Week Thirteen - Perception

Another week, another post where the blank page has been open for 24 hours and half an idea is floating around in my head as I try to pin it down.

I think it vaguely ties in with what I said a couple of weeks ago about how it's sometimes hard to judge where you are in a relationship (short-hand for an interaction with someone else - not exclusively 'romantic') and how it can impact on self-esteem despite best efforts.

As most things often do, it starts with music.  Music is brilliant obviously - having that ability to conjure up a person, place or moment in time based on a few notes played in a certain order is something special.  Part of the problem of course is that it works both ways - for every moment you want to remember, there's usually something you're trying to forget (and obviously they're always the songs that stick in your head).  To steal from Jay-Z's Blueprint² album title - it's a gift and a curse.

This starts with a track from The Streets' 2008 album 'Everything Is Borrowed' - namely "I Love You More (Than You Like Me)"

'Perfect Sound Whatever' by James Acaster is a great read about music and mental health

Of course the thing with music that makes it so brilliant is that the interpretation becomes personal to us.  I can't ever understand what prompted Mike Skinner to write that song but I know that those 10 words - I think I love you more than you like me - have almost become a kind of shorthand for my perception of many of my relationships.

That's not to say it's actually true by any means of course, but that perception is sometimes difficult to disentangle yourself from.  I'd been trying to think about why that is and I think it's down to certainty - or more specifically, a lack of it.

Most of the time I'm fairly clear about what I'm thinking, even if actually articulating it is somewhat difficult (*cough* case in point *cough*) but knowing what someone else is thinking or feeling is a lot less clear and is often where our old friends Worry and Anxiety pop round uninvited and put their feet up on the sofa.

Objectively there's nothing to worry about of course - those relationships you've had for years have stood for that long because they're built on solid foundations.  Nothing to worry about right?

I love this one

"What if they didn't understand what I meant when....?"

"What if I upset them when...?"

"What if they're mad because...?"

"What if they don't want to be friends anymore...?"

I had my eyes opened at StressControl last year when I found out that not everybody thinks these things and worries about them like I do.  If you're one of those people, then kudos to you - but it partly felt like my reality was being torn down and rebuilt.  Again, objectively of course people don't all think like that because it makes very little logical sense.  But it's hard to free yourself from that when it's been your perception for so long.

Under the old regime there were a few tried and tested options when those questions started floating around:

1. Seek any kind of constant reassurance (explicitly or implicitly) that the last thing I'd said hadn't been misinterpreted or that you'd not upset the status quo
2. Qualify what (I thought) I'd done wrong in a painstaking level of detail that would make War & Peace look like a short story
3. Assume I'm burdensome and a distraction that people would happily do without (not in that way - chill)
4. Shut down - don't make the effort because it can't or won't be reciprocated in the way I expect - better to not bother than show vulnerability

Point number 3

Point number 4

Sorry - a lot of relevant memes this week...

And so, via a slightly circuitous route, we come back to Mike Skinner and the woes he and I share - "I think I love you more than you like me".  The last couple of points on that list above are the kinds of things I associate that line with - being at the extreme of one feeling while perceiving that everyone else is at the far end of another.

That perception genuinely feels hard to get over sometimes, though I've learned that often it's the arbitrary expectations that come with the perception that compound those difficulties.  Relationships can't be quantified or measured - they're things we know, feel and trust in.  

Worry and anxiety can make us question those things we know to be true, and have faith in and so, like with most things, it's the same few tricks that help us through.  What would we tell a friend feeling that way?  What is the likelihood that the thing we're obsessing over is actually happening?  How do we make mental space to be able to evaluate what we're thinking and experiencing in a rational way?   If in doubt, play the greatest hits right?

I envy the people that have that in-built way of just knowing this stuff is all OK without it being a large number of conscious thoughts.  Maybe you're all sociopaths or something?   Sorry - what I meant by that was..... please don't be mad at me.... are you upset....? Etc etc forever and ever...

(Oh - in diabetes news, I've had four consecutive days with bloods all under 10mmol so I guess I'm cured or something... - come for the sadness, stay for the diabetes)

Stay safe. Love you (more than you like me) x

Weeks Ten and Eleven - (Im)balance

Predictably I missed last Monday as it was a Bank Holiday and I had a week off.  I missed posting yesterday because I wasn't sure I had the right words to be able to articulate what I wanted to say.   I'm still not sure I do but let's see where this goes eh?

Since I last posed, I've edged a year closer to 40.  Facebook memories see to suggest I'm forever bound to say "older but not wiser - haha" and that absolutely feels true in one sense, but maybe less so in another.

Over the last year, I think StressControl and CBT have taught me some sense of self-awareness that I wasn't really conscious of before.  Whether I'm actually wise enough to be conscious of it in the moments I need to is a wholly different matter.

