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Diabetes has a profound impact on one’s mental health. This is so well known, in fact, that the negative emotions experienced in response to living with diabetes have, together, been defined as diabetes distress. Diabetes distress has been found to be experienced by 18-45% of adults living with diabetes. There are a number of techniques that are known to counter diabetes distress, and one recently studied is a mindfulness-based intervention. Mindfulness is not a magic bullet solution to diabetes distress, but it can be a helpful type of therapy when diabetes distress rears its pernicious head.
What Is Diabetes Distress?
Adults with diabetes can experience frustration, anger, overwhelm, and discouragement thanks to having to manage their diabetes on a daily basis. This is considered quite normal, and these feelings can come and go. However, the challenges of managing one’s illness are complicated by the negative emotional impacts of that illness.
Some of those negative emotions are so common as to be known as diabetes distress. Diabetes distress is comprised of four parts. According to Diabetes Canada, these include:
• The emotional burden of living with diabetes
• The distress associated with a diabetes self-management regimen
• The stress associated with social relationships
• The stress associated with the doctor-patient relationship
Anyone with diabetes can experience diabetes distress, no matter the type of diabetes they have. Those with diabetes distress may experience intense worry, fear, frustration, anger, and burnout.
According to Diabetes UK, the following are signs of diabetes distress:
• Feeling angry about diabetes and frustrated about the demands of managing it
• Worrying about not taking enough care of your diabetes but not feeling motivated to change
• Avoiding going to appointments or checking your blood sugars
• Making unhealthy food choices regularly
• Feeling alone and isolated
It’s important to note that while those with diabetes distress may experience some depression symptoms and some symptoms of anxiety, it is not the same thing as an anxiety or depression disorder. Diabetes distress involves negative emotions surrounding one’s diabetes, but those emotions don’t reflect how one feels about the rest of their life. Unfortunately, because many healthcare professionals are more familiar with looking for depression or anxiety disorders, diabetes distress tends to be less recognized and treated.
Not everyone experiences diabetes distress, however. The chances of experiencing this combination of negative emotions are greater for those with the following risk factors:
• Being younger
• Being female
• Having a lower education
• Living alone
• Having a higher body mass index
• Having lower perceived self-efficacy
• Having lower perceived healthcare provider support
• Having a poor-quality diet
• Having a greater perceived impact of glycemic excursions
• Having a higher number of diabetes complications
The Health Effects of Diabetes Distress
Not only are those with diabetes distress dealing with a heavy psychological load, but diabetes distress is also associated with lower health-related quality of life. This may be because those with diabetes distress tend to exhibit less self-management and poor glycemic control. According to Diabetes Canada, all of this results in elevated glycated hemoglobin (A1C levels), higher diastolic blood pressure, and increased low-density lipoprotein cholesterol levels in those with diabetes distress. And unfortunately, those physical effects come together to produce a 1.8-fold higher mortality rate and a 1.7-fold increased risk of cardiovascular disease.
Clearly, diabetes distress is more than just a psychological concern. It’s critical this type of distress be screened for and treated early and aggressively.
What Is Mindfulness for Diabetes Distress?
Mindfulness-based therapies are derived and adapted from Buddhist practices to help people relax their minds and achieve a state of calmness, peace, and happiness, and they are increasingly being used to alleviate the negative emotions of diabetes distress. People experiencing diabetes distress may not be able to escape a stressful emotion, but mindfulness can teach these people how to cope with it more effectively, and this prevents or delays the psychological complications. Mindfulness-based therapies have been shown to contribute to better self-care and diabetes self-management.
Mindfulness aims to use breathing techniques and meditation exercises to focus attention on the present moment without judgment. In other words, mindfulness helps a person not to experience concerns about the past or future by focusing only on the here and now, what’s happening around them and within them in the present.
Mindfulness-Based Therapies for Diabetes Distress
There are multiple types of mindfulness-based therapies, including:
• Mindfulness-based cognitive therapy – Participants learn to see negative thoughts and emotions as passing events rather than as states in which they get stuck. In this therapy, people pay attention to the present moment and become aware of their bodily sensations, emotions, and thoughts and the way those things interconnect. They learn to accept these experiences, recognize ineffective patterns, and then work to change those patterns.
• Acceptance and commitment therapy (ACT) – This therapy involves the processes of acceptance, defusion (a skill that is used to get some distance from thoughts and emotions), contact with the present moment, self as context (the concept that people are not the content of their thoughts or feelings, but rather are the consciousness experiencing or observing the thoughts and feelings), values, and committed action (taking action guided by one’s values); these processes increase motivation and reinforce meaningful behaviors.
