| Diabetes & Fear Why Fear Itself Can be a Diabetic’s Worst Enemy & What You Can Do to Overcome It
by Susan Shaw C.C.Ht. While driving my son Sam to school one morning, I was startled to see a new billboard that had appeared overnight. Huge letters read, "Blindness, amputation, kidney failure, death. Diabetes - its that serious." I felt a stab in the chest like a jagged black knife, as the words brought my own fears up in a flood of adrenaline. My diabetes was accepted as completely normal by my 9-year-old son, so normal, that for most of his life he thought that all moms had insulin pumps. Now, as he sat beside me looking up at the billboard, I was angry that my little boy had to find out about the possible long-term consequences of diabetes in one intrusive instant. I asked a diabetic friend Joan, if she had seen the same ad. She was also with her son in the drugstore, when she noticed a sign at the counter. "Oh, God," she thought to herself. "I hope he doesn’t see that. He internalizes everything. Obviously, the intentions behind the billboard were to raise funds and possibly to encourage early diagnosis of diabetes - worthy pursuits. But, the billboard also exemplifies a long existing practice in the diabetes community, one that exists between diabetics, their loved ones, and the medical profession - the use of scare tactics and fear as an attempt to motivate. ________________________________________________
"What you fear most overtakes you." Proverb ________________________________________________________________________ What is the long-term impact of this presence of negativity and fear in the diabetic community? And, even more importantly, what is the effect of our own fears on our motivation, our sense of wellness, and on our physical health? Take a Look at Your Fear - It Might Surprise You How do you feel when you read these words? BLINDNESS, AMPUTATION, KIDNEY FAILURE - DEATH. Focus in on your feelings for a moment and notice your emotions. Where do you feel those emotions or sensations in the body.... Do you feel suddenly motivated to take better care of yourself? Do you feel afraid? Do you feel hopeless? Sad? Angry? What other emotions or thoughts come to your mind? Is the idea in your mind somewhere that the worst possible complications of diabetes will become part of your future? Think about your future with diabetes, ten years from now, twenty years from now. What kind of mental images are you noticing? What kinds of pictures are you seeing in your minds eye about how your future with diabetes will play out? I ask you to become aware of your deepest fears about diabetes, not to traumatize you, but to notice that fear, more than the reality of your diabetes itself, may be having a substantial impact in your life. Fear may be decreasing your motivation to take care of yourself, your actual level of metabolic control, your ability to enjoy life in the moment, and may even have an impact on your goals, plans and dreams for the future. Although today’s more enlightened diabetes treatment programs strive to communicate concerns about diabetes in a more constructive manner, this billboard is evidence of the fact that scare tactics have commonly been, and still are, widely relied on to educate or motivate. Fear is an ever present and powerful influence for many of us. As a hypnotherapist who often works with diabetic clients, I have found fear is a central issue for people living with diabetes, and can manifest in fears of travel, driving, fear of exercise and even of insulin itself. Asking someone who lives with diabetes about their fears can elicit a surprising array of responses, from fear of hypoglycemia to fear of long-term complications, to fears about being able to perform on the job or to sustain relationships. Studies have shown that diabetics tend to fear insulin reactions as much as they fear long-term complications, leaving some between a rock and a hard place when it comes to blood glucose control. Fear of hypoglycemia is widespread, and according to a 1992 report in Health Psychology, this can lead patients to purposefully maintain elevated blood glucose levels. A German study on coping with fear of long-term complications states, "73% of subjects were concerned about developing late complications, 48% were worried about becoming helpless and requiring long-term nursing care and 44% feared that their children might also develop diabetes. Anxiety levels were particularly high in patients who had experienced hypo- or hyperglycemia in the past, who had been unable to achieve acceptable glycemic control or who had already developed long-term complications."1 One of the deepest fears that diabetics harbor is that of dying early. Joan, a diabetic for over 30-years, gave birth to a healthy son but experienced a dark time shortly thereafter when her diabetic father passed away from a heart attack. Joan felt that her father’s early and sudden death tied into her own fears about diabetes and of dying herself. "I was afraid of something happening to me after having a child," she explained. "It consumed me. I worried that I would end up in the hospital, or that if my number came up, it would turn my son’s life upside down." Joan sought help from a therapist, who disregarded diabetes as a contributing factor to Joan’s depression. Regarding her metabolic control at the time, Joan said, "I just didn’t care." Joan’s experience mirrors