Two decades of scientific research has demonstrated the physical and psychological benefits of writing about our troubles.

Patients with serious chronic illnesses such as asthma, rheumatoid arthritis, cystic fibrosis, cancer and HIV, when asked to write about their most stressful and emotional experiences, reported the following benefits:

• improved immune function;
• reduced blood pressure;
• improved lung and liver function;
• reduced pain;
• fewer days in hospital; and
• improved mood. (see note 1)

The idea of delving into your emotions, and exposing them on paper, may make you feel uncomfortable or vulnerable. Although a journal exploring your thoughts and feelings will give the greatest benefits, there are other types of diaries which can help you manage your Crohn’s or colitis.

Food and symptom diary

A common recommendation for those with inflammatory bowel disease (and many other illnesses) is to keep a food and symptom diary. As every IBD patient knows, and the Crohn’s and Colitis Foundation of America (CCFA) confirms, there is no specific eating plan which works for everyone. Keeping a detailed food and symptom diary helps you identify the foods that bother you, and is an important source of information for your doctor and nutritionist.

Maintaining a minute record may become tedious over time, but even if you keep the diary for only a few weeks you will become more aware of what you eat and may uncover patterns in your symptoms. Example food diary.

Wellness chart

A wellness chart is an easy way to track your disease and general well-being over extended periods of time.

A variety of indices, such as the Crohn’s Disease Activity Index (CDAI), are used to measure disease severity. These primarily record objective data such as blood analysis and weight; however, there is increasing interest in measuring the impact of IBD on the patient’s quality of life.

You can devise your own chart and rating system, customised for your common symptoms and triggers, which will only take a few minutes each day to complete.

Once again this will be a useful source of information for your doctor, and will help you take a more active role in your health management. Perhaps more importantly, it will encourage a broader, more realistic perspective of your health. We all have good and bad days – on the worst days it can be difficult to see the light at the end of the tunnel. Your wellness chart will remind you that you’ve had better days and most likely will again. Example wellness chart.

Medical timeline

From your first diagnosis, keep a simple timeline of your treatment. At minimum include medications (with dosage), tests and results, and major events in your disease. If you can, also include names of doctors consulted and notes of your discussions.

Initially you will be able to recount all these details from memory, but as the years pass you will be surprised how quickly one test blends in with another, and you might forget the name of that particular medication you took for a month and then stopped because you had a bad reaction.

This information is particularly useful when you change doctors, or if you have to see a new doctor in an emergency situation. It will also be very helpful if you wish to assist with IBD research – I was disappointed that I could not remember more details concerning my initial diagnosis for a recent research survey.

Journaling or the one-sentence diary

Give yourself 15-20 minutes a day to write about how you are feeling and what has been happening in your life. Wake up 15 minutes early to make the time, or write just before bed. Grammar and spelling are not important; you don’t have to use sentences, or even words (you might draw a picture). If even this seems overwhelming start with a one-sentence diary.

Whatever form your diary or record-keeping takes, the key is to keep doing it! Set an achievable goal and don’t berate yourself if you miss a day – just be sure to do it the next. As you continue you will find it easier and once you have built a string of entries you will begin to see and feel the benefits.

Rebecca Leigh

References
1. Baikie & Wilhelm, “Emotional and physical health benefits of expressive writing”, Advances in Psychiatric Treatment vol. 11 (2005): 338-339

Why do we fail?

In The Now Habit, Neil Fiore explains that our resistance to action, our procrastination, is not due to laziness or lack of discipline. He says that there is always thinking and reasoning (although we may not be conscious of it) directing our behaviour. If we can be more aware of this thinking then we can recognise when it is flawed, and we can develop strategies to overcome negative thinking. Fiore explains much more than this, but let’s apply this simple summary to the matter of starting a new exercise program.

On the surface we might make excuses like ‘I don’t have time’ or ‘it’s not important’. We discussed last week that making a conscious choice to change a behaviour will help overcome initial resistance. But under the surface we may be avoiding our exercise program because we are afraid: we have failed before and don’t want to fail again; we think that we are too unfit and it will be too hard; etc. If we identify these thoughts and examine them objectively we would see that they are flawed: our success or failure is completely determined by our behaviour (which we control) and we can only get fit by exercising (which can be made as easy as we need it to be to start).

