Brief Overview of the Case
Discuss about the Analyse The Case Of Diabetes Patient Julie.
The case at hand, suggests that Julie is currently suffering from Diabetes 2, which is not only affecting her physical health, but is also affecting her mental stability and emotional well-being. Starting with the diagnosis, Julie’s life has remarkably changed. From being an administrative assistance in the past, she has been reduced to a crippled person suffering from ill-health, battling with the problem of weight gain as well as the anxiety caused by the loss of a normal, carefree life she used to lead earlier. Obesity is a very common condition of almost any patient suffering from Diabetes 2, and in fact 85% of the patients are uncontrollably obese or overweight. However, Julie is unable to reconcile herself with the fact that she has adopted various strategies to combat her weight gain issue, and yet has been able to do nothing about it. This is impacting her motivation negatively, and this loss of motivation is highly undesirable in case of a Diabetes patient, as it is an important tool needed for efficient management of the patients with Diabetes 2. In controlling diabetes as well as managing weight, self-care behaviour of the patient can only help the patient control diabetes through strict adherence, which however can be impacted by the patient apathy, characterized with lack of initiative and motivation.
As stated by Grover et al., (2015), motivation and self-regulation plays the most significant role in consideration with management of weight and other related behaviours. Leading a predominantly sedentary live has become a regular activity of people in the recent time. Accordingly, it is justifiable to adapt certain psychological as well as other self-regulatory features in the behaviour of a person in order to be motivated and control weight. According to the Theory of Planned behaviour, there is predictive power to and there can be changes in the behaviour of a person if the person wants. There are certain norms and individualistic intentions that actually decide the behaviour of a person (Kemps, Tiggemann, & Hollitt, 2014). If the situation of Julie Green is taken into consideration, it can be said that she has certain responsibilities to perform with respect to her husband and children. Obesity is indeed a fatal disorder and that she has to be cautious enough to understand the importance of losing weight and leading a healthy life. It is only her intensions and will that would help her to overcome from the present situation. The psychological theory, Theory of Self-actualisation also states that there is a need to understand the potentiality of each person to be focused on a particular arena (Kemps, Tiggemann, & Hollitt, 2014). It is important for Julie Green to understand the present situation and be prompt enough to come down to a particular approach that would help her to improve her present health condition. As evident that Julie was also suffering from stress due to her health issue, according to the stress and coping theory, she would cope-up with the situation if she manages to overcome the current health problems that she is facing.
Description of Problems
From an emotional perspective, it should be noted that Diabetes 2 is a chronic health problem, that is accompanied by obesity and other obesity related problems, such as partial disability, that can potentially impact the mental stability of the patient. In the present case, Julie is experiencing a persistent feeling of loss of motivation, a bitter feeling of anxiety and depression as well as loss of self-esteem because of her overweight and her helpless condition in managing the same. It is a well-known fact that anyone who suffers from diabetes and depression have poorer metabolic as well as glycemic control which again, in turn, is claimed to intensify the symptoms of depression. While comprehending the emotional problem of Julie, it is important to note that she is emotionally unstable primarily because of the diagnosis of the disease itself, which she finds to be incurable. Now, the rigour of managing the chronic disease itself is emotionally destabilizing her, as she is experiencing a feeling of powerlessness in controlling her situation. Next, she currently weighs 120kg, which is adding to her depressed mood as well. Further, what is worsening the situation for her is that Julie is also suffering from other health issue related complications associated with Diabetes, such as partial disability and walking problems, which has created a feeling of despair, hopelessness, anxiety as well as loss of interest in daily activities.
Mrs. Green has been refereed to me after she has complained of going through an emotional turmoil regarding her weight gain issues. It is seen that she has been overweight for a quite a large period of time and she has even tried her best to change her diets to reduce her weight. She has found no result and instead she has been further affected by diabetes and pain in her joints. All these had added to her physical discomfort and mental instability. She had not been able to experience any positive outcome form her diet plan and moreover adding to het physical disabilities like walking with help of stick has affected her motivation and she no longer feels the urge to get back in shape. This case history of hers can be explained by the help of trans-theoretical theory which described her behaviour in five important steps. The main issues that had affected her motivation have been identified in the fourth and last stage of the theory which will be discussed in the following paragraph.
Analysis of the Case History and Factors Leading to the Problem
The first stage of weight loss is that here an overweight individual has no intention to change the lifestyle probably as they see no reason or benefits of doing so (Phelan et al., 2015). However, Mrs. Green overcame it and reached the next stage which is the contemplation stage where the individual reaches a conscious decision to lose weight. This stag was successfully attended by Julie as well. The next stage is the preparation stage where the individuals sees benefit behind taking initiatives to lose weight (Katterman et al., 2014). Here, Julie also expected to get rewards in the form of losing her weight and so he prepared herself with such a motivation to lose weight. In the action stage also, Julie tried to set goals and take actions by taking in each and every kind of diet which she believed would reduce her weight. However it was in vain and this led her to relapse back into the first and second phase again and again. Staying in action plan for a long time makes an individual to lose motivation as stated by researchers and the same had happened with Julie (Dombrowski et al., 2014). The maintenance stage is the stage where individuals maintain their good habits which they have developed by changing their bad habits. This stage was a total failure as the previous action stage was not properly conducted by Julie.
