Never worry about calling that friend or relative you haven’t spoken to for years. They are just like you and will be busy with their lives and wondering if they should call you. Always try and make time for a coffee or beer or just a chat with your friends and family, they are literally the anchors of your life. They reflect who you are and how you live your life and are the ones standing with you in your time of need and you in theirs.

One more thing before you go, another common theme from these studies is patients often comment how they wished they had lived true to themselves and had the bravery to live their lives as they wanted to and not how they thought others wanted them to.

So here is a little experiment to leave you with, in Australia, the life expectancy is just over 82 years which is actually only 718,320 hours, this really doesn’t sound like much does it? But it gets more powerful when you divide that by three. A third for sleep and at least a third for work leaving you with less than 240,000 hours of free time…..then subtract how ever many years you have lived.

Life is genuinely very short and you should strive to live your own life and as positively as possible.

“Happiness is not something you postpone for the future; it is something you design for the present” – Jim Rohn

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