Nimeet K 00:11
It's time to be well with your health. I'm Nimeet.

Shanna M 00:13
I'm Shanna.

Nimeet K 00:14
Welcome to "Adventist HealthCare & You" podcast. We are back with our new episode today. And our topic today is chronic conditions and mental health. Shanna, did you know that about 133 million Americans are living with chronic conditions now?

Shanna M 00:28
I didn't know the exact number, but I did know that many of us have something chronic that is affecting our quality of life or our daily lives.

Hannah Gyasi-Adonten 00:36
Thank you.

Michele Brinson 00:36
Hi, thanks.

Nimeet K 00:36
Yeah, that's a significant amount of people. And you know, we need to talk about that more, so we can be aware of it. And to discuss this more, we have our two experts Michele Brinson and Hannah Gyasi-Adonten. Michele is a behavioral health therapist with Adventist HealthCare Outpatient Wellness Clinic, and Hannah Gyasi-Adonten, the nursing manager with Behavioral Health at Adventist HealthCare Shady Grove Medical Center. Welcome.

Shanna M 00:37
Thank you for coming. So we're talking chronic conditions, but we're talking about a mental health component of that, that starting with not only is our physical health important, but our mental health is just as important, how does having a chronic condition affect our mental health? Or what can we do to support ourselves?

Hannah Gyasi-Adonten 01:18
It does affect us, any medical, chronic medical condition affects us mentally, in the sense that you find, the person finds themselves dealing with different things that affects the activities of daily living, and the fact that they're unable to do things like they used to affects them, they feel hopeless, and they feel that they need to isolate themselves, they feel anger, they feel a sense of, you know, low self esteem, because suddenly, they're dealing with something that is different in their lives, and especially when it affects their work, then that exacerbates the mental well being. So you find people getting into depression,

Michele Brinson 02:07
You can also experience health related anxiety, the anxiety about your health conditions, that's something that affects a lot of people, or you can develop general anxiety, the more worry we have about one thing, the more likely we are to worry about a lot of things. And a chronic condition, as we all know, is something that's ongoing for a long period of time, it's life changing. And so that can create a lot of anxiety, unknowns about the future.

Shanna M 02:34
And even when you said, you know, impacts work, impacts our daily life, even, you know, a lot of people have diabetes, for example, type two diabetes, that could affect even just the foods that they eat. And so even you know, in food is oftentimes central to people's lives and families and having to do it differently, really may impact their enjoyment or the way, you know, the way they typically would interact with family or friends. And so that's, that's a tough thing to deal with.

Hannah Gyasi-Adonten 03:02
Yeah, and a lot of times, in mentioning diabetes, together with hypertension, you're dealing with other conditions that trickle in, that affects the person's social life or in their intimate life, and such that they are unable to interact well with your partners. And that is a big, big component that can send them downhill. And, you know, like I said, before, brings on anger, brings on, you know this isolation feeling like, everyone is looking, you know, seems to see what is actually going on with them.

Shanna M 03:42
Is it accurate to say, if you have a chronic condition, like diabetes, or hypertension, heart disease, or something like that, and if you have a mental health component to that, that it can actually make some of the physical symptoms worse too?

Hannah Gyasi-Adonten 03:53
Exactly, yes, it makes it worse, because not only are you dealing with a physical condition, you're also thinking about a lot of things, you're worrying about a lot of things that are going on in your life. And so it drives the individual to do other things, even though they have this mental health component. There are other things they find themselves doing, added to the stress that they encounter, they might resort to drinking. Even though they know it could trigger mental health or exacerbate their condition, they resort to drinking other substances, using illicit substances or resorting to self medication with other things that they find themselves.

Nimeet K 04:41
So when an individual gets to that level, they're leaning towards substances or other avenues that are not healthy, how can like family members, how can they assist them?

Shanna M 04:42
Or their physicians?

Nimeet K 04:46
Or their physicians, too. Yeah!

