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Type 2 diabetes is a dynamic, progressive and heterogenic disease which usually appears during maturity. Diabetes doesn’t have only physical effects on individuals, but also psychological. Accepting diabetes, organizing life according to diabetes (waking hours, sugar level measurements, exercise and diet), is not an easy period for everyone.
Answers will greatly vary from person to person regarding the question ‘What did you feel and how did you respond when you first learned that you are diabetic?’ Because your response to this question is not entirely independent from your response to the daily problems you encounter and your strategies for handling these problems before you learned that you are diabetic. Some may think ‘I have to do everything I can for a healthy life, I have to take good care of myself’, while another may say ‘My life will be very difficult from now on’ Responses varying from person to person, or even varying for the same person may show up. Your methods for handling the daily problems you encounter define your approach to diabetes and its treatment.
Most difficult thing for individuals after diabetes is to form a new eating order. Directives from our parents that each generation has experienced during childhood such as ‘You will finish everything on that plate!’ and food industry that continuously drive us to consume with TV commercials shape our eating behavior. Changing these habits in a single day that the individual had for years is the main reason of feelings such as anger, frustration and denial. Even more so for us as the food and eating culture of our country (our famous hospitality, breakfast and dinner gatherings with our family and loved ones that last for hours) plays a very important role for our socialization. And because of this, the idea of changing our eating behavior leads us to believe that we have to change many more things in our life along with it.
ANGER AND ANGER MANAGEMENT
People who suffer from chronic diseases usually blame themselves. ‘I wish that I didn’t smoke, I wish I didn’t ignore walking, I wish I chose a healthier diet’. Those wishes are not entirely wrong. An unhealthy life style and stress cause chronic diseases. However, blaming yourself after learning that you are diabetic not only changes anything, but also may prevent you to accept the truth and move on or may cause depression. Accepting the situation on the other hand, may encourage you to take diabetes under control. The best thing to do here is to accept diabetes, be at peace with yourself and starting from that day, focus on the question ‘How can I live healthy?’ We should not forget that the most important point of diabetes is a healthy diet and exercise. Denial is health-wise the most dangerous defensive mechanism for individuals suffering chronic diseases. Since the disease is being denied, stress will decrease, but negative impact of the disease on that individual’s future will be very strong. Because if the patient denies diabetes and continues on with his/her life as if everything is normal, this will make it easier for the chronic diseases caused by diabetes to appear and progress.
STRESS AND STRESS MANAGEMENT
Feelings such as anger, happiness, sorrow, excitement are normal feelings experienced by everyone. Being an angry person doesn’t make you a bad person. The important thing here is that the individual shouldn’t direct that anger to his/her social surroundings, like his/her friends, relatives, family etc. In order to handle anger, you can get a notebook and write down everything and everyone that made you angry, or places where you get angry and use that knowledge in the future to control your anger. Also as mentioned before, muscle relaxation and breathing exercises are important for anger management. Because muscle relaxation and breathing exercises teach us how our body reacts when we are in tense and calm situations, therefore they allow us to notice a probable tense situation and control it. Improving our communication skills is also essential for anger management.Even though anger is a feeling that may also be caused by diabetes, it can also appear during the process of creating a new life style consistent with diabetes. Therefore interpersonal relationships of diabetic individuals may worsen. It should not be forgotten that anger shows itself differently on each and every person. This fact should be considered when anger management is being tried to be established. The feeling of anger is connected to how you view an event rather that the event itself. Following the diagnosis of diabetes, anger may show itself because of many reasons, such as when trying to adapt to a new life, or not being able to eat whatever you want to, or your relatives and friends constantly interfering with everything you eat. Muscle relaxation, breathing and physical exercises such as walking are quite effective during the process of adaptation to a new life consistent with diabetes and establishing anger management.
Many researches were made about stress. As a result of these researches, although it may differ for every person, stress can be described as:
Even though the description of stress and the factors that cause stress may differ from person to person, the physiological responses are similar: Faster heartbeat, sweating, faster breathing etc. In addition to the communication we have with our surroundings and ourselves, muscle relaxation and breathing exercises also play an important role to cope with stress. Just like in every other respect, improvement of communication skills plays important role to handle stress. The way we ask questions is also important for an effective communication. Questions starting with ‘why’ may lead to a defensive response from the other person. Questions like ‘what do you feel about ….’, instead of ‘why’ are quite important for an effective dialogue because they don’t judge the other person, but rather make him/her feel that we are there to hear him/her out.
How we communicate with ourselves is also important to handle stress. When we have a problem with our family, saying ‘I’m tired of this, I’m leaving this house’ is an example to negative communication with ourselves. Instead of this, saying ‘We encountered similar problems before, we overcame them all and we can do it again. How should we solve this problem?’ is a positive communication. Creating a positive communication with ourselves is the most important step to handle stress.
