Improving psychological symptoms of depression and stress in people with diabetes

Pearson, S., Wills, K., Woods, M. et al. Effects of Mindfulness on Psychological Distress and HbA_1c in People with Diabetes. Mindfulness (2018). First Online: 10 February 2018. https://doi.org/10.1007/s12671-018-0908-1

Abstract (excerpt). Type 2 diabetes mellitus (T2DM) is a prevalent chronic condition that is associated with a high degree of psychological distress. The aim of this study was to evaluate the effectiveness of a novel approach to delivering an intervention of mindfulness practice (IMP) to a patient population with a demonstrated need for psychological support.

The novel approach utilised a self-directed audio compact disc (CD) recording of mindfulness practice. In this randomised controlled trial, 67 participants with T2DM (mean age = 59.4), attending outpatient clinics, were randomised to an IMP (n = 31) or a control (n = 36) group.

Participants receiving the IMP reported significant reductions in depression and stress when compared with the control group. At the 12-week follow-up, there was an overall reduction in depression and stress in the IMP group relative to the control group.

The current study has shown that an easily accessible self-directed IMP was effective in improving psychological symptoms of depression and stress.

*IMP = intervention of mindfulness practice

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A mindful approach to diabetes self-management

DiNardo, Monica, et al. “A Mindful Approach to Diabetes Self-Management Education and Support for Veterans.” The Diabetes Educator, vol. 43, no. 6, pp. 608-20. https://doi.org/10.1177/0145721717738019

From the Abstract. The study used a single-group pretest-posttest repeated-measures design. The 90-minute Mind-STRIDE training, adapted from Mindfulness Based Stress Reduction (MBSR), was provided as the final component of a half-day diabetes self-management education class at a Veterans Affairs (VA) outpatient diabetes clinic.

Following initial training, participants were asked to practice mindfulness at home for 10 minutes each day during the 3-month study. Study recruitment and retention were calculated as rates. Veteran and diabetes educator satisfaction were assessed by rating scales and open-ended comments. Psychosocial-behavioral and metabolic outcomes were assessed at baseline and 3 months after initial training.

Overall, participants and diabetes educators were highly satisfied with the Mind-STRIDE intervention. Significant improvements were found in diabetes distress, diabetes self-efficacy, [and] diabetes self-management behaviors.

Results suggest feasibility, satisfaction, and positive preliminary effects. Efficacy testing by randomized controlled trial with analysis of covariance structures is warranted.

Moderating effect on emotional distress in Diabetes patients

van Son, J., et al. (2014). The association between mindfulness and emotional distress in adults with diabetes: Could mindfulness serve as a buffer? Results from Diabetes MILES: The Netherlands. Journal of behavioral medicine, 1-10.

From the Abstract. People with diabetes have a higher risk of emotional distress (anxiety, depression) than non-diabetic or healthy controls. Therefore, identification of factors that can decrease emotional distress is relevant. The aim of the present study was to examine (1) the association between facets of mindfulness and emotional distress; and (2) whether mindfulness might moderate the association between potential adverse conditions (stressful life events and comorbidity) and emotional distress.

Analyses were conducted using cross-sectional data: 666 participants with diabetes (type 1 or type 2) completed measures of mindfulness, depressive symptoms, and anxiety symptoms. Hierarchical multiple regression analyses showed significant associations between mindfulness facets (acting with awareness, non-judging, and non-reacting) and symptoms of anxiety and depression.

These mindfulness facets appeared to have a moderating effect on the association between stressful life events and depression and anxiety. However, the association between co-morbidity and emotional distress was largely not moderated by mindfulness. In conclusion, mindfulness is negatively related to both depression and anxiety symptoms in people with diabetes and shows promise as a potentially protective characteristic against the influence of stressful events on emotional well-being.

MBI for physical conditions: evaluating levels of evidence

Carlson, L. E. (2012). Mindfulness-based interventions for physical conditions: a narrative review evaluating levels of evidence. ISRN psychiatry. Article ID 651583. Full text.

