Targeted Training in Illness Management (TTIM) for Individuals with

Serious Mental Illness (SMI) and Diabetes Mellitus (DM)

Instructors Manual

Draft Date: April 14, 2012

-------------DRAFT COPY----DO NOT DISTRIBUTE---------

TTIM is primarily derived from the Diabetes Awareness and Rehabilitation Training Program (DART),
(McKibbin 2006) and the Life Goals Program (LGP) (Bauer and McBride 2003). The material from
this manual has been adapted in collaboration with the developers of DART (Dr. Christine McKibbin
and colleagues) and the Life Goals Program/LGP (Dr. Mark Bauer and colleagues):

McKibbin, C.L., Patterson, T.L., Norman, G., Patrick, K., Jin, H., Roesch, S., Mudaliar, S., Barrio, C.,
O'Hanlon, K., Griver, K., Sirkin, A. & Jeste, D.V. (2006). A lifestyle intervention for older schizophrenia
patients with diabetes mellitus: A randomized controlled trial. Schizophrenia Research, 86(1-3), 36-44.
(DART)
Bauer, M.S. & McBride, L. (2003) Structured Group Psychotherapy for Bipolar Disorder: The Life Goals
Program, (2nd ed). New York, NY: Springer Publishing Company. (LGP)

TABLE OF CONTENTS
STEP ONE (GROUP SESSIONS)

Pages

Overview of the Program ................................................................................................................................3

Welcome Letter ................................................................................................................................................4
Session 1:

Orientation and introductions, Emphasize ground rules, establishment .............................. 6-14

of a therapeutic relationship, Discuss facts and misconceptions about SMI,
An introduction to DM

Session 2:

The challenge of having both SMI and DM, Stigma of SMI and strategies ...................... 15-26
to cope with stigma, Relationship of SMI symptoms and functioning in
response to stress and DM, An introduction to personal goal-setting

Session 3:

Personal SMI profile (what does worsening illness look like for you), ............................. 27-35
triggers of SMI relapse, personal action plan for coping with SMI relapse

Session 4:

Diabetes complications and benefits of change, Symptoms of high/low .......................... 36-52

blood sugar and blood sugar monitoring

Session 5:

Problem-solving skills and the IDEA approach ................................................................. 53-64

(Identify the problem, Define possible solutions, Evaluate the solutions,
Act on the best solution), Talking with your medical and your mental health
care providers, Role play of communication with care providers

Session 6:

Treatments for SMI and for Diabetes, Nutrition for best physical and emotional
health, Reading labels ........................................................................................................ 65-92

Session 7:

Substance use and its effects on SMI and on DM, Replacing unhealthy sugar
and fat, Problem- solving to feed your body healthfully ................................................. 93-107

Session 8:

Effects of exercise on physical and emotional health, ................................................... 108-115

The Importance of daily routine and good sleep habits

Session 9:

Medications and psychological treatments for SMI, .................................................... 118-130

A personal care plan to take care of the mind and the body

Session 10:

Social supports and using your available supports, Types of ........................................ 131-142
Physical Activity and your community

Session 11:

Taking care of your feet, staying on track with medication treatments ......................... 143-147

Session 12:

Illness management as a life-style, Acknowledgement of group progress, ................... 148-154

Setting the stage for Ongoing Illness Management and Recovery (Step 2)
TTIM Completion Certificate .............................................................................................155

STEP TWO (FOLLOW-UP)

Instructions for Follow-up sessions ............................................................................................................157
Nurse telephone follow up sessions..................................................................................................... 158-162
Peer-Educator telephone follow-up sessions .............................................................................................163