Hannah Gyasi-Adonten 04:55
It is vital that they have that support, because you realize that with chronic mental illness, for example, having that support system will go a long way in helping the person find balance, because that support system will encourage them to follow their treatment regimen. Because that is vital, because once they lose sight, they lose that, then they start going downhill. So having that support in their lives makes a difference. But as you know, having that support system presupposes that the individual is willing to also work with that support system, because a lot of times depending on where the stage where the person is, they might decide to give up or they get so stressed that they don't want to continue or they just self destruct. So there are a lot of things, a lot of things to work out with that too, and having the loved ones be a truly, a good support system without being enablists.

Nimeet K 06:07
Yeah, I think it's a vicious cycle, right? Because you want to make sure that they have the drive, but they may not have the drive because they may be depressed or have anxiety or things along those ends. But Michele, you mentioned anxiety and depression, what other mental illnesses are impacted with chronic conditions?

Shanna M 06:24
Symptoms, yeah symptoms,

Michele Brinson 06:25
Definitely symptoms. So I just want to kind of make a little clarifying statement here. When we say depression, we're talking about clinical depression, there are a lot of components that have to kind of fall in line for it to be considered clinical depression. But you can have depressive symptoms, sadness, hopelessness, lack of interest, those symptoms, there have to be five of them in place to meet the criteria, and they have to have been in place for a minimum of two weeks. So just saying that someone well, she seems sad, so she's depressed, not quite the same. You know, but when we are dealing with diagnosed depression, that's something that we want to make sure that caregivers are doing all they can to support the person. There's a lot that you can do that you may not even be aware of, lots of little things, small coping skills, different activities, keeping yourself active as possible, keeping as engaged in things that you enjoy as possible, all those things add up to helping to improve the mood.

Shanna M 07:29
It's very normal, then for someone with a chronic condition to have anxiety, to have either depression at some point or some of the depressive symptoms like sadness or feeling low for a little while. And then really important for the caregivers and our loved ones to be on the lookout and offer some of those coping things that you said.

Michele Brinson 07:51
Yeah, absolutely. I think another thing that's really important for caregivers, is to be as open to hearing what you have to say and non judgmental as possible. So if somebody is already feeling vulnerable, because they have a chronic health condition, they're already feeling like, well, I'm less than, it's gonna be really hard for them to open up and say, not only do I have this health condition, and I'm vulnerable in that way, but hey, I'm also feeling really sad or down or isolated, you have to make that space for them. You have to create a safe space for them to be able to say that by being non-judgmental. If someone comes to you and says, hey, I'm feeling really low, that was brave. You know, you have to kind of acknowledge that, but what you don't want to do is you don't want to say I don't feel that way, or you shouldn't feel that way. What else are they going to be able to share with you? Just being able to say something more along the lines of that sounds really hard. How can I help?

Shanna M 08:49
Yeah, and I like what you said too, about not being judgmental, even in the sense when they, if they say they're feeling low or something like that, like let them have those feelings, but also on the other side of that, as a caregiver was someone that has a chronic condition, not being judgmental, when maybe they're struggling with managing that chronic condition and making them feel bad. Like oh, you shouldn't have eaten that because of the you know, your diabetes or whatever, like, being there to help them manage it and not being judgmental, when they might not do it exactly the way maybe you would or you know, because it's hard.

Michele Brinson 09:23
So much better to say good try! Good effort today. I saw that you really wanted to, we'll get him tomorrow.

Shanna M 09:30
Yeah. And I guess the same is be kind to yourself, too. If you have a chronic

Michele Brinson 09:31
Self-Compassion

Shanna M 09:35
There you go.

Michele Brinson 09:37
I didn't do as much as I wanted today. But I'll get them again tomorrow, I'll keep trying and I can improve. That upward spiral is really going to be important as opposed to creating that downward spiral of oh, I didn't do it, I'm never going to be able to do this and then all of a sudden we're feeling really defeated. And when you feel defeated, you don't want to do a lot. You don't even want to take your medication sometimes, you don't want to follow your regimens.

Shanna M 10:01
Yup.

Michele Brinson 10:02
And to add to that, the feeling of not being judgmental, as we already know, with anything that has to do with mental illness, there's already this feeling of stigma, the issue of stigma, because not only do we have the societal stigma, we have the individual themselves have feeling that stigma as an individual, so that affects them. So making any statement that makes them perceive that you think there's something outwardly wrong with them, makes them want to shut down. That is why we need to be open

Shanna M 10:44
and talk about it.

