Approaching the world each day with a bright attitude and a smile on our face is not always an easy task. We are often faced with multiple challenges, many outside of our control, that are stressful, worrying and at times, depressing. Sometimes, it can be difficult to put on a positive attitude for others, let alone ourselves. This becomes even more difficult when trying to manage diabetes, which can be scary, and which requires ongoing adjustments. Unsurprisingly, living with diabetes is commonly correlated with low mood and depression. However, building positive emotion into our daily lives is possible, and can easily be incorporated into our ongoing self-care routines, just like our diabetes management.
Control and Acceptance
One of life’s greatest challenges is facing difficult things outside of our control. We may freeze and hyperfocus on the negative aspects of a situation which makes us feel worse, trapping us in a cycle of defeat. Radical acceptance is an approach to life to help us break free from this cycle. It involves accepting what is outside of our control, while directing our positive intentions to what is within our control. Radical acceptance does not mean we have to be “happy” with difficult situations but recognizes that focusing only on this negatively impacts our emotions. By acknowledging what is outside of our control, we can work within this understanding to live life fully to the extent we can, allowing us to reduce the discomfort of things we cannot change – such as a diabetes diagnosis.
Part of radical acceptance when living with a chronic condition involves self-compassion. When living with diabetes, we may have a self-critical voice that makes us feel worse. Say we have a change in diabetes management and now need to use insulin. Self-critical thoughts such as “this is your fault” or “you might as well give up” can arise, making us want to avoid the use of insulin. We may instead try unrealistic diet or exercise regimens in an attempt to manage blood sugar, which can be difficult to follow leading to further distress and despair.
Radical acceptance and self-compassion would have us approach the situation differently. We would acknowledge the self-critical voice, be non-judgmental to ourselves and try using insulin with a lens of forgiveness and recognizing this will take some time to get right. We can also build self-compassion and acceptance by writing down successes we have had with diabetes management in the past; when the self-critical voice gets activated, we can reread the note out and remind ourselves that we can manage diabetes, in time, despite the difficulties we face. Two things can be true at once: we can be upset with diabetes management, but we can also be kind to ourselves and our self-management at the same time.
Using behaviour and action to build positivity
When we experience a negative emotion, it often makes us feel like we have no energy and can’t do the things we want or need to do. We may, consciously or unconsciously, be avoiding things that could improve our mood, leading to a slippery slope. The more things we avoid that make us feel better, the worse we end up feeling.
A therapeutic tool to re-engage and increase positive emotion is known as behavioural activation. This involves incorporating more positive experiences into our lives despite what our initial negative emotions tell us (e.g. “I’m too tired,” or “Nothing will change how I feel,” etc.). Believe it or not, the saying “Fake it until you make it” is true! Say we have been avoiding socializing with others as we are feeling it won’t make us feel better. With behavioural activation, we would try it anyway and assess how it affected us. More often than not, people are surprised at how much engaging in the activity improved their emotions no matter what their initial mood was telling them. What is clear from research is that increasing positive experiences in our lives, such as through behavioural activation, is strongly correlated with increased mood and motivation.
Behavioural activation can be used when addressing diabetes. Perhaps we have been encouraged by our diabetes educator to prepare more home cooked meals as a way to improve blood sugar control. When we are feeling low this may seem impossible, leading us to make choices that negatively impact our blood glucose and in turn making us feel more disappointed, and the cycle repeats itself. Using behavioural activation, we can start with small steps. Perhaps if making dinner every night feels too overwhelming, we start instead with prepping healthy snacks to take to work instead of choosing an unhealthy option on the run. After doing this for some time we feel more motivated and our mood improves, leading us to feel up to cooking dinner twice in the following week, and building from there. Alternatively, we can try to couple an unpleasant task with a positive activity: so, we make dinner at home and then visit a friend after dinner, as we know seeing them makes us feel better. Soon we begin to realize that the negative voice in our head may not always be right, and doing the avoided activity not only improves our mood but also our diabetes management.
Staying present
In our lives we are often pulled in many directions, which results in negative emotion. We may ruminate on things from our past that we have difficulty accepting, feel upset with aspects of our lives that are challenging, or worry about what the future may bring. With our minds drawn in so many ways at once, it is natural to feel overwhelmed or deflated. Mindfulness gets us to do the opposite – remain engaged in the present moment while accepting, to the extent we can, the aspects that are uncomfortable. By doing so, we minimize our mind wandering to things that distract us and cause discomfort. Similar to radical acceptance, mindfulness is not ignoring the aspects of life that may be difficult but acting in a way to remain present and connected.
When most people think of mindfulness, they tend to think of meditation. While meditation is an example of mindfulness, mindfulness practices are extremely diverse and broad. What works for one person may not work for you, and that’s okay! If meditation feels too tricky, there are sure to be other mindfulness practices that resonate with you. Mindfulness activities can range from structured practices such as meditation, to simple activities you can do throughout the day such as breathing exercises. The key component is engaging with the present moment and what you are doing at the time. Similar to both radical acceptance and behavioural activation, mindfulness is well researched and has been shown to improve positive emotion.
Let’s put this into a diabetes perspective. Perhaps we notice our anxiety peaks around the time we take our insulin or test our blood sugars. Our mind may be racing, negatively anticipating the discomfort of administering our insulin or checking our blood sugars, and expect the worst possible outcome. This can lead to increased anxiety and the avoidance of these crucial diabetes management behaviours, but avoiding them only maintains (and often increases) the anxiety. Incorporating mindfulness involves still doing the insulin injection or blood sugar testing but remaining present in the moment. Perhaps we spend a couple minutes beforehand listening to music and engaging in deep breathing, followed afterwards by going for a walk. While we can’t avoid the negative aspect of our diabetes self-care regimen, mindfulness during the activity can help us ride the wave of discomfort associated with it.
Starting small
Incorporating radical acceptance and self-compassion, increasing positive behaviours and utilizing mindfulness may feel overwhelming. Because of this, as mentioned previously, the best approach is to start small and build over time. Instead of jumping deep into the above techniques, we can start a small trial and error process to see what works for us individually. Some ideas to get you started could include:
- Spending a few minutes each day to acknowledge the difficulties we face, but also reminding ourselves of the positives as well. We can reflect on what we are proud of with regard to our diabetes management, the difficulties we have overcome, and remind ourselves that even though managing diabetes is difficult there is no perfect way to approach it. We can only try our best.
- Incorporating small moments of peace and breaks into our days. Perhaps after coming home after a long day, before we start rushing with errands at home, we take 5 minutes to go for a walk and slow our mind, or play with our pet.
- Instead of engaging with our self-critical voice, think about what we would tell or do to support a friend in the same situation. We are often far more critical to ourselves than those around us, as we recognize doing so would hurt them. By speaking to ourselves how we would a loved one, we can stop negative criticisms in their tracks.
- Finding ways to increase positive experiences into our daily lives despite how small they may seem. Even 10 minutes spent doing something we love or that makes us happy can have a powerful impact on how we feel.
Stress, difficulty and negativity are everywhere in our lives, but it doesn’t mean we have to succumb to them. While we may not be able to change or control what goes on around us, we can take steps to increase our ability to build positive emotion and experiences in our lives. As with anything related to improving our mental health, it is important to recognize this doesn’t happen all at once, but is instead built upon small, incremental changes to how we live day to day. Moving towards a more positive life doesn’t happen by maintaining the status quo; rather, it involves moving purposefully towards changing our daily practices and experiences.
