Diabetes Self-Management Articles

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Listening to Diabetes
Using Guided Imagery for Relaxation and Insight

by Susan Shaw, M.S.W., C.Ht.

Allowing the mind to form images that represent calm, comfort, peace, happiness, spiritual awe, and deep relaxation activates the relaxation response, a phenomenon identified by Herbert Benson, MD, in which the nervous system deactivates the stress response. Brain waves, respiration, heart rate, muscle tension, and blood glucose all decrease, while immune function and feelings of well-being increase.

Many practitioners of imagery find that certain forms of it can help uncover causes of fear or anxiety that may be buried in the subconscious. Imagery can also be used to find ways to lessen the intensity of these feelings and solutions to the problems they cause. Thus, practitioners often speak of a cycle of healing and renewal, beyond the relaxation response, that can begin through imagery and lead to improved mental health and well-being.

While the professional literature on imagery refers to successful uses with a wide variety of medical and psychological conditions, there are only a handful of studies that have looked specifically at diabetes. In a 1999 study, nurses Harriet Wichowski and Sylvia Kubsch reported that people with diabetes who listened to an imagery script designed to increase adherence to recommendations for blood glucose monitoring, exercise, weight management, and diet showed improvement in these areas. In a 1990 study, doctors at the State University of New York encouraged a small group of adolescents with diabetes, all of whom had a history of poor compliance with treatment, to visualize achieving personally meaningful life goals despite diabetes. For example, one teen imagined his future as a firefighter in colorful detail, right down to the feeling of riding on the back of a speeding fire engine and noticing details like the buttons on his coat. After engaging in this imagery, dramatic drops in HbA1c levels were noted in the group, indicating improved blood glucose control.

Forms of imagery
Imagery happens in our minds all the time; it is inherent to how we think and feel and part of what makes us who we are. “No one owns imagery,” Marielle Fuller, a famous practitioner and teacher of imagery at UCLA, used to say in response to those who might claim authorship. Individuals can feel free to experiment with imagery for themselves, but those who would like to facilitate imagery for others need to seek appropriate training.

Researching imagery is problematic because of its varied forms; no one is exactly sure which one will work best in a given situation. Imagery is commonly used both in individual sessions and in groups, with or without an audiotape, and with or without a trained facilitator present.

And then there are different methods for the imagery itself. Each of the following methods requires that the participant relax in a comfortable position with the head supported, in a place free of interruptions. Ample time is required to get the maximum benefit from imagery, since this requires several integral phases, as noted by psychologist Jonathan C. Smith. These phases are withdrawal (from the physical world), release (from everyday burdens and analytical thinking), recovery (from fatigue and tension), and opening up (back to the physical world, renewed and refreshed). Half an hour is ideal for this process.

Evocative imagery. Evocative imagery allows images to arise spontaneously. Begin by identifying a desired state, close your eyes, and then allow an image to form that represents that state. You might search for an image that represents calm, relaxation, peace, joy, love, or — an important one for people with diabetes — acceptance. Remain open to whatever form the image takes. Sometimes images seem so ordinary that the journeyer (a common term for someone engaged in imagery) doubts the image is valid, but the subconscious always picks the “right” image. Ocean waves are a common image, but the family dog or the quiet of a bedroom are also common. The key to any image is to “entertain” it for a long time: to explore it with curiosity, engaging the image fully into the psychosomatic network by noticing smell, sound, movement, color, texture, and taste.

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