Absolutely I am Dwight

One of the main themes at StressControl was about how we often judge ourselves more harshly than we would others and are our own worst critic.  At CBT we talked about how powerful meaningful relationships are and how they can make a really positive difference to how we feel.  I guess that latter part at least is familiar to many people right now given that lockdown has many of us distanced from those people we rely on.

I think where I've often felt like I've struggled is in finding those relationships.  I've got a catalogue of reasons why that's the case - you can leaf through that at your own leisure - but I think I large part of it is down to not being able to understand where the right balance (or equilibrium - get some mileage out of that economics degree) is.

But this is where the words dry up a little.  I'm not sure how to get that final point down:

    a) without coming across with an inflated sense of self-importance 

    b) succinctly or 

    c) in any kind of way which actually gets to the heart of what I'm trying to say

I guess the point is that I often feel like I mis-judge what those friend/relationships should look like or what the dynamic is.  Pushing way too hard when there's no need, cutting myself off entirely because it's easier than working through what the middle ground should look like or just driving myself crazy with self-doubt, worry and anxiety.  Where this was bad before, lockdown has made it a lot worse.

Imbalance

I've thought about referring myself back to IAPT but I'm still not sure I'm clear on the thing that would be most helpful so I'm keeping that in my back pocket for now.  I've thought about seeing a GP though that's kind of a nuclear option I'd rather not take.  And there's no way I'm going near a surgery right now in any case.

I think I've got most of the tools and knowledge to be able to make this better (there's the wisdom) but it's still difficult to take that mental step back and use them objectively.  That bit is really hard, and the nagging self-doubt that asks whether I am good enough makes it tougher.

It's ridiculous when you see it like this - but seeing it like this is the tough part

As this blog becomes progressively about mental health and less about diabetes, I probably need to grab food so I don't have a hypo in a meeting later on.

Stay safe x

(And don't worry, I've ordered Lego)

Week Eight - One Nice Thing

At least I think it's week eight... I know lockdown officially began on March 23rd but I'd definitely been working at home for about a week and a half before that.

Some of the days do have that sense about them and at times it definitely feels like they're merging into an amorphous blob of stuff.  Some days fly by and then others seem to draw themselves out forever.  A three-day weekend definitely helped me reset to a large degree but there's something about this situation that's exhausting.  A couple of days with no alarm and no real need to do very much or even get beyond the garden feel like they've wiped me out.  I'm fairly sure it's down to the mental effort we're expending trying to keep on an even keel.

Most of this last week's diabetes problems have been about keeping out of the red and in the black which I will admit has felt a little relentless at times.  After some extensive research over the last few days, I think I'm close to publishing a paper confirming that bourbon biscuits have little to no effect on blood sugar whatsoever.  I am also implying that they therefore have no calories either...  It'll pass as it always does, but feeling like you're constantly scouring the kitchen cupboards for something to eat can be another layer on top of everything else you're trying to think about.

A couple of things sprang to mind this week.  Firstly that it's felt harder at times to maintain that 'deep breath, think before you speak' approach to communicating, whether that's at home or at work.  I think the current climate (sick of writing that) and how far we are into this way of living gets to us all at some point, and it's almost inevitable that some part of us will snap, however briefly.  It's also easy to have our head down thinking about our own situation, when the reality of it is that everyone has their own version of that too.  I'd like to think I've been generally conscious of that - what feels like 40 hours of video calls a week means you can't help but understand people's circumstances, but it's no bad thing to be more explicit about it in my thinking.

The other thing is really to think of One Nice Thing about the day and try and hold on to it.  After StressControl I tried to write three positive things down from each day before I went to bed as a reminder that the stress and anxiety was always balanced out by other things.  I've lowered the bar a fair bit for the time being, but hoping it continues to make some small difference.

After a couple of glorious days, the weather turned yesterday so we had some ultimate comfort food in meat and potato pie

This was the sunset on Thursday after my dad got taken to hospital (and thankfully discharged with antibiotics about 8 hours later)

Managed to order some Lego that's usually only available from one shop at Legoland in Denmark - they've made it available online due to COVID

It's still a massive set of ups and downs and it's the same for everyone I talk to as well.  In some sense, it's hard to take comfort from the fact that everyone is on this relentless roller coaster, but at the same time it's kinda reassuring that everyone can almost certainly relate to how you're feeling at any given moment, even if it remains largely unsaid.

Safe safe alert safe x

Week Seven - Ups and Downs

On their debut album 'Love, And Other Catastrophes" the aptly named Skint & Demoralised sang about major highs, manic lows and that's a little what this last week has felt like.

When it's been good, it's been really good.  When it's been bad, well... it's been bad.

Having diabetes has felt like a lot more of a job this last week as you'll see below.  Yesterday in particular ended up with me curled up, asleep on the sofa at about 3pm with a nice hypo headache.

