Category Archives: #Stress

On getting rid of negative thoughts …

A depressed young man sat down next to the grey-haired, stooped figure of his elderly grandfather.

Why are you looking so sad and sorrowful?” the old man asked.

Grandpa, I feel like I can’t find any rest, day or night. I feel utterly useless; that I’m a disappointment to all the people I once loved. I feel like I’ve messed up my whole life. When I’m around other people, I make them feel sad. I doubt if there’s anyone out there that still loves me,” the young man explained. It’s as if my conscience is constantly accusing me of being useless and disappointing my parents and friends.”

The grandpa sat quite still for some time, pondering over his grandson’s dilemma, stroking his grey beard and deeply in thought.

You must learn to correctly identify the voices talking to you and accusing you” the old man gently whispered.

Let me tell you an age-old tale; a story that was carried on from one decade to the next one, as a story told by the wise old men from the tribe, to the children when the nights are cold and they huddle together around a small cooking fire,” he continued …

There was an old man who felt sad and useless; the love of his life could not give him a son for future generations. She remained barren despite the two of them trying everything they knew of, to conceive. They also fervently prayed for a miracle.

In total despair his wife told him, “Please take my slave girl for yourself; take her to bed and let her conceive your child. Her child will be my child, as our ancient customs dictate, under such circumstances.

The slave girl fell pregnant and gave birth to a son. But the she didn’t react subserviently as the custom dictates. She believed she was superior to her barren mistress, and mocked her. The mistress was deeply hurt, and got very angry. She banished the haughty slave girl, sending her into the desert. An Angel appeared to her and urged her to go back and to submit.

Years later the mistress fell pregnant as well; this was nothing short of a miracle. When her young son reached the age of about four, the family had a weaning festival as tradition required.

There were already hard feelings between the banished slave girl who had borne the husband’s first child, and her mistress; and this negative feeling spilled over into the older son’s attitude. He started mocking his younger (half) brother incessantly, and never let up.

Eventually the younger son was ready to explode with frustration. He ran to his mom and said, “My older brother keeps on belittling me in front of all the visitors, he keeps on mocking me, please help me,” he cried. “I can’t take it anymore!”

The old man’s love of his youth ran to him pleading, “Please tell your older son and his mother to leave us! Their attitudes are absolutely uncalled for! They’re turning our son’s life into a misery!”

The old man looked at her with astonishment. “You know I can’t do that! She is my wife by law! You told her I should take her and conceive a child with her! Her son is my own son … in fact, according to tradition he is your son, and I can’t send them away into the desert!”

This explanation did nothing to placate his real wife. She kept nagging and nagging as only a woman could do. “Send them away! Send them away! Tell them to go!”

When he couldn’t stand it any longer, in total despair he relented. “Alright then! If you keep on, and on, and on, pressurising me to send them away, why don’t we go and pray and ask God what we should do. Then you will hear God telling us that I can’t send them away; they are my family according to our tradition, and I have a legal responsibility towards them.”

So they went to a quiet place to seek God’s presence and to pray.

WHAT DO YOU THINK THE OUTCOME WAS?!

It can’t be true, we must be mistaken, listen what God is saying” the old man cried. “God said, ‘Send them away, the son of this slave girl may not inherit anything from all your riches! There is not enough for both of them; only your real wife’s son may inherit.’ “

But Grandpa, what are you trying to tell me through this age old story?” the depressed grandson was confused. What is the connection between this story and my terrible fight with my conscience accusing me?”

THAT WASN’T THE END OF THIS AGE-OLD STORY … ALMOST 2000 YEARS LATER, ITS MEANING IS FINALLY BEING CLARIFIED.

The slave girl and her son represent laws made by men to live by. According to the teachers of that era 2000 years ago, living by certain rules was the only way to attain inner peace and peace with God,” the grandpa goes on to explain.

But these man-made rules are harsh and almost impossible to adhere to. Consequently, it is almost impossible to achieve that sought-after peace of mind, and peace with God.”

