By Rosie Walker of Successful Diabetes and Jen Nash of Positive Diabetes
Last Friday was International Happiness Day, a very enjoyable-sounding occasion when the world’s happiness quotient is focused on. People were asked on TV stations, radio and around the world ‘what makes you happy ?’ and contributed such aspects of their lives as children, long walks, sunsets and chocolate cake! One report on the BBC showed a café offering massage and laughter therapy to promote happiness!
All that may sound a bit trivial, obvious even, but there is a serious message behind the day, which is that more and more people, and younger people, report feeling lonely. Loneliness leads to isolation, low self esteem, a lack of self-worth and even feelings of not wanting to live anymore. It can also lead to physical ill health, which can all add up to a vicious circle of misery. Knowing this, the simple ways of trying to help make people happier, look much more important.
Happiness is also a factor in the ‘Emotional HBA1C’ – that’s HbA1c, but with the letters creating different meaning from the traditional. Recently, at Diabetes UK’s annual conference, we presented this emotional version, one where instead of being short for the medical terms ‘Haemoglobin’ and ‘A1c’, the letters stood for psychological factors which can also contribute to this all-important result, upon which so many decisions in diabetes care are made. However, these factors are often ignored in diabetes care services. We believe that being more aware of them can help people with diabetes and health professionals alike: Here’s what our HBA1C letters stood for, and why: .
Happiness: Being happier and relaxed – or, put another way, less stressed and distressed - can reduce blood glucose levels.
Balance: Looking after diabetes enough, in the face of all the pressures of ‘real life’, contributes to keeping a health balance which in turn influences blood glucose.
Attachment: Negative family experiences in early life can sometimes make it difficult later to look after diabetes and form relationships, including with health professionals. This might lead to less attention on diabetes care and, in turn, HbA1c.
1st things first: Being able to prioritise diabetes care, when it needs attention is likely to lead to better health. Diabetes can be thought of as a baby who demands the caregivers’ full attention, even when they are busy with something else. Working out how to look after the ‘diabetes baby’, however disliked, can positively affect the HbA1c result.
Curiosity: for the person to be curious about their own diabetes and identify the factors and strategies which work for them personally and they can cope with, makes a big difference to the end result of HbA1c.
For health professionals, these ‘emotional HBA1C’ factors give clues to how to create an environment in a consultation, meeting or education session, that pays attention and actively discusses how the person is coping emotionally as well as discussing the medical aspects. An example of a ‘health professional emotional HBA1C’ might look like this:
Help people to define their main issue of concern.
Be accepting of the person’s point of view.
Acknowledge feelings as well as practical content.
1 main idea or insight to take away from the encounter .
Concentrate on person’s agenda.
Our workshop was very well received and attended and we’ve created a full summary, including the participants’ reflections at the end and the slides we used to explain the ‘Emotional HBA1C’ in more detail and the evidence for it. We invited people to create their own ‘Emotional HBA1C’ of the aspects of diabetes they felt influenced the medical HbA1c, and use it in their life and work with diabetes. .
We invite you to download the workshop summary and we hope this new way of looking at HbA1c inspires you. If you decide to create your own ‘Emotional HBA1C’, perhaps you’d share it with us, here?
Wishing you happiness, today and for the future!
Positive Diabetes
Successful Diabetes
Showing posts with label emotions. Show all posts
Showing posts with label emotions. Show all posts
Sunday, 22 March 2015
Monday, 26 January 2015
The Blueprint to Weight Loss?
In our first guest blog, clinical psychologist and specialist in emotional eating, Dr Jen Nash gives us plenty of ‘food for thought’!
We are in the midst of an overweight and obesity epidemic and whilst current health education messages are doing well to raise our awareness of the need to ‘eat less and move more’, we know for every person who can implement this advice, there are many more who struggle. This leads to a sense of failure and increased hopelessness, for both the individual who is overweight, and the healthcare professionals involved in their care, who quickly reach the limits of their perceived ability to help them.
Traditional medical and diet advice seems to treat weight loss as if it is a logical, rational process – for example, there is often an assumption that education alone leads to behaviour change. But knowledge doesn’t always lead to desired change, does it? How do we know this? Partly because many NHS health care professionals themselves struggle as much as those who they help – if not with their weight, then perhaps with their choices around alcohol, exercise, nicotine and other health decisions.
