Don't Ignore Symptoms and How to Cope With A Diagnosis : With Harvard Psychologist Ellen O'Donnell

One of the most common themes is guilt. So parents feel so guilty for having missed those early signs. So I live with type 1 myself. I wasn't diagnosed till I was 21. So type 1 diabetes is an autoimmune disease. So that's what the screening does, is to check to see if you have the autoantibodies that ultimately would attack the beta cells in the pancreas that make insulin.

As parents, we always want our kids to be able to bounce back from setbacks, to be able to shake things off and get back to normal or better than normal. However, There are times when we can't hit that rewind button, when there is an experience that presents a new way of life. And in those cases, it's not about going back and doing it better. Rather, it's more about finding a new normal and accepting that things have changed, but that we can rely on our strengths to move us forward. My guest today has dedicated her career to helping families and kids do just that, to accept some of the hardest moments imaginable and to move forward building on their strengths. Stick around because she's going to share some of her best tips and tools to stay resilient in the face of adversity. Hi, welcome to the Mind Body Space podcast. I'm Dr. Juna, your host. This is where you're going to get your science-backed information that keeps us resilient and well.

Recently, I've been working really hard on Relax to Soar Resilience System.

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Hi, I'm so excited today to have Dr. Ellen O'Donnell. She's a clinical child psychologist at Mass General Hospital for Children and Shriners Hospital, and she's the assistant professor at Harvard Medical School in child psychology. She specializes in working with children and families affected by type 1 diabetes, traumatic burn injuries, and other chronic illnesses. She's also the co-author of the parenting book Bless This Mess.

How are you? Good. Nice to see you.

Nice to see you also. I know you give a lot of talks around town. Tell us a little bit about that. Sure.

Yeah. Well, we were able to meet at the Pediatric Mind Body Conference. Yes.

The inaugural Mind Body Conference for Pediatrics, which was awesome at my favorite place, Benson-Henry Institute for Mind Body Medicine at Harvard Medical School. I loved your talk there. Yes.

Talking a little bit about building resilience in kids with chronic illness, and I tend to do a lot of events with groups like Breakthrough T1D, American Diabetes Association, diabetes camps.

So, are you doing some of those special camps? What are you doing this summer?

Mostly, I'm co-director of our internship in child clinical psychology at MGH, so we have new interns starting, so getting them up and running.

That's always exciting.

It is exciting. And I've been doing more work, actually, with Breakthrough. We're going to be doing some focus groups of families who got an early diagnosis of type 1 diabetes via autoantibody screening for Oh, so— And so it's been kind of a busy summer of research projects and applications.

They're now diagnosing type 1 earlier?

No, it can be identified— there's the ability to screen for the autoantibodies that predict the onset.

Mm-hmm.

And if you have 2 or more autoantibodies, then the likelihood of developing type 1 diabetes is that much higher. And so there are some potential treatments that can kind of delay diagnosis. And there's also a push, really, there's some people pushing for universal screening, because while there's some increased risk, for first-degree relatives, it's actually only marginal. So, maybe being better able to identify kids who are likely to develop type 1 could prevent some of the complications that often happen at diagnosis.

So, you're saying that a lot of it's not even genetic?

Correct.

Correct.

So, we used to think that type 1 is just genetic, but now we're seeing more and more that it's not. So, some people are pushing for everyone to get tested, perhaps, is what you're talking about? Exactly.

But it's interesting, your risk is highest if your father has type 1 diabetes, lower if your mother has type 1.

Mm-hmm.

Lower, but oftentimes there's no known family history when someone's diagnosed.

Yeah. And it's separate from type 2 diabetes, which is—

Exactly.

An onset later in life.

Exactly.

And type 1 tends to be younger, even though now we're not sure if sometimes there's a trigger, right? Like a viral infection perhaps could trigger it?

Exactly. So, right. So the key difference between type 1 and type 2 is that type 1 diabetes is an autoimmune disease. So that's what the screening does, is to check to see if you have the autoantibodies that ultimately would attack the beta cells in the pancreas that make insulin. So I live with type 1 myself. I wasn't diagnosed till I was 21.

