Patients keep a log of their thoughts and feelings, the times of day they occur, and what triggered them. This helps them evaluate whether their thoughts are appropriate given the facts. That process, in turn, facilitates deciding whether the correct course of action is to try to change a situation or change one's negative reaction to it. “Patients can't change the fact that they have diabetes, but they can change the way they manage it,” he said.
Patients are taught to use the mnemonic “I AM WORTH IT” to ask: Is the matter Important? Are negative thoughts/feelings Appropriate? Is the situation Modifiable? And, balancing the needs of myself and others, is it Worth It? If the answer to all four questions is “yes,” action skills to change the situation include problem solving, assertion, and saying “no.” If the answer to any of the questions is “no,” then “deflection skills” such as distraction, thought stopping, and relaxation/meditation are the next step.
Among the “action skills” is a systematic approach to problem-solving: Define the problem, generate alternatives through brainstorming, make a decision, implement the decision, evaluate the outcome, and revisit other options if needed. Assertion is another often-needed skill, in which patients are taught to ask others to change their behavior, to listen to them–or importantly, for people with chronic illness–to ask the physician for more information.
If “deflection” is the better course of action, relaxation exercises such as the one that Dr. Williams took the audience through may be in order: Picture a stop sign and say, “Stop” to yourself. Take three deep breaths, and say, “Relax” on each exhale. Inhale while clenching fists, then relax them on exhale. Inhale while clenching feet, then relax on exhale. Inhale while shrugging shoulders, then relax them on exhale. Inhale while tilting head to the right, then straighten on exhale. Inhale while tilting head to the left, then straighten on exhale. Finish with a “plain” inhale/exhale cycle.