The Effectiveness of Cognitive-Behavioral Approach in Alleviation of Depression, Anxiety and Stress Risks in Diabetic People
,
Abstract
Objective: Stress, anxiety, and depression affect the diabetic patient by causing symptomatic changes. Considering the destructive effects of psychological symptoms on the health status of diabetic people, our aim was to investigate the effectiveness of cognitive-behavioral therapy (CBT) in improving the psychological outcomes of diabetic patients.
Method: This trial is a quasi-experimental type that uses a pretest-posttest design with a control group. A total of 62 people were selected based on the inclusion criteria and randomly divided into two experimental and control groups. All subjects in the intervention group underwent CBT training twice a week for eight sessions, while those in the control group did not receive this intervention. Before and following the intervention, the depression, anxiety and stress scale (DASS-42) was utilized to evaluate the psychological symptoms of all participants. The data were analyzed through analysis of covariance (ANCOVA) and SPSS-23 software.
Results: There were no significant differences between the two groups in terms of age, gender, marital status, parenthood, and education level (P > 0.05, n = 30 in each group). Additionally, there was no significant difference between the mean DASS-42 scores before the intervention (P > 0.05). However, after the intervention, the experimental group exhibited reduced levels of depression, anxiety, and stress compared to the control group (P < 0.001). The values of Eta for depression, anxiety, and stress subscales were equal to 0.809, 0.669 and 0.776, respectively, which means that 80.9%, 66.9%, and 77.6% of the changes in these symptoms in the experimental group are related to the training received through the CBT approach.
Conclusion: It can be concluded that diabetic patients who suffer from psychological symptoms can benefit from the CBT approach to reduce their stress, anxiety, and depression levels.
1. Wang L, Li X, Wang Z, Bancks MP, Carnethon MR, Greenland P, et al. Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018. Jama. 2021;326(8):1-13.
2. Esteghamati A, Larijani B, Aghajani MH, Ghaemi F, Kermanchi J, Shahrami A, et al. Diabetes in Iran: Prospective Analysis from First Nationwide Diabetes Report of National Program for Prevention and Control of Diabetes (NPPCD-2016). Sci Rep. 2017;7(1):13461.
3. Sadock BJ. Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. Lippincott Williams & Wilkins. 2007.
4. Navarro-Flores E, Pérez-Ros P, Martínez-Arnau FM, Julían-Rochina I, Cauli O. Neuro-Psychiatric Alterations in Patients with Diabetic Foot Syndrome. CNS Neurol Disord Drug Targets. 2019;18(8):598-608.
5. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069-78.
6. Katon WJ, Rutter C, Simon G, Lin EH, Ludman E, Ciechanowski P, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005;28(11):2668-72.
7. Egede LE. Effect of depression on self-management behaviors and health outcomes in adults with type 2 diabetes. Curr Diabetes Rev. 2005;1(3):235-43.
8. Azami G, Soh KL, Sazlina S-G, Salmiah MS, Khosravi A, Aazami S, et al. The effect of depression on poor glycemic control in adults with type 2 diabetes: The mediating roles of self-efficacy and self-management behaviors. Diabetes Metab J. 2020;25(3-4):80-9.
9. Schmitt A, Bendig E, Baumeister H, Hermanns N, Kulzer B. Associations of depression and diabetes distress with self-management behavior and glycemic control. Health Psychol. 2021;40(2):113-24.
10. Alzahrani A, Alghamdi A, Alqarni T, Alshareef R, Alzahrani A. Prevalence and predictors of depression, anxiety, and stress symptoms among patients with type II diabetes attending primary healthcare centers in the western region of Saudi Arabia: a cross-sectional study. Int J Ment Health Syst. 2019;13:48.
11. Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care. 2003;26(10):2822-8.
12. Fisher L, Skaff MM, Mullan JT, Arean P, Glasgow R, Masharani U. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Diabet Med. 2008;25(9):1096-101.
13. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012;36(5):427-40.
14. Yang X, Li Z, Sun J. Effects of Cognitive Behavioral Therapy-Based Intervention on Improving Glycaemic, Psychological, and Physiological Outcomes in Adult Patients with Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials. Front Psychiatry. 2020;11:711.
15. Leahy RL. Cognitive therapy techniques: A practitioner's guide: New York, NY Guilford Publications; 2017.
16. Beltman MW, Voshaar RC, Speckens AE. Cognitive-behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials. Br J Psychiatry. 2010;197(1):11-9.
17. Safren SA, Gonzalez JS, Wexler DJ, Psaros C, Delahanty LM, Blashill AJ, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes. Diabetes Care. 2014;37(3):625-33.
