Comparison the Effectiveness of Schema Therapy and Cognitive-Behavioral Therapy on Lifestyle and Blood Sugar in Patients with Type 2 Diabetes

The increase in type 2 diabetes has been attributed to factors such as lifestyle changes such as less healthy diets and physical inactivity. Therefore, an unhealthy lifestyle is a dangerous factor for type 2 diabetes (5). Lifestyle is an important issue in controlling blood sugar to control type 1 and type 2 diabetes (6).
Another treatment method is cognitive-behavioral therapy. In cognitive-behavioral therapy, disproportionate thoughts and thinking about the lack of effective coping strategies with the disease are intervened; This approach is based on cooperation between the patient and the therapist, the duration of the treatment is short, and it tries to develop self-help skills in clients (10). This approach, relying on inductive methods, teaches the patient to look at thoughts and beliefs as hypotheses whose validity has not been confirmed, and through homework, he practices the required skills with the individual (11). It has also been shown that one of the components that has a great impact on physical health and chronic diseases are primary incompatible schemas, whose improvement is the primary goal of treatment in schema therapy (9). Schema therapy is an evidence-based treatment that uses theory and other techniques and integrates them into a systematic treatment model (11). Considering the above contents and the negative impact of diabetes on individual and social life on the one hand, the importance of discovering the best method to minimize the negative effects of diabetes on the other hand and considering the efficiency of both treatments and since in the previous studies which has shown that there is no schema therapy and cognitive-behavioral therapy on increasing lifestyle and reducing blood sugar in type 2 diabetes patients, in order to solve this research gap, the question is answered whether there is a difference between the effectiveness of schema therapy and treatment Is there a cognitive-behavioral difference between increasing lifestyle and reducing blood sugar in type 2 diabetes patients?

In order to conduct this semi-experimental research that was conducted with a pre-test and post-test design with a control group, among the people with type 2 diabetes in the first six months of 2019 in Kish Island who had referred to the Diabetes Association of Kish Island in order to control their symptoms and treat their disease. (293 people) 42 people were selected as available and randomly divided into three schema therapy groups: 14 people, 13 people for the cognitive-behavioral group, 15 people for the control group. Miller and Smith (2006) completed the questionnaire, which includes 20 questions and is on a 5-point Likert scale (always 1 point, often 2 points, sometimes 3 points, rarely 4 points and never 5). Then the people of the experimental group in the schema therapy group underwent 8 sessions of schema therapy by Yang and Klosko Vishar (2003) and the experimental group of cognitive-behavioral therapy underwent 8 sessions of cognitive-behavioral therapy by Li He (2007) in Skyroom software, 24 hours After the last intervention session, all the subjects completed the questionnaire again and performed the blood sugar test. Finally, descriptive statistics (tables, graphs, central and dispersion indices) and multiple covariance analysis (MANCOVA) and Benferoni post hoc tests were used using SPSS-24 software for statistical analysis of data. became.

The results showed that the difference in lifestyle (F = 6.16) and blood sugar (F = 5.11) between the experimental group and the control group is significant after removing the pre-test effects. The eta square (effect size) indicates that 26% of the differences in lifestyle and 22% of the differences in blood sugar in the post-test were related to the difference between the two groups and for the independent variable (cognitive behavioral therapy and schema therapy). Therefore, it can be said that schema therapy and cognitive-behavioral therapy have a significant effect on lifestyle and blood sugar in patients with type 2 diabetes. As Table No. 4 shows, there is a significant difference between the cognitive behavioral therapy and schema therapy groups with the control group in the post-test phase (p<0.01) in the variables of lifestyle and blood sugar. It was also found that there is no significant difference between any of the lifestyle variables and blood sugar in the experimental groups of cognitive behavioral therapy and schema therapy (P<0.05). Therefore, it can be said that both cognitive behavioral therapy and schema therapy had a significant effect on the variables of self-management, lifestyle, self-compassion and blood sugar of patients with type 2 diabetes, but no significant difference was observed in their effectiveness.

The results of the data analysis showed that the difference in the mean scores of the subjects' group in lifestyle and blood sugar between the experimental group and the control group is significant after removing the pre-test effects. In explaining the impact of cognitive-behavioral therapy on the lifestyle of patients with type 2 diabetes, it should be stated that cognitive-behavioral therapy helps patients to overcome their problems in treatment sessions by implementing the role of reinforcement and feedback and providing appropriate exercises; This increases their self-efficacy. In this therapeutic intervention, because the patients organize their absolute beliefs, rumination of thoughts and dysfunctional attitudes (shoulds and compulsions) about situations and conditions are reduced, and this leads to an increase in the improvement of people's reactions to respond to threats. Physical-psychological, concentration disorder and low motivation of patients will be (18).
In explaining the effectiveness of cognitive behavioral therapy and the cognitive content of therapy sessions and the perceptual change of patients, the lifestyle of patients changes; Because in this treatment, by learning new methods and strategies to deal with stress, patients under cognitive behavioral therapy can better use problem solving skills for their behaviors. On the other hand, it can be said that the stress caused by suffering from a chronic and permanent disease such as diabetes causes many behavioral and psychological complications for the patient and his family; which causes a wave of unhealthy behaviors and unhealthy lifestyle in these people (19).
Regarding the effectiveness of schema therapy on the lifestyle of patients with diabetes, it should be stated that the researchers came to the conclusion that incompatible schemas are related to the adoption of unhealthy lifestyles. The presence of early maladaptive schemas may differentiate between individuals who have a healthy lifestyle and those who do not. The existence of negative and pessimistic views towards life that arise through initial incompatible schemas, all of them cause negative emotions and the emergence of unhealthy behaviors in life, the first result of which is damage to the person and finally not using Lifestyles become healthy.