The Effectiveness of Mindfulness -Based Cognitive Therapy on Perceived Stress and Cognitive Avoidance in Patients with Type 2 Diabetes

Diabetes mellitus is one of the most common metabolic disorders in the world, and its increasing prevalence has become a significant public health concern in the 21st century. Perceived stress is one of the most important psychological factors affecting physical illnesses such as diabetes. Stressful events can impair self–care and health behaviors in diabetic patients, resulting in a delay in insulin use, failure to monitor blood sugar properly, and dislike of exercise. Besides its physical effects, diabetes and its stress have adverse psychological effects such as depression and anxiety. One of the important factors in depression is cognitive avoidance. Cognitive avoidance refers to various mental strategies by which individuals change their thinking during social communication. Among these interventions, we can mention mindfulness–based cognitive therapy. This therapy is one of the third wave cognitive–behavioral therapies recently used to treat some conditions and mental disorders and promote mental health. According to the research, awareness therapy is effective in perceived stress and cognitive avoidance in type 2 diabetic patients.

The present research was a quasi–experimental study with a pretest–posttest design with a control group. The statistical population consisted of all women with diabetes referred to the Birjand Diabetes Center, Birjand City, Iran, from September 2017 to March 2018. A total of 30 eligible volunteers were selected and randomly assigned to the experimental and control groups (each group with 15 participants). The inclusion criteria included the patient's consent to participate in the study, having a minimum literacy, receiving a definitive diagnosis of type 2 diabetes for at least one year, not receiving psychotherapy and medication before entering the study, and being 20 to 50 years old. The exclusion criterion included absenteeism for more than three sessions from the treatment sessions. Perceived Stress Scale (Cohen et al., 1983) and Cognitive Avoidance Questionnaire (Sexton & Dugas, 2009) were used to collect pretest and posttest data. Mindfulness–based cognitive therapy intervention was performed for the experimental group during eight 90–min sessions, but the control group did not receive any intervention. Descriptive statistics (mean and standard deviation) and inferential statistics (the Chi–square test [to compare the age status and duration of diabetes in the two groups], multivariate and univariate analysis of covariance) were used to analyze the data in SPSS software version 24. The significance level of all tests was considered α = 0.05.

The results showed that by eliminating the effect of pretest, significant differences were observed between experimental and control groups in the mean scores of perceived stress (p=0.018), cognitive avoidance (p=0.009) and its components of suppression (p=0.004), thought substitution (p=0.001), distraction (p=0.032), avoidance of threatening stimuli (p=0.019) and the imaginations related to thoughts (p=0.041). Also, the effectiveness of mindfulness–based cognitive therapy was obtained on perceived stress (0.242), suppression (0.263), thought substitution (0.340), distraction (0.153), avoidance of threatening stimuli (0.181), the imaginations related to thoughts (0.140) and the overall cognitive avoidance score (0.455) in type 2 diabetic patients.

According to the results of this study, mindfulness–based cognitive therapy effectively reduces perceived stress and cognitive avoidance in patients with type 2 diabetes, so that it can be used as an effective intervention method.