The younger son, borne years later by the old man’s first love, symbolises something totally different,” he continues. “The last-born son stands for the fact that we can resist the accusations brought on us by man-made traditions (the older son, whom the slave girl gave birth to). We have the assurance that God allows us … wait, no; he actually orders us, to send that ‘older son’ and his accusations packing! He gives us freedom. He sets us free from all the mockery of the ‘older son’.”

The grandpa turns to his grandson. “You see, this ‘son’ and his mockery of you, is pretending to be your conscience. He wants you to believe that it is your conscience that accuses you of not being good enough; of being a failure. Of being someone you should be ashamed of being. But this is not true. This ancient fable reveals what God wants you to do when you’re faced with all these inner accusations and self-doubt: ‘SEND THEM AWAY! BANISH THEM!’ It’s not your conscience condemning you. It’s man-made rules and traditions that condemn you and bring you down!”

The younger son of the old man’s first love, represents the freedom that God gives us. There is not enough energy in you to listen to both these voices, they will totally and utterly exhaust you. Distinguish which one is the voice of the evil one. The one who pretends to be your conscience. Chase him away tell him to keep quiet! Tell him that God gave you a new direction… to not listen to that voice, to banish him! Turn around. Listen to the other voice, telling you that the accusations are false … telling you that you are free, that you have endless value in God’s eyes, and that is all that really matters.”

Ponder on this, my boy. It’s not your conscience accusing you, it is the evil who pretends to be your conscience. Send him away with the authority that God gives you. Instead listen to the other voice telling you how precious you are to God, and how much he values you, and that is all that matters. There is nothing of any higher value than God’s evaluation of you. Believe that. Keep telling yourself that, and you will be free!”

The young man rose from his grandpa’s porch chair, and straightened up for the first time in a long time. For the first time in many months, he had hope in his eyes. Against all odds, he decided to listen to the wise old man. To shut out the negative accusations. To embrace the freedom that was his; and by God’s grace, to live life seeing God’s worth of him.

***

Author’s note: This article was inspired by Dr Caroline Leaf, author of ‘The Perfect You’. In her book, she explains that the thinking of toxic thoughts can change gene expression in just the same way that exposure to chemicals and pollution does. Our DNA is developed to react to the language of our thoughts and the words following these thoughts. Recent neuro-scientific studies have shown that oxytocin, secreted by the brain, can literally ‘melt away’ negative thought bundles, thereby facilitating the ‘re-wiring’ of new non-toxic pathways. Dopamine works with the oxytocin to achieve this melting down of the negative thought bundles. We know that endorphin release makes us feel good, and also helps to ‘detox’ the brain. When we do good things, and when we reach out to others in love, endorphins are released, making us feel better. Broadly speaking, these findings collectively communicate the fact that our mind influences our brain. I encourage you to read this profound author’s work.

Reference:

Author: Caroline Leaf

Year published: 2017

Book title: The perfect you

Publisher: Grand Rapids Division of Baker Publishing Company

DIABETES, DEPRESSION AND STRESS

Depression is not generally listed as a complication of diabetes. However, it can be one of the most common and dangerous complications. The rate of depression in diabetics is much higher than in the general population. Diabetics with major depression have a very high rate of recurrent depressive episodes within the following five years. (Lustman et al 1977) A depressed person may not have the energy or motivation to maintain good diabetic management. Depression is frequently associated with unhealthy appetite changes. The suicidal diabetic adolescent has constant access to potentially lethal doses of insulin.

At this point in time, it is well accepted that psychological factors and psychiatric conditions can affect the course of medical illnesses. There is some suggestion that the stress of depression itself may lead to hyperglycemia in diabetics. The interaction between cardiovascular disorders (such as heart attack and high blood pressure) and depression has been extensively studied. Anxiety and depression can also affect other conditions including irritable bowel syndrome, headache and skin diseases. Treatment of anxiety and depression may lead to a better medical prognosis and well as a better quality of life.