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Overview of the Program

TTIM is a psychosocial treatment that blends psychoeducation, problem identification/goal-setting,
behavioral modeling/reinforcement and mental health care linkage which has been adapted to the primary
care setting, and targeted for SMI participants with DM. TTIM is intended to improve both mental health
and DM outcomes among individuals with SMI and DM and is guided by principles of social cognitive
theory.
TTIM starts off with 12 group sessions conducted over a 12-week time period (Step One). The
interventionist conducting the group therapy for individuals with SMI and DM should be a trained nurse
with a background in diabetes and a comprehensive understanding of the issues relevant to individuals with
SMI. The groups will be co-lead by an individual with both SMI and DM who has developed expertise in
self-managing both of these illnesses.
Each session will last 60-90 minutes and will conclude with an interactive question/answer/comment
session that will be lead by the nurse educator or the SMI peer leader depending upon the specific session
content. Every attempt will be made to minimize embarrassment associated with asking questions. For
instance, the nurse educator will be trained to ask, Are there any things that you have heard people say
about mental illness or diabetes that you have wondered about? The setting will purposely maintain a
welcoming and social format.
After the 12 sessions are completed (Step One) individuals will participate in a 48-week maintenance period
(Step Two). In Step Two participants will have one telephone maintenance session with the SMI peer
leader every other week for the first 3 months after the conclusion of the TTIM groups and monthly
thereafter. The Nurse Educator will meet monthly with each TTIM participant after the conclusion of the
TTIM groups. If in-person visits are burdensome for the TTIM participants, the Nurse Educator visit may
be conducted by telephone. During Step Two, the nurse educator will provide the individuals primary care
and mental health providers with an update on the individuals participation in TTIM and a copy of their
personal care plan. Contact will be made by fax, telephone, or secure message via the electronic medical
record system. Contact between the TTIM nurse and clinicians will occur at minimum after TTIM group
conclusion and twice more during Step Two.
Review of this manual serves as a guide to facilitate learning to cope with BOTH SMI and DM. Although
this manual is highly structured, some of the flow of the individual group segments will be determined by
the characteristics of the group participants, the nurse interventionists and the peer educator.

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Welcome Letter

Dear TTIM Group Participant,

Welcome and congratulations! You have been invited to participate in the Targeted Training in
Illness Management (TTIM) Program. The focus of TTIM is for individuals with mental illness and
Diabetes to feel more confident in coping with and managing both mental illness and Diabetes. An
important part of TTIM is learning from each other. We believe that TTIM will help you to be a better
illness self manager. We are very happy to have you join us and hope you enjoy the program.

Sincerely,

Martha Sajatovic, M.D.

TTIM Treatment Manual v 4/14//2012

Neal Dawson, M.D.

TTIM
----- Step One -----

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Session 1: Orientation and introductions, Emphasize ground rules, Establishment of a

therapeutic relationship, Discuss facts and misconceptions about SMI, An introduction
to DM
Supplies and Equipment Needed for Session 1:
1. Name tags
2. Flip charts and markers or laptop and projector with visual aids in PowerPoint.
3. Posters identified at the end of this session
4. Extra pens/pencils for group members
5. Light snacks appropriate for individuals with DM
6. 2-3 door prizes
SESSION 1 TIME SCHEDULE
Part one: Setting the stage ................................................................. 30 min
Part two: Facts and Myths about SMI ............................................. 30 min
Part three: An Introduction to Diabetes .......................................... 20 min
Summary of Todays Lesson ............................................................ 5 min
Homework Assignment: None
Note to Leaders:
In this session you will: 1) provide an orientation to the nature of the class, ground rules, and group member
introductions; 2) Establish an accepting/therapeutic relationship and 3) teach participants some facts about
SMI and on Diabetes, what each of these is (and is not), and provide a brief introduction.
Encourage sharing by each participant. The emphasis should be on learning through discussion modeling,
practice, feedback, and reinforcement. Maintain a positive atmosphere in the classroom and give frequent
and abundant praise for classroom participation, questions, and answers. This emphasis on the positive will
encourage participation and will enhance learning and promote good attendance.
At the end of class, it is important to ask group members to summarize what they have learned and then
provide the structured summary to remind patients of all information and skills that they have learned in the
session.
Visual aids are important to use since it is likely that some of the participants will have vision, hearing,
memory, and /or learning problems. Place posters and flip charts at the front of the classroom and leave
them there during the entire session. For reference, place flip charts or other visual aids from prior sessions
also at the front of the classroom.

