Cognitive behavioural therapy and diabetes

Clinical psychologist, Daniel Sher, explains how cognitive behavioural therapy, a psychological tool, can help people with diabetes to thrive.

What is cognitive behavioural therapy?

Cognitive behavioural therapy (CBT) is a form of psychological therapy that is widely used by mental health professionals because it is so effective in treating a wide range of psychological conditions.

How does CBT work?

CBT helps people recognise and replace unhelpful thinking patterns. Often, dysfunctional ‘automatic thoughts’ flit through our minds, below the level of conscious awareness. If these thoughts are distorted or problematic, they may lead us to feel emotional distress.

This, in turn, can lead to behaviours, such as sleeping all day, binge eating or neglecting our responsibilities, that tend to worsen our mental health.

How can CBT help people living with diabetes?

• CBT can help people living with diabetes to address misconceptions about their self-management that tend to sabotage their efforts at looking after themselves.
• People with diabetes are at an increased risk of experiencing psychological disorders, including depression, anxiety and eating disorders. CBT has been shown to help people with diabetes in particular to improve their mental health. This, in turn, makes it easier to manage diabetes.
• Diabetes is a life-long condition. For this reason, ongoing support is needed: diabetes patients are at risk of relapse and burnout! CBT helps people to think about behavioural changes that are going to serve them in the long run.
• In recent times, in-depth scientific studies have been conducted on people with diabetes who get help via CBT. The research suggests that CBT can help people with diabetes improve their glycaemic control, experience a better quality of life and reduce the risk of long-term complications.
• CBT can reduce stress. When people are anxious or upset, cortisol (a stress hormone) is released into the bloodstream. Cortisol can negatively affect blood glucose levels. Furthermore, when we are stressed we are more likely to fall behind on our self-management and perhaps even engage binge eating or other unhealthy behaviours. By helping us to cope with stress and anxiety, CBT can help overall diabetes control.

What are the advantages of CBT?

• CBT is evidence-based. Over the years, a large amount of scientific research has been conducted to show that CBT is a powerful way of improving a person’s mental health.
• CBT is focussed on the present. While some forms of therapy involve looking at our past to understand our current difficulties, CBT is focussed on thoughts and feelings that affect one’s functioning in the here and now.
• CBT aims to empower the client. Often, having diabetes can make a person feel powerless. CBT can help one to develop practical skills which can empower a person to take back control.
• Compared to other forms of therapy, CBT is a relatively short-term intervention. For this reason, it is often considered to be one of the most efficient and affordable ways of getting help.

What are the disadvantages of CBT?

• CBT involves a structured programme, which may not always be suitable for people with more complex mental health difficulties.
• CBT requires motivation and commitment. It is only helpful for those who are willing to put in the time and effort. Ultimately, what you put in is what you get out.
• CBT is present-focussed. The downside to this is that CBT does not always pay enough attention to how our past has shaped us; and to how our unconscious mind affects our current functioning.

Where to get help

If you have diabetes and would like to get a bit of extra support, speak to a psychologist or psychiatrist near you. Keep in mind that CBT is a specialised skill that needs to be provided by a board-certified professional. Ideally, try to find a clinical psychologist who is trained in CBT and has experience in working with diabetes.

Sources:

Seyed-Reza, A., Norzarina, M. Z., & Kimura, L. W. (2016). The Benefits of Cognitive Behavioral Therapy (CBT) on Diabetes Distress and Glycemic Control in Type 2 Diabetes. Malaysian Journal of Psychiatry, 24(2).

Li, C., Xu, D., Hu, M., Tan, Y., Zhang, P., Li, G., & Chen, L. (2017). A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for patients with diabetes and depression. Journal of Psychosomatic Research, 95, 44-54.

Uchendu, C., & Blake, H. (2017). Effectiveness of cognitive–behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes mellitus: a systematic review and meta‐analysis of randomized controlled trials. Diabetic Medicine, 34(3), 328-339.

Driessen, E., Smits, N., Dekker, J. J. M., Peen, J., Don, F. J., Kool, S., … & Van, H. L. (2016). Differential efficacy of cognitive behavioral therapy and psychodynamic therapy for major depression: a study of prescriptive factors. Psychological medicine, 46(4), 731-744.