If we are increasingly aware of what we ‘should’ be doing to care for our health, what gets in the way of being able to implement these recommendations? Oftentimes we will sigh, “I’m just not motivated”.
I’d like to suggest that you ARE motivated! You don’t usually have to ‘motivate’ yourself to get dressed in the morning, or clean your teeth, or kiss your child goodbye, or turn up for work. You probably don’t talk about ‘getting motivated’ to do these tasks of life. Why? Because these activities are in line with your identity, your self-esteem and your values. You value your child feeling loved as they go to school, so you organise yourself to wave her off in the morning. You value not breathing your garlic breath from last night’s dinner on your colleagues, so you organise yourself to make time to brush your teeth in the morning!
So we are all motivated to do EXACTLY the right thing for us, given not just one, but two aspects of our experience:
1. Our knowledge + information
2. Our emotions + values
Medical and health educational models are great at the first part – imparting knowledge and information - but where in our health care settings are we talking about emotions and values?
These conversations are largely absent when it comes to discussing diet and weight loss, yet it is our emotions and values that are the bridge between ‘knowing something’ and ‘doing it’. These are the guide to all our decisions in life; including our decisions about our health and what to eat. Psychological models address emotions, but access to a clinical psychologist for people with obesity, whilst recommended by national guidelines, is extremely limited in current services.
‘The EatingBlueprint’ is a novel way for non-psychologists to start addressing the psychology of weight loss, without the jargon and potential stigma of some of the traditional psychological approaches. It is based on a blend of evidence-based psychological therapies (including solution-focussed, dialectical, compassionate, mindfulness, cognitive-behavioural and attachment approaches, for those who are interested in the detail!).
The logic of the blueprint is that trying to simply follow a diet to create the body/weight you want, without looking at the emotional ‘mindset’ about eating, is like trying to build a house before laying the foundations.. Strong foundations are needed to build a house – and a blueprint is needed as a guide. The EatingBlueprint is designed to support the development of the emotional mindset foundations necessary for both weight loss success and maintenance. To continue the analogy, the blueprint for the house’s foundations contains rooms, and in the EatingBlueprint, these ‘rooms’ are:
1. Forgiveness
2. Focus
3. Fun
4. Feelings
5. Foresight
6. Fables
7. Framework
8. Future
Let me talk you through the ‘rooms’
1. Forgiveness
The blueprint begins by normalising the idea that it is difficult to lose and maintain a healthy weight. We are fighting a biological, psychological and environmental/social world that is set up to promote weight gain, and the person is not “wrong” or “bad” for being overweight. This step is designed to provide relief from shame and stigma and set the scene for an approach that isn’t about success or failure, rather one that involves self-discovery.
2. Focus
This area aims to encourage the noticing and overcoming of “mindless” eating. While it is usual to eat mindlessly for non-hunger reasons occasionally, we can be helped by the use of strategies to interrupt frequent mindless eating. This can be encouraged using a simple question: “WHY am I eating?” or, simply, “WHY?” WHY is an acronym that stands for:
• Wait
Remembering to pause before eating is challenging – so, in the short term, the person is invited to use a reminder on their dominant hand or wrist (e.g. a charity band - members of the EatingBlueprint receive a subtle wrist band as a reminder). This is just a short-term strategy until the automatic nature of eating becomes interrupted.
• Hungry?
This invites the person to ask themselves, “Am I really hungry? How physically hungry am I, on a scale of 0–10? If I’m not hungry, what AM I hungry for?” (e.g. for a break, as a reward, for a distraction, to cheer myself up or to bond with someone).
• Yes
This relates to saying ‘yes’ to the food or ‘yes’ to whatever the person is truly hungry for. If the person is physically hungry, this involves saying “Yes” to food and eating. If the person is not truly hungry and still eats, that’s okay too. Change takes time and the act of simply pausing brings an awareness to what was an unconscious process.
The power in this area is to help the person to discover what they are truly “hungry” for and ask themselves whether they can get their hunger met by something other than food. In time, they can begin to say ‘yes’ to this identified need, instead of the food.
The areas of the blueprint that follow are designed to help increase the flexibility to choose between a range of responses to food.