I talked about distractions last week and that's still the name of the game right now.  A combination of things mean that I worked til 9:30pm - 10pm three days running (having stopped for dinner and half a film).  Normally I'd be cursing even the need to work after about 6pm, let alone actually doing it, but it felt strangely calm - almost relaxing - to have something to keep my find focused.  It also had the benefit of making me feel almost productive at some point too.

I talked a bit about managing the voices/thoughts last week too and that's still been very challenging at times, particularly when trying to switch off at night.  I'd taken to kind of half going to bed, but staying up til gone midnight some nights over the last few weeks just so I could exhaust myself.  The problem with that is that it's a great short-term fix but long term you end up asleep on the sofa on a Sunday afternoon.

And I think that's almost been a lot of lockdown in a nutshell - some of the short term difficulties can be managed, but I'm not sure I've figured out how to do it in a sustainable way that doesn't just create a different problem to solve another time.

Worth mentioning a few of the highlights as well just to remember the highs as well as the lows:

1. Made Australian Crunch over the weekend - proper throwback to school dinner desserts and one of the best chocolate things going (Galaxy milk choc on top for best effect)
2. Bought a new Xbox and played a lot of Lego Marvel Superheroes with Violet
3. Managed to run 10km (with Violet on her bike) on Sunday - first time over that distance in a year, and awarded myself this medal from a virtual race

Finally, I know I've been really lucky to be able to call on a couple of close friends who have helped me be objective and rational (for me at least) and taken the edge of some of those manic times. I won't name names, but if you're reading this and it sounds like you, it probably is.  Thanks.

I guess the message is the same.  It's hard sometimes, and lockdown life makes it harder to manage and to escape.  One of Violet's favourite quotes is this from John Lennon.  I find it hard to believe in it sometimes and it almost feels a little but trite, but to hear a 10 year old say it every so often does give you some hope

Stay safe x

Week Six - Distraction

Another Monday and another week of largely remaining indoors.

It's felt a little.... more straightforward this week.  I'm loathe to say 'easier' because it's felt a little like peaks and troughs over the last few days.  A relatively quieter week at work has helped so that's something.

So far the sun's kept shining which I think is definitely a positive to cling on to.  I think a few days of rain (which looks forecast for this week) will make for a somewhat less manageable lockdown experience.

I've also tried to make a very conscious effort to look for distractions or hobbies to give me some focus.  Certainly something beyond staring at some game on my phone at least.

I've got round to listening to a podcast that I never thought I'd find time for.  It's called  Office Ladies and is an episode-by-episode behind the scenes rewatch of The Office - An American Workplace (scientifically the best TV comedy of all time).  At about an hour an episode it's a good start to a weekend morning and means I'm learning some new stuff about a show I could practically quote.  It also ties in nicely with my inspired decision to start and rewatch the whole thing from the beginning too.

The last few weeks I've got more and more into my newest middle-class hobby which is rock painting!  It all started when we found a couple on the ground near where we live while we were on our daily walk and spiraled quite quickly from there.  Historically I've never been someone you'd associate the words "artistic" or "patient" with but I'm certainly learning to harness the latter.  I've found it helps me stay calm and feel focused, and there's a bonus that it's a good family activity for us all.

This weekend's efforts

We've also reached that stage where we've had a family quiz over Zoom.  A top score of 9/20 suggests we all need to reset our expectations of what 'easy' is.

Of course it's not all sunshine and plain sailing, but I'm definitely at the stage where I know that's not going to be the norm, even if I'm a little way of mastering how to cope with it.

I think one of the hardest things I've found over the last week (and feels like something that's been a fairly constant background for me for a while) is finding it hard to stop myself following a thought to some fantastical and unlikely resolution.

It's hard to really describe what that's like without using examples I'd rather not share here, but it often comes down to something jumping into my head and staying there while I simultaneously try to forget about it entirely and completely fixate on it in the worst possible ways.

I found these resources from Mind which helped a little, and resonated well with some of the learning from StressControl last year.  I'm not convinced I'm 'hearing voices' and I don't think it necessarily strays into intrusive thoughts per se, and certainly not harmful intrusive thoughts.  It's more that I find it hard to not fixate on something once I start.

And so that's where distractions come in.  For me, right now it's a balance between distracting myself with new things that I'm enjoying and also learning to manage and try to de-escalate the stress and anxiety when distraction doesn't work.  It's a learning curve that feels a little steeper because of the situation we find ourselves in right now, and ultimately I think it comes down to celebrating the good days and stopping the bad days from bringing you too far down.

Stay safe x

Weeks Four and Five - Get Back on Track

I skipped last week.  Partly because it was Easter Monday and partly because it was the first lie in past 9am I'd had in years and I let the day get away from me a little.

I think it's fair to say my general wellbeing has deteriorated over the last couple of weeks - I'd forgotten how easy it is to let everything get out of control if you don't keep at least one eye on it.  At times like these it feels much harder to be conscious of it because it isn't one single thing - it's everything that you need to be mindful of.  As my friend Taylor would say, it's kinda like death by a thousand cuts.