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Part One: Setting the Stage

Script for Nurse Educator:
Welcome to the Targeted Training in Illness Management (TTIM) program. We are pleased that you
could join us! This is a program that will review and teach new skills that you will need to cope with both
your mental illness and your diabetes.
The focus is on helping YOU to be more in charge of your health and illnesses. (Empower YOU)! This
program is NOT meant to replace diabetes self management education.
For the next 60 weeks, we will work with you to achieve the best possible control of your mental illness
and your diabetes. TTIM has two steps. In step one, which lasts for about 12 weeks, we will have a
group session one time per week. Each group session will last for about one and one half hours. After
step one is done, we will follow up with you individually on the telephone or in person for an additional
48 weeks. At the end of this time we hope that you will feel more confident about managing your own
mental illness and your diabetes. The focus is on helping YOU to be more in charge of your health and
illnesses. Here to help you are a trained nurse educator and an individual who has experience in dealing
with both mental illness and diabetes (Peer Educator)
Note to Leaders:
The Nurse Educator and Peer Educator should introduce themselves at this point.
Script for Nurse Educator:
There are many topics to cover in this group and your group leaders may spend a lot of time speaking,
however, you will be asked to participate by providing information about your experiences to the class
and by practicing skills both by yourself and with other group members. If you have any questions about
or problems with any aspect of the class, please feel free to mention them to your group leaders. We are
part of your team and want to help you do your best. We are now going to lay out the basic ground rules
of the group sessions
Note to Leaders:
Discuss ground rules, allowing time for questions. Provide examples that involve participants and seek all
members agreement for ground rules. Provide contact information for group leaders.
GROUND RULES:
ATTENDANCE: We base each session of the group on the previous sessions. Therefore, we ask all of you
to attend each session if you can. If you cannot attend, we ask that you please contact one of your group
leaders. This will prevent the group from worrying if you do not show up.
THE SAME TIME FOR ALL: We want to make sure that everyone has enough time to speak and share
experiences. So we ask that you be aware of others who may also wish to speak and alert the group leaders
if someone who would like to speak does not get a chance to speak.
BE POSITIVE AND CONSTRUCTIVE: If you would like to offer a suggestion or advice to another
group member, we encourage you to be supportive and positive so that you dont accidentally make the
other person feel bad. We should assume that everyone does the best that they can and our job is to make
comments that are non-judgmental, helpful, encouraging and supportive.
CONFIDENTIALITY: Deciding to participate in this group is a very personal choice. Some people would
prefer to keep the fact that they participate in a group to themselves. So, we ask that you not share any
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personal information about other group members with people outside of this group. It is okay to tell others
about your experience in the group, but for everyones safety and comfort we ask that you not reveal
specific information about anyone here to anyone else outside of the group.

Participant Introductions:
Nurse Educator Script:
Lets get to know one another a little bit more. Please write your name down on the name tag you have
been given and wear the name tag during the first session. We will then go around the room and learn a
little bit about of each of you. You have been invited to participate because you, like our Peer Educator,
have experienced having both mental illness and Diabetes. You have probably learned some things about
these illnesses and it is very likely that we can all learn from each others knowledge and experience.
We will be asking the following questions. Please do not worry about having a right answer, as
answers might differ a lot for each of you and it is perfectly ok to not know some of these answers.
List of questions to ask each group member during introduction:
1. What is your name? (Write all first names down on flip chart)
2. When were you diagnosed with Diabetes?
3. What is one concern you have about being diabetic?
4. When were you diagnosed with a mental illness? Do you know what type of illness?
5. What is one concern you have about having a mental illness?
6. What is one thing that you would like to learn from this group?

Note to Leaders:
In this exercise take about 20 minutes to introduce members to the group. Assist group members who have
difficulty initiating dialogue by providing additional structure to the task.

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Part Two: Facts and Myths about SMI

Group Focus Point: Facts and Misconceptions about Mental Illness
Facts about serious mental illness (SMI) (Poster 1): Review and discuss Poster #1.
Untrue things that people might say (Myths) about serious mental illness (SMI) (Poster 2): Review
and discuss Poster #2.
Note to Leaders:
Review each of the facts and myths. Ask group members if they have ever heard of these before. Ask them
what their thoughts and feelings are about these facts and myths. Allow a brief period of time to allow
members to generate their own facts and myths about SMI based upon their own personal experience.

