Determining the Effectiveness of Acceptance and Commitment-Based Therapy on Stress, Cognitive Attentional Syndrome, and Glycosylated Hemoglobin in Type 2 Diabetic Patients

The progression of complications and high costs of diabetes treatment in these patients is mainly due to inadequate blood sugar control. So, one of the most important goals in treating these patients is to achieve proper blood sugar control; an important indicator of this control is glycosylated hemoglobin (HBA1c). The best goal in controlling and treating diabetes is to keep this index within the normal range. People with diabetes have stress and anxiety in social interactions due to constant life changes, fear of high blood sugar, and understanding how they differ from others. Their main problem is fear of what others think of them. As a result, they may avoid many social situations. Psychological stress in people with diabetes can initiate or exacerbate hyperglycemia by activating the pituitary–adrenal axis. On the other hand, one of the most essential factors in the emergence and persistence of mental disorders in victims is the content and thought style of people. From the metacognitive perspective, a mental disorder is caused by activating a specific thought style and poisoning, which is cognitive–attention syndrome. Cognitive Attentional Syndrome is defined as a repetitive thinking style that manifests itself in the form of rumination, threatening attention, and dysfunctional coping behaviors. Patients with type 2 diabetes face many problems, so using effective treatment methods to improve the psychological characteristics of these patients is essential. In this regard, one of the effective treatment methods to improve psychological characteristics that many researchers have recently considered is acceptance commitment therapy. This type of treatment is one of the third–wave behavioral therapies that emphasizes comprehensive awareness, along with openness and acceptance of pain. Diabetes is the most common disease caused by metabolic disorders that are associated with long–term complications; the burden of this disease is increasing in the world, especially in developing countries. Therefore, it has become one of the public health concerns in the 21st century, and every year, a lot of money is spent on diabetes treatment and complications of diabetes. Thus, there is a need for new studies for its prevention and treatment. Given the prevalence of this disease in society and its complications, timely intervention is essential to reduce mental health problems and consequently improve self–management and blood sugar control. On the other hand, few studies on the relationship between stress and blood sugar control (HbA1c). Considering the role of acceptance and commitment therapy in treating diabetes in the country, research in this area is not sufficient and coherent, and different dimensions of this issue have not been well studied. To our knowledge, no direct study has been done on the effectiveness of acceptance and commitment therapy on Cognitive Attentional Syndrome in type 2 diabetic patients by considering glycosylated hemoglobin.

This quasi–experimental research employed a pretest–posttest design with a control group. The study population included all people with type 2 diabetes who were referred to Hajiabad Zirkuh Health Center, Hajiabad Zirkuh, Iran, in the fall of 2020. A total of 30 eligible people who volunteered to participate in the study were included in the study and then randomly divided into two groups: experimental and control (each 15 patients). To collect the necessary data, the Stress Anxiety Scale (Lovibond and Lovibond,1995), Cognitive Attentional Syndrome (Wells, 2009), and glycosylated hemoglobin test with autoanalyzer were used in the pretest and posttest. Then, Hayes et al.'s (2011) acceptance and commitment–based treatment was performed in 8 sessions of 90 minutes only for the experimental group, and the control group did not participate in the training. Data were analyzed with multivariate analysis of covariance using SPSS software version 24 at the significance level of α=0.01.

The results showed that after adjusting the pretest scores, the mean scores of stress, cognitive attentional syndrome, and glycosylated hemoglobin in the experimental group were significantly reduced compared to the control group (p<0.001).

Based on the findings, acceptance and commitment–based therapy reduced stress, cognitive attentional syndrome, and glycosylated hemoglobin in patients with type 2 diabetes.