Were there any symptoms beforehand or no?

No. I mean, that's the thing. It can be a really sudden onset— Wow.

—of symptoms.

And that's where that trigger question comes in.

Yeah.

So this idea of being able to screen so that people are not shocked by the sudden onset of severe symptoms, but might notice earlier symptoms, is key.

And did you have any earlier symptoms? Like, what are the symptoms you would look for?

The main symptoms to look for are thirst. So, increased thirst, weight loss despite continuing to eat the same amount of food, fatigue, dry skin, other infections or viral illness. But oftentimes, I think, you know, the thirst and the weight loss are so kind of subtle and gradual in the months before the acute onset that it's easy to miss.

Mm-hmm.

So, one of the projects that we did recently was we've developed an intervention, a supportive intervention for parents of kids who are newly diagnosed with type 1. And as part of that intervention, in the first session, we ask their diagnosis story. And we did a qualitative analysis of those stories to kind of understand what are the themes that come up, what's the experience of families around a new diagnosis of type 1 in a child. And one of the most common themes is guilt. So, parents feel so guilty for having missed those early signs.

Mm-hmm.

It makes perfect sense. You're living with them, you're not noticing that they're losing weight, or they'll attribute it to things like, you know, kids were diagnosed in the summer, it's hot outside, of course they're super active, they're running around all the time, Of course they're thirsty. Of course they're losing weight. And it's not until it becomes extreme and then they're really sick that parents say, no, something is wrong here. Let's bring them to the doctor. Bring them to the emergency room. There's all this guilt about having missed the early signs, but they're so subtle.

As if we don't feel guilty every day anyway.

Exactly. Why piling on and piling on?

We're always feeling guilty.

Exactly. Exactly.

But you were 21, so you must have been in college.

I was.

And you just noticed it during, like, a time of probably stress or something. You probably chalked it up to stress. Yeah, exactly. It was the fall.

of my senior year of college. I had all those symptoms that kind of were gradually building. I thought I must have mono, because that's the college sickness, right?

Mm-hmm.

So I went to the college health center, and I said, I think I have mono or maybe strep. And they tested me for both, and they said, no, you don't have mono, you don't have strep. It must be a virus. Drinking fluids, get your vitamin C, rest. And things weren't getting better. And interestingly, it was one of my roommates, her mom was a nurse. I'd never met her mom. We were in Boston, and her mom was in Minnesota. But my roommate, you know, dragged her along This was a long time ago. So dragged her long cord telephone into my room and said, Ellen, I'm on the phone with my mom, and my mom thinks you have type 1 diabetes, because she had told her my symptoms, and her mom was aware. So—

Telemedicine.

The earliest telemedicine. Exactly.

I love that story.

Of course. I mean, my roommates were noticing, why is she so tired? She's falling asleep all the time. So she was worried about me, so she told her mom.

Wow. I love that story. That's great.

But it's not really well known.

Especially for somebody who's like 21. Exactly.

Yeah. Which is not— yeah. People assume that type 1 is— it used to be juvenile diabetes, but that's really why they've kind of moved away from that, because people can be diagnosed in their 60s with type 1.

How prevalent is it? So, for example, like breast cancer, it's like 1 in 8 or 1 in 10. How prevalent is it?

That is a good question. So, in the US, the prevalence is about 5 in every 1,000 adults and 4 in every 1,000 youth.

Thanks for bringing this awareness to this.

Yeah, no, absolutely. It's very high on the list of you know, childhood illness, like food allergies and celiac, other autoimmune conditions are up there too, but— and they often co-occur too. So, that's especially tough. I always say that my job as a diabetes psychologist is to make sure that having type 1 doesn't get in the way of all the way more important things in a child and family's life.

So, you're a diabetes psychologist, but you're also a trained psychologist in general.

Exactly.

And you happen to specialize, and I love this, that once somebody's diagnosed, they immediately have you as well, because You know, you're treating the whole mind-body thing. So, is this a special program, or are most diabetes programs like this?