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Part Three: An Introduction to Diabetes--Understanding Your Blood Sugar and How

Your Body Uses the Food You Eat
Nurse Educator Script:
Now we are going to shift gears and talk about a medical condition that all of you haveDiabetes. We
will talk about the basic problem in Diabetes, which has to do with an abnormality in processing and
using fuel from the food you eat.
All of the food you eat changes as it moves from your stomach to your intestines. Some of this food is
broken down into sugars. These sugars enter your blood stream and are known as blood sugar. (Your
doctor may also call it blood glucose) Talk to your doctor about what your blood sugar (glucose) level
should be. (Poster 3).
We are going to go through some frequently asked questions in order to learn some of the basic facts
about Diabetes.
What is blood sugar used for?
Blood sugar travels in your blood stream to all of the cells in your body to give them the energy they need.
How do the cells in your body get the sugar from the food you eat?
Blood sugar cannot enter the cells in your body all by itself. It needs help. How? Insulin! Insulin is made
by the pancreas, a gland behind your stomach. Insulin is a hormone. Insulin helps sugar enter the cells.
You Answer: What helps the blood sugar enter your cells?
_______________________________________________

How Insulin Is Used?

Think of the cell as having locked doors. Insulin is the key that opens the doors so the sugar can get into the
cells.
In People with Diabetes, Blood Sugar Can Build Up
A person with diabetes cannot use the sugars formed from the food they eat. There are two reasons for this:
1. The body may not make enough insulin, or
2. The cells do not allow the insulin to work as well as they should. This is called Insulin Resistance.
(The cells resist the insulin).
This is a problem. If sugar cannot get from the bloodstream into the cells, then it stays in the blood. Sugar
may eventually build up to high levels. These high levels can be harmful to your body over time.
Is there a Cure for Diabetes?
Right now, there is no cure for diabetes. We hope that, in the future, there will be. For now, good treatment
including a healthy diet and exercise can help to keep your blood sugar level at a healthy level. A normal
sugar level does not mean that your diabetes is cured. But a normal blood sugar level does show that you are
taking good care of yourself!
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Managing Your Blood Sugar

There are three important ways that YOU can help to keep your blood sugar at normal levels.
1. EAT A HEALTHY DIET
2. EXERCISE
3. TAKE YOUR MEDICATIONS
You Answer: What is one thing you can do to keep your blood sugar at a healthy level?
________________________________________________

Note to Leaders:
Give door prizes for the first/best answers to the questions on blood sugar/Diabetes. Let group participants
know that good health and a relaxed mental state is the best prize of all for being able to manage ones
illnesses, but that door prizes will be given at each TTIM session because we feel it makes it more fun for
everyone.

Session 1 - Summary:
Nurse Educator script:
Today we learned some information about each other and the expectations for the group. We learned
some facts and myths about mental illness.
We also learned about blood sugar. High blood sugar is a common problem associated with Diabetes.
High blood sugar can be caused by a low level of insulin in your blood. It can also be caused by your
cells ignoring the insulin that is there. Keep in mind, however, that by watching your diet and exercising
and taking your medications, you can help keep your blood sugar at healthy levels.
We realize that you had a lot of information today. Some of it was likely review and some may be new
information.
My group co-Leader, (Insert name of Peer Educator), and I hope that you found this group session both
interesting and enjoyable.
We want to emphasize that YOU are the best managers of your own illnesses and we are here to help you
gain confidence in doing what you can do to have the best possible health.
Next time we are going to talk more about this and help you to work on your own personal goals.
Please remember to bring your glucose meter with you to the next session.

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Session 1 - Poster 1

FACTS about serious mental illness (SMI)

1. SMI such as schizophrenia, bipolar disorder (manic-depressive
illness), and depression are PHYSICAL illnesses that are a result of
a problem in how the brain works.
2. Schizophrenia and Bipolar disorder (manic-depressive illness) occur
in about 10 of every 100 people
3. Major Depression occurs in about 16 of every 100 people
4. SMI is a leading cause of disability in the U.S. and in the world
5. No one has exactly the same symptoms
6. SMI is often long-lasting (chronic) and individuals may get better
for a while, and then have a relapse
7. While there is no cure for SMI, there are many things that can
help such as medications, counseling, healthy life style and not using
drugs and alcohol.
8. Some people with SMI can hear voices (hallucinations) or have
extreme fear (paranoia). This is called psychosis by medical
professionals and is not uncommon among those with SMI. In most
cases periods of psychosis are brief.
9. A lot of people experience negative attitudes and discrimination
because of their mental illness. This is called STIGMA
10. Many people with SMI do not discuss it. But lots of people are
living with SMI and are OK with it.

