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Anxiety Reduction in Diabetes Mellitus Patients: An Internet-Based Cognitive Behavioral Therapy Intervention Study

In the IDA elective course "Advanced Applications: Individual Differences, Personality, and Health", students write a grant proposal on a topic to improve health in individuals with chronic diseases by promoting lifestyle change. Congratulations to Sophie van Lieshout for winning (one of) the best grant proposal award! 

The Problem

Diabetes Mellitus (DM) is a metabolic disorder causing elevated blood glucose levels (i.e., hyperglycemia) as a result of the body’s inability to secrete sufficient amounts of insulin to store blood glucose (Type 1 DM) or the body’s insensitivity to insulin (Type 2 DM) [1, 2]. It affects approximately 415 million people worldwide, of which 10% suffer from Type 1 DM and 90% from Type 2 DM [1, 3]. To regulate DM, patients should monitor their blood glucose levels throughout the day and respond appropriately in case of hyperglycemia through, for example, the self-injection of insulin or the adjustment of their insulin pump [4, 5]. This can be stressful, so approximately 40% of DM patients experience diabetes-related anxiety symptoms, which is much more than in the healthy population [6-8].

Societal Relevance

Not only can these anxiety symptoms negatively affect a person’s quality of life, but they also adversely impact the progression of DM by impacting metabolic processes or leading to avoidant behaviors regarding, for example, the self-injection of insulin [7, 8]. Therefore, considering the large number of people affected by DM with comorbid anxiety symptoms, it is of great importance to devote attention to this topic and to develop an efficient intervention to reduce the anxiety symptoms and thus prevent the worsening of DM.

Scientific Relevance

An evidence-based form of therapy that has been shown effective in the reduction of diabetes-related anxiety in patients with Type 2 DM is cognitive-behavioral therapy (CBT) [9-12]. However, research on its effectiveness in Type 1 DM patients is largely lacking and although most DM patients suffer from Type 2 DM, Type 1 DM patients must not be forgotten, as anxiety symptoms are equally relevant for them [7].
Additionally, the implementation of CBT online is gaining popularity, as this significantly reduces time and cost investments and is equally effective as face-to-face CBT [12, 13]. However, studies investigating the effectiveness of internet-based CBT (iCBT) in patients with DM have mainly targeted the reduction of depressive symptoms and reported a decrease in depressive, as well as anxiety symptoms [13], but it is unclear whether this decrease in anxiety symptoms is attributable to the iCBT intervention or the decrease in depressive symptoms. Therefore, research focusing solely on the effectiveness of iCBT for DM patients with diabetes-related anxiety symptoms is needed.

Outline and Timeline of the Study

Fit within HSRI Theme: Personalized Prevention and Care

This study fits within the HSRI cross-cutting theme of “Personalized Prevention and Care”, in which the topic of integration of individual differences into health care is central. The iCBT intervention developed for the current study is a flexible program that can be tailored to the needs of individuals. For example, treatment goals will be discussed in the first session to identify the patient’s needs and desired gains. In subsequent sessions, the patient’s specific maladaptive beliefs and thoughts will be identified and challenged and problem-solving skills will be identified that suit the capabilities of the patient. Therefore, in the iCBT intervention, individual differences are acknowledged and incorporated into treatment, to make it individually tailored.
Another strong suit of this iCBT intervention is that its costs regarding time and money are relatively low compared to face-to-face CBT, making it more accessible to a greater number of people. As it is expected that the iCBT intervention will be effective in reducing diabetes-related anxiety symptoms, costs can be minimized, while the quality of healthcare is guarded as well.

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