I’ve been talking with my clients a lot recently about how to manage anxiety and stress. We’re all experiencing probably a higher level of anxiety than what we’re used to. Some people have a lot of skills for managing that and some of us don’t
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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
I remember when I was seven, my Great-Uncle Benji said to my parents, “Allison needs a dog.” It was at that time, my life changed. I was a very quiet, reserved kid, but dogs brought me out of my shell. They were with me during good times, painful times and major life events—and loved me no matter how I reacted to these situations. They remained stable forces in my life, even during the darkest turmoil.
Nowadays, I work with clients who live with depression, anxiety and addictions, and they don’t always feel like there is hope. It’s hard for them to see light in the midst of their darkness, and peace seems so far away. But when I use my dogs during pet therapy visits, I see how animals brighten up a person’s mood, even if it’s for a short time. That moment allows a small trickle of light into that person’s heart, which may not have been there before.
During one session in particular, a client asked if she could get on the floor because she wanted to talk to my therapy dog about something “very important.” She buried her head into my dog’s fur and talked about the horrible week she had endured. Stroking my dog’s fur, my client was overcome with a sense of calm in a way I could not have accomplished by merely talking with her. No judgments, no expectations—just a furry hug.
When we’re facing despair, loneliness, chronic health issues, depression, addictions, or anything beyond our ability to cope, a pet can help ease the pain. He or she can give us a reason to get out of our thoughts to focus on a sense of purpose. The relationship we have with our pets is real and symbiotic—what I give to my pets comes back to me in ways that can’t be measured.
Research shows the benefits of pet therapy (in fact, its first known use dates back to the 9th century!). Boris Levinson was the first clinician to truly introduce the value of animals in a therapeutic environment. In the 1960s, Levinson reported that having his dog present at talk therapy sessions led to increased communication, increased self-esteem and increased willingness to disclose difficult experiences. Ever since, people have been turning to pets for comfort and support during periods of emotional turmoil. Hugging and speaking with a pet who won’t judge you for your feelings or thoughts is cathartic and helps people get through rough times. Pets also reduce symptoms of anxiety or depression, giving people a reason to get up in the morning. Other benefits are unconditional love, acceptance, a “buddy” that encourages physical activity, which leads to healthier lifestyles.
If you’re unable to own a pet, there are many ways to reap the benefits of a pet relationship. Volunteering at a local shelter or helping rescue groups or pet therapy organizations such as Pet Partners (a national organization that promotes positive human-animal interactions) are ways to save pets’ lives, and possibly your own.
By Allison White, ACSW, LCSW, CCDP-D
https://www.nami.org/Blogs/NAMI-Blog/November-2016/The-Power-of-Pet-Therapy