Nimeet K 10:47
You know, I think from a caregiver's perspective, like, it's very important for us to encourage them to speak more, but also, from the patient perspective, I think we want to encourage them to speak as well. And if they don't have that relationship with the provider, maybe it's time to change providers or look for someone, and that build that relationship with them.

Shanna M 11:04
Yeah and that your primary care provider is there to help you or or your other physician, whoever's taking care of you what you know, whoever your, whatever your provider is, is that not only talk about your physical health, but add in how you're feeling as well, because they can help you find the resources like Hannah and Michele.

Michele Brinson 11:23
I think one thing that's going on today that maybe wasn't happening as much 10 years ago, that I'm really excited about is every time you go to see a provider, they're going to ask you at least those two PHQ9 questions. And what are those? They're usually have you been feeling sad, down depressed? or blue? Or have you been feeling hopeless?

Shanna M 11:47
And that's to start a conversation to, to help you find the resources that you need. And sometimes it is just talking about it. So just opening that door is important. Yeah,

Hannah Gyasi-Adonten 11:58
and more and more, we find a lot of the facilities having this integrated care, where you have like a one stop shop, you know, so it makes it easier. And I think people more and more beginning to understand the importance of mental health. That it is a necessity, there is nothing to be ashamed of needs to be taken care of.

Michele Brinson 12:23
Our bodies, and our minds are all part of the same system. And, you know, one thing that's great about the way that our bodies and our minds are designed to work together is that simple act of talking creates happiness chemicals. Even if we don't solve your problems today, the fact that you got the opportunity to just kind of get it off your chest and talk about it creates these chemicals that you'll walk away going, oh, I feel better now.

Hannah Gyasi-Adonten 12:50
Yeah.

Michele Brinson 12:50
I don't know why.

Hannah Gyasi-Adonten 12:51
And that is why we are combining the treatment, pharmacological treatments with non pharmacological treatments like psychotherapy, with medication component, because together, they help the individual who has a need.

Michele Brinson 13:08
Absolutely. So on the one hand, medication can help kind of lift the mood up, reduce the anxiety to a point where you feel like you can get out there and start utilizing coping skills. And then psychotherapy comes in and says, hey, here are your coping skills, what can we do? And they just kind of go hand in hand.

Nimeet K 13:28
So what are some of the community resources out there, that or peer support groups that individuals could utilize out in the community who are living with chronic conditions, you know, have some mental health history as well.

Michele Brinson 13:40
So I know that there are different groups, you can do a very quick search on a website like Psychology Today, just for chronic conditions groups, and it'll pull up different groups in your area, whether or not they you know, take your insurance, whether they're free, you can investigate that there. Then there's private groups that also have specific groups about pain management or specific groups about caregiving. I know I've referred a lot of people to caregiver support groups, because we also have to remember that the caregivers have to be good in order to give the care.

Hannah Gyasi-Adonten 14:16
I think the county also, depending on which county you live in, the county has lots of resources, going on the website and searching, you can find a lot on mental health ACT teams, different resources out there for individuals.

Shanna M 14:16
Yeah

Shanna M 14:33
And even finding support groups that have your chronic condition may allow you a opportunity to learn from others, learn that you're not the only one. And as you said Michele talk, just get it all out there. Yep.

Michele Brinson 14:49
Talk Therapy.

Shanna M 14:50
Yes.

Michele Brinson 14:51
People in support groups actually learn from one another. Someone might bring up, hey this is what I did to help feel better today or this is what I did how I learned to manage my medications and my foods better than other people go. Oh, wow, what a great idea. I should do that too.

Michele Brinson 15:05
Yeah, I had a patient once tell me we need to talk more about all these mental illnesses. And that will help other people come out and express their need.

Shanna M 15:19
Well, we often say How are you feeling? You know, and you kind of list oh my knee hurts or this or that. And but really, you know, also that mental part of it, that emotional, how are you feeling? And yes, that's not just when you're with your provider or whatever, it's not just the physical part of it. It's what you're feeling inside?