Research on mindfulness-based interventions (MBIs) for treating symptoms of a wide range of medical conditions has proliferated in recent decades. Mindfulness is the cultivation of nonjudgmental awareness in the present moment. It is both a practice and a way of being in the world. based cognitive therapy (MBCT).

This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness, followed by a theoretical discussion of the application of mindfulness in these situations. The literature evaluating MBIs within medical conditions is then comprehensively reviewed, applying a levels of evidence rating framework within each major condition. The bulk of the research looked at diagnoses of cancer, pain conditions (chronic pain, low back pain, fibromyalgia, and rheumatoid arthritis), cardiovascular disease, diabetes, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and irritable bowel syndrome.

Most outcomes assessed are psychological in nature and show substantial benefit, although some physical and disease-related parameters have also been evaluated. The field would benefit from more adequately powered randomized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program “dose” in determining outcomes.

Brief meditation improves sleep, relaxation, and more accepting approaches to the illness experience

Keyworth, C., et al. (2013). A mixed methods pilot study of the acceptability and effectiveness of a brief meditation and mindfulness intervention for people with diabetes and coronary heart disease. Behavioral Medicine, (just-accepted).

Excerpts from the Abstract: Mindfulness based interventions can successfully target negative perseverative cognitions such as worry and thought suppression, but their acceptability and effectiveness in people with long term conditions is uncertain.

We therefore pilot tested a 6-week meditation and mindfulness intervention in people (n = 40) with diabetes and coronary heart disease. We used a sequential mixed-methods approach that measured change in worry and thought suppression and qualitatively explored acceptability, feasibility and user experience with a focus group (n = 11), and in-depth interviews (n = 16). The intervention was highly acceptable, with 90% completing ≥5 sessions.

Meditation and mindfulness skills led to improved sleep, greater relaxation and more accepting approaches to illness and illness experience. At the end of the 6-week meditation course worry and thought suppression were significantly reduced. Positive impacts on psychological health may relate to acquisition and development of meta-cognitive skills but this needs experimental confirmation.

Mindful eating and diabetes self-management

Miller, C. K., Kristeller, J. L., Headings, A., & Nagaraja, H. (2013). Comparison of a Mindful Eating Intevention to a Diabetes Self-Mangement Intevention Among Adults With Type 2 Diabetes A Randomized Controlled Trial. Health Education & Behavior. Epub before print. Abstract.

Excerpts: Mindful eating may be an effective intervention for increasing awareness of Mindful eating and diabetes self-management, improving eating regulation and dietary patterns, reducing symptoms of depression and anxiety, and promoting weight loss. Diabetes self-management education (DSME), which addresses knowledge, self-efficacy, and outcome expectations for improving food choices, also may be an effective intervention for diabetes self-care. Yet few studies have compared the impact of mindful eating to a DSME-based treatment approach on patient outcomes.

Adults 35 to 65 years old with type 2 diabetes for ≥1 year not requiring insulin therapy were recruited from the community and randomly assigned to treatment group. The impact of a group-based 3-month mindful eating intervention (MB-EAT-D; n = 27) to a group-based 3-month DSME “Smart Choices” (SC) intervention (n = 25) post-intervention and at 3-month follow-up was evaluated. Repeated-measures ANOVA with contrast analysis compared change in outcomes across time.

There was no significant difference between groups in weight change. Significant improvement in depressive symptoms, outcome expectations, nutrition and eating-related self-efficacy, and cognitive control and disinhibition of control regarding eating behaviors occurred for both groups at 3-month follow-up. The SC group had greater increase in nutrition knowledge and self-efficacy than the MB-EAT-D group at 3-month follow-up. MB-EAT-D had significant increase in mindfulness, whereas the SC group had significant increase in fruit and vegetable consumption at study end. Both SC and MB-EAT-D were effective treatments for diabetes self-management. The availability of mindful eating and DSME-based approaches offers patients greater choices in meeting their self-care needs.