Why is social support important in managing chronic conditions?
Research shows that high levels of social support from family, friends, and peers leads to better health and faster recovery from chronic conditions. Social support can be crucial in helping patients with diabetes cope with the illness and improve their adherence to treatment.
Family, friends, and peers can be instrumental in helping patients stick to a healthy living plan by doing things like encouraging them to participate in sports, exercising with them, preparing healthy meals and eating at the same time as them, praising them for following diets, suggesting steps to help them take medications on time, attending medical appointments with them, and planning activities around their self-care routine. Helping in these ways can help them stick to a diet, exercise, and self-care plans; take medications; and test blood sugar levels consistently.
What’s the difference between helpful and harmful support? How can harmful support become helpful support?
Unfortunately, friend, family, and peer support can sometimes be obstructive and harmful. For example, family members might undermine or sabotage self-care efforts by nagging, arguing, and criticizing; tempting patients with unhealthy foods; planning unhealthy meals; questioning the need for medications; and insisting that patients should handle diabetes or chronic conditions on their own. Harmful family behaviors can decrease patients’ motivation, self-efficacy, and adherence to medication and diet recommendations, and can drive up family conflict.
Thankfully, these harmful behaviors can be coachable. Even in the face of personality issues and relationship dynamics that may be difficult to change, family members can still be taught how to redirect arguing and nagging behaviors to more supportive, helpful behaviors. Family members and friends can be coached to help patients set goals, problem-solve, and make decisions collaboratively, as well as how to offer emotional support, listen actively, and communicate effectively.
What if harmful support cannot be turned into helpful support?
If you are experiencing a relationship with a family or friend that is important to you and interfering with your goals or aspects of yourself, you can try to problem-solve by assertively requesting that your family member or friend behave differently. It may be the case that, thanks to longstanding dynamics in your family system and difficult communication patterns, you may require an expert like a coach or a therapist to step in (more on that later.) If you have not tried to ask your family member or friend to act in a more helpful way yet, though, it is well worth giving this a shot in a skillful way.
You can use the DEAR MAN skill from Dialectical Behavior Therapy (DBT) to assertively describe the problem in a relationship and maximize the chance that the problem will be resolved effectively. Here are the steps:
Describe the current situation (if necessary). Stick to the facts.
“Over the past few weeks, you have been promising me that you would eat healthily with me, but you’ve been eating chips and cookies every night at dinner.”
Express your feelings and opinions about the situation. Don’t assume that the other person knows how you feel.
“When you eat unhealthy foods at dinnertime, I get upset and feel like you don’t appreciate how much effort I am putting into trying to manage my diabetes.”
Assert yourself by asking for what you want or saying no clearly. Do not assume that others will figure out what you want. Remember that others cannot read your mind.
“I would really like it if you would eat whatever healthy meal I cook for the family at dinner instead of junk food.”
Reinforce (reward) the person by explaining positive effects of getting what you want or need. If necessary, also clarify the negative consequences of not getting what you want or need.
“Life would be so much easier for me if you ate healthy food at dinner with me, and I think you might notice a difference in how you feel, too.”
Mindful: Keep your focus on your goals. Maintain your position. Don’t be distracted. Don’t get off topic.
Be a “broken record”: Keep asking or expressing your opinion over and over and over. Ignore attacks and distractions; just keep making your point (“I would still like you to eat healthily with me.”)
Appear confident: Appear effective and competent. Use a confident voice tone and physical manner; make good eye contact.
Negotiate: Be willing to give to get. Offer and ask for other solutions to the problem. Reduce your request. Say no, but offer to do something else or to solve the problem another way. Focus on what will work.
“How about if you eat healthily with me during the weekdays?”
Ask for other solutions. “What do you think we should do?”
DEAR MAN and other communication skills can be very helpful when it comes to getting family members on board with your healthy living plan. If you are dealing with family members or friends who are offering harmful rather than helpful support, talk to your PCP if you have not done so already. They may be able to connect you with a diabetes educator, health coach, therapist, or support group that can teach you and your loved one ways to transform obstructive support into more helpful support.