Review Examines Traditional, Newer Forms of CBT on Diabetes-Related Distress

While cognitive behavioral therapy (CBT) is known to be effective for generalized depression and anxiety, it is only recently that research has begun exploring its specific use in diabetes, including looking at the effects on depression, anxiety, and glycemic control.

A recent analysis examined the effects of cognitive behavioral therapy (CBT) and newer forms of CBT on distress related to diabetes, including specific factors faced by individuals living with diabetes.

Recent research has focused on the impact diabetes has on mental well-being. Diabetes-related distress is described as psychological distress specific to diabetes that relates to the emotional and logistical challenges of living with the condition. The researchers, from Kings College London, noted that people with diabetes are twice as likely to have depression and have a 25% higher prevalence of anxiety.

Although CBT is known to be effective for generalized depression and anxiety, it is only recently that research has started to explore its specific use in diabetes, including looking at the effects on depression, anxiety, and glycemic control, the investigators reported.

Even less is known about the impact of so-called “third wave” forms of CBT, which includes acceptance and commitment therapy (ACT, which encourages the acceptance of unwanted thoughts and feelings) and mindfulness-based therapy, which aims to increase the awareness of current moments in time.

The systematic review and meta-analysis sought to clarify the efficacy of these interventions for diabetes-related distress and the benefits for depression and anxiety. It also sought to pinpoint the specific intervention components that are the most beneficial in treating diabetes-related distress.

The researchers searched 7 electronic databases from inception to April 2021, and after applying exclusion criteria and removing duplicates, 22 randomized controlled trials were included covering 4123 participants.

The trials were conducted in 12 countries; all of the trials randomized participants at an individual level and 2 studies also randomized by health clinic. Most of the participants were female. Ten trials focused on type 2 diabetes and the rest focused on either type 1 diabetes or both types.

Results showed that when diabetes-related distress was the main outcome of the trials looking at CBT, the effect was significantly larger.

CBT for diabetes-related distress significantly reduced distress (significant mean difference [SMD] = –0.278; P = .010). It also reduced depression (SMD = –0.604; P = .016).

While effects from the third-wave CBT approaches for diabetes-related distress were not statistically significant, they were still beneficial. Third-wave CBT significantly lowered anxiety (SMD = –0.451; P = .034).

Although some evidence has indicated that CBT is linked with a reduction in hemoglobin A1C (HbA1C), that finding was not uncovered in this review, as no significant effect of either intervention on HbA1C was seen.

The mode of delivery of the therapy was also examined. CBT can be provided in person or over video or telephone. All methods were beneficial, the study found.

“CBT interventions that included a digital component, were delivered by a psychological practitioner, and included behavioural activation bolstered the effects on diabetes-related distress,” the authors reported.

However, direct comparisons could not be made with delivery methods of the other forms of CBT examined, since the third-wave approaches were only delivered face to face.

The authors said that "more robust interventional studies aimed at treating diabetes-related distress primarily" are needed.

Reference

Jenkinson E, Knoop I, Hudson JL, Moss-Morris R, Hackett RA. The effectiveness of cognitive behavioural therapy and third wave cognitive behavioural interventions on diabetes-related distress: a systematic review and meta-analysis. Diabet Med. Published online August 28, 2022. doi:10.1111/dme.14948