3. Fun
Eating is pleasurable and entertaining and it can become “a friend”. The person may need help to look for ways to increase non-food sources of pleasure and entertainment when there is an urge to eat for non-hunger reasons.
4. Feelings
It is common to use food to “stuff down” emotions that are not easy to express. It is a skill to be able to express emotions authentically to both ourselves and others and we often need strategies to express emotions rather than to dull them with food. The EatingBlueprint provides a template for identifying and expressing feelings in ways other than through food.
5. Fables
These are the family stories and rules about food, spoken and unspoken. Phrases like “eat your vegetables before having dessert” and post-rationing sayings such as “don’t waste food” and “finish everything on your plate” have value, but we need to question the modern day utility of these ideas and create more helpful narratives that serve us.
6. Foresight
To continue to maintain a healthy we need to know ourelves, learn from previous life experiences and manage their thinking styles relating to food. This step encourages the person to plan ahead and learn from the “predictability of life” (e.g. Christmas and meals out) and think about how to use this self-knowledge to experiment with new behaviours. It also invites the person to challenge the “good/bad” rules of diets using cognitive behavioural therapy techniques.
7. Framework
Weight loss isn’t a solo journey. The impact of family influence, the physical environment and handling social events are all crucial. The person needs assertiveness skills to be able to say “no” to the “feeders” in their lives, and to spot the signs of sabotage, often by well-meaning but threatened loved ones. The blueprint aims to provide these skills.
8. Future
Weight loss is a skill, yet we don’t treat it as being in this paradigm. Like learning to drive a car, it is a process that requires coaching and facilitation, and “mistakes” and “slipups” are an integral part of the journey that need to be welcomed. The blueprint teaches how to “update the default” and stay solution-focused on the weight loss journey.
The Psychology of Weight Loss in the NHS
None of the areas of the EatingBluprint are 'rocket science', so why aren’t we systematically addressing them? Arguably, because obesity is treated within a medical model, and considered a medical/educational problem, not an emotional or psychologically related one. NHS Clinical Psychologists and therapists are generally limited to offering structured cognitive behavioural therapy (CBT), in an individual or small group format, as recommended by UK national guidelines, so these ideas aren’t particularly available to staff to utilise.
Do people struggling with obesity need to work with a Clinical Psychologist? Controversially, I say perhaps yes, because there is quite a body of evidence that suggests many who routinely use food for emotional regulation have a history of psychological issues. The incidence of trauma, childhood abuse, sexual abuse, low self-esteem and depression is high among people who are obese and in those presenting for weight loss surgery. Despite this, access to psychological services for obese people has been limited to screening for psychiatric disorders in preparation for bariatric surgery.
Whilst certainly surgery is an option for some, if we view obesity as (in part) a problem with emotions, then bariatric surgery is attempting to put a plaster on a very deep emotional wound. This may go some way to explain why this type of surgery is less successful than expected. Achieving and maintaining a healthy weight requires skills of emotional regulation and the ability to tolerate distress - in other words it takes a highly developed person. We need to widen the scope of clinical psychology and other health professionals working in the field of obesity, to empower people with:
• skills to be able to identify their emotions
• strategies to make a choice other than food
So the person is in control, not the food
Interested in finding out more about the EatingBlueprint?
The EatingBluerint is a 12-week online weight loss support programme, that empowers members to master their inner relationship with eating, through bitesize videos (10-30 mins each) with accompanying ‘experiments’ to implement new weight loss skills in daily life. If you’re someone struggling to lose weight, or a health care professional interested in using the EatingBlueprint method in your routine consultations, you can get your Free E-Course – ‘Why the F*** Are We So Fat?!’ by visiting the PsychBody website
Training workshops in the EatingBluperint Method can be organised by contacting Dr Jen Nash, Clinical Psychologist directly at hello@psychbody.com or via enquiries@successfuldiabetes.com
What do you think of Dr Jen’s ideas? Share your response and insights here and let’s discuss this important issue and this unique way of looking at it
We are in the midst of an overweight and obesity epidemic and whilst current health education messages are doing well to raise our awareness of the need to ‘eat less and move more’, we know for every person who can implement this advice, there are many more who struggle. This leads to a sense of failure and increased hopelessness, for both the individual who is overweight, and the healthcare professionals involved in their care, who quickly reach the limits of their perceived ability to help them.