Really good question. Ideally, most diabetes programs would be like this. It's part of the American Diabetes Association's standards of care that they really want behavioral health to be integrated. Lots of programs have access to social work, some have access to psychology, but it really is a challenge. And not only that, I mean, there's a shortage of pediatric endocrinologists and diabetes care specialists in general. So for kids that aren't near a major academic medical center or a big city, it's really difficult to access. And even in some of those programs, it's not necessarily the routine like it is at Mass General where they— where every family gets to meet with the psychologist. So we really try to normalize it that this isn't because anybody thinks there's anything wrong with you or you're not coping well. This is a significant stress on a child and family, and everybody could benefit from support in dealing with stress. Mm-hmm.

Yeah. And also like there are behavioral things, for example, like with anybody else, you probably want them to eat healthy and exercise and manage their stress and all of that, because it is, as we are starting to understand, this general inflammation could affect the level of autoimmunity, right?

Right. Right.

So stress, as you know, has something to do with that. And stress can often come from what we're thinking and what our perspectives are on something, right?

Exactly.

And then that affects our behaviors. So that classic CBT triangle where you have your—

Exactly.

Emotions affecting your thoughts, affecting your behavior, and then vice versa in that triangle. So—

Exactly.

And that's where the resilience comes in. And that's what you and I having so much in common, we're so passionate about it. But I love your definition because you talk about resilience in a little bit of a different way than just bouncing back from setbacks. So can you tell us a little bit about that?

I don't like to think about it as bouncing back, I think, because so many of the kids and teens and families that I work with have gone through something that I think really forces you to find a new normal. There is no going back. There's no going back from a diagnosis of an illness that at the moment there's no cure for, and you're going to have to manage for the rest of your life. There's no going back from a serious burn injury that's going to— that's left you with scars that you have to manage the rest of your life.

Wow.

And a lot of times there's loss associated with these things.

Like grief, right?

Grief. Absolutely.

Grief for your healthy self or—

Exactly. Yeah. And in some cases, I work with kids and families who really suffered significant loss of a family member in an accident or in, you know, something that has brought them to me.

Oh wow.

So I don't like to talk about going back. I just don't think that makes sense.

Mm-hmm.

I think that's everybody's initial reaction, right? I know I've had that experience of going through something traumatic or stressful or life-changing and sort of, I'll say, you know, again, metaphors, like I'm, I'm frantically looking for the rewind button or the back button.

Yeah.

That's a very natural reaction. And the resilience comes when you realize you can't, there's no going back. So we have to find a new normal. How do we get through this? How do we kind of find some maybe new strength in the broken places and move forward?

Yeah, I was just going to say that. I love that. And then that's where the acceptance comes in, right?

Yes. Yes.

And I think the normalization is so important because if you're human, you're going to have something happen to you. You're eventually going to get something—

Yes.

Something's going to break down.

To make it through without anything? Wow.

I don't think you—

That's pretty rare.

No one's gonna make it through, so.

Exactly, exactly.

As far as we know, we're still mortals. But, but yeah, so everybody's gonna suffer at some point. I guess it's such a difficult thing when you're younger and most kids are healthy, I guess, around you and your peers aren't having issues that maybe you don't even know about it. You know, they probably have other issues, right? So when you talk about resilience, you're teaching them how to work with the situation at hand, which is a very important skill for anyone. So accept what's going on and then either at first, I guess, not really find the strength or it doesn't matter. Is there an order to this? No, right? It's just whatever's uniquely working for you.

Yeah, I think it's one of those— yeah, it's a both/and situation. And everything can be happening all at once.

I love it.

And I think that the point you make too, it's really clear when you talk about acceptance that acceptance doesn't mean being okay with whatever happened or even embracing it or being happy about it. You know, that's ridiculous. Acceptance, like you said, is just acknowledging what is happening and what I am not able to change. There is no rewind button. So where do we go from here?

And you talked a lot about the stronger at the broken places, which I guess what you're talking about is finding strengths, other strengths. For example, you, now you're helping people deal with the disease that you ended up with.

