In addition to the physical health management needs associated with living with diabetes, we hear more and more about related mental health needs. In previous Discuss Diabetes articles, Dr. Paul Ciechanowski provided us with insight into “diapression,” and Dr. Bill Polonsky offered his thoughts on diabetes burnout. In light of the New Year and the establishment of resolutions, I thought it might be a good time to explore the mental health aspects of motivation and goal setting, and how this may be helpful for those living with diabetes. To learn more about this area, I turned to Dr. Amy Walters, Ph.D., Director of Behavioral Health Services at St. Luke’s Humphreys Diabetes Center.
A licensed clinical psychologist, Amy began her career in diabetes care by attending camp. “About 17 years ago, I met with some great nurses who were part of the Idaho Diabetes Youth Program,” she recalled. “They were looking for a psychologist to volunteer at their camp to be able to address some of the social and emotional needs of the kids there. I started volunteering in the summers with Camp Hodia, and just fell in love with the population. I felt like there were so many unmet needs in terms of addressing the difficult emotional part of coping with diabetes.”
When one of Amy’s twin daughters was diagnosed with type 1 diabetes at a young age, Amy’s career path became even more clear to her. “Even though I had no personal connection to diabetes prior to my camp work, I now had a very personal connection through a child living with diabetes,” she said. “It really changed the course of my work and became a focus of my clinical practice.” Soon thereafter, Amy started working with the Humphreys Diabetes Center, where she focused on issues associated with diabetes management.
In her work with diabetes patients, Amy often employs motivational interviewing techniques. “Motivational interviewing is a great approach in how to work with people to help them make changes,” she explained. “We want to build a partnership where we help people identify what’s important to them and what they want to change. By doing so, we can help draw on their own internal motivation for change and help them identify realistic ways to make those changes.”
The first step is to identify someone’s values, priorities and goals. “Having an empathetic relationship with somebody is key,” she said. “We strive to really listen and understand who they are, where they are, and what they want. We systematically target, using motivational interviewing, what areas they think might be helpful to start changing. Understanding that helps us pinpoint a purpose and focus.”
Identifying and understanding barriers to making change is next. “We start looking at what kinds of things are getting in the way of their goals,” she said. “I use a model that looks at a number of different elements of diabetes care, starting with behavioral and emotional elements. We also look at thinking components – the thoughts or beliefs that might be getting in the way of achieving goals. Then we look at environmental components, what in their environment might be impeding their goals. We help them set up an environment that supports rather than sabotages their health goals.”
A barrier Amy often sees is high expectations for “perfect” diabetes care. “There’s a lot to managing diabetes and for some people that can feel very overwhelming,” she said. “They may have that feeling of, ‘I have to do this perfectly every time or what’s the point?’ One of the things we work on is helping people recognize some of those thought patterns that get them into trouble. We try to help people set realistic expectations, find ways to stay motivated and focus on just the next small step instead of expecting mastery of everything at the same time. This helps them to stay engaged in their own change process.”
Amy also notes barriers unique to specific age groups. “With the youngest age group, we work a lot on how parents can help kids be kids and still manage their diabetes,” she said. “When we get into adolescence, parent conflict is probably the number one issue that I see, with needs around testing limits, having independence and getting to make mistakes. In the young adult age group, we often see issues with the life transition of leaving home. Sometimes their parents have had a major role in their diabetes care and now it’s falling to them. Then for many of our adult patients, burnout‘s a really common factor, or just trying to juggle diabetes and all of life’s demands.”
Once people make changes, maintaining them can be a challenge. “It’s not unusual to have a slip up or to struggle again,” she said. “We talk about that, so they can recognize it when it happens. Setting up a positive support system is critical. Families, friends, coworkers and church communities can be really encouraging and inspiring. Having realistic expectations about what they can do and how to achieve it is also key. If they do get to a place where they’re struggling, they can just come in and touch base to get things back on track. We’re here to help them.”
Bumps in the road happen, and that’s ok, according to Amy. “Just because you might struggle one moment doesn’t mean all is lost,” she said. “We can get back on course and keep going. Once you identify your goals and what’s important to you, it gives you direction. Then, if you feel like you’re getting off track, you can focus back on the goal and what you did before that worked. Goals and values serve as a compass to direct our choices and keep us on track.”
I, for one, can certainly relate to bumps in the road related to making healthy lifestyle changes. It’s encouraging to think about identifying one’s priorities and going back to them when motivation may slip. What helps you focus on your goals? I’d love to hear in the comment section below. Be sure to check back later this week to read about Amy’s adventures at diabetes camp.
All the best,
Disclosure: Dr. Amy Walters received no compensation for this post. All opinions contained in this post reflect those of the interviewee, and not of Sanofi US, its employees, agencies or affiliates.