Mediating Role of Self-Acceptance in the Relationship between Self-Actualization, Self-Transcendence, and Distress Tolerance in Diabetic Patients

IntroductionDiabetes is a chronic and costly disease that has a high prevalence throughout the world, Iran, and specifically in Yazd province. Considering the heavy psychological and economic costs of diabetes and its complications, it is important to pay attention to all the factors that can increase diabetes self-management. Since self-management is the main key to controlling diabetes and postponing the occurrence of diabetes complications, it is valuable to pay attention to distress tolerance and its affecting factors as one of the significant factors in diabetes self-management. Self-acceptance, self-actualization, and self-transcendence are proposed as three psychological factors that seem to improve people's distress tolerance. But evidence shows that self-acceptance can play a mediating role in the relationship between self-actualization, self-transcendence and distress tolerance in type 2 diabetic patients; however, few studies have investigated the relationship between these variables in diabetic people, which shows the necessity of conducting more studies. MethodThis is a descriptive-correlational study, performed using path analysis. A total of 207 questionnaires were administered by the available sampling method to type 2 diabetic patients living in Yazd province. The data was gathered using the Distress Tolerance Scale (Simmons & Gaher, 2005) and the Existential Fulfillment Scale (Loonstra, 2007). The Existential Fulfillment Scale is composed of three subscales: self-acceptance, self-actualization, and self-transcendence. The correlation and structural equation analysis were conducted to analyze the data using SPSS-23 and AMOS-24 software, respectively.  ResultsThe results showed that self-acceptance, self-actualization, and self-transcendence have a significant positive relationship with distress tolerance in diabetic patients. In other words, self-actualization has a positive and direct effect on distress tolerance (r =.22, p<.01), self-transcendence has a direct and significant effect on distress tolerance (r =.23, p<.05), and the direct effect of self-acceptance on distress tolerance is statistically positive and significant (r =.24, p<.001). The data also revealed that self-actualization has a direct and positive effect on self-acceptance (β=.29, p<.001), and the direct effect of self-transcendence on self-acceptance is statistically positive and significant (β=.21, p< 0.01). Also, self-acceptance plays a mediating role in the relationship between self-actualization and distress tolerance (Sobel test = 2.72, p<.01), and self-acceptance has a mediating role in the relationship of self-transcendence with distress tolerance (Sobel test = 2.45, p<.05) in diabetics. The distress tolerance of diabetic patients can be predicted up to 22% by the sum of self-actualization, self-transcendence, and self-acceptance (p<.01). ConclusionThe results showed that individuals with type 2 diabetes who have higher self-acceptance, self-actualization, and self-transcendence show higher distress tolerance. Considering the mediating role of self-acceptance in the proposed model, it is suggested that by trying to promote the self-actualization and self-transcendence of diabetic patients, their self-acceptance of diabetics is improved. Higher self-acceptance, in turn, leads to greater distress tolerance and ultimately better diabetes self-management.