For over three hundred years, physicians have suspected an interaction between the emotions and the course of diabetes mellitus. Studies have examined whether stressful events or psychiatric illness might precipitate either Type I (insulin-dependent) or Type II (Non-insulin dependent) diabetes. So far, study results are not conclusive.

Now that we have more accurate methods of measuring glucose control, it has become easier to measure both short-term and long-term effects of emotional factors on blood glucose level. One study found that children judged to have a “Type A” personality structure had an increased blood sugar elevation in response to stress. Children with a calmer disposition had a smaller glucose rise when stressed. (Stabler et al. 1987) A 1997 study suggested that Type I patients with a history of a psychiatric illness might be at increased risk for developing diabetic retinopathy. Those patients with a psychiatric history were found to have a higher average glycosylated hemoglobin. (a measure of long term diabetic control) (Cohen et al. 1997) Children whose relatives made more critical comments had significantly poorer glucose control. Interestingly enough, emotional overinvolvement between family members was not correlated with poor diabetic control. (Koenigsberg et al. 1993) Diabetic adolescents had a higher incidence of suicidal ideation than expected. Those with suicidal ideation took poorer care of themselves. Not living in a two-parent home was associated with poorer long-term diabetes control. (Goldston, et al. 1997)

Recent studies have suggested that effective treatment of depression can improve diabetic control. In a study by Lustman and colleagues, glucose levels were shown to improve as depression lifted. The better the improvement, the better the diabetic control. (Lustman et al. 1997a)

Being diagnosed with diabetes is a major life stress. It requires a large number of physical and mental accommodations. The individual must learn about a complex system of dietary and medical interventions. Lifestyle, work, and school schedules may have to be altered. This can consume a lot of energy for both the individual and his or her family. Just as important, are the psychological adjustments. One must adjust to a new view of oneself. For those who liked to see themselves as invincible, this may be particularly difficult.

Many newly diagnosed diabetics go through the typical stages of mourning. These are denial, anger, depression and acceptance.

Denial: This can be one of the more dangerous stages of the grief process. It may not occur only once. Many individuals cycle back to this phase several times. The honeymoon phase, associated with early Type I diabetes, may reinforce denial. Denial is a common stance for adolescent diabetics.

Anger: It really does seem unfair. The type II diabetic, trying to lose weight, may envy heavier people who seem to enjoy good health. One might erupt at someone who innocently offers a desert. Unfortunately, anger can drastically affect glucose levels.

Depression: Mild depressive feelings are a normal part of grieving and adaptation. As long as they are not pervasive or prolonged, they may not be harmful. However, when the depression lasts a long time, becomes severe or interferes with diabetic management, one should seek prompt treatment.

Acceptance: Individuals achieve different degrees of acceptance and inner peace. Some will need to experience the denial, anger and depression several times as they move through different phases of life and different stages of diabetes. Some people move through a chronic disease to a state of much greater self-knowledge. They may actually say that the diabetes was, in part, a blessing. Through their close attention to diet and exercise, and their close monitoring of stress levels, they have arrived at a deeper understanding of themselves and their relations to others. They realize that for all human beings, life is vulnerable and precious.

Often, individuals with depression do not realize that they are depressed. It is easy to attribute the symptoms of depression to the diabetes. This is particularly difficult since depressed diabetics may have poorer glucose control. Sometimes a spouse or close friend can give good feedback. However, medical professionals or mental health clinicians may be the best ones to determine what is the diabetes and what is due to depression. A psychiatrist has had medical training before specializing in mental health. He or she can sort out the diagnosis, communicate with your regular doctor and help coordinate the treatment of the depression with treatment of the diabetes.

