family-diabetesMarketing researchers have spent much time discovering ways to sell goods, such as food, clothing, sevices, and electronics.  One tactic is to draw in consumers through words.  Brian Wansink, professor of consumer behavior at Cornell University, found that consumers gave higher ratings to foods labeled with a gourmet name. Examples of this are everywhere.  

Walk into a Subway restaurant and you will not see white bread on the menu. What you will find is “Italian Bread.”  And even their meats have interesting names, like “Black Forest Ham,” which sounds much more appetizing than just a plain, old-fashioned standard ham.

Our taste buds are not the only things influenced by thoughts. Emotions, actions, and even the body are significantly impacted by cognitions. Several of the most effective forms of psychotherapy involve changing thoughts. Research has shown that each thought literally leaves an impression on the brain. Thoughts mold and shape this vital organ. For this reason, cognitive-behavioral therapy and dialectical behavioral therapy are utilized in the treatment of mental health disorders.

Thoughts also come into play with diabetes. A few examples of variables which impact the thoughts of someone with diabetes are as follows:

•    Reactions of family, peers, authorities, and society
•    Personal, familial, and communal conceptualization of diabetes
•    Expectations regarding the life of the individual with diabetes   

I recently went to HODIA’s DTreat, which was a weekend retreat for young adults with type 1 diabetes. About 40 individuals, 18-30 years of age, attended the retreat and the purpose of it was to gain social support and education. Accounts of stresses associated with this chronic disease were shared. Some people reported having been labeled as the “sick” child. The illness was catastrophized. Over the years, many of those growing up under this label proved to struggle with metabolic control and develop subsequently complications.

There is something to be said of self-fulfilled expectations. People often rise or fall to the expectations which are placed upon them. Providers can support patients and families in developing hardiness and resiliency. Because diabetes impacts families as a whole, it is imperative to bolster hardiness of the entire unit. M McCubbin and H. McCubbin said the following about hardiness: “Family hardiness specifically refers to the internal strengths and durability of the family unit and is characterized by a sense of control over the outcomes of life events and hardships, a view of change as beneficial and growth producing, and an active rather than passive orientation in adjusting to and managing stressful situation.”

Conceptualization of diabetes builds expectations regarding outlook for life. Perception of life impacts emotions and actions. Fortitude, endurance, and hardiness are required to continually implement prescribed treatment for diabetes management. Providers may assist in remaining solution focused and building on attainment of goals not related to diabetes. Positive attitudes are associated with better metabolic control, improved health, and a reduction in diabetes specific conflict in families. (1)

With a new diagnosis, providers can frame diabetes as a manageable condition. This can be done by giving examples of others who have achieved extraordinary things and benefited from diabetes. Telling horror stories of patients who lost limbs, experienced kidney failure, and eventually died as a consequence of poor management may not produce desirable results. These threats may serve as a barrier, creating resistance in following through with regular appointments and treatment recommendations.

The Family Hardiness Index is a tool to assess level of familial hardiness. Twenty statements describe hardiness which families are to rate the applicability of each item. Some examples include: “We work together to solve problems,” “We have a sense of being strong even when we face big problems,” and “We believe that things will work out for the better if we work together as a family.” (2)

Providers, consider being part of the family. Are the statements true in your relationship with patients and families?

Diabetes is not a death sentence. Determine what you may do to increase hardiness with those in your practice. Assist families and patients with diabetes management. Use words to express confidence and positively reframe diabetes. Like a pebble dropped in a lake, small words can produce powerful results.    


(1) Anderson, B. J. (2004). Family conflict and diabetes management in youth: Clinical lessons from child development and diabetes research. Diabetes Spectrum, 17(1), 22-26.
 
(2) McCubbin, M. A., McCubbin, H. I., & Thompson, A. I. (1991). FHI Family hardiness index. In H. I. McCubbin & A. I. Thompson (Eds.), Family assessment inventories for research and practice (pp. 127-136). Madison, WI: University of Wisconsin.