The main reason for the failure of the motivation was that she was not getting proper results for the diet plan she had taken. This was the outcome mainly because she might not have followed evidence based diet plan according to her individual requirement. She might not have followed a complete plan which would have aligned with her goal properly. Therefore inappropriate diet plan which she had perceived as the correct diet plan for her might have failed her and she lost motivation for that (Hardcastle et al., 2013).
Moreover, it is also seen that while she was failing in her attempt to reduce weight, she was affected by diabetes which gave her further troubles as he developed join pain and head to use sticks for walking at an age of 43. This physical pain affected her mental strength as well. Moreover she has no role figure to be encouraged with as all her family members except her youngest child was overweight. She got into a phase of depression for all these reason that affected her motivation entirely. She could see no way out and in course of time she developed the feeling that she has no way out of the situation. Hence, all the factors have to be judged properly before setting up a care plan for her for the best outcomes (Franz et al., 2015).
Depressive symptoms are common in case of the patients who are suffering from diabetes mellitus (Nouwen et al., 2010). This depressive symptom lays a burden on the family, patient and the health care system. In case of Julie, the rate of depression is assumed to be more because at present she is overweight, unemployed and is suffering from extreme joint pain. Psychological therapies are regarded to be the best for the treatment of the depression which Julie is experiencing at present. Such psychological therapies are devoid of any harmful side-effects as they do not employ the use of antidepressant drugs.
The most common therapy that is advised for the treatment of depression is Cognitive Behavioural Therapy (CBT). It is a short term intervention therapy in behaviour activation which eases the negative thoughts. CBT includes cognitive and behavioural strategies to overcome the depression arising out of the diabetes distress. It also reduces the perceived barriers to several factors of self-management and at the same time will increase the physical activity of Julie while assisting her in the coping skills (Petrak et al., 2010; Van der Feltz-Cornelis et al., 2010). The principal element of the CBT therapy are support, psycho education, problem solving, scheduling of physical actives via the application of pedometers, pleasant activities, thought control techniques training in the social skills, Socratic dialogue, cognitive restructuring and interpersonal contact along with crisis intervention.
This manual therapy is known as “Successful ageing with Diabetes” is a guided self-help intervention will provide a sense of belongings. It will be provided by trained moderators. Such therapy will engage Julie to participate in the social network of the people who also fall in the same bracket of type 2 diabetes mellitus and is suffering from depression due to obesity. The active participation in such programs will help Julie to fight back against her social and emotional isolation and thus uplifting her damaged self esteem. Such support from the same group of people will make her feel that she is not the only one who is suffering from such debilitating issues and thus she will gain strength, support and motivation and to act actively to fighting against the odds of the disease (Petrak et al., 2010). The moderators of such therapy will also promote reciprocal caring and sharing of the relevant data regarding diabetes and ageing. The main value of this group association will be considered in terms of the mutual aid offered by member to one another.
These kinds of therapies will help Julie to fight back against her depressive symptoms and indulge in physical activities to reduce her excess fat in her body. However, since Julie is experiencing excessive joint pain so firstly she needs to recover from her pain in order to enter into rigorous physical exercise regime. Recovery of joint pain will require time and this will demand patience and the CBT therapy along will manual therapy of “Successful ageing with Diabetes” will help her achieving the same. Similarly CBT will help her to fight back against the odds and social bullying and actively participate in the motion of reducing weight while fighting against diabetes mellitus (Petrak et al., 2010).
Dombrowski, S. U., Knittle, K., Avenell, A., Araujo-Soares, V., & Sniehotta, F. F. (2014). Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. Bmj, 348, g2646.
Franz, M. J., Boucher, J. L., Rutten-Ramos, S., & VanWormer, J. J. (2015). Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. Journal of the Academy of Nutrition and Dietetics, 115(9), 1447-1463.
Grover, S. A., Kaouache, M., Rempel, P., Joseph, L., Dawes, M., Lau, D. C., & Lowensteyn, I. (2015). Years of life lost and healthy life-years lost from diabetes and cardiovascular disease in overweight and obese people: a modelling study. The lancet Diabetes & endocrinology, 3(2), 114-122.
Hardcastle, S. J., Taylor, A. H., Bailey, M. P., Harley, R. A., & Hagger, M. S. (2013). Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up. International journal of behavioral nutrition and physical activity, 10(1), 40.
Katterman, S. N., Kleinman, B. M., Hood, M. M., Nackers, L. M., & Corsica, J. A. (2014). Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review. Eating behaviors, 15(2), 197-204.
Kemps, E., Tiggemann, M., & Hollitt, S. (2014). Exposure to television food advertising primes food-related cognitions and triggers motivation to eat. Psychology & health, 29(10), 1192-1205.
Nouwen, A., Winkley, K., Twisk, J., Lloyd, C. E., Peyrot, M., Ismail, K., ... & European Depression in Diabetes (EDID) Research Consortium. (2010). Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis.
Petrak, F., Hautzinger, M., Plack, K., Kronfeld, K., Ruckes, C., Herpertz, S., & Müller, M. J. (2010). Cognitive behavioural therapy in elderly type 2 diabetes patients with minor depression or mild major depression: study protocol of a randomized controlled trial (MIND-DIA). BMC geriatrics, 10(1), 21. doi: 10.1186/1471-2318-10-21
Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319-326.
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