So work has definitely felt tough - we've got a big opportunity to make significant change right now in the wake of coronavirus and that's genuinely exciting.  It's also genuinely exhausting and the lack of variety that a constant stream of teleconferences presents is really challenging.

I also find it hard to learn from my past experiences... just because 18 meetings in two days is possible on paper, doesn't mean it's a good idea.  One of my learnings for all of life is to feel OK saying 'no' to people.  It's definitely hard when you need to do things at pace, but I know I can't work at that level relentlessly so something will have to change.

Whilst diabetes and me haven't ever been best friends, the last couple of weeks have tested our relationship a little more than usual.  You'd think being at home would allow you to control for all those external factors like early starts and dashing for trains, but my levels have been on as much of a roller coaster as my mental health, and of course there's an intrinsic link between the two.

Being cooped up has definitely reached that point where I've felt a bit cabin feverish.  This is the bit I'm maybe most frustrated about because it felt inevitable that this would take it's toll and I feel like I've idly watched it creep up and then run right past me and now I'm playing catch up.

I'm sure I'm not alone in realising how much difference my weekly routine makes to my general positivity.  Catching up with friends at Hillsborough, bacon butty from the cafe once a week, seeing people at ballet while Violet dances.... even the freedom that walking round ASDA gave me feels hugely important right now and I'm starting to miss it a lot.

I've been out every day and that's definitely a highlight and I'll keep doing it even in the pouring rain.  I've got back into cooking and baking with Violet in a fairly big way (despite feeling a little ashamed that it's taken a Hello Fresh delivery to remind me how much I love cooking).  I've also found a new family friendly middle class hobby in rock painting.  I'm definitely not the most creative or artistic person on the planet (or in my family...) but it's calming so I'll persist with it.  The meditation and breathing exercises I've got make a big difference too.  If you're after an introduction to those, Headspace are offering some free resources at the moment.

Keeping up with this blog and writing stuff down for myself is helping too.  I think it's about working out what sensible support mechanisms I can put in place for myself and my own sanity while this is all going on.  And remembering that I find some bits harder than others.  I still haven't found a way to talk kindly to myself, even after StressControl and CBT.  I'm better at calming myself sometimes, but this is the hardest part for me by some stretch so it just means I'll have to keep working at it and celebrate the small victories.

If you made it this far I hope you're staying safe and staying well.  The pic above is definitely tongue in cheek, but remember it's a marathon, not a sprint.

Take care x

Week Three - Practice What You Preach

Like most people, Fridays were the day I looked forward to the most - you know, back in the day where this endlessness didn't exist.

I'd walk Violet round to school, jump in the car and head out for a coffee with my wife before logging on a little later than usual.  Hectic diaries meant that Friday mornings were usually the only chance we both had an hour or so of free time so we'd make the most of it.  I used to have very few meetings so could catch up on all my work and head into the weekend relatively relaxed and caught up.

Now every day has a pretty consistent feel about it, with the remnants of my old regular meetings being the only reminder about the old 'structure' that life used to have.

Instead of looking forward to Fridays, I honestly feel like I'm just trying to survive them.  The last couple of weeks it's felt like I've shut my laptop down at 5pm (if I'm lucky) and I'm broken.

My job means I need to be there for a pretty large group of people who are all going through the same things, but with different perspectives, challenges and fears.  Actually it's not that I need to be there, I want to be.  My team do a hell of a lot and I think feels as familial as it could be for 30 people spread right across the UK, and I want to support all those people who are absolutely my work family.

What I'm struggling with is the ability to follow the advice I give everyone else - certainly not to the same extent.

My wife asked me why, given I'm pretty well-practiced at worrying whether or not the sun will come up tomorrow, am I being pretty laid back about this whole end-of-the-world-global-pandemic situation?

Stress Control and CBT definitely helped to some degree.  I can only control the things I can control. I need to find the thing(s) that drive that worry and be objective about them.  I need to rationally see what's going on around me rather than live life through some anxiety-fuelled lens of madness (this one is still hard sometimes). 

But that's not always how I feel.  Friday afternoon usually has me at that point where my chest aches... not physically, but that feeling you* get when you feel like you've been tense for a week and have only just realised it.

*I say 'you' - could just be me...

I know it's not possible to stick to the same routine I had 8 weeks ago, and I've started making changes.  A 10 minute walk around the block when I can manage it is a big part of the day, as is sticking on some calming music or a 10 minute meditation on my phone.  It's hard to explain the difference some deep breathing can actually make.

What I need to get better at is remembering this is a long haul.  Cramming my diary with meeting after meeting might give the illusion of productivity or accomplishment, but I don't think the cost is always worth the payoff.  I'm getting better at skipping out on those things I think don't need me and gradually getting better at making time for myself - even just to get up from my desk and sit on the sofa in my favourite corner for a few minutes.

