Effects Of Motivational Enhancement Therapy Plus On Diabetic Patients With Depression

PICO table

The research question is prepared with the help of the PICO framework. It mainly contains four important components that help in forming a proper clinical question. The research question that is developed is

“Does cognitive therapy along with Glycemic therapy provide better health outcomes on diabetic patients with depression in comparison to when only Glycemic intervention is provided alone?”

 Different key search terms had been used which include “cognitive behavioral therapy, Glycemic therapy, better health outcome, diabetes patients, diabetes with depression and others. These words are mainly fed in the two electronic bases like the PubMed, CINAHL and Medscape. These phrases were mainly taken in combination with that of the Boolean operators like the ‘AND’ and ‘OR’. These operators helped in broadening as well as narrowing the search results. Filters were used as it helped in the extraction of the different arricles that were published on or after 2014. Only English language paper was selected.

PICO table:

Researchers had conducted an interesting study with the motive of checking the effectiveness of the motivational enhancement therapy plus cognitive behavior therapy on depressive symptoms as well as in the health related quality of lives of people with type-2 diabetes. The research paradigm can be considered to be based on positivism (Huang et al., 2015). This is said so because the researchers had been seen to derive the conclusions about the effectiveness of the interventions through application of reason as well as logic. About 61 diabetes type-2 patients with depression were selected and were randomly allocated to two groups. One group was given the usual nutrition based and health education based care. The other group was also provided the same in addition to motivational enhancement therapy plus cognitive behavior therapy. The experimental group was seen to experience a significant reduction in the glycosylated hemoglobin, fasting glucose, and depressive symptoms and a significant increase in physical quality of life and mental quality of life. The people in the control group did not show any changes over time. Ethical considerations were followed effectively. Independent T test was done for statistical analysis if the results of two groups. The Institutional Review Board had been seen to approve the study. Written consents were taken from the participants. Confidentiality was also maintained throughout the study.

Evidence base articles are of the opinion that diabetes patients become vulnerable to the development of depression in the course of their health management procedures. About 30 to 40% of the diabetes patients come for treatment in the healthcare centers along with the com-morbid chronic issues of depression. Therefore, in order to ensure quality life of the patient provided pharmacological treatment like medication and Glycemic therapy cannot help the individuals completely to develop quality life. Therefore, nursing professionals need to develop interventions that would help in treating depression in the diabetes patient besides the mentioned interventions (Uchendu & Blake, 2017).

Research topic

Relationships between diabetes and depression are intricately associated. Different studies have given forward their thesis explaining the connection between depression and diabetes. Many of the studies have supported that the rigors of management of the diabetes can be often stressful and this aspect might lead to the symptoms of depression. Other studies have also found that diabetes can cause different complications and health problems and therefore these factors might worsen the symptoms of depression (Sharif et al., 2014). Again, the opposite approaches are discussed in the other articles. Researchers have stated that depression might lead to different poor lifestyle choices like unhealthy eating, smoking, less exercise and others that are actually the risk factors of diabetes. Depression can interfere with the ability to take self-care, perform tasks, and communicate effectively and others and therefore these can interfere with ability to manage successfully diabetes (Echevaria & Walker, 2014)).

Therefore, nurses should try to develop interventions which not only cures diabetes but also cures depression in the patients as both the disorders are found to be inter-connected and associated with each other. This research question is prepared following the National Strategic Framework for chronic conditions. The framework also takes in consideration with the ever-increasing rates of chronic conditions in the population of Australia because of changes in their lifestyles (Harvey, 2015). The solving of the research topic will be helping a large population of people who are suffering from the co-morbid situation of diabetes and depression and leading poor quality lives.