There's a lot of research that tells us that the people who adjust best or, you know, find joy, find happiness, find strength, are resilient are able to make meaning of the things that have happened to them.

Mm-hmm. Mm-hmm.

So meaning-making is really important to recovery and resilience. And I think that resilience is a muscle. So it's not something you're born with. It is a set of skills, a set of tools that you can learn, just like you can learn exercises to strengthen a muscle. And it takes time. And some days you're not going to have the energy, or maybe you worked really hard the day before and you're spent. And you need to take a break. So there's a lot of forward and backward movement, 2 steps forward, 1 step back kind of process. And I think you can absolutely be experiencing both at the same time. You can be feeling really overwhelmed and sad and frustrated and do something that day that is resilient.

And I always say, like, there's so many different parts of us. You know, for myself, I know I'm a different person in the morning versus at night.

Yes.

I'm definitely more negative at night, more positive in the morning. And, you know, they've looked at when it used to be 2 at a time, They looked at all the words at one point and they showed the differences from morning into the evening.

Interesting. Like a word cloud of what people are—

Yeah. They were, they were looking at trigger words and they saw that negativity starts around like 3, 4, 5 o'clock, just when our circadian rhythm gets us down into like that sleep state, almost like that second wave of tiredness in the afternoon. They showed that the negative words start to increase there. Mm-hmm. So there's so much like bio-psychosocial aspect, the knowing. Exactly.

Absolutely. And the knowing, you know, you knowing, oh, I am someone who tends to spiral in the afternoon and I'm more positive in the morning. That's a skill. That's a skill, right?

That's a skill.

And that's a sign of resilience to know yourself.

Absolutely. And I used to, I would tell you a funny thing when I started this podcast. I used to be so nervous at night, and it was just all these thoughts would come, like, why am I doing this? Why am I talking on a podcast? And that would only happen at night. Yeah. So I started to go to sleep earlier and early before those thoughts started happening.

Well, and I think also, I think there's a lot of messaging that sort of implies that one way of coping or one way of being is better than another. Mm-hmm. Um, my husband and I are polar opposites when it comes to being morning versus night people.

Okay.

Um, and, you know, he, we, I would say we worry equally about things. He's probably even more anxious than I am, but he can just shut it off at 10:00 PM. He can put his head on the pillow and, and turn off the worries and go to sleep. And I'll be sitting next to him, you know, with my book and my phone and writing things down and reminding myself about things for the next day and looking at him and just wondering, how does he do it?

How does he do it? What's his occupation?

He's an architect. He wakes up early and he is a morning person and he, the way he copes is, okay, I need to get a good night's sleep. I'm gonna shut down, I'm gonna go to sleep and I will get up first thing in the morning and immediately tackle whatever it is that's worrying me. So the sooner I go to sleep, the sooner I get to it, the sooner I get it done, I think is sort of his approach. And does he—

Does he wake up exactly at the same time every day?

He wakes up early the same time every day. Yep.

I think that's the number one thing for sleep, right? Waking up at the same exact time.

Exactly.

Waking up at a consistent time.

Yeah. And the most—

But I will often say to, to kids and families about that too, again, there's this idea that one way is better than another. And I think there's a lot of belief that it's better to be a morning person than a night person.

Oh yeah.

I think it's best to know what type of person you are and then work with that and what are the skills around that. So, you know, my dad has Parkinson's. He's in his 80s. He's never been a good sleeper. Like me, he's a night owl and, and would rather sleep late into the morning. You know, so I've, I've talked with my dad about that. I've said, Dad, you know, the best predictor is waking up at the same time every day. That doesn't mean you have to wake up at 7:00 AM every day. You're 85 years old. What do you have to do first thing in the morning? But wake up every day at 10:00 AM or 11:00 AM. Just be consistent about it because we know that that's helpful for sleep and quality of sleep.

Yes. And CBT-I, that's more powerful than sleeping pills. And the number one thing that they say is to wake up exactly at the same time every day, no matter how much you've slept. And obviously you're not supposed to try that when you're operating heavy machinery.

