Self-compassion may help diabetics control their disease

Learning to be less harsh or judgmental and more compassionate to oneself may help people with diabetes manage their disease and stave off depression, a recent study suggests.

Diabetes can be a stressful disease, the study team writes in Diabetes Care. The “relentless demand for healthy blood glucose control presents daily opportunities for failure and, thus, attacks on the self . . . (and) the practice of self-kindness may reduce psychological suffering,” they write.

Reducing the stress of managing diabetes might even have biological effects that improve the condition, they add. This is the first randomized controlled trial of a self-compassion intervention among people with diabetes, lead author Anna Friis told Reuters Health by email.

“Self-compassion-based treatments are founded on the notion that our tendency to be harshly self-critical or judgmental when we feel we have ‘failed’ or done something wrong makes our stress and distress worse,” said Friss, a psychologist at the University of Auckland in New Zealand.

“This is important because many diabetes patients suffer from depression and distress and we know that these mood problems make trying to achieve healthy blood glucose control even more difficult,” Friis said. “This is why there is an ongoing search for ways to help patients manage their mood, because we know this has important effects on their physical health.”

The goal of the training is to teach participants to actively react to diabetic symptoms, but with kindness, Friis said. Researchers recruited 63 volunteers with type 1 or type 2 diabetes in a New Zealand clinic to participate in an eight-week “mindfulness training on self-compassion.” Thirty one participants were assigned to a wait-list for the training and served as a comparison group.

The other 32 attended weekly sessions lasting two and a half hours that included formal meditation and training in “self-compassion practices aimed at developing the cognitive, behavioral and physical capacities to sooth and comfort oneself when depressed,” the authors write.

Participants received an email two days after each session summarizing what had been covered and the practices that could be done at home. At the beginning and the end of the eight-week program, and again after three months, participants answered questionnaires rating their depression symptoms and their level of distress related to their diabetes. The testing also measured feelings of self-kindness, common humanity and mindfulness as well as negative feelings like self-judgment and isolation.

In addition, participants had blood tests to measure A1c levels, which are a gauge of average blood sugar levels over time. After eight weeks and 12 weeks, there were no changes in mood, self-compassion or A1c levels in the comparison group. Among those who participated in the training program, self-compassion improved while distress and depression symptoms were reduced. Blood tests also showed a 1 percent reduction in A1c levels at the three-month mark compared to the start of the program.

The study cannot prove that the apparent psychological benefits of the program are responsible for the A1c reduction in the treatment group, or how that effect might work. It’s possible that feeling less stressed or depressed made it easier for participants to manage their diet, exercise and medications.

Or, since stress itself can affect hormones and metabolism in a way that raises blood sugar, the authors speculate that the self-compassion training could have directly helped to lower blood sugar levels by reducing stress hormones.

“There’s no vacation from diabetes,” said Alicia McAuliffe-Fogarty, a psychologist with the American Diabetes Association. “You have to carb count, make insulin decisions and manage your stress levels on daily, sometimes hourly basis.”

Diabetic patients do need self-compassion to manage their disease, said McAuliffe-Fogarty, who wasn’t involved in the study. “It’s easy to blame yourself when you don’t meet a 50 pound weight loss goal,” she told Reuters Health, “but if you forgive yourself you can start by giving yourself a smaller goal such as losing five pounds to accomplish, and improve your health.”