Symptoms of Depression: These are based on the Diagnostic and Statistical Manual of the American Psychiatric Association, 4th Edition. (DSM-4)

  • Depressed mood for most of the day
  • Decreased pleasure in normal activities
  • Difficulty sleeping or significantly increased need to sleep
  • Weight loss or weight gain.
  • Feelings of guilt or worthlessness
  • Low energy level
  • Difficulty making decisions of concentrating
  • Suicidal thoughts
  • Treatment of Depression:

The most important starting point is an accurate diagnosis. There have been major advances in the treatment of depression. There are specific medications and specific psychotherapy techniques that have been shown to help depression. Often individuals do well with a combination of antidepressant treatment and psychotherapy. Be sure that your clinician is willing to take the time to communicate with your diabetes team. Ideally, the mental health clinician should be familiar with your type of diabetes.

Antidepressants: Today, we have a much wider variety of antidepressant medications than were available fifteen years ago. Because we have more medication choices, we can often minimize annoying side effects. The older tricyclic antidepressants can increase glucose levels in non-depressed diabetics. However, when depressed diabetics take them, diabetic control improves. (Lustman et al. 1996) Selective Serotonin Reuptake Inhibitors (SSRIs such as Prozac and Zoloft) are easier to administer and have fewer side effects, so they are more often used as the first line antidepressants. Sometimes they can cause decreased sexual desire. This may be a sensitive issue for some diabetics, especially those who have some sexual difficulty due to their diabetes. This is not a reason to avoid treatment. Keep an open dialogue with your psychiatrist. If the medication does affect sexual functioning, dose adjustment or a switch to another type of antidepressant can usually take care of the problem. Often, treatment of the depression can result in much better sexual functioning. Other types of antidepressants, such as Bupropion (Wellbutrin) or Venlafaxine (Effexor) add to our treatment options. Some people respond to the first medication. Other people may have to try several medications before they hit upon the right one.

Psychotherapy: Recently, researchers have made an effort to do good psychotherapy outcome studies. It turns out that several forms of psychotherapy really do work better than simple “tincture of time.” Cognitive psychotherapy is one of the methods that has demonstrated good results for depression. In this type of therapy, the individual identifies thought patterns associated with a depressive, hopeless outlook. Frequently these thought patterns are based on erroneously assumptions about self and others. The therapist helps the patient monitor such thoughts and to replace them with more effective positive ways of thinking. Cognitive therapy can also be helpful in non-depressed individuals who are having trouble with their diabetic management.

Anxiety and stress can also cause large jumps in blood glucose levels. Panic attacks may resemble hypoglycemic episodes and vice-versa. (When in doubt, treat it as hypoglycemia.) People respond differently to stressful situations. Given the same subjective level of stress, one diabetic may have a different glucose response from another. Because of this, one should monitor blood glucose more frequently during periods of stress. On the positive side, a conscientious diabetic may have a unique barometer of stress unavailable to the general population. There are a number of specific anxiety disorders that are treated differently. As with depression, there are specific medications and therapies that have been shown to work. If anxiety is severe, it is important to identify the specific type, so that one can embark on the right treatment. We will not cover all of these treatments in this article. The following are some general suggestions for dealing with stress and mild to moderate anxiety.

Examine your lifestyle for sources of stress. Are there stressers that can be eliminated?

Learn relaxation techniques. Yoga, meditation, prayer, and hypnosis may help. Make sure that you are getting enough sleep

Exercise. The body’s primitive stress response was designed to prepare the individual to fight or to run away. In our society, we do not usually respond to stress with physical activity. Exercise helps our bodies deal with the physiological results of stress.

Make a list of the things that are worrying you. When you have a concrete list, the problems often look more manageable.

Many people do not like the idea that they may have emotional difficulties. Some find it easier to attribute everything to physical problems or life circumstances. However, good diabetic management is dependent on the development of self-knowledge. Many of the things that other people’s bodies do automatically, diabetics must do consciously. This includes closer monitoring of both one’s blood glucose and one’s emotional state. Ultimately, the years of deliberately imitating natures beautiful and complex feedback systems can lead to a greater understanding and appreciation of body and mind.

References:

1 Lustman, PJ, Griffith, LS, Freedland, KE, Clouse, RE; The course of Major Depression in Diabetics Gen Hosp Psychiatry 1997; 19(2) 138-143.