Exactly.

Because, because it doesn't matter when you're doing CBT-I, you have to go to bed and wake up at the same exact time no matter what. Even if you went to bed at like 3:00 AM, you're getting up at 7:00.

But can you make it work with your own temperament? And if you know yourself, and, and that's key, I think too, for parents. So I talk a lot about that with, I do a lot of work around parenting and so So it's how can you kind of take these tools, take the science, take what we know, and apply it in the context of your own child and who they are and what their temperament is, or your own family situation or dynamics.

Yeah, I love that. It's so unique, right? I mean, I really think that accommodating is a really great thing to do. So if, I mean, everybody has to get up unfortunately at the same time for school, but let's say a kid has to get up a little later. Maybe you pack everything the night before. I mean, everybody should be doing that probably the night before.

Exactly. But I don't know though, that's, that should, right?

Oh yeah, that's true. I'm just thinking about all those mornings where it was like a crazy rush and everybody's stressed out.

That's the thing. If you are a family that's in a crazy rush in the morning, then yes, maybe you wanna think about preparing the night before. Yeah. But you, if you are a family of early risers, you know, and you need to go to bed early and the schedule at night bumps right up against bedtime and there's no time to prepare the night before, and that's what works for you, then that's what works for you.

Awesome.

So, I think it's, you know, individualized medicine, right?

No, it really is true. And everybody's so different. And you can, I think the only way you know is if you try different things and see what works and what doesn't.

Exactly.

And then keep an open communication with your family members, right?

And I bring that up a lot too with the families that I see. For example, with type 1, the great thing now is we have all kinds of technology to help manage type 1 diabetes.

Tell us, tell us a few of those that are your favorites.

Yeah, sure, sure. I think, you know, the insulin pump was transformative. I think people who don't know type 1 diabetes do tend to think that insulin pumps kind of manage diabetes for you, which is not entirely true. There is still a lot of self-management or parent management day to day. It is one of the most challenging Oh, wow. Okay. If not the—

What about AI? Have you seen any advances in AI helping?

So, we're not quite there yet, but what we do have are these kind of hybrid or semi-automated insulin pumps. So, essentially, what they do is they use fancy algorithms to take data from continuous blood glucose monitors, so CGMs, and use that data with other variables like, you know, either weight or the average amount of insulin that a person has needed in the past 3 days, or all of these different factors that go into these fancy algorithms that then the pumps can use to deliver different doses of what we call basal insulin throughout the day to kind of try to keep blood sugar levels even and within range. There's still a lot of human factor, though. So, anytime you eat, with most of the pumps—

Mm-hmm.

You need to count your carbohydrates and let the pump know how many carbohydrates you're eating so that it can help you to calculate how much additional insulin to take. So, of course, if you're a little off in your carbohydrate counting, you might be a little off in your insulin dosing. And then, of course, there's all of these factors that impact blood sugar that we have no control over. So, other hormones like cortisol, stress— If you didn't sleep well the night before. Or stress, exactly. And kids going through puberty, or women and their menstrual cycles, all of these— it's the endocrine system, so it's impacted by all these hormones. So, there's a lot we don't have control over that can still result in pretty wildly fluctuating blood sugar numbers and highs and lows that can have a big impact. But we do have all this technology now, and so there's a lot of choice. There's choices of different types of pumps and whether they have tubing or they don't, and which algorithm you think you like better.

I hope AI does more. I just can't understand why somebody doesn't have automatic carbohydrates. And whoever's listening, maybe you should do that.

Well, that's one place that I do think AI has been helpful. I've been trying out some of these apps that allow you to take a picture of your food and it tells you, it gives you an estimate of how many carbs.

It's so inaccurate.

But it's still pretty inaccurate.

But as a, you're a mom also. How old are your kids?

16 and 22.

Okay. You look very young for a mom of 22-year-olds.

Thank you.

But you still have a teen at home. So what are, what would you say are the core skills? What is your favorite core skill? Like stress awareness, breathing, imagery. What is your favorite one?

