I like honesty in my relationships with my patients and tell them that I will be completely truthful with them. As a nurse, dietitian, and certified diabetes educator, I find out what my patient knows about diabetes, what they need to know, and what their learning style is. Sometimes I will have a patient that has the knowledge of what they are supposed to do, but reach a stumbling block in carrying out needed tasks. They are honest and allow me to know that they would like to be happier with themselves and their own behavior if they kept their diabetes under control. They go on to say they don’t know why, but they don’t do what is necessary for controlling their blood glucose. Sometimes I suggest going to see a therapist that has skills in cognitive behavioral therapy to help them.

cognitive behavioral therapy for diabetesWhat is cognitive behavioral therapy?

This is a type of mental health counseling. The client works with a therapist to understand negative or inaccurate thinking. You can thus challenge the situations in your mind and start to respond to them in a beneficial way. People that have found this type of therapy beneficial include those that need to manage stressful situations and those that are anxious or depressed. (1) People that have diabetes have benefited from this type of therapy. It also helps many people control their urges to smoke or overeat. 

What does science tell us about behavior that is useful in terms of possible therapies?

Learned Helplessness- When unpredictable shocks are repeatedly given to animals, they get to a point where they do not make appropriate choices to avoid the shock. This happens even if they have the opportunity to learn to control the shock. This is thought to be relevant in people suffering from depression. (2) Approximately 10 percent of people in the United States suffer from depression. This jumps to between 15-20 percent for people with diabetes. (3)

Self-efficacy-There are differences between the responses of individuals towards environments and situations. This is thought to occur because of statements they tell themselves regarding their behavior and ability to exert control situations. (2)

The process of self-regulating behavior by language-When people are very young they depend on their elders to tell them what to do. As the child grows, they voice these rules or behavior first out load and then to themselves. Over time they may not even realize why they behave in a certain way. It becomes automatic. (2)

Are there any interesting studies about diabetes and cognitive behavior therapy?

In a press release from Massachusetts General Hospital, investigators have reported that their program leads to improved blood glucose control and helps to relieve depression in patients that have gone through an additional program focusing on cognitive behavioral therapy (CBT). Their program included diabetes self-care skills and also addressed depression in patients taking oral diabetes medications. The patients had poorly controlled type 2 diabetes plus the diagnosis of depression. In a year-long study, 87 patients were in a group in a program that is typically carried out in diabetes education programs. This included information on goal setting, blood glucose monitoring, nutrition, exercise and skills for managing their diabetes. Out of the 87 patients, 45 went on to receive CBT for an additional 9-12 weeks. This group worked on tasks such as adaptive thinking, reflection, relaxation, diabetes self-care concerns, scheduling their activities, depression and problem solving. Both groups of patients continued with any therapy or treatment for depression that was prescribed or if needed, they were referred for more therapy or a change in medication. The study took place over one year time which included a system that electronically monitored when their diabetes medication bottle was opened and by downloading their blood glucose monitor. Patients that had CBT too monitored their blood glucose and took their medications at a significantly higher level over the course of the study. More research needs to be done in CBT and diabetes. (4) 

A study was published in 2011 with both type 1 and type 2 patients demonstrating the effectiveness of an internet based CBT depression intervention. “The intervention was shown to effectively reduce depressive symptoms and diabetes-related distress equally for individuals with type 1 and type 2 diabetes.” (5) The course materials were based on the CBT Coping with Depression course developed by Lewinsohn.
 

Are there any programs that are offered on-line?

Novo Nordisk provides a program called “A Good Life with Diabetes” based on CBT that is assessable over the internet. Ask your physician and mental health therapist if this would be beneficial for you. It is an eight session program that helps guide patients towards relaxation, developing communication skills and dealing with concerns. Homework is necessary for this program. For more information about the Dawn Study by Novo Nordisk visit their website.

Ask your doctor if CBT is a possibility for you.  It may help you to reduce some of the distress that accompanies the day to day tasks of diabetes. It also may help with depression.

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