2 Stabler B, Surwit, RS, Lane JD, et al. Type A Behavior pattern and blood glucose control in diabetic children Psychosomatic Medicine 1987; 49: 313-316.

3 Cohen, ST, Welch, G, Jacobson, AM, et al The Association of Lifetime Psychiatric Illness and Increased Retinopathy in Patients with Type I Diabetes Mellitus Psychosomatics 1997; 38: 98-108.

4 Koenigsberg, HW, Klausner, E, Pelino, D et al. Expressed Emotion and Glucose Control in Insulin-Dependent Diabetes Mellitus American Journal of Psychiatry 1993.

5 Goldston, DB, Kelley, AE, Reboussin, DM Suicidal Ideation and Behavior and Noncompliance with the Medical Regimen among Diabetic Adolescents American Journal of Child and Adolescent Psychiatry 1997.

6. Lustman, PJ, Griffith, LS, Clouse, RE et al. Effects of Nortryptiline on depression and glycemic controlin diabetes: Results of a double-blind, placebo-controlled trial. Psychosomatic Medicine 1997;59(3) 241-250.
By Carol E. Watkins, MD
Northern County Psychiatric Associates

STRESS MANAGEMENT

What is Stress?

As a condition, which affects you, stress is the reaction of the mind and body to a stressor. A stressor is any event or force, which is powerful enough to affect the way you normally function, from a dead- line at work to a dose of flu to the death of a friend. Stressors like these can shake you, both mentally and physically, and the result is the condition known as stress.

What effect does stress have on you?

It’s known as the “fight or flight” syndrome. Back in pre-history, when humans lived much simpler lives, a stressor would probably be something like an encounter with a lion. The body would immediately react by preparing you to either fight the animal or run away as fast as possible. Hormones like adrenaline flood the body, giving the muscles higher tone so they are ready to react quickly. The heart beats faster, filling the muscles with blood from which they can draw energy, you breathe faster to get more oxygen and think faster to help you think your way out of trouble. There are a whole lot of other, similar effects, all of them intended to make as many resources as possible available in a crisis. When the stress response is prolonged, it can have serious consequences, on both your body and your mind.

Stress disorders may be classified as follows:
  • Acute stress disorders occur when a person is exposed to a severe stressor causing intense fear, helplessness or horror and experiences recurrent thoughts or flashback episodes, associated with symptoms of anxiety lasting for up to 1 month after the traumatic event.
  • Post traumatic stress disorder is diagnosed when such exposure to a severe stressor is associated with distressing recollections of the event and severe anxiety, lasting for more than 1 month.
  • Intermittent stress is when a person regularly experiences stressors, leading to episodes of anxiety, and begins to feel that their life is “spinning out of control”.
  • Chronic stress develops when ongoing exposure to anxiety causing stressors over a sustained period of time leads to feelings of hopelessness or worthlessness, and even thoughts of suicide.
How does stress affect the body?
  • Heart and circulation: while your pulse rate gets faster, your blood pressure rises. The blood gets stickier, so that if you are injured, it will clot more easily.
  • Mouth, throat and digestive system: the mouth and throat become dry as fluids are diverted away from places where they’re not essential. The digestive system shuts down – you don’t need to spend energy on digesting food when faced with a lion!
  • The skin: as the blood flow is diverted away from the skin, it becomes cool, clammy and sweaty. Your hair often feels as though it’s standing on end, because the skin tightens.
  • The immune system: the white blood cells are the immune system’s soldiers which fight off infection, so they are sent to parts where you might be injured, like the skin and bone marrow.
  • All of these reactions would not be dangerous if they were only taking place briefly and occasionally. But long-lasting stress can have serious implications:
  • Raised blood pressure over the long-term can lead to heart disease, strokes or kidney failure if it is left untreated. Stickier blood increases the likelihood of a blood clot, which may block arteries and cause a heart attack.
  • Prolonged disruptions of the digestive system can cause unpleasant symptoms like diarrhoea or constipation. Stress is linked to irritable bowel syndrome or spastic colon, which causes bouts of severe pain, and can also lead to episodes of extreme diarrhoea, followed by constipation.
  • Skin conditions like psoriasis, exzcema and acne may be made worse by stress.
  • Chronic stress affects the immune system, making you more vulnerable to developing infections like colds and flu, and even certain cancers.
  • Stress can also disturb your hormonal system. Women may produce smaller amounts of oestrogen – which makes them more vulnerable to heart disease, they can even stop menstruating. Stress is linked to a reduced desire for sex, and men may experience erectile dysfunction (impotence).
  • Since stress tightens up the muscles in preparation for action, it’s obvious that prolonged stress could cause stiffness and spasms.
  • All these physical disturbances may cause a disruption in sleeping patterns.
How does stress affect the mind?

