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Systemic therapy may boost self-esteem in diabetes
INDIANAPOLIS — In addition to clinical support, self-esteem building is also needed to produce positive outcomes among patients with diabetes, according to a presentation by Janis Roszler, MSFT, RD, CDE.
Roszler, diabetes educator, author, and marriage and family therapist in Miami Beach, Fla., said that patients with low diabetes self-esteem are classified as those who doubt their ability to care for their diabetes or feel pessimistic about completing self-care tasks.
Janis Roszler
This poor self-esteem could result when patients become overwhelmed when their attempts to control their diabetes continue to fail. Negative comments from health care providers, family and/or friends, and the chronic stigma attached to the disease can all have a negative impact on a patient’s self-esteem, according to Roszler.
According to Roszler’s presentation, the poor self-esteem can be caused by:
- Complications with diabetes;
- Symptom visibility, such as blood glucose swings, numbness, fatigue, hypoglycemia;
- Self-care tasks which are too difficult;
- Pre-existing poor self-esteem;
- Depression; and
- Guilt.
Self-esteem can be raised by family, individual or group therapy. Roszler suggested a systemic therapy, with an emphasis on strength-based counseling approaches like narrative therapy, solution-focused therapy, medical family therapy, cognitive-behavioral therapy, experimental family therapy, psychoanalytic family therapy, structural family therapy and strategic family therapy.
Roszler said letting patients know that others share the same difficult issues they face often helps patients feel less alone, less “broken,” and begin to feel more hopeful.
For more information:
Roszler J. #W04. Presented at: The American Association of Diabetes Educators 2012 Annual Meeting & Exhibition; August 1-4, 2012; Indianapolis.
Disclosure: Ms. Roszler reports no relevant financial disclosures.
Perspective
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People who believe they can successfully complete self-care tasks will be more willing to attempt them. Those who are less confident may be less willing to try self-care tasks and listen to the guidance that educators offer. As we know, diabetes control is not a perfect science and outcomes can be unpredictable at times. Patients with little diabetes self-esteem will be more easily discouraged when their glucose level doesn’t behave as expected. They may assume their negative outcome is a reflection of their inability to care for their disease.
Many patients embrace treatment advances that help them enjoy improved diabetes control, such as carb counting, rapid acting insulin, glucose monitors, CGM’s, insulin pumps, etc., but others find these options overwhelming. They require a lot of time and instruction to use well. Those who aren’t confident in their ability to carb count well, for example, may return to using sliding scales for insulin adjustment, which are far less effective. Many who can’t confidently employ the results they get from their glucose monitors may stop testing or misuse the data.
Providers should consider how confident their patients’ feel about their ability to take care of their diabetes and adapt all guidance to help them move forward. If they feel they can’t handle their diabetes due to lack of confidence, take small steps to increase knowledge and skills.