Treatment: Cognitive-Behavioral Therapy for Depression in People with Diabetes
2015 EST Status: Treatment pending re-evaluation Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings
Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources
Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved
Insufficient Evidence: No meta-analytic study could be identified
Insufficient Evidence: Existing meta-analyses are not of sufficient quality
Treatment pending re-evaluation
1998 EST Status: Strong Research Support Strong: Support from two well-designed studies conducted by independent investigators.
Modest: Support from one well-designed study or several adequately designed studies.
Controversial: Conflicting results, or claims regarding mechanisms are unsupported.
Strength of Research Support
- Basic premise: Diabetes is a group of chronic diseases that requires the patient to make lifestyle changes and regularly engage in many complicated health behaviors in order to prevent the development of medical complications, some of which are life-threatening. People with diabetes are twice as likely to develop depression compared with the general public and commonly experience a condition that often overlaps with depression called “diabetes distress”. Diabetes distress is the emotional distress directly related to the burden of living with diabetes. Psychological factors can affect adherence to the diabetes regimen, which directly affects the physiological well-being and quality of life of a person with diabetes.
- Essence of therapy: Cognitive-Behavioral Therapy addresses both the psychological and adherence issues that are important to overall well-being in people with diabetes. CBT skills are used to address cognitions and behaviors inherent in depression that affect self-care behaviors necessary to be adherent to the medical regimen. The result is improved self-efficacy for managing diabetes self-care behaviors and acquisition of coping skills for managing both depressive symptoms and self-care behaviors.
- Length: 10-12 sessions, though the protocol is flexible and can be tailored to patient needs.
Editors: Amanda S. Phillips, M.S.
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice
Treatment Manuals / Outlines
Books Available for Purchase Through External Sites
- Coping with Chronic Illness: A Cognitive-Behavioral Therapy Approach for Adherence and Depression (Safren, Gonzalez, & Soroudi, 2008)
Measures, Handouts and Worksheets
- Breaking Free From Depression and Diabetes – Patient booklet describes the relationship between depression and diabetes
- The Emotional Side of Diabetes: 10 Things you Should Know – Patient booklet describes cognitive, emotional, social, and behavioral aspects of living with diabetes
- Diabetes Distress Scale (Polonsky et al., 2005)
- Diabetes Distress Scale for Adults with Type 1 Diabetes (Fisher et al., 2015)
- Diabetes Distress Scale for Parents of Teens With Type 1 Diabetes (Hessler et al., 2016)
- Diabetes Distress Scale for Partners of Adults with Type 1 Diabetes (Polonsky et al., 2016)
- Hypoglycemia Attitudes and Behavior Scale (Polonsky et al., 2015)
- Hypoglycemic Confidence Scale (Polonsky et al., 2017)
- Diabetes Burnout: What To Do When You Can’t Take It Anymore (Polonsky, 1999)
Important Note: The books listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.
- Behavioral Diabetes Institute – The Behavioral Diabetes Institute provides a number of videos describing treating depression in diabetes, the emotional side of diabetes, and presentations intended for people with diabetes.
Type 2 diabetes
- Is cognitive behavioural therapy focusing on depression and anxiety effective for people with long-term physical health conditions? A controlled trial in the context of type 2 diabetes ellitus (Wroe et al., 2018)
- Web-based cognitive behavior therapy for depression in people with diabetes mellitus: A randomized controlled trial (Newby et al., 2017)
- Psychosocial and clinical outcomes of a cognitive behavioral therapy for asians and pacific islanders with type 2 diabetes: a randomized clinical trial (Inouye et al., 2015)
- A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes (Safren et al., 2014)
- The effect of cognitive-behavioral group therapy on depressive symptoms in people with type 2 diabetes: A randomized controlled clinical trial (Sharif et al, 2014)
- A psychoeducational intervention (SWEEP) for depressed women with diabetes (Penckofer et al., 2012)
- Cognitive behavior therapy for depression in type 2 diabetes mellitus: A randomized, controlled trial (Lustman et al., 1998)
- Predicting response to cognitive behavior therapy of depression in type 2 diabetes (Lustman et al., 1998)
Type 1 diabetes
- A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients–a randomized controlled trial (Amsberg et al., 2009)
- Cognitive behavioural therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled Type 1 diabetic patients: long-term effects on HbA moderated by depression: A randomized controlled trial (Snoek et al., 2008)
- Short-term effects of cognitive behavioural group training (CBGT) in adult Type 1 diabetes patients in prolonged poor glycaemic control: A randomized controlled trial (van der Ven et al., 2005)
Mixed Type 1 and Type 2 Diabetes
- Reduction of depressive symptoms predicts improved glycaemic control: secondary results from the DIAMOS study (Schmitt et al., 2017)
- The effect of a Diabetes-Specific Cognitive Behavioral Treatment Program (DIAMOS) for patients with diabetes and subclinical depression: Results of a randomized controlled trial (Hermanns et al., 2015)
Meta-analyses and Systematic Reviews
- Web-based interventions for depression in individuals with diabetes: Review and discussion (Franco, Gallardo, & Urtubey, 2018)
- A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for patients with diabetes and depression (Li et al., 2017)
- Cognitive behavioural therapy on improving the depression symptoms in patients with diabetes: a meta-analysis of randomized control trials (Wang et al., 2017)
- Psychological interventions for the management of glycemic and psychological outcomes of type 2 diabetes mellitus in China: a systematic review and meta-analyses of randomized controlled trial (Chapman et al., 2015)
- A review of treating depression in diabetes: Emerging findings (Markowitz et al., 2011)
Other Treatment Resources
- Effects of motivational enhancement therapy plus cognitive behaviour therapy on depressive symptoms and health-related quality of life in adults with type II diabetes mellitus: A randomised controlled trial (Huang et al., 2016)
- Motivational enhancement therapy with and without cognitive behavior therapy to treat type 1 diabetes: A randomized trial (Ismail et al., 2008)
- Effects of cognitive behavioral coaching on depressive symptoms in a sample of type 2 diabetic inpatients in Nigeria (Onyechi et al., 2016)
- Does Mindfulness-Based Cognitive Therapy benefit all people with diabetes and comorbid emotional complaints equally? Moderators in the DiaMind trial (Nykicek et al., 2016)
- Effectiveness of cognitive-behavioral stress management on psychological stress and glycemic control in gestational diabetes: A randomized controlled trial (Zaheri, Najar, & Abbaspoor, 2017)