Comparing the Effects of Metacognitive Therapy and Reality Therapy on Depression, Quality of Life, and HbA1c in Patients with Type 2 Diabetes

Due to the global prevalence, increasing mortality, and susceptibility of diabetes, as well as its significant biopsychological dimensions, providing medical and psychological treatment to the affected patients, is vital. A highly frequent problem in patients with type 2 diabetes is depression; this condition directly affects the individual’s biopsychological health. Furthermore, its prevalence in patients with type 2 diabetes is 2–3 times higher than the general population. Depression can directly impact the biological characteristics of subjects with diabetes, such as fasting blood glucose and HbA1c. Moreover, it greatly affects the Quality of Life (QoL) and mental health of this group. Inattention and late diagnosis of psychological issues in diabetics can threaten their health; accordingly, comorbid biopsychological and behavioral problems may complicate the disease control. Eventually, it leads to other physical problems associated with diabetes, such as cardiovascular disease, retinopathy, blindness, neuropathy, and so on. Thus, this study aimed to compare the effects of Metacognitive Therapy (MCT) and Reality Therapy (RT) on depression, QoL, and HbA1c in patients with type 2 diabetes.

This was a quasi–experimental study with a pretest–posttest–follow–up and a control group design. The statistical population included all female patients with type 2 diabetes in Karaj City, Iran, in 2020; They initially completed the Beck Depression Inventory (BDI; Beck, 1996) before entering the experimental setting. Subjects with a depression score of >11 were randomly assigned to the study. In total, 45 eligible volunteers were randomly available as a sample. Then, they were randomly divided into the MCT and RT experimental groups and controls (n=15/group). The inclusion criteria of the study were having a minimum literacy to complete the questionnaires; the age range of 40–60 years; a one–year history of type 2 diabetes, and no abuse of drugs and use of psychotropic drugs. The exclusion criteria also included the presence of severe physical illnesses due to diabetes, such as renal failure, vision, etc.; receiving psychological therapies during the intervention; taking any sedatives or psychiatric drugs; increasing the dose of diabetes–related drugs; absence from >2 intervention sessions and the patient's unwillingness to continue treatment. The MCT and RT groups received eight 90–minute intervention sessions; however, the control group received no intervention. The required data were collected using the BDI–II (Beck et al., 1996), the Quality of Life Questionnaire–SF36 (Weir & Sherborne, 1992), and the HbA1c blood test. In all study groups, a pretest was performed before the intervention and after 8 sessions, the posttest was performed. Finally, one month after the posttest, in the follow–up phase, the mentioned measures were re–performed. For data analysis, descriptive statistics, including mean and standard deviation were used. Moreover, inferential statistics, including repeated–measures Analysis of Variance (ANOVA) and Bonferroni posthoc test were employed in SPSS at p<0.05.

The present research results suggested that by controlling the pretest effects, MCT and RT presented a reducing effect on depression (p<0.001) and an increasing effect on QoL (p=0.012) in the study subjects. There was no significant difference in the posttest and follow–up scores between the MCT and RT groups; this effect remained until the follow–up stage (p>0.05). Concerning HbA1c, MCT and RT provided no significant effect (p=0.661) and were not significant over time (p=0.542). Additionally, there was a significant difference between the MCT and RT groups and the controls (p<0.001). However, there was no significant difference between the MCT and RT groups in this regard (p=1.000).

According to the current research results, MCT and RT were effective in reducing depression and increasing QoL among patients with type 2 diabetes; the therapeutic results of the interventions lasted until the follow–up step.