One of the most common problems that stressed people experience is an inability to concentrate and to remember. You may suffer from feelings of panic or fear, you may be more irritable and get angry more often and more easily, you may even suffer from depression, feeling that you are worthless and that life is not worth living.

Good stress and bad stress

Not all stress is bad stress. A certain amount of stress is normal and keeps body and mind functioning. Your feelings about the source of the stress contribute to how well you handle it, so good stress is less likely to have bad consequences. None of us would be very healthy if our lives contained no surprise, delight, shock or demands of any kind!

How do you cope with stress?

For most of us, the most common answer is, very badly. We tend to do all the wrong things under stress: we eat badly, reaching for fast foods loaded with sugar and fat, and forget to take our multi vitamins or chronic medications. We drink too much alcohol in an effort to relax, we smoke and we feel we don’t have the time to exercise. To avoid the dangers of stress, we really need to adopt a strategy that addresses the whole of our lives.

Stress management techniques

Exercise makes the body better able to cope with the physiological effects of stress. It improves circulation, loosens up muscles stiffened by tension and has a profound impact on your mental health – there’s strong evidence that exercise helps to fight off one of the most unpleasant mental effects of stress – depression.

Good nutrition: Your body and mind can’t cope with stress if you aren’t getting the nutrients they need to operate. Try to eat five portions a day of fruit and vegetables. You need a mix of vegetables to get the best nutrition – dark green leafy vegetables, orange-coloured vegetables, which contain lots of anti-oxidants, cruciform vegetables like cauliflower and broccoli, which contain cancer-fighters. It’s actually quite hard to get the nutrition you need from your food these days.

Nutritional supplements

Food loses nutrients as it is harvested, handled and processed. So nutritional supplements will help to keep you well nourished. Choose a good multi-vitamin, and if you are under special stress, top up with extra B-complex vitamins, and a mix of calcium and magnesium. Calcium and magnesium also have a good effect on mental functioning.

Support from others. Devote some of your precious time to nurturing your personal relationships. Spend time with family and friends, and don’t hesitate to get help from a counsellor if you feel the need. Very often, all we need to release a build-up of pressure is a listening ear.

Reduce stress at work. Take a long, hard look at how you operate at work, and change it if necessary. Effective time management is essential. Organise and prioritise! Learn to delegate. Resolve to say ‘No’ if you feel that you are being overburdened. Communication is vital.

Relaxation techniques: As mentioned, stress management embraces a wide range of strategies and actions which address every aspect of our lives and it can be very helpful to incorporate one or more of the following relaxation techniques into your regular activities:

  • Deep breathing
  • Muscle relaxation
  • Massage therapy
Conquer stress – a lifetime commitment

Sometimes it feels as though it’s just too much effort to put into place any of the stress-beating tactics outlined here. But that’s the stress talking! It will be hard to discipline yourself to exercise, to eat properly, to meditate every day or practise one of the other relaxation techniques mentioned, but once you get into a routine, you will find that the effort is more than repaid by the results!

Recommended Reading: “Proverbial Stress Management Busters” by Prof. L. Schlebusch. (Publisher: Human & Rosseau).

Courtesy of Medical Essentials, Health Information