A study had been conducted a randomized control trial with diabetic patients who were also suffering from depression. The experimental group who had received motivational enhancement therapy plus cognitive behavior therapy along with the usual care for diabetes had better outcomes than the control groups who only received usual care. Positive health outcomes were found as reduction in the glycosylated hemoglobin, fasting glucose, and depressive symptoms and increase in physical quality of life and mental quality of life in the experimental group. However, patients in the control group received the usual care and did not show any changes over the time (Huang et al., 2015). Therefore, it can be stated that the behavioral interventions helped in facilitation of the significant improvement in the Glycemic control as well as psychological adjustment. These helped the patient in strengthening their diabetes control skills. Therefore, nurses can take part in the delivering of behavioral intervention for diabetes patients to decrease their depressive symptoms (Sharif et al., 2014)).

Literature review

Another research had also discussed the importance of Mindfulness-Based Cognitive Therapy and Cognitive Behavior Therapy for the treatment of the depressive symptoms in the patients with diabetes. One interesting feature was that the researchers only did not consider the diabetes type-2 patients but also the type-1 patients as well. The study had shown that application of both MBCT and CBT was associated with greater reduction of the depressive symptoms in the patient in the experimental group in comparison to the patients in the waiting list control who received only the usual care (Tovote et al., 2014). Both the interventions were also found to have a positive impact on the other indicators off functioning as well. It increased the well-being as well as the reduction of the anxiety and diabetes related distress. Therefore, from this result, it can be stated that both the psychological interventions not only help in managing depressive mental issues but also have positive outcomes of diabetes management and ensures better quality living in the diabetes patient. However, the study showed that these interventions did not have positive impacts on management of the HbA1c values. These might be because the values were obtained from patient’s medical records instead of the scheduling additional measurements at designated time points. Therefore, further researches on this aspect can be conducted in the future as well.

Another study conducted that showed the efficacy of using web-technology as well as mobile phone interventions for those diabetic individuals who are also suffering from depression but have poor access to mental healthcare services or does not want to take mental health services. The program was named “Mycompass” and had modules with detailed description and steps that would help in motivating the individuals to change their behaviors and overcome depressive symptoms. The study showed that consumers have accepted this program positively and depressive symptoms were seen to be improved significantly. They accepted it as an effective and accept treatment option for the people with the diabetes (Menting et al., 2017). However, one interesting aspect that the researchers also discussed is the significant and sustained improvements in the diabetes self-efficacy beliefs and diabetes related distress. The striking feature found here that although the program “Mycompass” had no diabetes management specific content, yet it brought out positive outcomes in diabetes related health situations. Improvement in the self-confidence and being energetic by nature can be the suspected contributors that make the patients manage their diabetes symptoms and comply with the interventions successfully.

Dissemination of the research findings can be explained as the process that involves distribution of the results to the different individuals. Such individuals would be able to use the information and this would help in maximizing the benefits of the aim without any form of delay. The primary findings of the research are that cognitive behavioral therapy along with usual care in diabetic people with depression yield positive outcomes (Semenkovich et al., 2015). They help in managing the depression and have positive outcomes on the effective management of diabetes symptoms. The core principle of the dissemination would mainly be focusing on the engagement off the stakeholders and utilization of the appropriate opportunities. The main audience would be the nursing professionals involving them from the first steps planning to that of the steps if implementation (Echevari et al., 2014). Again, gaining feedbacks and suggestions from the nurses on this approach would help the organizations to develop better plans for increasing awareness among patients and developing their accessibilities to such forms of treatments. Podcasts, blogs, and social media, info-graphics and many others can be utilised for spreading the research ideas among the patients, nurses, healthcare organisations, charities and others so that they can also get benefits from the research (Alanzi et al., 2014).

It is important for the healthcare professionals working in the primary healthcare centers to participate in training procedures to develop skills to conduct cognitive behavioral therapy. Evidence based researches show that most of the patients of diabetes suffer from depression. As the primary healthcare professionals need to provide holistic and comprehensive care to the patients, therefore, it becomes their duty to be trained in the psychological therapies besides providing the usual care to the patients (Nordgreen et al., 2016). The training procedures will help them to develop skills and will make them able to provide a comprehensive care that will help in healing both mental and physical symptoms. These would help in developing the quality life of the patients (Huang et al., 2016).