Traditional medical and diet advice seems to treat weight loss as if it is a logical, rational process – for example, there is often an assumption that education alone leads to behaviour change. But knowledge doesn’t always lead to desired change, does it? How do we know this? Partly because many NHS health care professionals themselves struggle as much as those who they help – if not with their weight, then perhaps with their choices around alcohol, exercise, nicotine and other health decisions.
If we are increasingly aware of what we ‘should’ be doing to care for our health, what gets in the way of being able to implement these recommendations? Oftentimes we will sigh, “I’m just not motivated”.
I’d like to suggest that you ARE motivated! You don’t usually have to ‘motivate’ yourself to get dressed in the morning, or clean your teeth, or kiss your child goodbye, or turn up for work. You probably don’t talk about ‘getting motivated’ to do these tasks of life. Why? Because these activities are in line with your identity, your self-esteem and your values. You value your child feeling loved as they go to school, so you organise yourself to wave her off in the morning. You value not breathing your garlic breath from last night’s dinner on your colleagues, so you organise yourself to make time to brush your teeth in the morning!
So we are all motivated to do EXACTLY the right thing for us, given not just one, but two aspects of our experience:
1. Our knowledge + information
2. Our emotions + values
Medical and health educational models are great at the first part – imparting knowledge and information - but where in our health care settings are we talking about emotions and values?
These conversations are largely absent when it comes to discussing diet and weight loss, yet it is our emotions and values that are the bridge between ‘knowing something’ and ‘doing it’. These are the guide to all our decisions in life; including our decisions about our health and what to eat. Psychological models address emotions, but access to a clinical psychologist for people with obesity, whilst recommended by national guidelines, is extremely limited in current services.
‘The EatingBlueprint’ is a novel way for non-psychologists to start addressing the psychology of weight loss, without the jargon and potential stigma of some of the traditional psychological approaches. It is based on a blend of evidence-based psychological therapies (including solution-focussed, dialectical, compassionate, mindfulness, cognitive-behavioural and attachment approaches, for those who are interested in the detail!).
The logic of the blueprint is that trying to simply follow a diet to create the body/weight you want, without looking at the emotional ‘mindset’ about eating, is like trying to build a house before laying the foundations.. Strong foundations are needed to build a house – and a blueprint is needed as a guide. The EatingBlueprint is designed to support the development of the emotional mindset foundations necessary for both weight loss success and maintenance. To continue the analogy, the blueprint for the house’s foundations contains rooms, and in the EatingBlueprint, these ‘rooms’ are:
1. Forgiveness
2. Focus
3. Fun
4. Feelings
5. Foresight
6. Fables
7. Framework
8. Future
Let me talk you through the ‘rooms’
1. Forgiveness
The blueprint begins by normalising the idea that it is difficult to lose and maintain a healthy weight. We are fighting a biological, psychological and environmental/social world that is set up to promote weight gain, and the person is not “wrong” or “bad” for being overweight. This step is designed to provide relief from shame and stigma and set the scene for an approach that isn’t about success or failure, rather one that involves self-discovery.
2. Focus
This area aims to encourage the noticing and overcoming of “mindless” eating. While it is usual to eat mindlessly for non-hunger reasons occasionally, we can be helped by the use of strategies to interrupt frequent mindless eating. This can be encouraged using a simple question: “WHY am I eating?” or, simply, “WHY?” WHY is an acronym that stands for:
• Wait
Remembering to pause before eating is challenging – so, in the short term, the person is invited to use a reminder on their dominant hand or wrist (e.g. a charity band - members of the EatingBlueprint receive a subtle wrist band as a reminder). This is just a short-term strategy until the automatic nature of eating becomes interrupted.
• Hungry?
This invites the person to ask themselves, “Am I really hungry? How physically hungry am I, on a scale of 0–10? If I’m not hungry, what AM I hungry for?” (e.g. for a break, as a reward, for a distraction, to cheer myself up or to bond with someone).
• Yes
This relates to saying ‘yes’ to the food or ‘yes’ to whatever the person is truly hungry for. If the person is physically hungry, this involves saying “Yes” to food and eating. If the person is not truly hungry and still eats, that’s okay too. Change takes time and the act of simply pausing brings an awareness to what was an unconscious process.