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Session 1 - Poster 2

UNTRUE things that people might say (Myths)

About Serious Mental Illness (SMI)
1. SMI is caused by immoral behavior or using drugs or alcohol.
2. People with SMI are unable to make important decisions about their
healthcare
3. People with SMI are not very smart
4. A person who has experienced psychosis is not able to manage their own life
or affairs.
5. Medications for SMI are a crutch and should be avoided in order to not get
addicted.

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Session 1 - Poster 3: Your Digestive System

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Session 2: The challenge of having both SMI and DM, Stigma of SMI and strategies to
cope with stigma, Relationship of SMI symptoms and functioning in response to stress
and DM, An introduction to personal goal-setting
Supplies and Equipment Needed for Session 2:
1. Name tags (optional for sessions two and three)
2. Flip charts and markers or laptop and projector with visual aids in PowerPoint
3. Posters and Handouts identified at the end of this session
4. Extra pens/pencils for group members
5. Light snacks appropriate for individuals with DM
6. 2-3 door prizes
SESSION 2 TIME SCHEDULE
Part one: Challenge of having both SMI and Diabetes ..................... 10 min
Part two: Stigma and Coping with Stigma ........................................ 20 min
Part three: SMI, Stress, and Diabetes ............................................... 25 min
Part four: Personal Goal Setting ....................................................... 30 min
Summary of Todays Lesson ............................................................ 5 min
Homework Assignment: Setting a Personal Goal

Note to Leaders:
In this session you will discuss the challenge of having both SMI and DM, Stigma of SMI and strategies to

cope with stigma, Relationship of SMI symptoms and functioning in response to stress and DM. The
session will conclude with an introduction to personal goal-setting. A key component of this session is
INTERACTION between group attendees and group leaders. In particular, group members can hear
examples for the Peer Educator on how he or she has struggled with stress and managing both their SMI
and diabetes. Members will be encouraged to provide their own comments and points of view.
Since each session in this course builds on the skills learned in the previous session, it is important to have a
brief review. Review last sessions home practice. Encourage sharing by each participant. The emphasis
should be on learning through discussion modeling, practice, feedback, and reinforcement. Maintain a
positive atmosphere in the classroom and give frequent and abundant praise for classroom participation,
questions, and answers. This emphasis on the positive will encourage participation and will enhance
learning and promote good attendance.
At the end of group, it is important to ask group members to summarize what they have learned and then
provide the structured summary to remind patients of all information and skills that they have learned in the
session.
Visual aids are important to use since it is likely that some of the participants will have vision, hearing,
memory, and /or learning problems. Place posters and flip charts at the front of the classroom and leave
them there during the entire session. For reference, place flip charts or other visual aids from prior sessions
also at the front of the classroom.

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Part One: Having a Mental Illness and Diabetes Together:

Nurse Educator script (Poster 4): Review and discuss Poster #4.
People with SMI are more likely to have diabetes than people without SMI. At the same time, people
with diabetes are more likely to have SMI than to those who do not have diabetes.
People with SMI and Diabetes have medical and mental health problems. Examples of this are higher
rates of heart attack and psychiatric hospitalization. So, if SMI and Diabetes are not in good control, it
could effect how long a person lives.
Studies show that taking care of Diabetes has good effects on mental health and that taking care of your
mental health has good effects on Diabetes. So you can have a healthier and longer life by taking care of
your SMI AND your Diabetes.
Taking care of SMI includes taking prescribed medications, following up with counseling/case
management, avoiding drugs and alcohol, having daily routines such as a regular time to go to sleep and
wake up, as well as taking advantage of supports like family and friends.
Taking care of Diabetes includes following a proper diet, exercising, taking prescribed medications and
testing blood sugars as recommended.

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Part Two: Stigma of SMI and Strategies to Cope with Stigma:

Nurse Interventionist Script:
We are now going to talk about STIGMA. This follows the discussion we had last session on myths
about mental illness.
Our feelings and knowledge about mental illness are influenced by what we have learned from other
people. One of the difficulties that some people encounter is psychiatric stigma. Psychiatric stigma is
caused by the inaccurate beliefs, stereotypes, myths, and misconceptions people have about mental
illness. Stigma influences the way others act toward those people who have mental illness. Stigma also
affects the way people feel about having mental illness and can even affect a persons behavior. For
example, it may make a person less likely to take their medication. Have these comments affected the way
that you think, feel, or manage your condition?
What might be some good ways to deal with cope with STIGMA?
Note to Leaders: Discuss ways to cope with Stigma (Poster 5). Review and discuss Poster #5.