Leo Babauta at Zen Habits suggests
that the main obstacles to establishing a regular exercise habit are:

• We make it too difficult for ourselves by starting with big goals that are hard to sustain
• We try to tackle too many goals at once and cannot maintain the necessary focus
• We don’t give ourselves good motivators (such as keeping a log, joining a group, rewarding success)

So how do we succeed?

After creating the right frame of mind, you are ready to practice your good health habits. Here are my top tips.

1. One achievable goal

You want to maximise your chance of success. Zen Habits advocates tackling one goal at a time so that you can give that goal your full focus. You should also make your goals achievable according to your circumstances. If you are sick then it might be a big achievement to simply get out of bed and take a walk around your yard. The important thing is you are establishing a habit (ideally at the same time each day) and you can build on this as you get stronger.

2. Measure your success

Keep a log of your success and feel proud when you stick to your resolution. Most importantly, don’t berate yourself if you slip or miss a day. Negative self-talk will only set off a cycle of negativity and further avoidance as we discussed last week. Remember that each moment is an opportunity to make a different choice. As in now. And now. You get the idea.

3. Stop thinking

That’s right. You’ve considered all your options and made a positive choice as to what you want to achieve. And you have established specific, measurable goals which support your vision of success. You did all this with your ‘good’ brain – the positive, rational, motivated brain.

However, the brain you have at 5:30 am when the alarm reminds you it’s time for a bike ride, or the brain you have during that mid-afternoon low when your chocolate craving hits maximum, this is your ‘bad’ brain. And you must not engage in any dialogue with your bad brain. Your bad brain is very cunning and will offer all sorts of reasons why you shouldn’t go for a ride today, how you will catch up tomorrow, how one day won’t make a difference. And you’ll argue valiantly but eventually be convinced by the very logical reasoning of your bad brain.

The trick is to create very specific instructions for yourself (with your good brain) and then follow those instructions automatically with no further discussion. If bad brain starts up don’t even engage in debate – go into auto pilot and get the job done.

4. Make it regular and make it fun

It is easier to establish a habit if you do it everyday. Give yourself a goal – exercise everyday for the next two weeks or do not eat any chocolate for the next seven days. The longer you can do it consistently the easier it becomes! Do whatever you can to make it an enjoyable, fun habit. Listen to your MP3 player while you walk, give yourself a small reward everyday you don’t eat chocolate (what about putting that $1.50 you saved on the Snickers in a jar and buying a book or CD at the end of the month?).

Engineer for success

This idea from Zen Habits may sound too scientific and complicated, but basically it is about creating ‘cheats’ which will pull you towards your goal and push you away from what you don’t want. Make the path you want to follow easy for yourself, and make the other choices more difficult!

Leo Babauta includes lots of examples, and some of these we have already touched upon. But when you think about the strategies in this framework you can see why they work. Here’s just a few:

• Increase positive feedback for the habit by keeping a log (giving you satisfaction), getting positive support from others (locally or online) and rewarding yourself.
• Decrease negative feedback for the habit, such as the discomfort of starting exercise, by only doing a little bit in the beginning. If your craving chocolate, try some fruit and nuts (if they agree with you).
• Increase negative feedback for not doing the habit. You want to make it hard not to do the habit. If you’re trying to exercise, get rid of the TV and Internet and make your house uncomfortable, until you do your exercise.
• Decrease positive feedback for not doing the habit. What tempts you not to do your habit today? If you’re trying to exercise in the morning, the positive feedback from avoiding the exercise is staying in bed and getting more sleep. Set up multiple alarms all around your room and don’t go back to bed. You’re up now so why not go for a walk? Have someone waiting to meet you for your morning exercise.

Good luck IBDers – let me know how you are going with your good health habits!

Rebecca

And having IBD (or any chronic illness) makes it even harder. We must contend with fatigue, nausea, pain and diarrhea (and more), and with occasional feelings of hopelessness and depression. There are plenty of completely reasonable excuses available: “I’m too tired to do anything” or “I’m sick all the time anyway so why not have that chocolate / coffee / wine, even though I know it will make me feel worse”.

Why try?

As explained on the About page, my philosophy on IBD treatment is that:

• The human body comprises many systems working as a whole;
• Any improvements to your holistic health are beneficial – this applies whether you have a chronic disease or not;
• Improvements to your holistic health may not directly affect the course of your IBD but will help you feel better in your daily life.

However, and most importantly, no-one can know your body like you do and ultimately you must make informed choices about how best to look after yourself.