the conclusions of the German study that "fear of long-term complications is often coupled with a markedly increased level of depression and a decreased level of acceptance of the diabetes." The Influence of Medical Pessimism Lisa, a diabetic now in her 40’s, recalls her stay at Children’s Hospital when she was a little girl of ten, newly diagnosed with diabetes. A nurse came into her room to turn off the television late one night when Lisa was alone. The nurse seized the opportunity to admonish Lisa in great detail of all the ways in which diabetes could eventually ravage her body if Lisa didn’t ‘take care of herself’. Lisa remembers pieces of the nurses tirade word-for-word. "One day, you’ll wake up, and you’ll be blind," the nurse scolded. "And it can happen just like that." Lisa, especially impressionable as a 10-year-old, fell under the influence of what Andrew Weil, M.D. calls a "medical hex", a manifestation of a pervasive attitude in western medicine known as ‘medical pessimism’. As Dr. Weil explains in ‘Spontaneous Healing’, medical pessimism exists because "too many doctors are deeply pessimistic about the possibility of people getting better, and they communicate that pessimism to their patients and their families." In his book, Spontaneous Healing, Weil cites an example of a patient struggling to recover from ulcerative colitis. The man’s doctor told him, "Listen, I’ve got nothing more to offer you, and chances are you’ll eventually develop colon cancer." Physicians are well aware of a phenomena known as "white coat syndrome", where a patient’s blood pressure rises because of anxiety experienced when the doctor enters the room. When we are anxious, especially if we are worried about our health or in actual physical distress, we are particularly sensitive and suggestible to the proclamations of physicians. As Dr. Weil writes, "Doctors in our culture are invested with the very same power others project onto shamans or priests." The colitis sufferer was unable to sleep for three nights and stated that the idea of getting cancer still ‘haunts him’. Lisa recalls that she had nightmares about going blind throughout her teen years and panicked whenever her vision was blurry on awakening in the mornings, wondering if she had come to the day when she would suddenly be blind. These are not necessarily extreme examples of ‘medical pessimism’ in action. Take a moment to think about the influence of medical pessimism in your life, and see if there are influences which may be effecting you, whether they are subtle or overly dramatic. Why Fear Cannot Motivate You Although gloomy predictions and harsh admonitions about the complications of diabetes might be made by well-intentioned people, those who operate under the influence of medical pessimism are coming from a place of fear and frustration themselves. In the long run, fear has no ability to motivate those who live with diabetes, and living in a state of fear, whether it is downplayed or intense, does great damage to our emotions, the body itself, and ultimately, our ability to hope. "The effect of a medical hex is despair," according to Dr. Weil. If fear had the power to motivate, all of us who saw the ad campaign, "Blindness, amputation, kidney failure - death" would have instantly become models of perfection in all our diabetes self-care routines. Instead, fear has exactly the opposite effect. Remember the results of the German study - the more fear, the greater the depression and the lower the level of acceptance of the diabetes. Joan recalls at age 17 when she was bedridden during an exacerbation of neuropathy pain in her feet. Fortunately, the episode was brief and Joan has had no further difficulties with foot pain for many years. However, she remembers being in bed and looking at a diabetes dictionary with photos of toes infected with gangrene. "The pictures were horrible and they absolutely terrified me," says Joan. However, to this day, "I still don’t check my feet religiously." Many of us who live with diabetes feel constant guilt over all the things we think that we ‘should’ be doing, and also fear the consequences of not doing them. But, the more fear we experience, the less likely we are to perform many important self-care tasks. "You’re in Denial" Denial is another term used to describe the failure to take responsibility for health. However, a more compassionate and in-depth look at the essence of denial shows that the tendency to deny reality is simply a logical and human response to extreme fear. The more fearful a person is of diabetes, the greater the tendency will be to push the reality of diabetes away. My own experience in working with diabetic clients has taught me that the realization that they are in a state of denial, or the experience of being labeled ‘in denial’ by a doctor or therapist, causes great frustration. However, when denial is understood as merely fear, the fear can be acknowledged, dealt with, and often lessened, allowing the person to move forward to face diabetes more directly. Fear and Physiology Fear is a useful mechanism when human beings need to respond quickly to some type of danger. Sudden fear triggers an immediate and intense reaction within the sympathetic nervous system, known commonly as "fight or flight". Cascades of stress hormones prepare the body for action by increasing muscle tension, heart rate, blood pressure and breathing. Coincidentally, the