Comparing The Effects of Acceptance and Commitment Therapy and Self-Management Training on Psychological Capitals in Women With Type 2 Diabetes and Psychological Insulin Resistance

Diabetes, as one of the most widespread chronic diseases, is accompanied by high risks of biopsychological symptoms, reduced quality of life, early disability, and death besides imposing a high economic burden on the individual and society. Research indicated that some psychotherapies effectively control and cope with this illness. However, few studies have addressed Psychological Insulin Resistance (PIR), i.e., more prevalent among women, and its nonuse can make the patient suffer from numerous complications. Studies suggested that self–efficacy, resilience, and hopefulness associated with people with diabetes are severely reduced due to chronic disease. Moreover, psychological assets, which include the components of self–efficacy, resilience, optimism, and hope, impact coping with stress, overcoming psychosocial and health–related adversity, and lifestyle modification in patients with diabetes. The present study aimed to compare the effects of the Acceptance and Commitment Therapy (ACT) and Self–Management Training (SMT) on Psychological Capitals (PCs) in women with type 2 diabetes and Psychological Insulin Resistance.

This was a quasi–experimental study with a pretest–posttest–follow–up and a control group design. The statistical population consisted of all type 2 diabetes women referring to Gilan Diabetes Society in 2020. 48 individuals were voluntarily selected by the convenience sampling method concerning the inclusion criteria. After obtaining their informed consent, they were randomly assigned into 3 groups and administered the pretest. Luthans' Psychological Capital Scale was the instrument employed in this research. The questionnaire's validity was verified by explanatory factor analysis. Using Cronbach's alpha coefficient, the total reliability score of the PC item equaled 0.89. A study conducted in Iran found that Cronbach's alpha coefficient for the overall score of the PC item was 0.89. Moreover, the item–total correlations indicated excellent validity. Besides, the researchers applied Hayes and Strosahl's ACT package in eight 90–minute sessions to conduct the interventions. The SMT for chronic illnesses intervention of Schreurs et al. was also performed in six 90–minute sessions. After administering the posttest and follow–up stages, the research data were analyzed using repeated–measures Analysis of Variance (ANOVA) and Bonferroni post hoc test in the SPSS.

The group–by–time interaction effect in the ANOVA was significant for the overall score of the PC, hope, resilience, self–efficacy, and optimism (p<0.001). The control and experimental groups substantially differed in pretest, posttest, and follow–up steps. There was no difference in the overall score of the PC and its subscales in the pretest stage between the SMT and control groups (p</em>>0.05); therefore, the study groups were similar. In the posttest step, a significant difference was found between the control and SMT groups. Thus, the SMT group outperformed the control group respecting improving PC and its subscales in the study subjects (p</em><0.001). There was no difference in the overall score of the PC and its subscales in the pretest stage between the ACT and SMT groups (p</em>>0.05); therefore, these groups were similar. A significant difference was found between the ACT and SMT groups in the posttest. Thus, the Act group outperformed the SMT group concerning improving PC and its subscales in the study participants (p</em><0.001). Finally, all changes remained stable at the follow–up design in the experimental groups (p</em><0.001).

The obtained results revealed that the PC scores in both experimental groups were higher than the control group, and the ACT group outperformed the SMT group. The changes observed in the experimental group were also stable in the follow–up phase to some extent. The collected results can solve the problems associated with patients with diabetes in hospital and private counseling centers.