Feature

Every 21 seconds, an American is diagnosed with diabetes. Often, the stress of living with this chronic disease, combined with the disease itself, wreaks havoc on a patient's blood sugar levels, causing fatigue and frequent urination, as well as such long-term problems as heart, eye and kidney disease.

But with their unique behavioral training, psychologists can help people with the condition reduce that stress and improve their quality of life, said psychologist Richard R. Rubin, PhD, professor of medicine at The Johns Hopkins University School of Medicine and former president for health care and education at the American Diabetes Association, during APA's 2007 Annual Convention.

Data from a 2001 international study on the attitudes, wishes and needs of people with diabetes show that less than a third of patients fully adhere to their recommended diet, exercise and medication regimens, said Rubin, noting that the vast majority of diabetes treatment falls into the challenging category of self-care.

"We live in a fast-food, all-you-can-eat world, and people with diabetes often feel like they're being told that they can't do anything," said Rubin, who has both a sister and a son with diabetes.

The mental health toll of the disease can be immense: A 2001 meta-analysis in Diabetes Care (Vol. 24, No. 6, pages 1069-1078) shows that depression rates among patients with diabetes are nearly double that of the general population, and depression in these patients is often more chronic. In addition, patients with diabetes often suffer stress and burnout from constantly monitoring their condition, and they report anxiety about hypoglycemia, in which blood-sugar levels drop below normal and can result in confusion, irritability, fainting or sometimes, death.

And with close to one-third of U.S. adults now identified as having higher than normal blood glucose levels-a condition known as pre-diabetes-psychologists may have their work cut out for them as increasing numbers of people with diabetes seek mental health treatment.

With the help of workshop co-leader Suzanne Bennett Johnson, PhD, chair of the department of medical humanities and social sciences at the Florida State University College of Medicine in Tallahassee, Fla., Rubin discussed ways psychologists can help patients overwhelmed by diabetes. He advised psychologists to help patients:

  • Identify their successes. Begin each session asking a patient about what they're doing right in managing their diabetes, said Rubin. "Every person with diabetes already knows that they're doing so many things wrong," he said. "Start with the positives."

  • Determine their main source of distress. Work with the patient to identify the disease factors that trigger their anxiety-for example, the belief that diabetes controls their life, or interpersonal distress when friends and family do not give them the support they need.

  • Avoid that stress. Develop coping skills related to their areas of concern. For example, if a patient's biggest problem is overindulging when they go to a party or out to dinner, help them develop a plan before they go: Maybe they could skip the bread or potato with a meal, so that they can order a small dessert.

The most important thing is that the strategy be something the patient believes they can stick to, said Rubin.

"You can come up with a million things that might be helpful, but it will do absolutely no good if it doesn't work for that person," he concluded.

Further Reading

  • Anderson, B., Rubin, R.R. (2003). Practical Psychology for Diabetes Clinicians. (Second ed.) Alexandria, Va.: American Diabetes Association.

  • Arsham, G.M., Feste, C., Marrero, D.G., Rubin, R.R., Rubin, S.H. (2003). 101 Tips for Coping with Diabetes. Alexandria, Va.: American Diabetes Association.

  • Biermann, J., Rubin, R.R., Toohey, B. (1999). Psyching Out Diabetes: A Positive Approach to Your Negative Emotions. (Third ed.) Los Angeles: McGraw-Hill.