Diabetes - Psychotherapy and counselling

Psychological or emotional distress in people with diabetes takes two forms :

• (i) Coping difficulties, which arise as a consequence of the daily stress and hassles of living with the disease.
• (ii) Frank psychopathology.

Coping Problems :

Why coping problems are common?
Coping problems are so common among people with diabetes largely because the demands of diabetes management are so substantial. Factors outside the patient’s control often affect glycaemic control, and the avoidance of diabetes related complications cannot be guaranteed. There are no vacations from diabetes and it affects every aspect of a person’s life, including job, social life, recreation and family life.
Another thing that makes diabetes regimen so demanding is the fact that many of its requirements are unpleasant and almost everyone feels that diabetes-related dietary restrictions are a major burden.
Many of these individuals are stress-responsive, and the release of stress induced counter-regulatory hormones can dramatically affect their glycaemic control.

Consequences :
The sense of being overwhelmed, to parallel diabetes mellitus, the technical name for the disease which affects our patients, is one factor leading to the low levels of diabetes self care.
Some studies reported a wide range of findings, with medication taking adherence highest and life style behaviour adherence lowest.

Self-care :
Self care is a critical issue in diabetes, because more than 99% of diabetic care is self care. The majority of diabetes care takes place not only in the health care provider’s office, but literally countless times each day in the places where people with diabetes live, work, eat and play.
One essential goal of diabetes care is to improve diabetes related coping skills among people with diabetes and as a consequence, to improve self care behaviour, metabolic outcomes and quality of life as well.
Quality of life is affected by improved coping skills, both directly, through reduced emotional distress, and indirectly, through the effects of coping skills on self care, glycaemic control and long term health outcomes.

Relaxation training :
Some studies support the notion that improving the stress management or coping skills can improve self care, metabolic outcomes and quality of life. Example : several studies of people with type 2 diabetes generally report improved glucose tolerance and reduced long term hyperglycaemia following biofeedback assisted relaxation training (BART). While several studies reported positive effects of BART and related treatments for those with type 1 diabetes, others found no such benefits.

Group coping skills :
A wide range of interventions including therapy groups, self help groups, support groups and diabetes camps have been employed to promote more effective coping with the day-to-day hassles of diabetes.
Most of the interventions used peer modeling and role-play techniques and took place in group settings.
It was found that adolescents who participated in a series of sessions designed to improve diabetes-related coping skills were less depressed, and also tended to have higher self-esteem and more often used emotion-based coping skills, when compared with a control group.

Key elements of diabetes specific coping skills :
The counselling process by means of which the health care provider facilitates the development of diabetes related coping skills in people with diabetes involves a number of specific techniques. These techniques are designed to help patients identify problematic diabetes related issues, identify thoughts and feelings associated with these issues, identify attitudes and beliefs underlying the problem and establish self care goals, and develop and commit to a plan for achieving the goal.