Being Mindful of Diabetes Distress

Diabetes patients may reduce depression and emotional problems through mindfulness based cognitive therapy

December 6, 2012 / Author:  / Reviewed by: Robert Carlson, M.D

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(dailyRx News) For many patients, living with diabetes is no easy task. The day-to-day struggle of controlling the disease can take a toll on one's mood. Being mindful of the moment may help diabetes patients boost their mental health.

Diabetes patients dealing with emotional problems may benefit from mindfulness-based cognitive therapy, according to a recent study.

In mindfulness-based cognitive therapy, patients learn to pay attention to their feelings of stress and depression while developing a new relationship with those feelings.

The idea is to help patients understand their negative feelings, to discover what makes them vulnerable to those feelings and to become aware of the factors that lead to those feelings.

"Seek help if diabetes is affecting your mood."

Emotional distress is common in patients with diabetes, according to Ivan Nyklíček, PhD, of the Center of Research on Psychology in Somatic Diseases at Tilburg University in the Netherlands, and colleagues.

"Patients with chronic illnesses such as diabetes, cancer or chronic pain, need help in managing their tendency to become overwhelmed by patterns of negative reactive thinking and negative beliefs that cause so much suffering and anguish."

"This is what programs such as mindfulness-based cognitive therapy (MBCT), mindfulness-based stress reduction (MBSR) and mindfulness therapy attempt to address," said Peter Strong, PhD, a professional psychotherapist and author of The Path of Mindfulness Meditation.

In their study, Dr. Nyklíček and his fellow researchers set out to see if mindfulness-based cognitive therapy could reduce emotional distress and improve health-related quality of life in patients with diabetes.

Compared to usual care, mindfulness-based cognitive therapy was better than usual care at reducing stress, anxiety and symptoms of depression.

In addition, mindfulness-based cognitive therapy was better at improving patients' quality of life.

Mindfulness therapy did not appear to have an effect on HbA1c (a measure of blood sugar over time) or diabetes-specific distress (emotional issues directly related to living with diabetes). However, patients in the mindfulness group with high levels of diabetes-specific distress tended to show a reduction in diabetes distress compared to the usual treatment group.

Mindfulness is an awareness skill - first taught by the Buddha 2,600 years ago - designed as a practical way to curb negative thinking that the Buddha saw as the main cause of mental suffering, according to Dr. Strong.

"The first training in mindfulness is to simply become aware of your mental reactions. Remember, it is what you don't see that has most control over you," said Dr. Strong.

"Training yourself to see the negative beliefs and thoughts the moment they arise helps you counteract the habit of becoming trapped in unproductive negative thinking and the suffering that results from rumination, worrying and 'what if' thinking.

"Mindful awareness opens up a window of choice that allows you to stop the reactive thoughts the moment they arise and before they start to proliferate and gain strength," he explained.

"However, mindfulness is much more than just learning to become more aware. It also has a responsive quality," Dr. Strong continued.

"We learn how to respond to our pain or reactive thinking with acceptance based on compassion, kindness and caring. This kind of acceptance is often described as embracing, opening to, turning toward, the pain or negative thoughts. The power of genuine acceptance for facilitating both mental and physical healing is well-established and has been demonstrated in countless studies," he said.

The study involved 70 diabetes patients who underwent mindfulness-based cognitive therapy and 69 patients who received usual care.

To measure stress, the researchers used the Perceived Stress Scale. Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale. Mood was measured using the Profiles of Mood States. Diabetes-specific distress was measured using the Problem Areas in Diabetes.

The researchers also used the 12-item Short-Form Health Survey to measure health-related quality of life.

The effect of each therapy was calculated using Cohen's d. A Cohen's d explains the amount of difference between two groups. A Cohen's d of 0.2 is often considered small difference; a Cohen's d of 0.5 is considered a medium difference; and a Cohen's d of 0.8 is considered a large difference.

For this study, Cohen's d was used to show the difference in effects between mindfulness-based cognitive therapy and usual care.

From their study, Dr. Nyklíček and colleagues found mindfulness-based cognitive therapy was more effective at improving:

  • stress, with a Cohen's d of 0.70
  • depressive symptoms, with a Cohen's d of 0.59
  • anxiety, with a Cohen's d of 0.44
  • mental quality of life, with a Cohen's d of 0.55
  • physical quality of life, with a Cohen's d of 0.40

Put plainly, there was a relatively larger difference between the two treatment groups when it came to stress, but a relatively smaller difference when it came to anxiety and physical quality of life. There was a medium difference between the two groups in terms of depressive symptoms and mental quality of life.

The study was published November 27 in Diabetes Care, a journal of the American Diabetes Association.

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Review Date: 
November 28, 2012
Last Updated:
February 25, 2013