Member Spotlight: Joseph Napora
Joseph NaporaMember Spotlight
This edition of Member Spotlight focuses on the work of long-time NASW-Maryland member Dr. Joseph Napora, LCSW-C, and his work helping individuals with diabetes manage stress and adopt a mindful approach to wellness. His 2010 book
“Stress-Free Diabetes: Your Guide to Health and Happiness” outlined the principles of this approach and provides a blueprint for anyone wishing to manage a chronic illness or stress.
When did you first become interested in working with patients living with diabetes?
In 1984, when the Johns Hopkins Comprehensive Diabetes Center opened, I was invited to become a member of the faculty and to address psychological/emotional issues as part of the Center's educational program. I grew up in a family with the disease and as I got more familiar with it, I realized how everyone suffered emotionally from my grandfather and uncle's (my mom's brother) poorly controlled diabetes. This association became a strong motivation to help others to have good control and to avoid undue suffering both for the person with the disease and others close by. As my work at the Center and subsequently at the Suburban Hospital Diabetes Center in Bethesda evolved, I realized that the impact of stress on diabetes care was largely ignored. Diabetes control then, and to a large extent even now, was limited to diet, exercise and medication . . . period. Teaching the principles and skills of effective stress-management became a primary objective of my work.
What is it about diabetes that can make it such a difficult-to-manage condition?
Effective management of diabetes is very demanding, requiring a high level of self- control. For the individual with diabetes, blood glucose fluctuates, sometimes extremely, with food intake, physical activity and stress along with the action or inaction of insulin. Consequently, the control of diabetes requires a rigid regimen including maintaining a healthy diet, monitoring blood sugar levels, managing medications, exercising regularly and keeping stress to a minimum. Maintaining this regimen can be stressful, but these are not the only sources of stress in dealing with diabetes.
The potential for stress is high due to the danger of a sudden and severe drop in blood sugar level (disorientation and loss of consciousness), the discomfort of symptoms of poor control (frequent urination, fatigue, irritability) and the threat of serious complications (coronary disease, neuropathy, renal failure, visual impairment). In addition, coping with the disease can be emotionally disturbing, a problem often complicated by the uninformed reactions of family, friends and coworkers. It has been estimated that the incidence of depression is 3 to 5 times higher for individuals with diabetes than for others.
What is the most important message in your book, “Stress-Free Diabetes: Your Guide to Health and Happiness”?
To manage diabetes well, you not only have to be diabetes smart?ie, to know the diet, exercise and medication bit--you have to be stress smart. Excessive or prolonged stress works against good control both in the short and long-term. Stress can seriously elevate blood sugar levels very quickly; and in the long-term, excessive stress impairs the capacity for self-care and causes severe wear and tear on vital life systems. Today, the increase in external stressors makes the control of diabetes more and more difficult. Given the high potential for stress and its harmful effects, stress management is an essential element of diabetes control and general well-being.
In the introduction of your book, you say diabetes can be both “stressful” and “distressing.” What is the difference?
There is a fine line between the two and they are often used interchangeably. I think of stress as a multilayered reaction (biological, physiological, psychological and behavioral) to the perception of danger; whereas distress commonly refers to a level of considerable emotional and physical suffering.
Can the information in your book be used only for individuals with diabetes, or is it applicable to patients living with other chronic conditions?
I am so glad you asked this question. When you asked earlier about the most important message in my book, my first reaction was to answer that the perspective and techniques presented can be of value to anyone who is in stress, whatever the source might be. Some stress is helpful at times (the angst about the complications of diabetes or about failing a test in school will motivate someone to do what is needed regardless of how undesirable the task might be); but excessive, prolonged stress is toxic for anyone, causing serious physical, mental and behavioral consequences. Prolonged or excessive stress puts wear and tear on the immune, coronary, renal, digestive, sexual and mental systems. Anyone who practices the principles and skills of stress management presented in the book will derive substantial benefit from them.
What is the most important thing a client has taught you?
Two things: (1) Many people suffer from stress and do not have the knowledge and skills for containing their stress-demons. (2) Clients are strongly empowered when they know how to prevent or, at the very least, minimize the impact of life's adversities. I have had so many clients express joy, optimism and enthusiasm for the future having obtained the know-how of stress management.
Your catchphrase “Don’t believe everything you think!” is intriguing – what does it mean?
In "The Power of Positive Thinking," Norman Vincent Peale (1952) wrote, “ . . . the greatest factor in any undertaking is one’s belief about it.” Mahatma Ghandhi wrote that our beliefs become our thoughts and ultimately our destiny.
A major premise in my work is that much, if not most, of our stress is a result of accepting faulty beliefs as reality?what I have come to call "cognitive warps." The "catchphrase" is my way of saying "be a perpetual skeptic, especially when something is not working for you." It is a mindful way of living as opposed to functioning habitually, on automatic pilot as we all do to some extent. The message is that many of our beliefs are baseless and can needlessly diminish happiness, health and well-being. An example my fellow social workers will readily understand is the belief held by so many: "I am not good enough," a message easily acquired in childhood from the messages received from disgruntled parents, teachers and peers. With this frame of reference, one's self-perceptions and self-regard are warped in negative ways even if the belief has no basis in fact. The catchphrase reminds us to ask the mindful questions: "Is the belief I am going by real; and even if it has some truth, is it relevant to me in this situation? Is the belief working for me? If not, is there a belief that makes sense in this situation?"
You’ve said that you incorporate humor into everyday life, and have lectured on the use of humor as a coping mechanism. What are some ways you use humor with clients?
In addition to the classes at the diabetes centers, I have presented to a variety of groups, and I have always included the value of a humorous spirit and how to develop it; the responses have consistently been favorable. I gave a presentation at our 2010 Annual Clinical Conference titled "Is there a place for humor in your clinical practice" for a group of about 75 social workers. A lot of people long for ways to lighten the load; mirth and laughter do it well. Keep in mind that humor is recognized as only one of a few "mature" defense mechanisms.
Two ways I have used humor with patients are modeling (telling of some humorous experiences even when they make me look a bit foolish) and using cartoons that I have collected that relate to patients' foibles and self-consciousness. These are effective antidotes for the common disease of "taking oneself too seriously."
My doctoral dissertation (1984) at the U. of Md. School of SW was a study of the effects of humor on the well-being of senior adults. The results were significant and wonderfully positive.
In addition to his work as a clinical psychotherapist at Johns Hopkins Diabetes Center, Dr. Joseph Napora has a private practice specializing in the treatment of diabetes, chronic pain and other chronic illnesses; coping with surgery; and recovery from emotional trauma.