So I need to practice more of what I preach.  Always easier to be objective for other people and I need to give more of that to myself.

If you got this far - thanks.  Hope you're managing well too.

Stay safe x

Controlling Your Future

If you want to catch up you can find the pre-session, week one ("What is Stress?"), week two ("Controlling Your Body"), week three ("Controlling Your Mind"), week four ("Controlling Your Thoughts") and week five ("Panic and Sleeping Well") posts in the links

And so StressControl comes to an end.  The title is from one of the slides in this session, but there was an open understanding that it's something easier said than done.  We followed a broadly similar approach as previous weeks, this time looking at our personal wellbeing and then covering a quick summary of the previous five weeks.  I'm going to talk a bit about wellbeing here as well as covering some of the things I've noticed or that have changed since I started, as well as what some next steps might be.

Wellbeing

In week one, we covered the idea that stress is a continuum with high levels of stress at one end, and low levels at the other.  This is a distinction worth making because it's not the goal to eradicate stress entirely, but to try and put ourselves towards the lower end of this particular spectrum.  If we think about stress as this horizontal line, wellbeing can be thought of as a similar, vertical continuum with poor wellbeing at the bottom and good wellbeing at the top.

The World Health Organisation talks about these two extremes as 'languishing' and 'flourishing' and of course, the idea is to move ourselves towards the flourishing end more often than not, whilst also increasing our ability to manage our stress.  As with anything worth knowing, overlaying these two concepts gives you a handy 2x2 matrix:

Recreated on my phone so more simplistic than it should be, but you get the idea...

Obviously we want to be in the top left as often as possible and in the bottom right as scarcely as possible, and because we're people, we'll often move around all four of these.  Some high level stats suggest that for every 10 people, three are langishing, five are middling and two are flourising and the tools we have at our disposal are aimed at keeping us away from the languishing end of the spectrum as often as possible.

We talked about what sort of things you could do to try and improve your own wellbeing, and with my work hat on for the briefest of moments, I was pleased to see that volunteering your time was something that was encouraged.  Being able to contribute to the wider world around us increases our own personal wellbeing too.  Listening to music, being more physically active, getting more fresh air and practicing mindfulness were all suggested too.  Learning something new or picking up an old hobby came up too and the idea is that our brains value the sense of accomplishment that comes with learning or completing something.

Mindfulness is something we hear more and more of but it was interesting to hear the definition they gave, which was really about focusing on the moment we're in without letting ourselves worry about the future or brood about the past.  It sounds fairly simple when you hear it like that, but trying to let your mind focus purely on what our sense are experiencing right here and right now can be hard.  I think autumn is a good time to try more of that as the leaves change colour, the air gets a little cooler and the familiar scent of fireworks starts to fill the air.  It's definitely something that needs practice, but along with some of the breathing exercises we covered, I think it can be really helpful.

We also talked about the fact that we almost certainly talk to ourselves much more harshly than we would do to anyone else who may be going through something similar. We're often our own worst critic, telling ourselves that something should be easy to do, or that worrying or feeling down is something we can just snap out of, when we'd take a kinder and more gentle approach to friends or family or came to use with the same feelings.  I think we all probably recognise that, and it's useful to think about what our compassionate self would say to our stressed self.

The final thing we covered was something I've heard of before but am yet to try and it's the idea of finding three things to be grateful or thankful for each day.  I suppose the idea behind it is that we're allowing ourselves to think about the positive things we've experienced rather than having that feeling that there's nothing good going on.  I'll see where I get to...

We finished the course with a quick tour back through the other five sessions but I won't repeat those here - links at the top of this post if you want to check out anything particular

What's changed?

So what have the last six weeks meant practically?  Well six weeks isn't really a long time so some of the changes or differences are in their infancy and as they said, it's almost like the hard work starts now when putting these things into practice every day away from the course.

I'll start with the positives:

• I've definitely used my rational voice more when I'm approaching known stressful situations (e.g. travelling).  I now need to think about being able to have that midset when more unexpected areas of stress arise.
• I've cut out more caffeine later in the day.  This is pretty difficult sometimes as my work schedule can be a little unpredictable but overall it's an improvement.
• I've followed some of the progressive muscle relaxation and breathing techniques fairly regularly and I think the breathing in particular has been really helpful.
• I've started blogging again - admittedly only about this course, but it's got me back into something I enjoy when I feel like there's something worth writing down
• I've started listening to a bit more music and watching a little less Netflix.  Music has been a longstanding passion of mine but it had become a smaller part of my day and redressing that has been good
• I've done more to cut out eating/snacking to try and cope with feeling tired or stressed.  Early days but it's a step in the right direction
• I've gradually started doing a little more exercise.  It's not quite as regular or frequent as I'd like, but definitely feels like a positive step
• I've only had one tension headache in about two months - that's definitely worth celebrating!