Muscle relaxation and breathing exercises have important impacts on anger and stress management and anxiety issues. Sparing some time to relax helps to relieve the physical effects of stress and physical fatigue caused by stress. To perform relaxation exercises for 20 minutes, at least 3 times a week allows the body to tire less within the day and to regenerate lost energy. Practice is important to achieve a good effect with relaxation exercise. As you keep practicing relaxation techniques, you will be able to relax without much effort in a few minutes. You can perform some relaxation exercises by lying on a bed or sitting on a chair where you can rest your head. You should start exercise by first focusing on your breath. Breathe slowly from your nose and exhale slowly from your mouth. After that, focus on your hands and stretch them while breathing. Keep them stretched for a few seconds then relax. Now focus on your arms and stretch your arm muscles while breathing, keep them stretched for a few moments then relax your arms while exhaling. After relaxing your hands and arms, take a deep breath from your nose and stretch your neck and shoulder muscles by lifting up your shoulders. Again after waiting for a few moments, exhale slowly from your mouth and relax your neck and shoulder muscles. Repeat this exercise for your chest (by holding your breath in your chest), abdomen (by holding your breath in your abdomen), hips, legs, feet and face. Repeat this breathing exercise after relieving each part of your body. In time, you will see that you can achieve faster and deeper relaxation.
Problem solving techniques are also important for handling stress
Calmly following these steps will help you to handle the problem causing stress, and solve it in a controlled manner.
Lastly, the importance of social support in stress management should not be neglected. Family, friends, and an expert you can consult when necessary, being in solidarity with people who are under stress because of similar reasons can help you handle and overcome stress. Unfortunately, stress is not something we can remove from our lives all together. Family relations, problems with our friends, financial problems, health concerns and even the traffic in our country can cause stress. The important thing is to manage this stress and minimize the psychological and physiological damage caused by stress.
SURGERY ANXIETY AND PSYCHOLOGICAL READINESS AFTER SURGERY
Anxiety is a biological alarm system for living beings that is activated when a dangerous situation is detected. Like when we sense our life is in danger, face uncertainty, encounter new social surroundings or when we will undergo surgery. The rate and intensity of anxiety varies from person to person and is largely determined by past experiences. It can show itself as an emotional (fear, excitement, sadness, feeling of inability), physical (heart and stomach discomfort, shivering, frequent need for toilet) or cognitive (amnesia, lack of concentration, not to be able to think anything else, the thought of ‘I’m not in control’) reaction. Everyone can be anxious in their lives at certain times. It can even be considered abnormal not to be anxious in some situations. However, there is a difference between anxiety and anxiety disorder. Anxiety is not always a bad thing and can even encourage us to achieve our goals. If the anxiety you are experiencing is so intense that it is disturbing you, if you are trying to run away from whatever causing it, if it’s hampering your daily life, then this situation can be described as anxiety disorder.
To handle anxiety, the question of ‘Why you are anxious?’ is important. Knowing what is causing anxiety makes it easier for you to handle anxiety. Generally people choose to run away rather than to face the situation causing anxiety when they feel anxious. However this is not a solution, it is only postponing the problem only for a short time.
Facing anxiety, on the other hand, allows you to see the ways you can develop to solve the situation causing anxiety. When you are feeling anxious, you should remind yourself that everyone can experience success as well as failure and that you have strengths of your own.
As mentioned above, one of the situations that can cause anxiety is surgery. Surgery anxiety at a normal level is understandable and is to be expected. It can also help you not to underestimate the surgery and motivate you to take good care of yourself. But if surgery anxiety prevents you to undergo an operation which will help you regain your health, then this needs to be worked upon. Fear of surgery/surgery anxiety is quite common. Anxiety degree may increase especially as the day of surgery draws close. The fact that someone else is in control can make you feel uncomfortable and anxious.
Surgery anxiety is a physiological circumstance caused by fear of surgery (faster heartbeat, sleeping disorder, nausea). Most important way of dealing with surgery anxiety is to acquire as much as possible information from your doctor and surgery team regarding the operation (the procedure that will be performed, why such an operation will be made, risks of anesthesia).
A person experiencing surgery anxiety usually fails to focus on the operation’s outcome. If you will regain your health following surgery and refusing the operation will have negative effects on your health, then thinking that there is no need to worry about the operation will decrease anxiety. Which means thinking about the impacts of undergoing or refusing the operation on your health and quality of life is a good way to deal with surgery anxiety. When you feel anxious about the operation, remind yourself that the outcome will be good and your health will get better. If you can’t handle surgery anxiety/fear of surgery, and the anxiety continues without decreasing, then consulting an expert might be a good idea. For such circumstances, the expert might offer useful exercises and studies that can help you when you are under stress or anxious and if need be, can direct you to a psychiatrist for medical treatment as well.
ADAPTING TO THE NEW LIFE AFTER SURGERY
Each major surgery can be perceived as a threat towards body integrity. After Ileal Interposition operation, the fact that you will need to change your eating behavior, especially when considering the importance of food culture in our country (daily exercise, routine controls, probable exhaustion during recovery period) can make it difficult for you to adapt to this new life. Social support is very important during this period. Spending some time together with your family and friends, suitable travel plans that will not tire you out (when your doctor sees fit) and starting new hobbies will help you to preserve your psychological wellness after surgery and overcome adaptation problem.
During this period, breathing and muscle relaxation exercises will also prove to be useful to relax your mind and body, and tire less within the day.
It is normal to experience adaptation problems after surgery. However, if you experience problems that hinder your functionality, taking psycho-social training and personal therapy will be useful.
Psk. Özge Tuğçe GÜDÜL
