Coping with Anxiety & Depression: A Conversation with a ... Depression... · Coping with Anxiety & Depression: ... The unpredictableness of diabetes –humans prefer control ... EdD

Coping with Anxiety & Depression: A Conversation

with a Psychologist/PWDNicole Bereolos, PhD, MPH, CDE

Clinical psychologist/certified diabetes educator/PWD (type 1 x25 yrs)

DiabetesSisters/Diabetes Unconference, Alexandria, VA

October 15, 2017

What we already know.

• Diabetes SUCKS for PWD and those that love them!!

• It takes a LOT of work to try to manage diabetes

• Life, by itself, has too much stress and diabetes is just “icing on the cake”

Diabetes & Depression (Roy & Lloyd, 2012)

• Type 1

• 12%, range 5.8–43.3% vs. 3.2%, range 2.7–11.4% (with vs without type 1)

• 3x higher

• Type 2

• 19.1%, range 6.5–33% vs. 10.7%, range 3.8–19.4% (with vs without type 2)

• 2-3x higher

• Higher in women (with and without diabetes)

What is clinical depression?

• Per DSM-5 (2013)

• Must be present for at least 2 weeks

• Must cause clinically significant impairment

• Must have either depressed mood or loss of interest/pleasure

• And… (5 or more of the following)

• Significant weight loss or gain or changes in appetite

• Insomnia or hypersomnia

• Moving faster or slower than usual

• Fatigue or loss of energy

• Feelings of worthlessness or guilt

• Diminished ability to concentrate or make decisions

• Recurrent thoughts of death or suicidal ideation

Diabetes Distress

• unique, often hidden emotional burdens and worries that are part of the spectrum of patient experience when managing a severe, demanding chronic disease like diabetes (Fisher et al, 2012)

• Compared to clinical depression, diabetes distress affects diabetes self-management behaviors only

• Aka Diabetes Burnout – William Polonsky, PhD, Behavioral Diabetes Institute, San Diego, CA

Anxiety

• “a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome” – dictionary.com

• Overgeneralization of your physical sensations and/or environment

• Important to first rule out low blood sugar and side effects from medications

• Can have physical and psychological symptoms

• Racing thoughts, sweating, palpitations, increased heart rate, nausea, shaking

Diabetes-related Causes of Anxiety

• Constant focus on numbers – blood sugars, HgA1C, weight, cholesterol, etc

• Being judged on those numbers CONSTANTLY

• The unpredictableness of diabetes – humans prefer control

• Effects of food, stress, hormones, emotions, exercise

• Fear of trying new things, being alone, traveling, etc – getting out of comfort zone

Examples of Health Coping (Kent et al., 2010)

• Fulfilling health care obligations (keeps appointments, takes medication)

• Expressing emotions

• Seeking help; looking for answers

• Demonstrating basic problem-solving skills

• Incorporating physical activity into one's life

• Being proactive

• Demonstrating self-efficacy

• Overcoming barriers

• Having an adaptive coping style

• Being motivated

• Being optimistic

Cognitive Behavioral Therapy (CBT)

Resources for Diabetes Distress

• DOC (diabetes online community; #DOC)

• Dr Polonsky

• Ginger Vieira, PWD

Bibliotherapy

• David Burns, MD

• William Knaus, EdD & Albert Ellis, PhD

12

Bibliotherapy

13

National Mental Health Resources

• Agency for Healthcare Research and Quality

• American Association of Suicidology

• American Psychiatric Nurses Association

• *Anxiety Disorders Association of America

• CDC

• *Salvation Army

• *Depressive and Bipolar Support Alliance

• Institute of Medicine

• *Mental Health America

• Mental Health Liaison Group

• National Association for Rural Mental Health

• National Association of Anorexia Nervosa and Associated Disorders

• National Association of County Behavioral Health and Developmental Disability Directors

• National Association of State Mental Health Program Directors

• *1-800-SUICIDE

• National Council for Community Behavioral Healthcare

• *American Counseling Association

• *National Institute of Mental Health

• The National Institute of Alcoholism and Alcohol Abuse

• National Institute on Drug Abuse

• * American Psychological Association

• *SAMHSA

• *Catholic Charities

Personal Moto

• “Which is bigger, you or your diabetes?”

• “Who is in control, you or your diabetes?”

• “Who do you want to win, you or your diabetes?”

Key Take-Aways Simplified

•Balance

•Conversation

• [email protected]