And a couple of things that aren't as good:

• I'm a lot more conscious that sometimes I just find myself clenching my jaw and I'm not sure how often it's been going on, but it needs to be very deliberate recognition of it before I stop
• I'm a lot more conscious of a pain or ache in my neck.  I can't work out if it means my pillow isn't quite right, or whether it's just holding tension in that part of my body
• I'm equally more conscious of the pain I get in my hip/leg that came before, during and after the London Marathon in April so I think I need to dig out the foam roller again for that
• I still feel knackered all the time

So what next?

We did a wellbeing questionnaire in weeks one, four and six and whilst my score in the stress half of it decreased (10 to 9 to 8), the low mood half remained fairly static (14 to 13 to 14) and I guess that's something to think about.  A lot of the symptoms associated with stress also correlate to the idea of low mood and whilst that might make the stress part of the diagram more manageable, it means you end up being fairly static on the wellbeing axis.

One of the facilitators suggested I ring up the IAPT wellbeing number and book in for some one-to-one discussion about disentangling the stress and anxiety from the low mood.  That feels like a pretty big step.  Part of me thinks that it should be easier having done this course - remember it took six months for me to ring up to book onto this in the first place.  Having taken the first couple of steps it should be easier to take the next few.  But it also feels hard to put yourself in a vulnerable place to talk about something you probably don't really understand yourself.

I'm going to keep plugging away with the techniques we learned on the course, and keep reinforcing the positive things I've started as best I can.  Progress isn't perfectly linear in things like this and it's OK to have the occasional step backwards as long as you're taking a couple forward too.  And I'm probably going to make that call...

If you made it this far (both on this post and throughout the course) then I hope it's been helpful in some way.  Everyone's experiences and circumstances are different so use what you can and discard the rest.  Hopefully I'll keep coming back to the keyboard more often than not - the focus can be quite cathartic sometimes.

Diabetes UK are running a hugely important campaign about improving the provision of and access to a variety of emotional support services. People with diabetes are twice as likely to suffer from burnout or difficulties with their own mental health compared to those without the condition. Some estimates suggest that one in ten people with diabetes are clinically depressed. You can read more about the vital It's Missing campaign by following the link. My story is just my story. If you need to talk to someone about how diabetes is making you feel, you can ring the Diabetes UK Helpline on 0345 123 2399 or you can ring Samaritans 24 hours a day on 116 123

Panic and Sleep

If you want to catch up you can find the pre-session, week one, week two, week three and week four posts in the links

Welcome to week five - dealing with panic and getting a better night's sleep.  Instead of covering these with the usual 'theory/practice' approach, I'm going to talk about them as two separate topics as that's really how we went through them in the session.  We were down to 10 (plus three people observing) yesterday which is a far cry from our 20 we started with, and I was a little surprised as I'd expected sleep to be a big draw.  One of the facilitators actually said that many people book onto StressControl explicitly for the sleep info as it's something that a lot of people want to know more about.  But first - panic:

Panic

We talked about what panic is and how those extreme feelings linked to fight or flight can, in some circumstances make us feel like we're dying.  A lot of the symptoms of panic are (unsurpisingly) similar to those of stress or anxiety - sweating, dizziness, heart palpatations, clammy hands, shortness of breath etc... Some regular readers may also notice that these are also symptoms some people experience when having a hypo (happy Hypo Awareness Week by the way...) so understanding the cause is really important.

We also talked about panic can be a response to a particular situation (confined spaces and having bloods taken from my arm), or can also be 'out of the blue' panic.  If you've never had a panic attack, it's not something I'd recommend.

In terms of management, a lot of techniques we've covered over the last few weeks came in to play.  Focusing on breathing is key as it helps us regulate our internal biology. We talked quite a bit about hyperventilating and how this adds to feelings of panic as you're upsetting the oxygen/carbon dioxide balance whichcan fuel some of the symptoms.  It's not something I have a lot of personal experience with though.

Aside from breathing, remembering to engage our rational voice helps - you might feel like you're going to faint, but if you never have, is that a likely outcome or is the fear fuelling the problem?  We didn't cover avoidance in relation to panic so based on my own experience, I can tell you I actively do avoid situations that involve confined spaces where I can.  I can't avoid blood taking though so it was reassuring that my own personal brand of coping (deep breaths, play some music, focus on something else) is largely in line with proper advice.  I think it's helpful to add in the rational thinking bit too though (although I very nearly did genuinely faint once...)

Sleep

It did feel like sleep was the thing with the biggest build up, so it may be disappointing to here how it was nearly all grounded in the most mundane, common sense approach imaginable.  As with most things throughout the course, it's reassuring that there's nothing too complicated to learn that's brand new, but also makes you wonder why you can't always see the easy common sense stuff for yourself.

