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- Living with diabetes means you have a relationship with your condition—whether you consciously realize it or not.
- If your relationship with diabetes involves a lot of negative self-talk and self-criticism, it might be time to learn a few strategies from a psychology method known as acceptance and commitment therapy (ACT).
- With an ACT-based approach, you can accept the difficult and often inevitable emotions that come with managing diabetes and commit to refocusing your energy on what you can control.
Whether you’re aware of it or not, you have a relationship with your diabetes. Maybe it’s a relationship that’s driven by perfectionism and negative self-talk, or by avoidance and neglect. However it manifests, the quality of that relationship can affect how you manage your diabetes, from consistency (or lack thereof) with healthy habits like exercise to your ability to maintain a medication regimen if you need one. One way to help improve that relationship? Explore the strategies used in acceptance and commitment therapy (ACT).
What Is Acceptance and Commitment Therapy?
According to Psychology Today, acceptance and commitment therapy (ACT) is an action-oriented therapy method that involves learning how to stop avoiding and denying negative emotions by practicing acceptance of these feelings and hardships as appropriate responses to certain experiences and committing to making changes in areas that you can control.
In the context of diabetes management, researchers have seen “great results with ACT in terms of helping with diabetes distress,” says Dr. Harpreet Nagra, PhD, VP of behavior science and advanced technologies at One Drop. Diabetes distress is characterized by excessive worry, frustration, anger, and burnout that make it hard for you to take care of your health and keep up with your day-to-day diabetes management (this survey can help you evaluate your own level of diabetes distress).
While more robust studies are needed to confirm the benefits of ACT for people living with diabetes, research suggests that ACT-based interventions and strategies can not only help with diabetes distress but they’re also associated with better health outcomes in diabetes, including improvements in A1C and increased self-care behaviors.
But how does ACT work for diabetes management, exactly? First, think about some of the negative emotions you’ve dealt with while managing your health. Perhaps you’ve caught yourself ruminating for days about a single high blood sugar reading, or maybe you feel hopeless when you get to the gym and try to figure out the workout machines.
Whatever difficult emotions you encounter in your own relationship with diabetes, the first step in practicing ACT is to focus on acceptance, says Dr. Nagra. That means making peace with the fact that “self-blame is going to come up” sometimes, regardless of how well you manage your health overall. Given the numbers-focused nature of diabetes management—from A1C values to insulin-to-carb ratios—it’s easy to feel defeated when those numbers aren’t “perfect.” Plus, when you live with diabetes, you’re literally making hundreds of extra decisions per day compared to people who don’t live with your condition. More decisions mean more opportunities to evaluate and, potentially, criticize yourself.
The key to practicing acceptance in diabetes management, explains Dr. Nagra, is to remember that these self-evaluations are temporary. “You always have the chance to engage in self-evaluation and self-management differently each time a new decision is presented to you,” she says. “If you can let yourself pass through those moments without getting stuck in them, that can help improve your relationship with diabetes over time.”
Commitment, on the other hand, is about dedicating yourself to combating those automatic negative thoughts—or, as Dr. Nagra puts it, “becoming unstuck from self-criticism.”
“It’s about moving away from negative self-talk and self-judgment and embracing self-compassion,” she explains. Even if your blood sugar levels aren’t where you’d like them to be one day, or your doctor lectures you about your A1C, remember to evaluate your success not just based on those numbers, but also on your consistency and dedication to healthy habits, whether it’s meal prepping nutritious lunches for yourself or managing your stress by practicing meditation when you find the time.
“Negative self-talk often stems from there being a lot of emphasis on changing your lifestyle so that you can manage your health,” making it easy to blame yourself when you don’t get the results you want, says Lena Suarez-Angelino, a licensed clinical social worker (LCSW).
But, notes Dr. Nagra, your sheer commitment to a healthy lifestyle is still worth recognizing. Even if you don’t see certain changes right away, that doesn’t mean you have to negatively evaluate yourself or take on every inconsistency or “failure” as something that’s “wrong” with you, she explains.
Putting ACT Into Action
ACT-based strategies can go a long way in bettering your relationship with diabetes—and you don’t have to tackle them alone.