Breathing. I mean, that's just—

'Cause it's with you. Yeah.

It's with you all the time. It's the simplest thing. It's the first step to anything else. I mean, of course I teach all kinds of things like you mentioned, imagery or progressive muscle relaxation and cognitive restructuring and all of those things. But I just, I know for myself, I can't access anything until I've taken at least one deep breath. And I think—

So if you're gonna tell parents right now, The first thing, like, let's say your kid's resistant to what you have to say. What is a tip you would give to parents?

Yeah.

Well, at first I'll say they're probably not gonna listen to you. I mean, one of my favorite stories ever was my now 16-year-old was, I think, in like first grade or something. And I came in to, you know, was tucking him in at night and he said, Mom, I learned this thing in school today that you totally should be teaching your kids. You know, because he calls 'em my kids that I, at the time, my kids that I would see at work. And he starts teaching me deep belly breathing, you know? I love it. Like, Mom, I'm like, well, that's awesome, except I've been trying to teach you that since you were 2 somehow.

So they're getting it in the schools somehow. Yeah, that's awesome.

So as a parent, I think the first thing you can do is you need to take a deep breath yourself. So that's— I know for me, I can't do anything, like I said, until I've taken a deep breath myself.

What if the parent's annoyed that you said that to them? What if they're like, too bad, I'm not doing that? Because I have this pet peeve about so many experts telling— and I'm an expert Yeah. I'm in that group. So many people telling parents like, you need to model this, you need to do this first. But like a lot of parents never grew up with any of this neuroscience or psychobiosocial training. And these are kind of new for people. Like, you know, most parents now had grown up in just regular upbringing. They weren't like, oh, your brain is doing this. You, you know, your vagus nerve. So they might have some internal resistance to it. And also maybe they can't regulate themselves. Definitely. I know, I know I was not able to regulate myself all the time as a parent. For sure. So I tend to say, maybe ask the kids, help me regulate also.

Yes.

Because kids love telling you how, like you said, your son was like, you should do this with your kids.

Exactly. Exactly.

So I think that's so helpful.

No, I think you're, you're tapping into exactly something really important there. So I will also often say, like, to take a kind of a parallel example, a lot of times I'll see parents who will say that they're, you know, maybe their teen who's really struggling absolutely refuses to see me or any therapist or any counselor or anybody at all.

Okay.

And again, it's kind of nice in the diabetes clinic setting, everybody sees me, so they don't really get a choice. I just sort of walk into the medical visit, but that's not typical. And so, I will suggest to parents that they tell their child that they are seeing me. You know, I know you don't want to go see Dr. O'Donnell, and I get it, but I'm going to meet with her anyway because I'm at a loss. Things are not working here. I'm doing my best to parent you and be the parent that you need, but obviously something's not working. And so I need some help to figure out how to be a better parent.

So I admit.

And that's a big ask for a lot of parents too. When I talk about the deep breath, actually, I sometimes don't even talk about it. I just do it. Because if you realize now, I mean, we've just been talking about taking deep breaths and I've already done it 3 times. If someone else takes a deep breath in your presence, whether it's virtual or in person, the chances that you're gonna do the same, it's one of those mirroring things that we just pick up on.

It's like yawning.

Exactly. It's contagious. Exactly. A deep breath can be contagious. So if I just do it in a room with a parent before I respond to something, sometimes you'll see that you've elicited a relaxation response in the other person.

Awesome.

And then when you kind of explain that part of it to them, that like, try that. Did you notice that that just happened? You know, I'd encourage you to try that at home with your child. Try just before you say or do anything going— they'll probably get annoyed because they'll see that you're taking a deep breath and that maybe you're annoyed at them, but the chances are also that they might take a deep breath and you might elicit a little bit of a cooling down or kind of a relaxation response in them just by taking the deep breath yourself. Um, and yet it has the added benefit of calming you down before you speak.