release of stress hormones also adversely effects blood sugar management, as adrenaline blocks the action of insulin. When fear and anxiety are omnipresent, without an opportunity to return to balance, the body mind system remains in a state of tension. Stress inhibits digestion, reproduction, growth, and tissue repair. The long-term havoc that stress creates in the body is now well-known, including a host of complaints such as depression, muscle tension, migraines, hypertension, ulcers and a decreased ability of the immune system to fight infection, to name only a very few. Essentially, fear or stress, in itself, makes us sick. A Self-Fulfilling Prophecy Living in fear of whatever horrible things might happen to us in the future, whether our fear is of hypoglycemia during the night or of what might occur over the next twenty years, confuses the reality of what our quality of life is like right now. Fear makes diabetes itself seem much more threatening, and, in making us less motivated or capable of accepting diabetes and caring for ourselves, the likelihood of complications or worsening of complications actually increases. Fear is a self-fulfilling prophecy--fear creates more fear. What you fear most overtakes you, and what you focus on, becomes your reality. In living with diabetes, the mechanism that sometimes makes us less than we could be, less capable of enjoying life, is not necessarily diabetes, but simply - fear. Countering the Fear Response Herbert Benson, M.D. of the Mind Body Institute at Deaconess Hospital and Harvard Medical School, coined the term ‘the relaxation response’ to describe the inherent ability of the body to achieve a healing state of focus and calm. Almost the exact opposite of ‘fight or flight’, the parasympathetic nervous system functions to allow the entire body mind system to return to homeostasis. Metabolism slows down, the body requires less oxygen, tense muscles are loosened, and the body’s organs and systems can rest under less demand. Blood pressure, breathing, heart rate and muscle tension decrease, and the brain itself generates slower, anxiety relieving brain waves, conducive to calm and focus. How do we ‘turn on’ the relaxation response? Doctors once believed that the parasympathetic nervous system was beyond our conscious control. However Dr. Benson states that we can ‘call’ the relaxation response at will, using simple meditatitive or self-hypnotic techniques like repeating a soothing word or prayer. Dr. Benson also recommends focused exercise like walking, while passively disregarding intrusive thoughts to focus the mind. The ability to experience intense states of relaxation is inherent in each individual. The practice of eliciting the relaxation response repeatedly has been shown to reduce anxiety and depression, reduce hypertension, decrease chronic pain and insomnia, and even decrease cardiac arrhythmias. The positive effects of relaxation are cumulative, and can balance out the long-term damage that stress does to the body and emotions. The Benefits of Confronting Fear The German clinical program designed to alleviate fear of long-term complications in diabetes included relaxation training, ‘fantasy’ exercises to encourage participants to ‘dream new dreams’ for the present and the future, as well as direct confrontation and exploration of fears through discussion. Additionally, diabetics were asked to ‘put their diabetes into perspective’ by describing what is positive about their lives, and to formulate action plans to make any desired changes. After only 7 sessions, some individuals showed marked improvement in metabolic control. The study concluded that "the patients have become more confident about dealing with potential complications and have become more involved in activities that provide subjective improvement in the quality of their lives". Overall, the participants showed decreased anxiety, and an increased ability to be flexible and accepting with regard to diabetes and its management. A study at the State University of New York used hypnotherapy as a positive approach to improve compliance in adolescent diabetics. The researchers asserted that diabetic teens, when educated about the ability of "good" glycemic control to prevent complications that could take place 30 years in the future, developed the belief that these complications would occur only in others and in the elderly, never in them. Clearly, more emphasis on the possibility of complications would have no benefit. Instead of reinforcing the goal of avoiding negative experiences in the long-term, the teens benefited from setting personally meaningful goals which were achievable over the next few years. One teen expressed a desire to be a fireman. Hypnosis was used to allow the boy to experience achieving his dream, making the experience ‘real’ to the point of noticing the buttons on the fireman’s uniform as he rode on the fire truck. Patients used self-hypnosis to reinforce that they could achieve positive, meaningful goals while being "the boss of their disease". The study concluded that in a group of 7 "non-compliant" teens, the average HbA1C dropped from 13.2% to 9.7%, and the average fasting blood sugar from 426 to 149 mg/dl.2 Secrets to Lasting Motivation As Joan’s grief and depression subsided, Joan was motivated to become an insulin pumper and to care, once again, about her metabolic control. "When I’m