The Effectiveness of Acceptance and Commitment Therapy on Anxiety, Depression, and Lipid Profile of Patients with Type 2 Diabetes

Diabetes is one of the most common chronic metabolic diseases characterized by abnormalities in carbohydrate, protein, and fat metabolism. The most common symptoms are glucose intolerance or hyperglycemia, which causes short– and long–term complications of diabetes. Diabetes is a metabolic disorder characterized by insulin deficiency and secretion. Diabetes consists of two types, type 2 and type 1. In type 2 diabetes or non–insulin dependent diabetes, the produced insulin by the pancreas does not work well. Diabetes occurs when the pancreas does not release enough insulin or the secreted insulin does not work properly. Reports indicate an increase in the prevalence of type 2 diabetes in developing countries by 4%. The disease alone caused 4.9 million deaths worldwide in 2014, and it is estimated that by the year 2030, Iran will become one of the most populous countries in the world in terms of diabetes. In the etiology of type 2 diabetes, the role of environmental factors is prominent. Studies have shown that complications are common in these patients, especially long–term complications such as cardiac, ophthalmic, and renal, as well as psychological problems in personal, family, and social relationships. Treating all these problems has a high cost, both directly and indirectly, for the patients and the government. Among the most important complications are psychological disorders (anxiety and depression) that negatively affect the patient's ability to perform and maintain recommended medical care. On the one hand, the psychological problems of chronic diseases, including diabetes, which are often overlooked, highlight the need for more attention to appropriate treatment. One of the treatments is Acceptance and Commitment Therapy (ACT). This therapy belongs to the third wave of cognitive–behavioral therapies that enhances one's psychological well–being rather than changing cognitions. Therefore, the present study aimed to determine the effectiveness of ACT on anxiety, depression, and blood lipid profile of patients with type 2 diabetes.

This study was a quasi–experimental study with a pretest–posttest design and a control group. The study population consisted of all type 2 diabetic patients referred to Birjand Diabetes Clinic in the spring of 2010. A total of 40 patients were selected and randomly assigned into two groups of 20 experimental and control groups. The ACT intervention was performed in eight 90–minute sessions. Data were collected by completing the Anxiety and Depression Scale (Levibond and Lovebond, 1995) and measuring blood lipid indexes before and after the intervention. Ethical considerations included accepting volunteer members in the group counseling sessions, willingly completing the questionnaires by the samples, proper scheduling of meetings, and keeping the information and names of individuals in the study confidential. It is worth noting that this study was approved by the Ethics Committee of Birjand University of Medical Sciences under code Ir.Mums.REC.1398.189. Data analysis was performed by calculating mean and standard deviation in the descriptive part and univariate and multivariate analysis of covariance in the inferential part in SPSS version 22. The significance level was considered at α=0.05.

After the intervention, depression and anxiety scores and lipid indices were significantly decreased in the experimental group compared to the control group (p<0.001). The Eta coefficients for the depression variable (0.220), the anxiety variable (0.0301), total cholesterol (0.257), triglyceride (0.397), LDL–cholesterol (0.184), and HDL–cholesterol (0.171) indicated the efficacy of ACT in reducing anxiety, depression and lipid profile in type 2 diabetic patients.

The results showed that after the intervention, the anxiety, depression, and lipid profile in type 2 diabetic patients were significantly reduced in the experimental group compared to the control group. So, it is recommended that this treatment be used as a complementary treatment for other psychosomatic diseases.