Yeah, no, I love that. And I think you're right. If you admit that you're having some difficulty and that your brain— I always talk, I call it brain talk. So if you just say, my brain is having issues and I need to calm down and this could work, could, would you use that? Exactly. Show me something, or etcetera. I don't know. Anyway, everybody has their own thing.

I mean, it's so cliché, you know, it comes up in couples therapy too.

Oh, okay. Couples, that's harder.

Yeah, you will use your I statements, not your you statements, right?

It's so much harder in couples therapy.

If I say to you, you need to calm down, is that gonna work?

Whoa.

Of course not.

What if you say your brain needs to calm down?

Maybe I like to say I— where you just said I need I'm getting heated. I need a minute to calm down before we keep talking about this.

Yes.

Or, I need to take space because it's not— I can't talk about this with this much anger and upset. I need, I need.

Yeah. Mm-hmm.

And I do think that it's a little unique for parents to take the most empathetic perspective. You're also kind of taught as a parent that your needs don't matter.

I know. Not that you're not important.

Right? That's my pet peeve because honestly, we're just people and our brains all have the glitches that everybody's brains do.

Exactly.

And, you know, explaining to your child that, yes, my brain was a child at one point. And still is in some ways. Yes. It's in the habitual, you know, memories ingrained in there. If you explain that to a child, I mean, I, I guarantee that it'll be better for Yeah. I mean, it takes time.

I'm not perfect.

Can you tell us a little bit about the resilience program that you're using now?

One of the things that we're working on right now is that we have adopted what was called the parent check-in. And so the parent check-in was developed by my graduate school advisor, now retired, Dr. Wendy Grolnick from Clark University. And it's rooted in self-determination theory, which is a theory of motivation. Which is really about what types of environments are most supportive for people, not just being motivated, but being motivated in ways that we know are healthy for us.

Mm-hmm.

So, more internalized types of motivation. So, basically, I'm doing this because it is meaningful to me in some way, or enjoyable for me in some way. And we don't expect diabetes management to ever be enjoyable. but it can be meaningful to somebody, or it can be connected to things that are meaningful to them.

Hmm.

The parent check-in, the idea of that was really basically what we're talking about, actually. The idea was, you know, parents take their kids yearly to the pediatrician for a well-child visit. Could they also have a sort of well-parent visit? And the parent check-in actually took some inspiration from the couples checkup, which was a couples therapy intervention that was similar. Why wait until couples are in crisis? Could they sort of do like a marriage checkup and meet with a therapist for 1 or 2 sessions and sort of check in, check up, see how things are going, maybe learn a few skills?

Mm-hmm.

And so, the parent check-in was designed to be implemented as part of those pediatric well-child visits. So, what we've done is to take the parent check-in and adapt it for families who are facing a new diagnosis of type 1 diabetes. We added a session because things are a little bit more complicated when you've gone through a recent stressor, like a new diagnosis. So, it's a 3-session intervention. It's really designed to address parents' distress about coping with this new diagnosis.

Sure.

And also provide some kind of support, education, practice in this approach to parenting that kind of sets up that environment that we know fosters intrinsic or internalized motivation for things. So, can we kind of set families up to be resilient? They have some skills for communicating about diabetes. So that they don't end up, you know, we know there is a pretty high rate of diabetes-related family conflict. There's very high rates of burnout where kids and teens just sort of really don't feel that motivation or energy to take care of themselves, or parents burn out and are overwhelmed by, you know, the added demands of dealing with health insurance and medications and approvals and the cost and the emotional burden. So, can we sort of give parents skills for themselves and that they can foster in their kids to buffer them against some of the long-term chronic stress of living with type 1 diabetes?

That's amazing. I have a few lightning round questions for you, like just quick ones.

Yeah, sure.

What's on your bedside table, like book-wise, or what are you reading right now?

Oh gosh, piles of books. I'm one of those piles of books people.

I'm the same, I'm the same. them, reading them sometimes.

Exactly.

What's an influential book that you would recommend? It could be something fun. It doesn't have to be anything.