on task and taking care of myself, I’m more clear and positive. I don’t harp on the doom and gloom," she says. As an adult, Lisa sought more education about retinopathy and learned that its progress is usually slow and very much treatable, and she no longer fears blindness. Clearly, fear and anxiety are in themselves, barriers to wellness, rather than motivators. When we hear some bad news about the onset of complications in a diabetic friend or relative, the initial jolt of fear may inspire us to cling tighter to our blood glucose meters, and resolve privately to work harder at maintaining control. However, those kinds of resolutions are usually short-lived. The ability to maintain motivation that lasts, and to live well with minimal fear and anxiety, lies in combating fear through practicing relaxation, and believing in and achieving goals that enhance a sense of purpose and appreciation of life. Diabetes Without Fear - Develop Your Own Personal Program Remember that you are a human being first and a diabetic second, and your value as a person has no relationship to whatever your blood glucose number might be in the moment. Don’t let your disease be your world. Knowing that fear can only negatively impact your emotions, your body, and your metabolic control, make a resolution to release it. Instead, find ways to constantly increase your belief in your ability to live long and well, and to be healthy and productive. You’ll notice that the more you simply enjoy your life, the more motivated you are to maintain control of your diabetes so that you can keep pursuing what makes life meaningful for you. Decide that Your Outcome is Your Own Become aware of the influence of medical pessimism in your life and decide whether or not the information you are exposed to has any relevance for you. Learn everything you can, know the statistics, and then just decide which side of the statistics you plan to be on. Are you overly fearful because of stories about unfortunate incidences that happened to other diabetics? Just as watching the 11 o’clock news gives us a view of the world that magnifies only tragedy and trauma, we may be overly influenced by stories of bad outcomes while overlooking the positive. Take stock of where you are with your life and your health, and decide to be responsible for your own outcome. Practice Regular Relaxation Learn to activate the ‘relaxation response’ through self-hypnosis, prayer, or meditation and practice relaxing often. Remember that relaxing counters the damaging effects of stress hormones on the body and the metabolism. Learning to relax will have a positive impact for those diabetics who believe that stress has an negative impact on their blood glucose numbers, Set Meaningful Goals Set personal goals that infer that you will be healthy enough to achieve them, and then do them! Make sure that your goals include physical activity that you truly enjoy. Include goals that are achievable in the near future, as well as long-term goals. Write them down. Goals that motivate you to stay well can be as simple as designing and planting the garden you’ve always wanted, planning a special trip for your family, or just getting your bicycle out of the garage and riding around the block a few times. Reinforce Belief with Guided Imagery Just as our would-be fireman increased his motivation and decreased his HbA1C by riding on the fire truck during self-hypnosis, you can use guided imagery and/or self-hypnosis to experience your goals and dreams as if you have already achieved them. (Diabetes Interview; September 1997) Imagery, sometimes called ‘visualization’ is not unlike meditation or daydreaming. Simply find a quiet comfortable place, close your eyes, and allow your waking I love and approve of myself. I love and approve of my body. I feed it nourishing foods and beverages. I exercise it in ways that are fun. I recognize my body as a wondrous and magnificent machine and I feel privileged to live in it. Affirmation to release fear, from Louise Hay dream to unfold. Repeatedly using guided imagery to experience positive visions of the future reinforces belief that the future you envision will indeed become your reality. Fear will have little effect on your state of mind when you truly believe that you will continue to be healthy and happy. You can ‘image’ damage to your body healing, what your day will be like with nice stable blood glucose levels, and any activity or pursuit that having good metabolic control would help you to enjoy. Make sure to spend at least 20 minutes focusing quietly on the experience and allowing it to feel ‘real’, as you notice all the sights, sounds, colors and emotions associated with it. Re-evaluate Where You Are How much of your attitude about diabetes is based on exactly what your health is like now, and how much is based on fear of what may come in the future? With such an intense focus on prevention of complications in diabetes treatment today, sometimes we forget that basically, in the present, we are really doing ok. Fear of the future may be detracting from your ability to appreciate your ability to function in the present. When encouraged to relax and focus in on the physical body, for diabetics, the realization often is a sense of surprise that the body is essentially healthy and even miraculous, in spite of diabetes. "My body works!" one diabetic client said, smiling. "And it works pretty well."
