Improve Type 2 Diabetes Management with Acceptance and Commitment Therapy

Improve Type 2 Diabetes Management with Acceptance and Commitment Therapy

 

By John M. de Castro, Ph.D.

 

Acceptance and Commitment Therapy (ACT) – “Be more present to the “here-and-now.” This focus helps to decrease being caught up in what happened in the past. It also frees individuals from worrying too much about the future. Being present helps you to more fully connect to and enjoy the moment. Observe thoughts and feelings in such a way that they no longer keep you stuck in life. Learning to observe through openness and acceptance can help you find freedom from negative thoughts and feelings. Clarify your values and then take action. Finding what is most meaningful to you and choosing to act on these values are important parts of the therapy. This will be part of the process of building a rich and full life.” – VA Mental Health Services

 

Diabetes is a major health issue. It is estimated that 30 million people in the United States have diabetes and the numbers are growing. Diabetes is the 7th leading cause of death in the United States. In addition, diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.

 

Type 2 diabetes is a common and increasingly prevalent illness that is largely preventable. Although this has been called adult-onset diabetes it is increasingly being diagnosed in children. Type 2 Diabetes results from a resistance of tissues, especially fat tissues, to the ability of insulin to promote the uptake of glucose from the blood. As a result, blood sugar levels rise producing hyperglycemia. A leading cause of this tissue resistance to insulin is overweight and obesity and a sedentary life style. Unlike Type I Diabetes, Type II does not require insulin injections. Instead, the treatment and prevention of Type 2 Diabetes focuses on diet, exercise, and weight control.

 

Recently, mindfulness practices have been shown to be helpful in managing diabetes. Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. It has been shown to be affective for a number of physical and psychological issues. The effectiveness of ACT to enhance management of Type II Diabetes is not known.

 

In today’s Research News article “A Randomized Controlled Trial of Acceptance and Commitment Therapy for Type 2 Diabetes Management: The Moderating Role of Coping Styles.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132195/

Shayeghian and colleagues recruited adult (40-60 years of age) patients with Type II Diabetes and randomly assigned them to either receive a one day diabetes health education training or health education plus 10 weeks, once a week two hour session, of group Acceptance and Commitment Therapy (ACT). The participants were measured prior to, after, and 3 months after the intervention for Glycated hemoglobin (HbA1C), diabetes self-care activities, acceptance of diabetes-related thoughts and feelings, and coping styles.

 

They found that ACT, in comparison to education only, resulted in significantly lower glycated hemoglobin, higher self-care activities and higher acceptance scores. This suggests that ACT promotes self-care and acceptance of their disease which translates into better plasma glucose management. Importantly, these benefits were still significant three months after treatment, suggesting that the effects are enduring. They also found that patients with effective coping styles had a greater impact of ACT on their self-care, suggesting that ACT works better for people who use effective strategies to cope with their disease.

 

These are exciting results, as Type II diabetes is so prevalent and effective self-care so important to the health of the patient. They suggest that ACT  improves the self-care that is so important for successful disease management. But the conclusions must be tempered with the fact that the control condition did not have an additional active intervention, e.g. exercise. So, the results could have been due to placebo effects, experimenter bias, attentional effects, etc. These results, though provide support for implementing a larger randomized controlled clinical trial with an active control condition or comparison to other active treatments.

 

So, improve Type 2 Diabetes management with Acceptance and Commitment Therapy.

 

“Results show that participants walked significantly further following the programme, and had lower levels of anxiety, depression and diabetes-related distress. Average blood glucose levels (HbA1c) were shown to have reduced by 0.6%. Qualitative interviews showed that participants found ACT Now! to be engaging, acceptable, attractive and helpful.” – NHS Grampian

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

Study Summary

Shayeghian, Z., Hassanabadi, H., Aguilar-Vafaie, M. E., Amiri, P., & Besharat, M. A. (2016). A Randomized Controlled Trial of Acceptance and Commitment Therapy for Type 2 Diabetes Management: The Moderating Role of Coping Styles. PLoS ONE, 11(12), e0166599. http://doi.org/10.1371/journal.pone.0166599

 

Abstract

Background and Aim

Evidence of the efficacy of existing psychological interventions for self-management in diabetes is limited. The current study aimed at assessing the effects of group-based ACT on self-management of patients with T2DM, considering the moderating role of coping styles.

Methods

One hundred and six patients with type 2 diabetes were randomly assigned either to the education alone (n = 53) or to a combination of education and group-based acceptance and commitment therapy (n = 53) over a period of 10 sessions. In each group, 50 participants completed a 3 month follow-up assessment.

Results

After 3 months, compared to patients who received education alone, those in the group-based acceptance and commitment therapy condition were more likely to use effective coping strategies, reported better diabetes self-care, and optimum glycated hemoglobin (HbA1C) levels in the target range.

Conclusions

Consideration of the role of coping style for a more accurate evaluation of the effects of acceptance and commitment therapy may be a useful addition to services provided for patients with type 2 diabetes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132195/

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