Cognitive–Behavioral Therapy for Adherence and Depression (CBT-AD) in Type 2 Diabetes

Abstract

Depression is one of the most common psychological problems among individuals diabetes, and it is associated with worse treatment adherence and clinical outcomes. As part of a program of treatment research aimed at integrating interventions for depression and treatment nonadherence, five depressed patients with suboptimally controlled type 2 diabetes were treated with 10-12 sessions of individual cognitive behavioral therapy for adherence and depression (CBT-AD) in a case-series design. The intervention was delivered in a hospital setting by a collaborative team consisting of a psychologist, a nurse educator, and a dietitian. Post-treatment, all participants demonstrated a decrease in depression severity and demonstrated improvements in diabetes self-care. Four of the five demonstrated improved glycemic control. These preliminary results provide evidence for the acceptability, feasibility, and potential utility of CBT-AD for patients with type 2 diabetes and depression.

Diabetes distress: understanding the hidden struggles of living with diabetes and exploring intervention strategies

“…Outcome studies that focus on depression and diabetes distress do provide positive evidence of clinical improvement. A study using cognitive behavioural therapy for adherence and depression (CBT-AD) in type 2 diabetes,56 which was delivered by a dietician, a psychologist and a diabetes nurse, resulted in reduced depression scores and improvements in self-management behaviours. Impressively, 75% of participants had better blood glucose control after the intervention 56.…”

Psychosocial interventions for people with diabetes and co-morbid depression. A systematic review

“…The remaining three studies had 69% (Georgiades et al, 2007), 80% (Simson et al, 2008), and 55% ( Out of the seven effect sizes calculated, however, only five were statistically significant. NRS by Gonzalez et al (2010) and RCT by Simson et al (2008) had CIs that included 0, indicating that the intervention had no effect. These two studies also had the smallest sample sizes of five and thirty respectively.…”

“…SMD was calculated for the three RCTs with two studies having a small effect of -0.42(Piette et al, 2011) and - 0.24 (Simson et al, 2008), while the other one having a large effect of -0.81(Penckofer et al, 2012). SMD for quasi-experimental trial forRungreangkulkij et al (2011) was -1.74.. SMGS was calculated for the three NRS and the effect sizes were mostly large with -0.91 for de Groot (2012), -1.22 forGeorgiades et al (2007), and -0.55, -1.87, and-1.94 forGonzalez et al (2010) with the respective depression scales.…”

“…The effect sizes calculated for a number of studies revealed that the interventions were generally consistent with this conclusion. The two studies(Gonzalez et al, 2010;Simson et al, 2008) with statistically insignificant effect could be attributed to their small sample sizes which generally have lower statistical power and predictive value(Button et al, 2013). Only two studies provided data to calculate follow-up assessment results and the evidence suggested that psychosocial interventions have some lasting effect as the participants' depressive symptoms remained improved over the next few months.However, taking the methodological quality of the included studies into account, this conclusion is at best overconfident.…”

The Future of Cognitive Behavioral Interventions Within Behavioral Medicine

“…Moreover, several studies support the efficacy of CBT for treating psychological disorders and reducing psychological distress in behavioral medicine populations, such as patients with cancer (e.g., Osborn, Demoncada, & Feuerstein, 2006), HIV/AIDS (e.g., Safren et al, 2009), type 2 diabetes (e.g., Lustman, Griffith, Freedland, Kissel, & Clouse, 1998), multiple sclerosis (e.g., Mohr et al, 2005), primary insomnia (e.g., Edinger, Wohlgemuth, Radtke, Marsh, & Quillian, 2001), and chronic pain (e.g., McCracken & Turk, 2002). The studies presented in this special issue of the Journal of Cognitive Psychotherapy add to our knowledge by demonstrating the efficacy and utility of CBT approaches for patients with cancer (Greer, Park, Prigerson, & Safren, 2009;Hopko & Johanson, 2009), cardiovascular disease (Irvine et al, 2009), diabetes (Gonzalez et al, 2009), and HIV (Brown, Vanable, Carey, & Elin, in press) in the rapidly changing world of chronic disease management.…”