“It’s extremely important to reach out to diabetes specialists who can guide you to the right resources,” says Aleida Saenz, a certified diabetes care and education specialist (CDCES) and director of patient education at the Diabetes Research Institute (DRI). “You don’t have to bear the burden of self-blame when coping with a chronic condition.” (Many One Drop coaches function as a CDCES, a registered dietitian/nutritionist, and a certified personal trainer.)
If you want to work with a therapist who’s trained in ACT, ask your primary care doctor if they can recommend someone, or, if you’re employed, talk to your company about possible mental health benefits. Psychology Today also lets you search for an ACT therapist in your area, and institutions like Columbia University offer both individual and group ACT. For more mental health resources, be sure to check out the American Diabetes Association (ADA)’s mental health provider directory, as well as sites like MentalHealth.Gov, the National Alliance on Mental Illness, and the Substance Abuse and Mental Health Services Administration (SAMHSA).
You can also try practicing ACT-based strategies on your own time. Here are a few ways to get started:
- Journal through moments of automatic self-criticism. Maybe your thoughts spiral into self-judgment whenever you try to meditate. Or perhaps you subconsciously call yourself an idiot whenever your blood sugar reading is way off from what you thought it’d be. “Write these thoughts down for yourself to see if there’s a particular narrative or story you’ve been telling yourself, like, ‘I should be able to manage my blood sugar by now,’” says Dr. Nagra. “Naming and describing whatever that narrative is for you can help you accept that story as your starting point, identify what you want to do with that story, and commit to figuring out how you might rewrite it.”
- Distance yourself from self-critical narratives. “Once you’re able to name and describe your narrative,” explains Dr. Nagra, “create some distance between you and that story.” For instance, if you criticize yourself for spiking your blood sugar at night with junk food, make sure you recognize why you’re engaging in that behavior in the first place. Is it due to emotional eating? Is it a way to try to avoid low blood sugar at night? Once you understand the reasoning behind your actions, it’s easier to distance yourself from self-critical thoughts, says Dr. Nagra. “The idea is that, instead of just accepting your actions—and whatever narrative you’ve created to explain them—as things that are part of you, you can separate yourself by adding the preface, ‘I’m having the thought that I’m going to have low blood sugar at night; that’s why I ate that bag of chips.’” So, the next time you try journaling about moments of self-judgment, see how it feels to write about your own narratives with the phrase “I’m having the thought that” before each one.
- Reframe some of your self-critical thoughts. Again, a huge part of ACT-based strategies is accepting the experience of occasional negative emotions as part of life with diabetes. Still, when you catch yourself judging your thoughts or actions, take a moment to consider how you might reframe that negativity into something more positive or, at the very least, neutral. For example, says Brooke Schwartz, LCSW, if you manage to get outside for a 10-minute walk after dinner, your automatic thoughts may default to something like, “I can’t even get outside for more than 10 minutes? I’m so lazy.” But what if, instead, you reflected on how proud you are that you got outside at all, even if it was only for a few minutes? “The former decreases the likelihood that you keep putting in the effort; the latter motivates you to continue getting outside,” explains Schwartz. “Even if you can’t shake these patterns completely, rewarding yourself with positive self-talk can help mediate the unwanted effects of self-blame and negative self-talk.”
- Recognize self-compassion as a reward. Many of us think of rewards extrinsically: money, decadent food, vacations. And, while it can certainly be helpful sometimes to have a tangible reward to look forward to after an accomplishment, it’s also important to see self-compassion as a reward itself. “Self-compassion can help you feel calmer and more empowered when managing difficult life circumstances,” explains licensed marriage and family therapist (LMFT), Nicole Arzt. That doesn’t mean you can’t treat yourself to a spa day or a night out on the town after meeting one of your health goals. But it does mean being gentle with yourself even when you feel like you “don’t deserve” those rewards, and recognizing that self-compassion is always within reach to make your life a little easier.
While One Drop coaches can support changes in your emotional well-being, they cannot diagnose and/or treat mental health conditions. If you or someone you know needs immediate help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline or text 741741, or chat online at suicidepreventionlifeline.org.
This article has been clinically reviewed by One Drop health coach, Lisa Graham, RN, CDCES and One Drop health coach, Alexa Stelzer, RDN, LD, CDCES.