18. Penckofer SM, Ferrans C, Mumby P, Byrn M, Emanuele MA, Harrison PR, et al. A psychoeducational intervention (SWEEP) for depressed women with diabetes. Ann Behav Med. 2012;44(2):192-206.
19. Uchendu C, Blake H. Effectiveness of cognitive-behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Diabet Med. 2017;34(3):328-39.
20. Welschen LM, van Oppen P, Bot SD, Kostense PJ, Dekker JM, Nijpels G. Effects of a cognitive behavioural treatment in patients with type 2 diabetes when added to managed care; a randomised controlled trial. J Behav Med. 2013;36(6):556-66.
21. Cummings DM, Lutes LD, Littlewood K, Solar C, Carraway M, Kirian K, et al. Randomized Trial of a Tailored Cognitive Behavioral Intervention in Type 2 Diabetes With Comorbid Depressive and/or Regimen-Related Distress Symptoms: 12-Month Outcomes From COMRADE. Diabetes Care. 2019;42(5):841-8.
22. Vlachou E, Ntikoudi A, Owens DA, Nikolakopoulou M, Chalimourdas T, Cauli O. Effectiveness of cognitive behavioral therapy-based interventions on psychological symptoms in adults with type 2 diabetes mellitus: An update review of randomized controlled trials. J Diabetes Complications. 2022;36(5):108185.
23. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales: Psychology Foundation of Australia; 1996.
24. Moghaddam A, Saed F, Dibajnia P, Zangeneh J. A preliminary validation of the depression, anxiety and stress scales (DASS) in non-clinical sample. Clinical Psychology and Personality. 2008;6(2):23-38.
25. Davazdah Emamy M, Roshan R, Mehrabi A, Attari A. The effectiveness of cognitive-behavioral stress management training on glycemic control and depression in patients with type 2 diabetes. Iran J Endocrinol Metab. 2009;11(4):385-92.
26. Asadnia S, Issazadeghan A, Ansari B. Evaluation of the effectiveness of cognitive behavioral therapy on decreasing depression levels and improving the lifestyle of patients with type 2 diabetes. Studies in Medical Sciences. 2013;24(10):812-22.
27. SAMADZADE N, POURSHARIFI H, BABAPOUR J. The effectiveness of cognitive-behavioral therapy on the psycho-social adjustment to illness and symptoms of depression in individuals with type II diabetes. 2015.
28. Hasar S, Nikdel F, Kharamin S. The effectiveness of cognitive-behavioral techniques training on procrastination, stress, anxiety and depression of high school female students. Armaghane-danesh. 2015;19(12):1105-17.
29. Abniki E, Abolghasemi A, Abbasi M, Moazzez R, Jalali R. The effect of group cognitive-behavioral intervention in stress management on improved hardiness and self-control in depressed women. Clinical psychology studies. 2015;5(19):99-118.
30. Lachini A, Amirsardari L, Zaman M. Efficacy of Education of Self-efficacy on Controlling HbA1c in The Diabetes-II. 2014.
31. Wampold BE, Minami T, Baskin TW, Callen Tierney S. A meta-(re)analysis of the effects of cognitive therapy versus 'other therapies' for depression. J Affect Disord. 2002;68(2-3):159-65.
32. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17-31.
33. Ridgway N, Williams C. Cognitive behavioural therapy self-help for depression: an overview. J Ment Health. 2011;20(6):593-603.
34. Chapman A, Liu S, Merkouris S, Enticott JC, Yang H, Browning CJ, et al. Psychological Interventions for the Management of Glycemic and Psychological Outcomes of Type 2 Diabetes Mellitus in China: A Systematic Review and Meta-Analyses of Randomized Controlled Trials. Front Public Health. 2015;3:252.
35. Davazdahemamy MH, Mehrabi A, Attari A, Roshan R. The Effectiveness of Cognitive-Behavioral Stress Management Training on Glycemic Control, Psychological Distress and Quality of Life in Patients with Type2 Diabetes. 2013.
36. Alanzi T, Alanazi NR, Istepanian R, Philip N. Evaluation of the effectiveness of mobile diabetes management system with social networking and cognitive behavioural therapy (CBT) for T2D. Mhealth. 2018;4:35.
37. Menting J, Tack CJ, van Bon AC, Jansen HJ, van den Bergh JP, Mol M, et al. Web-based cognitive behavioural therapy blended with face-to-face sessions for chronic fatigue in type 1 diabetes: a multicentre randomised controlled trial. Lancet Diabetes Endocrinol. 2017;5(6):448-56.