The power in this area is to help the person to discover what they are truly “hungry” for and ask themselves whether they can get their hunger met by something other than food. In time, they can begin to say ‘yes’ to this identified need, instead of the food.
The areas of the blueprint that follow are designed to help increase the flexibility to choose between a range of responses to food.
3. Fun
Eating is pleasurable and entertaining and it can become “a friend”. The person may need help to look for ways to increase non-food sources of pleasure and entertainment when there is an urge to eat for non-hunger reasons.
4. Feelings
It is common to use food to “stuff down” emotions that are not easy to express. It is a skill to be able to express emotions authentically to both ourselves and others and we often need strategies to express emotions rather than to dull them with food. The EatingBlueprint provides a template for identifying and expressing feelings in ways other than through food.
5. Fables
These are the family stories and rules about food, spoken and unspoken. Phrases like “eat your vegetables before having dessert” and post-rationing sayings such as “don’t waste food” and “finish everything on your plate” have value, but we need to question the modern day utility of these ideas and create more helpful narratives that serve us.
6. Foresight
To continue to maintain a healthy we need to know ourelves, learn from previous life experiences and manage their thinking styles relating to food. This step encourages the person to plan ahead and learn from the “predictability of life” (e.g. Christmas and meals out) and think about how to use this self-knowledge to experiment with new behaviours. It also invites the person to challenge the “good/bad” rules of diets using cognitive behavioural therapy techniques.
7. Framework
Weight loss isn’t a solo journey. The impact of family influence, the physical environment and handling social events are all crucial. The person needs assertiveness skills to be able to say “no” to the “feeders” in their lives, and to spot the signs of sabotage, often by well-meaning but threatened loved ones. The blueprint aims to provide these skills.
8. Future
Weight loss is a skill, yet we don’t treat it as being in this paradigm. Like learning to drive a car, it is a process that requires coaching and facilitation, and “mistakes” and “slipups” are an integral part of the journey that need to be welcomed. The blueprint teaches how to “update the default” and stay solution-focused on the weight loss journey.
The Psychology of Weight Loss in the NHS
None of the areas of the EatingBluprint are 'rocket science', so why aren’t we systematically addressing them? Arguably, because obesity is treated within a medical model, and considered a medical/educational problem, not an emotional or psychologically related one. NHS Clinical Psychologists and therapists are generally limited to offering structured cognitive behavioural therapy (CBT), in an individual or small group format, as recommended by UK national guidelines, so these ideas aren’t particularly available to staff to utilise.
Do people struggling with obesity need to work with a Clinical Psychologist? Controversially, I say perhaps yes, because there is quite a body of evidence that suggests many who routinely use food for emotional regulation have a history of psychological issues. The incidence of trauma, childhood abuse, sexual abuse, low self-esteem and depression is high among people who are obese and in those presenting for weight loss surgery. Despite this, access to psychological services for obese people has been limited to screening for psychiatric disorders in preparation for bariatric surgery.
Whilst certainly surgery is an option for some, if we view obesity as (in part) a problem with emotions, then bariatric surgery is attempting to put a plaster on a very deep emotional wound. This may go some way to explain why this type of surgery is less successful than expected. Achieving and maintaining a healthy weight requires skills of emotional regulation and the ability to tolerate distress - in other words it takes a highly developed person. We need to widen the scope of clinical psychology and other health professionals working in the field of obesity, to empower people with:
• skills to be able to identify their emotions
• strategies to make a choice other than food
So the person is in control, not the food
Interested in finding out more about the EatingBlueprint?
The EatingBluerint is a 12-week online weight loss support programme, that empowers members to master their inner relationship with eating, through bitesize videos (10-30 mins each) with accompanying ‘experiments’ to implement new weight loss skills in daily life. If you’re someone struggling to lose weight, or a health care professional interested in using the EatingBlueprint method in your routine consultations, you can get your Free E-Course – ‘Why the F*** Are We So Fat?!’ by visiting the PsychBody website
Training workshops in the EatingBluperint Method can be organised by contacting Dr Jen Nash, Clinical Psychologist directly at hello@psychbody.com or via enquiries@successfuldiabetes.com
What do you think of Dr Jen’s ideas? Share your response and insights here and let’s discuss this important issue and this unique way of looking at it
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