Give door prizes for additional, first/best answers on ways to cope with Stigma.

You Answer: Other ways I can cope with stigma:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

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Part Three: Relationship of Mental Symptoms and Functioning in Response to Stress

and Diabetes:
Nurse Educator Script:
Everybody has stress and everyone in this room (Including your group leaders!!) is likely to have some
future stress in their life. People respond in different ways when they are stressed or their SMI symptoms
are getting worse (relapse). This behavior can be called a coping response. Sometimes the coping
response has a good outcome. Other times the outcome can have no effect or be negative/bad.
Some coping responses can worsen Diabetes and mental state. Sometimes people will try one coping
response for a while, and then switch to another behavior if the first one does not work. Sometimes
people use more than one coping response when they are stressed.
Poster #6 shows some of the coping responses that people can have in response to stress. Think about
how these coping responses might have good/neutral or effects on both mental illness and on Diabetes
(Poster 6).
Review and discuss Poster #6.

Questions for the group:

1. Has any one ever used any of these in the past to deal with stress or symptoms of mental illness?
2. What kinds of coping responses can either worsen or improve Diabetes?
3. What would be coping responses to stress that could help BOTH mental illness and Diabetes?
You Answer: Coping responses that could help BOTH mental illness and Diabetes:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Note to Leaders:
Start with the list of possible coping responses and possible outcomes of these actions. Encourage group
members to generate additional coping responses and focus on identifying coping responses that can have
either positive or at least neutral effects on both SMI and Diabetes. Give door prizes to first/best responses
on coping responses for management of both SMI and Diabetes.
Conclude this segment by pointing out that learning to cope with stress requires both practice and patience.
By thinking about coping responses that are likely to be helpful in advance, individuals might be able to
plan and possible be able to use these ideas for future stress.

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Part Four: Personal Goal Setting

Nurse Educator script:
There is a saying, if you dont try, you wont succeed. We always have things that we want to
accomplish in life.
A goal is something we want to accomplish or change. We all have goals. Some goals can be reached in a
short time while others take a longer time to complete. We want to help you reach your goals, even the
ones that take a long time to achieve and seem hard to do. Now we will talk about the SMART rule for
setting goals and how you can use this to set goals that are best for YOU.
Setting Goals
In order to make changes and reach our goals we need to have a plan that is SMART:
S = specific
M = measurable
A = achievable
R = realistic
T = timeframe

To be specific you must know what you want to do and how you are going to do it.
To see if a change is taking place you have be able to measure your progress. How often are you
going to work on this goal?
If you are going to achieve a goal then it must be one that is important to you and something you are
committed to doing. This will keep you motivated so you continue to make positive changes in your
life.
A realistic goal is one that you feel you can do. While this goal should challenge you a bit, it should
not be so hard that you get discouraged and give up.
Every goal needs to have a timeframe of when you want to reach your goal. The time set to reach a
goal must also be specific, measurable, and realistic. Without a time frame some people feel they can
start at any time but then they dont!

Long-term and Short-term goals. Some goals are focused on making changes right now and some
goals are focused on changes that you would like to make over a longer period of time. It is important
to have both long and short-term goals to solve problems related to having SMI and to having
Diabetes.

Long-term Goals
Some of our goals take a longer time to achieve. These goals are often the result of many other short-term
goals. Examples would be:

Lose 10 pounds in time for my high school re-union in 3 months

Improve my A1C in the next 6 months

In 4 months I want to walk up the stairs to my apartment without getting out of breath

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Short-term Goals
We can reach our long-term goals by setting some short-term goals. Some of our goals may be things that
we want to complete in the near future, like in a week:

Walk to the grocery store three times a week starting this Sunday

I will call my sister two times a week starting tomorrow

Eat a fruit or vegetable every day this week

Note to leaders:
Poster #7 talks about the SMART rule and setting personal goals. Review and discuss Poster #7. This is a
good opportunity for Peer Educators to describe their own experience with self goals. For example, has the
Peer Educator ever had difficulty sticking to a healthy diet? Has he or she ever had difficulty trying to keep
stress down? How did he/she work on this problem?
This is the time for the Group Leaders to bring up Home Practice #1individual goal setting. Make sure
you have extra copies to hand out in class and this might be an opportunity to walk through an example of
goal setting.