38. Whitehead LC, Crowe MT, Carter JD, Maskill VR, Carlyle D, Bugge C, et al. A nurse-led interdisciplinary approach to promote self-management of type 2 diabetes: a process evaluation of post-intervention experiences. J Eval Clin Pract. 2017;23(2):264-71.
39. Fitchett G, Murphy PE, Kim J, Gibbons JL, Cameron JR, Davis JA. Religious struggle: prevalence, correlates and mental health risks in diabetic, congestive heart failure, and oncology patients. Int J Psychiatry Med. 2004;34(2):179-96.
40. Bener A, OAA Al-Hamaq A, E Dafeeah E. High prevalence of depression, anxiety and stress symptoms among diabetes mellitus patients. Open Psychiatr J. 2011;5(1).
2. Esteghamati A, Larijani B, Aghajani MH, Ghaemi F, Kermanchi J, Shahrami A, et al. Diabetes in Iran: Prospective Analysis from First Nationwide Diabetes Report of National Program for Prevention and Control of Diabetes (NPPCD-2016). Sci Rep. 2017;7(1):13461.
3. Sadock BJ. Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. Lippincott Williams & Wilkins. 2007.
4. Navarro-Flores E, Pérez-Ros P, Martínez-Arnau FM, Julían-Rochina I, Cauli O. Neuro-Psychiatric Alterations in Patients with Diabetic Foot Syndrome. CNS Neurol Disord Drug Targets. 2019;18(8):598-608.
5. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069-78.
6. Katon WJ, Rutter C, Simon G, Lin EH, Ludman E, Ciechanowski P, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005;28(11):2668-72.
7. Egede LE. Effect of depression on self-management behaviors and health outcomes in adults with type 2 diabetes. Curr Diabetes Rev. 2005;1(3):235-43.
8. Azami G, Soh KL, Sazlina S-G, Salmiah MS, Khosravi A, Aazami S, et al. The effect of depression on poor glycemic control in adults with type 2 diabetes: The mediating roles of self-efficacy and self-management behaviors. Diabetes Metab J. 2020;25(3-4):80-9.
9. Schmitt A, Bendig E, Baumeister H, Hermanns N, Kulzer B. Associations of depression and diabetes distress with self-management behavior and glycemic control. Health Psychol. 2021;40(2):113-24.
10. Alzahrani A, Alghamdi A, Alqarni T, Alshareef R, Alzahrani A. Prevalence and predictors of depression, anxiety, and stress symptoms among patients with type II diabetes attending primary healthcare centers in the western region of Saudi Arabia: a cross-sectional study. Int J Ment Health Syst. 2019;13:48.
11. Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care. 2003;26(10):2822-8.
12. Fisher L, Skaff MM, Mullan JT, Arean P, Glasgow R, Masharani U. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Diabet Med. 2008;25(9):1096-101.
13. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012;36(5):427-40.
14. Yang X, Li Z, Sun J. Effects of Cognitive Behavioral Therapy-Based Intervention on Improving Glycaemic, Psychological, and Physiological Outcomes in Adult Patients with Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials. Front Psychiatry. 2020;11:711.
15. Leahy RL. Cognitive therapy techniques: A practitioner's guide: New York, NY Guilford Publications; 2017.
16. Beltman MW, Voshaar RC, Speckens AE. Cognitive-behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials. Br J Psychiatry. 2010;197(1):11-9.
17. Safren SA, Gonzalez JS, Wexler DJ, Psaros C, Delahanty LM, Blashill AJ, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes. Diabetes Care. 2014;37(3):625-33.
18. Penckofer SM, Ferrans C, Mumby P, Byrn M, Emanuele MA, Harrison PR, et al. A psychoeducational intervention (SWEEP) for depressed women with diabetes. Ann Behav Med. 2012;44(2):192-206.
19. Uchendu C, Blake H. Effectiveness of cognitive-behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Diabet Med. 2017;34(3):328-39.
20. Welschen LM, van Oppen P, Bot SD, Kostense PJ, Dekker JM, Nijpels G. Effects of a cognitive behavioural treatment in patients with type 2 diabetes when added to managed care; a randomised controlled trial. J Behav Med. 2013;36(6):556-66.
21. Cummings DM, Lutes LD, Littlewood K, Solar C, Carraway M, Kirian K, et al. Randomized Trial of a Tailored Cognitive Behavioral Intervention in Type 2 Diabetes With Comorbid Depressive and/or Regimen-Related Distress Symptoms: 12-Month Outcomes From COMRADE. Diabetes Care. 2019;42(5):841-8.
