Improve Depression with Diabetes with Mindfulness
By John M. de Castro, Ph.D.
“There is reasonable evidence that mindfulness training decreases anxiety and depression in people with medical conditions like diabetes. On the other hand, what little evidence exists seems to suggest that this alone will not result in better self-management in chronic diseases such as diabetes.” – Andrew Keen
Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression. Depression can be difficult to treat. It is usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Even after remission some symptoms of depression may still be present (residual symptoms).
Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified. Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression and can be effective even in the cases where drugs fail. It is a combination of two effective treatments; mindfulness training with Cognitive Behavioral Therapy (CBT). There have been very few controlled trials comparing MBCT to CBT. Such trials could be important for identifying which patients respond best to the which treatment.
In today’s Research News article “What works best for whom? Cognitive Behavior Therapy and Mindfulness-Based Cognitive Therapy for depressive symptoms in patients with diabetes.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491069/, Tavote and colleagues conduct a comparison of the effectiveness of Mindfulness Based Cognitive Therapy (MBCT) and Cognitive Behavioral Therapy (CBT) for the treatment of depression that commonly occurs with diabetes patients. They recruited adult patients with Type I or Type II diabetes who were also depressed and randomly assigned them to receive either MBCT or CBT. Both treatments involved 8 weekly meetings lasting 45 to 60 minutes. Homework was also assigned. They were measured at baseline for demographic characteristics, clinical psychological symptoms, personality, and diabetes characteristics. They were also measured for depression prior to and following treatment and 9-months later.
They found, as have many others, that both Mindfulness Based Cognitive Therapy (MBCT) and Cognitive Behavioral Therapy (CBT) produced significant reductions in depression in the diabetic patients that were maintained at the 9-month follow-up. They also found that MBCT was superior to CBT in relieving depression in highly educated patients. The two treatments were not significantly different in effectiveness for patients who differed on disease-related characteristics, or on clinical and personality factors.
Hence, the results suggest that MBCT and CBT are equivalently effective for depression except for highly educated diabetics who respond best to MBCT. It is not clear why highly educated depressed diabetics respond better when mindfulness training is added to Cognitive Behavioral Therapy (CBT). This should be further investigated in future research studies.
So, improve depression with diabetes with mindfulness
“Many people with diabetes find it difficult not to judge themselves based on their blood glucose numbers. If the numbers are not in range, that makes them feel bad, and they stop turning to the meter. Mindfulness works not by eliminating guilt, shame, or depression but by guiding people to work though these emotions and accomplish what they need to do to feel better — either by pushing through a workout, passing up an extra piece of cake, or checking blood sugar even though they’re in a bad mood.” – Kara Harrington
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
Tovote, K. A., Schroevers, M. J., Snippe, E., Emmelkamp, P. M. G., Links, T. P., Sanderman, R., & Fleer, J. (2017). What works best for whom? Cognitive Behavior Therapy and Mindfulness-Based Cognitive Therapy for depressive symptoms in patients with diabetes. PLoS ONE, 12(6), e0179941. http://doi.org/10.1371/journal.pone.0179941
Abstract
Objective
Cognitive Behavior Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT) have shown to be effective interventions for treating depressive symptoms in patients with diabetes. However, little is known about which intervention works best for whom (i.e., moderators of efficacy). The aim of this study was to identify variables that differentially predicted response to either CBT or MBCT (i.e., prescriptive predictors).
Methods
The sample consisted of 91 adult outpatients with type 1 or type 2 diabetes and comorbid depressive symptoms (i.e., BDI-II ≥ 14) who were randomized to either individual 8-week CBT (n = 45) or individual 8-week MBCT (n = 46). Patients were followed for a year and depressive symptoms were measured at pre-treatment, post-treatment, and at 9-months follow-up. The predictive effect of demographics, depression related characteristics, and disease specific characteristics on change in depressive symptoms was assessed by means of hierarchical regression analyses.
Results
Analyses showed that education was the only factor that differentially predicted a decrease in depressive symptoms directly after the interventions. At post-treatment, individuals with higher educational attainment responded better to MBCT, as compared to CBT. Yet, this effect was not apparent at 9-months follow-up.
Conclusions
This study did not identify variables that robustly differentially predicted treatment effectiveness of CBT and MBCT, indicating that both CBT and MBCT are accessible interventions that are effective for treating depressive symptoms in broad populations with diabetes. More research is needed to guide patient-treatment matching in clinical practice.