• Dialectical behavior therapy (DBT) – This therapy works to correct emotion dysregulation by emphasizing and enhancing dialectical thinking patterns that acknowledge multiple tensions over rigid, dichotomous thinking. Mindfulness is a specific component of this therapy.
• Mindfulness-based stress reduction therapy – Participants use mindfulness meditation to alleviate suffering. They receive training in formal mindfulness meditation techniques involving simple stretches and postures.
Each of these types of mindfulness-based therapies was originally developed for a slightly different group of people, such as those with recurring depression or those with borderline personality disorder, but have now found usefulness in helping those experiencing diabetes distress. (Note that using these types of therapies does not indicate a person has a mental illness.)
However, not all mindfulness-based therapies for diabetes distress are created equal. According to a 2019 study by Guo et al., the following aspects of a therapy may make it more effective:
• Group-delivery
• Assignment of home practice
It may also be the case that mindfulness-based stress reduction therapy is more effective than other mindfulness-based therapies for diabetes distress. The same study also points out that those with higher levels of diabetes distress receive more benefit from these therapies, although it may prevent more severe distress in those who began therapy with lesser distress levels.
Other Treatments for Diabetes Distress
Diabetes UK has some additional suggestions for dealing with diabetes distress. They suggest:
• Be kind to yourself – People who suffer from diabetes distress may have unrealistic expectations of themselves and their diabetes management (with diabetes management supplies like these). It’s important to have realistic expectations when it comes to things like blood test results. You can also think about blood sugar as “high” or “low” and not “good” or “bad,” as the latter words may make you feel as though you have done something wrong. No one’s management of diabetes is perfect.
• Engage in self-care – Taking time for yourself by getting a massage or setting aside time for a long bath can be helpful, too. Whatever makes you feel better is something you can consider.
• Take a break – It may be that a few hours for a bath isn’t restoring enough for your mental health. While you can’t simply ignore your diabetes, you can “take a break” by reducing the amount of effort you are spending on your diabetes management. This could mean relaxing your targets a bit or reducing how many times you check your blood each day. (Make sure you talk to your doctor before making any management changes, even if they are temporary.)
• Talk about how you feel – Talk to your friends and family about your distress and how they can support you. Also, consider talking in an online support forum. Just getting your feelings out can feel like a weight off your shoulders.
• Get help from a professional – Your healthcare team is there to support your physical and mental health, and it’s important they know if you’re experiencing diabetes distress. They can help you by making small changes to your diabetes routine or recommending an education course – either of which may improve your diabetes distress. Psychological professionals (such as a therapist) may also be available to help you.
Other Mental Health Effects of Diabetes
While diabetes distress is common, other mental health concerns also frequently occur. According to Diabetes Canada, they include:
• Psychological insulin resistance – This is a strong, negative reaction to the recommendation that one may benefit from adding insulin to their diabetes regimen. This is particularly common when a person has previously been successful in managing their diabetes with noninsulin agents (like with empagliflozin [Jardiance] or sitagliptin [Januvia]).
• Fear of hypoglycemia – This is common when serious hypoglycemic experiences have been traumatic in the past.
• Mental illness – People with diabetes have a higher prevalence of many mental illnesses like depression and bipolar disorder. The reasons for this are complicated but may be in part due to factors related to diabetes management.
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Sources
1. Guo, J., Wang, H., Luo, J., Guo, Y., Xie, Y., Lei, B., Wiley, J., & Whittemore, R. (2019). Factors influencing the effect of mindfulness-based interventions on diabetes distress: a meta-analysis. BMJ Open Diabetes Research & Care, 7(1), e000757. https://doi.org/10.1136/bmjdrc-2019-000757
2. Niazi, A. K., & Niazi, S. K. (2011). Mindfulness-based stress reduction: A non-pharmacological approach for chronic illnesses. North American Journal of Medical Sciences, 3(1), 20. https://doi.org/10.4297/najms.2011.320
3. Robinson, D., Coons, M., Haensel, H., Vallis, M., & Yale, J.-F. (n.d.). Diabetes and Mental Health - Diabetes Canada. Diabetes Canada. Retrieved December 17, 2023, from https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-18#panel-tab_FullText
4. What is diabetes distress and diabetes burnout? (n.d.). Diabetes UK. Retrieved December 17, 2023, from https://www.diabetes.org.uk/guide-to-diabetes/emotions/diabetes-burnout