The healthcare organizations also need to incorporate enough resources so that the professionals can provide this form of comprehensive treatment plan. Moreover, they should also brainstorm and find out innovative strategies like the web-based technologies and mobile applications by which they can make the comprehensive form of treatments reach out to the remote areas of the nation or for those who are suffering from self-stigma and do not want to reveal the mental health issues to professionals (Hermans et al., 2015). Development of patient awareness is also important and patients should be made to know about the treatments options that include such psychological therapies. Organizations should develop policies and incorporate the interventions in diabetes treatment and management protocols (Menting et al., 2017).

References:

Alanzi, T. M., Istepanian, R. S., & Philip, N. (2014, August). An integrated model for cognitive behavioural therapy for mobile diabetes self-management system. In 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (pp. 5393-5396). IEEE.

Echevarria, I. M., & Walker, S. (2014). To make your case, start with a PICOT question. Nursing2018, 44(2), 18-19.

Harvey, J. N. (2015). Psychosocial interventions for the diabetic patient. Diabetes, metabolic syndrome and obesity: targets and therapy, 8, 29.

Hermanns, N., Schmitt, A., Gahr, A., Herder, C., Nowotny, B., Roden, M., … & Kulzer, B. (2015). The effect of a diabetes-specific cognitive behavioral treatment program (DIAMOS) for patients with diabetes and subclinical depression: results of a randomized controlled trial. Diabetes Care, dc141416.

Huang, C. Y., Lai, H. L., Chen, C. I., Lu, Y. C., Li, S. C., Wang, L. W., & Su, Y. (2016). 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. Quality of Life Research, 25(5), 1275-1283.

Menting, J., Tack, C. J., van Bon, A. C., Jansen, H. J., van den Bergh, J. P., Mol, M. J., … & Knoop, H. (2017). Web-based cognitive behavioural therapy blended with face-to-face sessions for chronic fatigue in type 1 diabetes: a multicentre randomised controlled trial. The Lancet Diabetes & Endocrinology, 5(6), 448-456. 

Nordgreen, T., Haug, T., Öst, L. G., Andersson, G., Carlbring, P., Kvale, G., … & Havik, O. E. (2016). Stepped care versus direct face-to-face cognitive behavior therapy for social anxiety disorder and panic disorder: A randomized effectiveness trial. Behavior therapy, 47(2), 166-183.

Semenkovich, K., Brown, M. E., Svrakic, D. M., & Lustman, P. J. (2015). Depression in type 2 diabetes mellitus: prevalence, impact, and treatment. Drugs, 75(6), 577-587.

Sharif, F., Masoudi, M., Ghanizadeh, A., Dabbaghmanesh, M. H., Ghaem, H., & Masoumi, S. (2014). The effect of cognitive-behavioral group therapy on depressive symptoms in people with type 2 diabetes: A randomized controlled clinical trial. Iranian Journal of nursing and midwifery research, 19(5), 529.

Tovote, K. A., Fleer, J., Snippe, E., Peeters, A. C., Emmelkamp, P. M., Sanderman, R., … & Schroevers, M. J. (2014). Individual mindfulness-based cognitive therapy (MBCT) and cognitive behavior therapy (CBT) for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial. Diabetes care, DC_132918. 

Tovote, K. A., Schroevers, M. J., Snippe, E., Sanderman, R., Links, T. P., Emmelkamp, P. M., & Fleer, J. (2015). Long-term effects of individual mindfulness-based cognitive therapy and cognitive behavior therapy for depressive symptoms in patients with diabetes: a randomized trial. Psychotherapy and psychosomatics, 84(3), 186-187. 

Uchendu, C., & Blake, H. (2017). Effectiveness of cognitive–behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes mellitus: a systematic review and meta?analysis of randomized controlled trials. Diabetic Medicine, 34(3), 328-339. 

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