About the Author: Susan Shaw, a diabetic for 30 years, is a Certified Clinical Hypnotherapist with offices in Tarzana, and Calabasas, CA.. She offers individual and group sessions, teaches guided imagery for Hypnotherapists, and a 6-week workshop called, "Diabetes Mind & Body". Susan welcomes your questions and comments and can be reached by calling 818/347-8120 or go to her Website by clicking here
The Stigma Against Diabetes By Susan Shaw C.C.Ht. Many of us who live with diabetes live with a sense of failure, frustration and fear of complications. Directed to follow strict guidelines for eating, medications, blood glucose testing, record keeping and more, few of us ever feel that we measure up. Tight standards for glycemic control have become a double-edged sword. If we meet those standards, we are helping to prevent long-term complications. But when our HbA1c number is elevated, the fear of onset or worsening of complications increases and a sense of failure grows. "I’m a diabetic, but I’m bad," people often say to me, as if their guilt is so great they feel compelled to confess their inadequacies. Suspending Blame and Fear The medical community constantly reminds us of the most devastating complications of diabetes, hoping to motivate us to care for our bodies. We might resolve to do better, but each new resolution lasts only a short while, before we fall back into behavior patterns that are familiar and comfortable. Why do our best intentions often fail? The subconscious mind is a ‘life script’ that holds the learned beliefs that determine our behavior. Willpower always loses. The battle against the more powerful subconscious belief system. For example, when we resolve to follow a diet, if the subconscious views overeating as a source of comfort and stress relief, our ‘diet’ only lasts until life’s ups and downs trigger us to fall back into the familiar pattern of eating for comfort. Reminders that we may lose our eyesight, endure amputation or lose kidney function generates tremendous fear. Fear only provides motivation if a traumatic
life event is powerful enough to jar the subconscious. Usually, motivation
from fear lasts only for the short run. "The path to living more
comfortably with diabetes may lie within." Additionally, fear brings
a long-term negative effect of increasing anxiety. These emotions, in
themselves, generate a stress response in the body which in turn, negatively
impacts blood glucose control. Essentially, others reminding us, and even
telling ourselves that we need to live differently with diabetes only
serves to keep us in a state of self-blame and anxiety. Because diabetes is such a complicated disease and it is our own responsibility to manage it, education about diabetes always comes first. We need a thorough understanding of the dynamics of food, insulin and medication, exercise and all the nuances which affect our bodies. But. if you thoroughly understand the nuts and bolts of diabetes, and you are not at peace with your health, weight or glucose management, the path to living more comfortably with diabetes may lie within. Creating Lasting Change So, how do we change our lifestyle and habits, improve blood glucose control, and live with more freedom from anxiety and fear? The only way to create long-term, lasting change is to change the subconscious script, thus changing beliefs about who we are, how we respond to diabetes, and building a sense of expectation that we can and will enjoy long, healthy, active lives. Each of us is on a special and personal journey with diabetes. Learning more about ourselves and our diabetes can ultimately add more meaning to our lives. Following are some of the steps that may help you to enjoy your living, with diabetes more fully. Quieting the Mind and Relaxing the Body. The relationship between poor glucose control and stress is well known. Stress and anxiety releases stress hormones, which interfere with insulin action and increase glucose release. Also, it's much more difficult to stick with self-care when routines are disrupted by stressful life events. "The frustration of the greatest revelation of our generation is the discovery that human beings, by changing the inner attitudes of their minds, can change the outer aspects of their lives." - William James poor diabetes control
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