We covered difficulty getting to sleep as well as difficulty staying asleep - I guess the difference between quantity and quality of sleep.  Very few silver bullets here, but some of the things worth remembering are:

1. Avoid caffeine before bed (and bear in mind it can stay in your system for up to eight hours)
2. Reduce hot drinks closer to bed time (although the benefits of an Ovaltine are the exception there)
3. Alcohol might help you get to sleep but it can affect the quality of your sleep and you shouldn't end up being dependent on it
4. Eating a big meal before bed means your body will be digesting if after you've gone to sleep which again can affect the quality of sleep you get
5. Cool (but not cold) temperature is best - around 18 degrees.  I felt particularly vindicated by this point as I'm a fan of sleeping with the window open
6. Reduce noise and light where you can (ear plugs, blackout blinds) but playing white noise can reduce the affects of environmental noise
7. Reduce screen time before bed (even where there are blue light filters)
8. Keep your bedroom for sleeping and not working, emails etc

We also covered how even small changes can have an impact so if you're struggling with sleep then some of these may be for you.

I think what I found frustrating here was the X factor that diabetes can chuck into the mix.  I didn't have a decaf coffee after about 5pm yesterday, cooled the spare room (early start means I get the spare room) and had ambient noise that I know helps me get to sleep.  And then I had a hypo at 2am and was up for about 40 mins before getting up at 4:40am...  

I guess you can only control what you can control, but the impact that diabetes can have on sleep is catastrophic sometimes.  I also know that weeks like this where I'll be sleeping in four different beds in seven days means I'll struggle.

So we're nearly at the end - next week is the final week of the course where we'll link all these bits together in an attempt to have a more concrete plan about improving our wellbeing and thinking about how we continue the work after the course has finished.  All the hard work is still to come I think as it's the ability to stay focused on these techniques away from a weekly structure.

Hopefully this has been helpful - see you next week.

Diabetes UK are running a hugely important campaign about improving the provision of and access to a variety of emotional support services. People with diabetes are twice as likely to suffer from burnout or difficulties with their own mental health compared to those without the condition. Some estimates suggest that one in ten people with diabetes are clinically depressed. You can read more about the vital It's Missing campaign by following the link. My story is just my story. If you need to talk to someone about how diabetes is making you feel, you can ring the Diabetes UK Helpline on 0345 123 2399 or you can ring Samaritans 24 hours a day on 116 123

Controlling your actions

If you want to catch up you can find the pre-session, week one, week two and week three posts in the links

Anakin Skywalker is out, Peep Show is back!  This week at StressControl was focused on being able to control our actions and understand how the things we'd covered in previous weeks (effects on our body and controlling our mind) link together.  

Before we started, we re-did the wellbeing questionnaire from week one.  I think I'd slightly improved more scores but only by one point each.  Interestingly I still scored higher for low mood than for stress/anxiety so there's something to think about in that!

We had the trusty Theory - Coffee - Practice triumvirate to guide us through the session.  I scribbled quite a lot down this time, rather than solely relying on the printed materials as my reference for afterwards.

Theory

As with last week, the most simplistic thing to understand is that if stress can affect our actions, then being able to exercise control over our actions gives us an element of control over stress.  This is true for our thoughts and for the physical effects of stress too.

Firstly, some of the common ways we act when we're stressed.  I suspect these are familiar to many of us at some point, but note this is by no means an exhaustive list:

• Argue
• Bite your mails
• Withdraw
• Anger outbursts
• Cry
• Take longer to do [certain] things
• Go quiet

The bold ones are certainly some that I identify with, although I'm not sure whether being a serial nail biter since I was about nine years old means I've got 30 years of stress to control... It also serves as a reminder that while we feel the physical and mental manifestations of stress ourselves, there can often be consequences for those closest to us.

One of the other key things we talked about was the idea of Avoidance and the short vs long-term trade offs that can have for us.  It's fairly logical and sensible once you hear it, but I definitely needed it spelling out to be conscious of it.

It goes like this:

If there's a particular situation or task that you know will cause you anxiety, your natural reaction is to avoid it.  In the short term that's great because it's reduced your anxiety.  The issue is that in the long term, it'll undermine your self-confidence and mean dealing with the stress or anxiety is increasingly hard.

The first part of that might be pretty obvious, but avoidance is telling ourselves we can't cope with a situation and so we withdraw and identify threats we wouldn't otherwise have considered.  

Going back to session one and the key principle of facing our fears we see the opposite.  Facing up to something rather than avoiding it is likely to be worse for our anxiety in the short-term, but it's building up our confidence to deal with stress in the long-term, which will have a positive impact on both self-confidence and self-esteem.

Practice

"So how do we do that?!" I hear you cry?  It's grounded in the idea of 'testing reality' and then engaging our rational/conscious voice (from session three) to do some problem solving.

Reality testing is really asking ourselves to consider two outcomes:

1. What's the consequence if the thing we're worried about happens?
2. What's the consequence if something else happens?

Remember the Big 5 Challenges?  We can use those to help answer the first question by being more conscious of our rational voice instead of our stress voice.