In the past I have been afraid that exercise will, at best, leave me feeling too tired to get through day to day life and, at worse, aggravate my disease. However, I have read many on the internet from patients, even those with very active disease, citing the benefits they feel from some form of exercise. I have spoken with my own doctor about it, who has said that despite my active disease there should be no problem with exercise such as walking or light weight lifting as long as I did not overtax myself.

Canadian researchers found that for people with mild Crohn’s disease, taking a walk a few times per week helped boost their well-being and quality of life. However the same report says that patients with moderate or severe symptoms of their Crohn’s disease should not engage in an exercise program until their symptoms are better controlled.

Of course, whatever you do must be appropriate to your circumstances and level of health.

Although strenuous exercise might be out of the question for you, you may like to try gentle stretching and movement, or meditation exercises. This, along with having a healthy diet and getting plenty of rest can only help your general health and well-being.

And here’s a final perspective on why we should maintain positive health programs. Referring to another article from “New York Times Magazine”, Gretchen from The Happiness Project surmises:

It turns out that people who stick to a doctor’s orders – say, by taking a prescription – are different, and healthier, than people who don’t. In one drug study, a group of men were assigned a drug or a placebo. The men who faithfully took their pills had significantly better outcomes than the men who didn’t – even the men who were only taking a placebo! The conclusion: a group of people who faithfully adhere to a program that they think healthful (taking vitamins, exercising, eating a better diet) will have a different outcome from a group that doesn’t…

How to build good health habits

Here are some of the ideas I have picked up about how to establish new habit (such as exercise) or change an existing habit for the better (such as switching from sweet to healthy snacking). I am focusing on health in this article, but many of these ideas can (and have) been applied more generally to whatever goal it is we wish to achieve.

The first step is creating the right frame of mind – a positive outlook that will help overcome initial resistance to a new healthy behaviour. Next week is step two – how to turn that new behaviour into a habit and keep it going!

Creating the right frame of mind

I read two great books for the first time this year: Getting Things Done by David Allen and The Now Habit by Neil Fiore. Each time I reread them I find something new. The following is a mash of the concepts from these books which had greatest impact on me, and my thoughts on how to apply them in daily life.

1. Don’t think ‘I have to’ or ‘I should’ or ‘if I don’t I am a bad person’

Trying to badger yourself into a new behaviour with authoritarian or critical self-talk will not work. This will only spark a childish, rebellious resistance which will lead to procrastination, avoidance, guilt and more negative self-talk about your own failings.

2. Make a choice

You choose your path in life, and although certain events (such as having IBD) are beyond your control, you choose how you will respond and behave. This is a powerful thing. Starting an exercise program or changing your diet because ‘it’s the right thing to do’ or because someone ‘told you to’ are not great motivators. Doing it because you have made a positive, informed and deliberate choice is much more powerful and will support you through the process.

3. Think through your options

If you are going to make a genuine choice, then you need to weigh up the options. You can choose not to exercise, to eat fatty or irritating foods, or to sleep erratically. What would the consequences of that behaviour be? Make a list. Or you could choose to undertake some type of exercise, eat better, and sleep regularly. What would the consequences of that behaviour be? Make a list.

4. Pull yourself towards the goal, don’t push

Hopefully you have considered your options and decided that you absolutely want healthier habits. Now focus on the positive consequences of this choice. Be very clear about why you have made this choice, give yourself a purpose statement eg. ‘I choose to exercise because it will make me stronger and give me energy to do things other things I love doing’.

Then, in the words of David Allen, envision wild success and describe what that looks like eg. ‘I will exercise for at least 20 minutes every day and I will be stronger and more energetic and I will be proud of my commitment and my achievement’. Record your purpose and vision statements somewhere you will see them regularly so, on bad days, you will be reminded of the positive reasons for making this choice and will be pulled towards your ultimate goal.

5. Repeat

Keep reminding yourself why you made this choice. Thinking about your higher purpose and your vision of success will get you through the ‘yuck factor’. Don’t dwell on the negative aspects like getting up earlier or stiff muscles or really wanting that piece of chocolate. There will always be less enjoyable aspects of any task, but dwelling on them and then telling yourself to ‘just push on’ will not help. Focus on positive outcomes and pull yourself towards your vision.

Check in next week for part 2 of this post – how to make your new good health behaviour a habit and keep it going!

Rebecca