Well, I'll say one of my most influential books ever, I think it's actually behind me on my bookshelf, is Far from the Tree, which is really, it's stories from parents. It's Andrew Solomon who's done a lot of really compelling writing from a perspective of psychology. And it's stories of parents and families who, for whatever reason, have children who are very different from them. He's the person who interviewed, actually, the parents of the Columbine shooters, but also parents of deaf kids, or parents of kids with severe disabilities, or just any ways in which kids are very— have turned out to be very different from their parents.

That's rough. Yeah.

Yeah. But I find it so inspirational because I think it's what we were talking about We talked about it's knowing your kid and knowing yourself, and it's all about temperament and the things that we can and cannot change and how do we learn to accept them and grow together as families despite whatever differences there might be among us. So it's one of my favorites.

How about, you talked about deep breaths. Do you do anything else like journaling or what's your go-to when you're freaking out?

I'm a yoga person.

Nice. What kind of yoga?

I mostly Ashtanga, but I'll do kind of anything.

Where do you go? And up there in the city?

Awesome.

I used to go to Down Under.

Yeah, Down Under's awesome. Since COVID I pretty much practice on my own. I will say a Peloton devotee, being able to do it in my own space on my own time. And I do like a lot of the yoga instructors there. And I like that you can do a 20 or a 30-minute class.

Yes. Yes.

That you don't have to commit to getting in the car and 2 hours of your time in your day.

Check out Dharma Yoga. I got a yoga teaching certificate with Dharma, and he just does a lot of meditation first.

Oh, awesome.

I just love when they do that. What do you have to say to caregivers and professionals like you who are helping people every single day? What do you wanna say to them when they lose it? We're people too, right?

Yeah.

And parents and moms. Yeah.

I wanna tell 'em there's so much power in apology. I think it's such an underestimated or undervalued skill.

I wonder if you have like, as a psychologist, like what is the best way to apologize? 'Cause like sometimes when you just say sorry, sorry, that, I mean, that really doesn't mean much.

Yeah. I actually do think it's, you know, I think it's important It's sort of, I'll also say no is a complete sentence. I actually think a genuine apology can be just those 2 words. I'm sorry.

Okay.

If it's said with intent and truth and meaningfulness, because there is no caveat, there's no condition on it, you know, I'm sorry you feel that way. Takes no ownership for your own act. That's not accurate.

That's the worst kind, right? I'm sorry you're feeling that way.

That's the worst kind. No, there's really power in those 2 words. Whether it's honestly, whether it's something that you've done that you regret or that, that has potentially hurt someone else, to simply say, I'm really sorry. Or if it's something that someone's been through that you can't change, to go back to that idea of grief and loss and supporting people through hard times, just to say, I'm so sorry that you've had to go through that.

So can you tell everybody where they can find your work and also your book? And are you going to write any more?

Absolutely. Actually, I'd love to write one that is for parents of kids with chronic illness or type ones. That might be in the works someday. Yeah, you can find that on Amazon or any online bookseller. It came out during the pandemic. It's actually called Bless This Mess: Modern Parenting in Chaotic Times. So we didn't know just how chaotic the times were going to be when we wrote it.

It was just in time. That's amazing.

It's really kind of— it's also about spirituality, which is so important.

So where do they find you? You practice in Massachusetts, so you can't necessarily treat people outside of Massachusetts, but where would they find you and your work?

Like, where can they get in touch with you? There is a website for the book, blessthismessparenting.me. Um, I'm on LinkedIn. I've done some writing for Cognoscenti, which is the opinion pages of our local NPR WBUR station.

Nice.

So that I'm most proud of and kind of passionate about.

I love it. I love the work you're doing. Thank you so much for being here.

I really, really, really enjoyed meeting you. I think, feel like a real kismet. We've got a lot in common and just, I enjoy talking to you and hearing your perspective.

Yes, for sure. Thank you.

Thank you for listening. Don't forget to hit subscribe and share and head on over to mindbodyspace.com/store to get your copy of the Relax to Source system that will put all of those microhabits of wellness into autopilot for you. Until next time, this is Dr. Juna signing off, wishing you and your loved ones wellness.