Michele Brinson 15:38
Yeah, absolutely. Sometimes it's an even, a better question to say, you know, where would you put your mood on a scale of one to 10. That's something that I open a lot of sessions with my patients with, so that they don't have to try and find the words to express it. But they're like, okay so if 10 is happiest, and one is i'm feeling lousy, i'm about five, or i'm about a six.

Shanna M 15:59
Yeah.

Michele Brinson 16:00
Then you can kind of take it from there. Okay, what would get you to a seven? Or why do you think you're at a five today? What can I do to help?

Hannah Gyasi-Adonten 16:07
That opens up the line of communication, because when you ask from zero to 10, you know, rating the mood, like we do that with our patients, you start talking even before you know it, you're discussing some other things and their mood suddenly changed from where they were before.

Shanna M 16:25
And I love all of these tips that you've given throughout here, because they're all things that we can ask ourselves to, and assess how we're doing inside as well, and decide, maybe I do need to talk out loud, maybe I can call someone or you know, asking ourselves these questions is important, too!

Hannah Gyasi-Adonten 16:42
I think it's, you know, making light of it, even though it's,

Shanna M 16:45
It feels heavy

Hannah Gyasi-Adonten 16:45
A heavy thing to ask. I find myself asking my son, I'm like, how are you feeling today? I mean, do you have any thoughts? I mean, what is your mood? And he's like, I'm not your patient, I'm like no we're talking because I believe when we talk about such things, often it makes it easier. It doesn't feel like oh, there's something wrong with expressing how I'm truly feeling or how the individual is truly feeling. So talking more about it makes it normal for people to

Shanna M 17:21
open up. Well, these are been wonderful tips and great discussion on, you know, if you have a chronic condition, some ways to help and manage it, but also, even if you don't, these are still some wonderful tips on if you are, or just, you know, not feeling like yourself. So thank you, is there anything we missed today that, that you want to address or add for our listeners?

Michele Brinson 17:43
I just wanted to add in that, you know, we have a lot of control over managing our own moods. So if there are things that you know, I know that if I go for a walk out in nature, that usually is going to bring my mood up, or I know that if I just sit in some sunlight for a little while, I you tend to feel better. Do those things when you know that you need to because a lot of times depressive symptoms, or depression, if you're suffering from real depression can cause you to do the opposite of what you need to be doing. And so we have that one coping skill we call opposite action. So if my depression is telling me to lay in the bed and not get up and wash my face and brush my teeth, then I know I have to do the exact opposite of that.

Nimeet K 18:27
Great advice.

Shanna M 18:28
Yeah and even, if those two things that you mentioned, like sitting in the sun or taking the walk, if you have a chronic condition, those things can often help that, just lifting your mood will help you, you know, your stress levels might come down.

Michele Brinson 18:41
When my mood is better, I start to feel optimistic, instead of feeling hopeless. I start to say what can I do? What else can I do? I feel a little better right now.

Shanna M 18:50
All, yup all connected?

Hannah Gyasi-Adonten 18:52
Yes. Because any form of exercise. It could be dance. I mean, you could just walking, or start dancing. If that is what your interests

Michele Brinson 19:02
If you're kind of confined to a chair, do some stretching in your chair, chair yoga is a good thing to try.

Hannah Gyasi-Adonten 19:07
Oh, that's something I came across the other day. I was like, okay, I have an exercise, what can I do? So you realize that those simple things, when you start doing them lifts your mood.

Shanna M 19:08
Yeah.

Hannah Gyasi-Adonten 19:08
So those are things you can do or tell each other, tell others about to lift up their mood.

Shanna M 19:27
Wonderful. Well, thank you both for being here. And thank you to our listeners. I hope you enjoyed this podcast today. To learn more about mental health services at Adventist HealthCare, visit Adventist HealthCare.com/MentalHealth, and to find upcoming health and wellness classes, visit AdventistHealthCare.com and click on classes and events. We do have some support groups out there available and we would love to hear from you. Leave us a rating or review wherever you listen to your podcasts. If you have a health topic you'd like to hear more about, send us an email at podcast at AdventistHealthCare.com Don't forget to like or follow our podcast so you get all of our new episodes. Thank you Michele and Hannah again and thank you to our listeners and be well!