Be Nicer to Yourself, and Your A1C Will Thank You: Self-Compassion, Depression, and Diabetes
Kindness Matters: A Randomized Controlled Trial of a Mindful Self-Compassion Intervention Improves Depression, Distress, and HbA1c Among Patients With Diabetes. Anna M. Friis, Malcolm H. Johnson, Richard G. Cutfield, Nathan S. Consedine. Diabetes Care 2016 Jun; DOI: 10.2337/dc16-0416
What is the problem and what is known about it so far?
Individuals living with diabetes have self-care responsibilities that can be overwhelming. This can lead to diabetes-specific distress, negative self-evaluation, and self-criticism of failures in managing one's diabetes. Major depression affects many people with diabetes, with mood symptoms and distress apparent in nearly one-third of all people with diabetes. Mood difficulties have been shown to be linked to poor blood glucose control and increased diabetes complications.
Why did the researchers do this particular study?
There have not been a lot of studies on psychological treatments that improve both mood and diabetes. The researchers wanted to see what effect, if any, self-compassion training could have on mood and diabetes. Self-compassion treatments are based on the idea that a major cause of mental distress is the tendency to be self-critical about failure, either real or believed failure. Self-compassion incorporates mindfulness and attempts to encourage a sense of common humanity (recognizing that everyone goes through difficult times) and self-kindness (responding to one's suffering with gentleness and understanding instead of judgment and criticism). Psychological studies show that self-compassion training helps people learn to sooth and self-comfort in times of suffering. Those who practice self-compassion learn to treat themselves in the same way they might treat a loved one in distress, by providing gentle comfort and tending to personal needs. For people with diabetes, the relentless demand for good blood glucose control presents daily opportunities for perceived failure and, as a result, more chances for attacks on the self. So, the researchers thought the practice of self-kindness may reduce the emotional suffering that leads to diabetes-specific distress and, in turn, may help people to achieve better diabetes control.
Who was studied?
The study included 63 individuals with either type 1 or type 2 diabetes, ages 18–70 years, who were fluent in English and able to attend at least six of eight scheduled treatment sessions. Participants were recruited at three hospital sites in Auckland, New Zealand, either by volunteer or at the recommendation of a physician or diabetes nurse.
How was the study done?
One group of 32 participants underwent a mindful self-compassion program: 8 weekly sessions, 2.5 hours long, in groups of 8–12. The other group of 31 participants received diabetes treatment as usual. Measures of self-compassion, symptoms of depression, diabetes-specific distress, and A1C were taken at the start of the study, at the end of the study, and 3 months later, after the study ended.
What did the researchers find?
The researchers found that 8 weeks of self-compassion training improved both mental health and metabolic outcomes in patients with diabetes. Mindful self-compassion training produced statistically and clinically significant reductions in measures of depression and diabetes distress in the treatment group, with results maintained after 3 months. Participants in the treatment group showed notable decreases in symptoms of depression and distress, and their A1C levels were significantly reduced by an average of nearly 1%.
What were the limitations of the study?
The treatment group was small, and the findings may only apply to those participants. Because the number of mood problems reported by the study participants was higher than the number reported by patients with diabetes in general, it is possible that patients with more distress volunteered for the trial. It is also possible that the benefits of the treatment are more easily detected among people with greater levels of distress and depression (and poorer blood glucose control).
What are the implications of the study?
This study suggests that learning to be kinder to oneself (rather than being harshly self-critical) may have both emotional and metabolic benefits among patients with diabetes. The ability to be kind and to understand oneself in the face of difficult feelings may be important for reducing the suffering linked to depression and distress and for improving A1C—the key clinical marker of effective diabetes management. The benefits of developing self-compassion might also extend to other chronically ill populations.