So then we problem solve:

• What problem do we want to solve?
• Figure out something that's well defined that would make us feel less stressed or anxious
• What will happen when I face my fear?
• Use the skills from controlling our thoughts to make our rational voice the dominant one
• Brainstorm
• What are the different courses of action I could take here?
• Choose the best option(s)
• Simple pros and cons of our options, and some honesty about whether we think these will bring us immediate success/change or whether we may need to refine them
• Work out a plan
• When will we take these actions?  Will it be more than one our our options?  Do we need to use some other skills/techniques (such as relaxation, breathing?)
• Put it into action
• Do what we've decided to do
• Review
• Did it go how we expected?  Will we do this again?  Do we need a more gradual approach?  Do we need to try something different?

When you read most (if not all) of this, it seems to be fairly common sense, and I think that's really important.  It's not a set of complex behaviours or tools that anyone needs to learn, but it's about being able to take a step back, try and disentangle ourselves from the immediacy of our situation and approach things differently.

There are some helpful handouts in the workbook to go through some situations in detail.  As I said last week, I think the difficulty for me lies in isolating some of these things in the first place.  But it's also not designed to be a quick fix, and most of the work will come after the course finishes.

I feel like I've started to put some of this into practice, particularly around my weekly train travel, but I also know that last week I jumped straight to a set of stress-induced thoughts and behaviours in a different situation, so I've still got work to do.

Session Five is looking at panic and improving sleep.  I only really experience panic in very specific situations so hopefully that'll be some easily translated learning.  I do a lot already to try and improve my sleep, so hopefully there'll be some things I can finesse there too.

If you made it this far, thanks and I hope it was of some use.

Diabetes UK are running a hugely important campaign about improving the provision of and access to a variety of emotional support services. People with diabetes are twice as likely to suffer from burnout or difficulties with their own mental health compared to those without the condition. Some estimates suggest that one in ten people with diabetes are clinically depressed. You can read more about the vital It's Missing campaign by following the link. My story is just my story. If you need to talk to someone about how diabetes is making you feel, you can ring the Diabetes UK Helpline on 0345 123 2399 or you can ring Samaritans 24 hours a day on 116 123

Coping With Christmas

This blog was first posted on the DiabetesUK website on 13th December 2012


Whilst Roy Wood famously pined for it to be Christmas every day, I sadly don't.  That's not to say I'm some Dickensian miser who can't bear the sight of a bit of tinsel or the jingle of some bells (well maybe in October - I digress).  I geninely look forward to Christmas, but I know it'll play havoc with me.

I'm a creature of habit, a person of routine, someone who enjoys certainty as much as it can ever be found.  Christmas (and I suppose I'm talking about most of December really) destroys a lot of that and makes life a little more chaotic.

Whilst there are plus points like seeing family and friends, there are the downsides like over indulgence.  Last year I was into my London Marathon training and was incredibly measured with what I ate, but that's not really the norm.  I think it's totally natural to want to unwind and indulge during your Christmas holiday and being diabetic shouldn't stop me from doing that - it just means a little extra work on my part.

With all that in mind, I've come up with a few tips for surviving the festive period (note that I'm not offering any tips on dealing with your inlaws...)

• Don't worry.  It's easy to get sidetracked by the number on your blood glucose meter at the best of times and with mince pies and chocolates flying around, I think it's inevitable that at some stage, you'll get a higher reading than you'd normally expect.  That said...
• Test a bit more often.  If your house is anything like mine, not only will you be eating things that aren't the norm, your mealtimes will end up being different too.  If you normally test 4 times a day, sticking an extra one in should mean you don't stray too far off course.
• Don't deprive yourself.  A slice of Christmas cake or an extra mince pie probably won't be your downfall (unless the slice of cake is the size of a house brick) and there's nothing worse than feeling like a martyr while everyone around you is having a great time.
• Keep the packets.  I'm terrible for throwing away boxes with nutritional information on them.  It's usually convenient to check the back of a packet for the carb values per serving (*cough* per mince pie *cough*) and adjust my dose accordingly.  It's less convenient if I've stuck the box in the recycling bin along with all the wrapping paper so try sand save them if it'll help you.
• Take the help that's there.  As you may have caught on, I'll definitely be sneaking the odd bit of dessert over the next few weeks but I'll make sure I've got things like low fat custard or reduced sugar ice cream to go with them.  No-one else round the dinner table can tell the difference anyway.  I've convinced myself I had low-sugar cranberry sauce last year but an internet search has proved fruitless (sorry!)

I suppose the message is the same one that should really apply regardless - enjoy everything in moderation.  Of course it's a bit harder to do when you're diabetic, but all the tools are there to help you.  Being diabetic is just different, not worse.

I hope you all have a fantastic Christmas and a very happy 2013.  I'll be back in the new year to talk about my diabetes study and DAFNE (amongst a whole host of other things).

Merry Christmas!

Andy