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Session 2 - Summary:
Nurse Educator script:
Today we discussed the challenge of having both SMI and DM, and ways in which people with SMI can
cope with both stigma and stress. Learning to cope with problems usually takes time and practice. No
one has all the right answers and we can all learn from each other.
To be healthy, many of us need to set goals. Today, we learned the difference between short and longterm goals. A short-term goal is something that you can achieve in one week where a long-term goal
takes a little longer. It is important to make your goal as strong as possible.
Strong goals use the SMART rule (Specific, Measurable, Achievable, Realistic, Timeframe). Use Home
Practice Handout #1 to start working on a SMART goal that is right for YOU.
Please remember to bring your glucose meter with you to the next session.

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HOME PRACTICE #1
Setting a Personal Goal

MY GOAL:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Place an x in the box for each day you worked toward your goal.
Day
Date
Comments

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Session 2 - Poster 4: Diabetes and Serious Mental Illness (SMI) are Related

SMI

DM

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Session 2 - Poster 5

Ways to Cope With Stigma

1. Search out and stay connected with people who provide support and do not judge me for
having a mental illness.
friends
family members
support/self-group
mental health provider: therapists, psychiatrists, social worker, case manager
2. Continue to learn about my illness and improve on ways to manage and cope.
3. Help teach others about the illness in order to minimize misunderstandings and gain
support.
4. Do not share illness-related symptoms and problems with individuals who will judge me
or treat me badly because of it.
Other ways I can cope with stigma:
_________________________________________________________________________
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Session 2 - Poster 6

Coping responses that people can have in response to stress:

Sleep longer

Working longer hours or harder

Using drugs or alcohol

Stopping medication

Call your doctor or therapist

Listen to music

Take it out on others by being irritable or argumentative

Stick to a regular routine

Go for a walk alone

Go for a walk with a friend/family member

Exercise

Over-eat

Spend a lot of time alone on the computer

Find a good listener to talk to

Questions for discussion:

1. Has any one ever used any of these in the past to deal with stress or symptoms
of mental illness?
2. What kinds of coping responses can either worsen or improve Diabetes?
3. What would be coping responses to stress that could help BOTH mental illness
and Diabetes?

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Session 2 - Poster 7

PERSONAL GOALS: SET YOURSELF UP FOR SUCCESS!

Have a plan that is SMART:
1. Specific what do you want to do and how will you do it?
2. Measurable how often are you going to work on this goal?
3. Achievable it must be important to you and something you are committed to doing
4. Realistic it must be something you feel you can do
5. Timeframe when do you want to reach your goal?
Examples:
1. Specific long term goal: In one year I want to lose 30 pounds and take less diabetes
medication. I will do this by being active every day for at least 30 minutes.
.
2. Measurable:
Short-term Goal: This week I will walk to the mailbox every day
3. Is this achievable?
4. Is this realistic something you can do?

Example of an unrealistic goal: I will go to the gym every day and work out for 2 hours.

5. Does this have a timeframe?

When you finish one short-term goal, think about setting another one until you are able to
reach your long-term goal.

To be specific you must know what you want to do and how you are going to do it.
To see if a change is taking place you have be able to measure your progress. How often are
you going to work on this goal?
If you are going to achieve a goal then it must be one that is important to you and something
you are committed to doing. This will keep you motivated so you continue to make positive
changes in your life.
A realistic goal is one that you feel you can do. While this goal should challenge you a bit, it
should not be so hard that you get discouraged and give up.
Every goal needs to have a timeframe of when you want to reach your goal. The time set to
reach a goal must also be specific, measurable, and realistic. Without a time frame some
people feel they can start at any time but then they dont!

Realistic vs. Not realistic examples:

Realistic goal: Eat either one fruit or 1 serving of vegetable each day this week.
Unrealistic goal: Follow a perfect diet, lose 20 lbs, find my soul mate and win $1million
dollars
in vthe
lottery.
TTIM Treatment
Manual
4/14//2012
Timeframe.examples:
Short-term Goal: In one week
Long-term Goal: In one month

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