22. Vlachou E, Ntikoudi A, Owens DA, Nikolakopoulou M, Chalimourdas T, Cauli O. Effectiveness of cognitive behavioral therapy-based interventions on psychological symptoms in adults with type 2 diabetes mellitus: An update review of randomized controlled trials. J Diabetes Complications. 2022;36(5):108185.
23. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales: Psychology Foundation of Australia; 1996.
24. Moghaddam A, Saed F, Dibajnia P, Zangeneh J. A preliminary validation of the depression, anxiety and stress scales (DASS) in non-clinical sample. Clinical Psychology and Personality. 2008;6(2):23-38.
25. Davazdah Emamy M, Roshan R, Mehrabi A, Attari A. The effectiveness of cognitive-behavioral stress management training on glycemic control and depression in patients with type 2 diabetes. Iran J Endocrinol Metab. 2009;11(4):385-92.
26. Asadnia S, Issazadeghan A, Ansari B. Evaluation of the effectiveness of cognitive behavioral therapy on decreasing depression levels and improving the lifestyle of patients with type 2 diabetes. Studies in Medical Sciences. 2013;24(10):812-22.
27. SAMADZADE N, POURSHARIFI H, BABAPOUR J. The effectiveness of cognitive-behavioral therapy on the psycho-social adjustment to illness and symptoms of depression in individuals with type II diabetes. 2015.
28. Hasar S, Nikdel F, Kharamin S. The effectiveness of cognitive-behavioral techniques training on procrastination, stress, anxiety and depression of high school female students. Armaghane-danesh. 2015;19(12):1105-17.
29. Abniki E, Abolghasemi A, Abbasi M, Moazzez R, Jalali R. The effect of group cognitive-behavioral intervention in stress management on improved hardiness and self-control in depressed women. Clinical psychology studies. 2015;5(19):99-118.
30. Lachini A, Amirsardari L, Zaman M. Efficacy of Education of Self-efficacy on Controlling HbA1c in The Diabetes-II. 2014.
31. Wampold BE, Minami T, Baskin TW, Callen Tierney S. A meta-(re)analysis of the effects of cognitive therapy versus 'other therapies' for depression. J Affect Disord. 2002;68(2-3):159-65.
32. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17-31.
33. Ridgway N, Williams C. Cognitive behavioural therapy self-help for depression: an overview. J Ment Health. 2011;20(6):593-603.
34. Chapman A, Liu S, Merkouris S, Enticott JC, Yang H, Browning CJ, et al. Psychological Interventions for the Management of Glycemic and Psychological Outcomes of Type 2 Diabetes Mellitus in China: A Systematic Review and Meta-Analyses of Randomized Controlled Trials. Front Public Health. 2015;3:252.
35. Davazdahemamy MH, Mehrabi A, Attari A, Roshan R. The Effectiveness of Cognitive-Behavioral Stress Management Training on Glycemic Control, Psychological Distress and Quality of Life in Patients with Type2 Diabetes. 2013.
36. Alanzi T, Alanazi NR, Istepanian R, Philip N. Evaluation of the effectiveness of mobile diabetes management system with social networking and cognitive behavioural therapy (CBT) for T2D. Mhealth. 2018;4:35.
37. Menting J, Tack CJ, van Bon AC, Jansen HJ, van den Bergh JP, Mol M, et al. Web-based cognitive behavioural therapy blended with face-to-face sessions for chronic fatigue in type 1 diabetes: a multicentre randomised controlled trial. Lancet Diabetes Endocrinol. 2017;5(6):448-56.
38. Whitehead LC, Crowe MT, Carter JD, Maskill VR, Carlyle D, Bugge C, et al. A nurse-led interdisciplinary approach to promote self-management of type 2 diabetes: a process evaluation of post-intervention experiences. J Eval Clin Pract. 2017;23(2):264-71.
39. Fitchett G, Murphy PE, Kim J, Gibbons JL, Cameron JR, Davis JA. Religious struggle: prevalence, correlates and mental health risks in diabetic, congestive heart failure, and oncology patients. Int J Psychiatry Med. 2004;34(2):179-96.
40. Bener A, OAA Al-Hamaq A, E Dafeeah E. High prevalence of depression, anxiety and stress symptoms among diabetes mellitus patients. Open Psychiatr J. 2011;5(1).
| Files | ||
| Issue | Vol 18 No 4 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v18i4.13626 | |
| Keywords | ||
| Anxiety Cognitive Behavioral Therapy Clinical Trial Diabetes Mellitus Depression | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Heyrat A, Nekoui B. The Effectiveness of Cognitive-Behavioral Approach in Alleviation of Depression, Anxiety and Stress Risks in Diabetic People. Iran J Psychiatry. 2023;18(4):388-395.
