May is mental health awareness month, and it is no secret that mental health + diabetes are intimately connected. Mental and emotional health is essential for overall health with and beyond diabetes. But people with diabetes are up to 50% more likely to develop mental health conditions like anxiety and depression due to immense self-care requirements and physiological changes(blood glucose dysregulation, digestive distress, sleep disruption).
This month, I'm offering yoga psychology tools for transforming thought, mood, and behavior with diabetes.
To start, we're looking at thought and cognition. The ancients described the energy of intelligence and knowledge as jñana shakti. Jñana is to know and possess insight, essential skills for managing diabetes. When the mind and body are disturbed by illness, worry, or obsession, our innate intelligence cannot shine through and inform our decisions.
According to yogic philosophy, we are constantly incurring new impressions from our experiences. Every experience that we have, whether positive or negative, leaves an imprint in our mind, through which we see the world. So, let's consider diabetes, a disease we do not receive a manual for and one that we have to learn through trial and error.
Our minds will hold onto negative experiences more readily than positive ones, forming deep grooves in our subconscious. It is estimated that it takes about five positive experiences to counteract one negative one. Considering this, it is no wonder that we can hold negative perceptions, biases, and thoughts regarding diabetes and our competency in taking care of it.
The thoughts we have about diabetes, expectations of treatment requirements, and our perceptions of how well we can handle the task will influence our attitudes about diabetes and, ultimately, our engagement in management (1)
There is a positive correlation between improved A1c outcomes, reduced anxiety and depression, and increased quality of life with T1DM and T2DM patients who feel effective at management, even when they make mistakes (2).
But this is not for everyone. The nature of the mind is to grip onto the negative. The ancients knew this, so they devised practices to help us rewire our thoughts, release and transform negative experiences into our strengths.
In both T1DM and T2DM, patients who believed they were worse off because of diabetes reported poorer physical functioning. Lower beliefs in treatment effectiveness yielded the weakest perceptions of health (4).
The silver lining is that beliefs, thoughts, and perceptions are changeable, implying that altering thought patterns could enhance self-management effectiveness and glycemic control.
How to Flip the Switch
To transform thought, we must go deeper than the constant chatter and look at what underlies our thoughts; and these are our core beliefs. Core beliefs are automatic, formed by past experiences, and activated by internal and external triggers. It is essential to recognize that core beliefs are not true; they are learned patterns from past experiences. We perceive them to be accurate, so they become our reality.
A common core belief in diabetes is: "I will never get my diabetes in control".
This core belief could be triggered by an suprise high or low, an undesirable A1c, or a person's comment, "should you really be eating that?"
Having a Conversation with Yourself, About Yourself
We can transform core beliefs through self-inquiry by asking ourselves questions and testing them against reality.
The first step is to identify the core belief - Look for a consistent thought pattern that repeats itself. A common core belief with diabetes is:"I will never get my diabetes in control."
The second step is to test whether the belief is helpful or harmful to your goal. Ask yourself questions like:
The third step is to transform an irrational thought into a helpful one - this is a process in yoga called praktipasha bhavana - or "cultivating the opposite".
Yoga Sutra 2.33 says when we have a conflicted view, we contemplate the situation from another perspective. In psychology, this process is called "benefit-finding." Studies show that teens with type 1 diabetes who can find a lesson in their diabetes management mistakes are more likely to have a better A1c (6).
It is not as simple as saying "serenity now" every time we notice an undesirable thought surfacing. Instead, it becomes an active meditation where we reflect on our thoughts without reactivity—when we see a harmful thought surfacing, we test its validity and then alter it with awareness.
Praktipaksha bhavana does not mean we deny the negative; diabetes is not all skittles and rainbows after all, and life would certainly be a lot easier without diabetes. But it suggests that we hold both the negative and positive together. If it were not for these challenges, I would not be half the person I am today. Because of diabetes, I have a greater understanding of myself and my body. I have more compassion for others and understand what self-discipline means.
(1)Snoek, Frank J., and T. Chas Skinner, editors. Psychology in Diabetes Care. 2nd ed, John Wiley & Sons, 2005, pp 215.
(2) McGonigal, Kelly. The Upside of Stress. 1st ed, Avery, 2015, pp 203.
(3)McGonigal, Kelly. The Upside of Stress. 1st ed, Avery, 2015, pp 202, Harvey, J. N., and V. L. Lawson. “The Importance of Health Belief Models in Determining Self-Care Behaviour in Diabetes.” Diabetic Medicine, vol. 26, no. 1, 2009, pp. 5–13. Wiley Online Library, doi:https://doi.org/10.1111/j.1464-5491.2008.02628.x.
(4) Harvey, J. N., and V. L. Lawson. “The Importance of Health Belief Models in Determining Self-Care Behaviour in Diabetes.” Diabetic Medicine, vol. 26, no. 1, 2009, pp. 5–13. Wiley Online Library, doi:https://doi.org/10.1111/j.1464-5491.2008.02628.x.
(5) Snoek, Frank J., and T. Chas Skinner, editors. Psychology in Diabetes Care. 2nd ed, John Wiley & Sons, 2005, pp 215.
(6) McGonigal, Kelly. The Upside of Stress. 1st ed, Avery, 2015 203
mental health yoga therapy diabetes
Evan Rachel Soroka