How Acceptance-Based Therapy Can Benefit People With Diabetes

Managing diabetes is an around-the-clock job, and living with depression or other mental health conditions can make managing blood glucose levels and remembering to take medication even more difficult. Yet research suggests that those living with diabetes are at least twice, if not three times, as likely to have depression as people living without. Data has also shown that mental health conditions such as depression are often underdiagnosed among those with diabetes. 

One behavioral strategy for addressing sadness, depression, and other negative thoughts about diabetes is Acceptance and Commitment Therapy (ACT). 

“ACT is a therapy that helps people accept their thoughts and feelings without judgment, focus on what truly matters to them, and take committed actions to live a fulfilling life, even when challenges like chronic illness or negative emotions arise,” said Ashley Peña, National Executive Director of Mission Connection Healthcare, a telehealth mental health service. 

Some research indicates that ACT may help with not only the blood sugar management aspect of diabetes, but self-care and emotional well-being as it relates to living with diabetes, too. One review of people with type 2 diabetes found that ACT improved blood sugar as well as acceptance for diabetes and anxiety levels. While continued research is needed, additional studies suggest that ACT may help individuals navigate the challenges of a chronic disease such as diabetes with greater resilience and a stronger commitment to their health.

Acceptance and commitment therapy: How it works

ACT is a type of cognitive behavioral therapy (a form of psychotherapy that helps people change negative thought patterns and behaviors to improve emotional well-being). Instead of avoiding negative emotions, this acceptance-based approach encourages individuals to acknowledge their negative thoughts without being driven by them, and instead redirects people to focus instead on what priorities are most important.

“For someone with diabetes, ACT can help them stop fighting their negative thoughts about the condition,” Pena said.

“For example, a person might feel overwhelmed by the constant need to manage their blood sugar. ACT helps them accept that these feelings are natural, rather than trying to avoid or suppress them, and instead focus on what’s important to them – like staying active or being present with loved ones – despite the challenges of diabetes,” Peña said.

Don’t try to avoid painful thoughts

At this year’s Diabetes and Mental Health Conference, Rachel Daws, a Boston-based therapist who works with adults living with diabetes and other chronic conditions, discussed how an acceptance-based therapy can offer support for people who are navigating both diabetes and mental health struggles at the same time. Daws, who is also a behavioral health clinician at Boston Medical Center and trained in Acceptance and Commitment Therapy, highlighted some key concepts behind ACT and how they can be applied to support people living with diabetes.

“As humans, our natural tendency when we feel something painful, whether it’s an injury, something uncomfortable, a negative thought — is to get rid of it,” she said. 

Ironically, however, trying to outrun negative thoughts and emotions often has the opposite effect. 

“When we try to avoid feeling negative feelings or thinking negative thoughts, it often ends up leading to more negative thoughts, more negative emotions, and it can actually reduce the quality of our life by pulling us away from the things that are most important to us,” Daws said. 

“We work so hard to avoid feeling that way that we end up missing out on the things that matter most.”

Instead, notice negative thoughts without judgment

That’s where an acceptance-based approach comes into play. “It encourages us to notice that these thoughts are just that,” Daws said. “We can’t make [thoughts] go away, but we can shift how much we allow those feelings to control us.” 

“The first step in getting unstuck from that point is to start to notice the negative thoughts or emotions that we’ve been working so hard to avoid,” Daws said. She encourages patients to drop the ‘if I can’t see it, it can’t hurt me’ mentality.

Identify your core values

A key component of ACT is identifying core values, or the things that are most important to us, as a reminder for people to remember which qualities they truly want to live by. This could be anything from wanting to make a difference in society to being a reliable friend or living a long life.

These values often encompass health and well-being. “What do you want to be able to look back and say about how you took care of your health?” Daws asked. “Maybe it’s ‘I worked really hard to manage my diabetes.’”

Use those values to map your goals

Once you’ve identified your most important values, ACT interventionists might suggest a committed action plan, according to Amie Grant, a licensed professional clinical counselor who utilizes ACT in her practice. 

"For someone managing diabetes and experiencing depression or negative thoughts, ACT interventions might include committed action plans [that involve] developing manageable, value-driven steps like prepping healthy meals, scheduling enjoyable movement, or attending medical appointments, even during periods of low motivation," Grant said. 

For example, you may set a goal to start a running routine that prioritizes their diabetes management, with a goal of running a 5K race using a plan that calls for increasing mileage three times per week over the course of several months. Then hold yourself accountable: Put it on your calendar, tell a friend to check in on your progress, and build in an incentive, like buying a new running belt, to help motivate you to stick with your goal, even when things get tough.

ACT and diabetes: The bottom line 

Acceptance and commitment therapy is a treatment approach that can be used to manage diabetes and mental health conditions like depression, as well as general negative thoughts related to living with diabetes. The approach encourages mindfulness, awareness, and other meaningful actions to address discomfort, as well as commitment to values-based actions.

To learn more about this behavioral approach, Peña recommends finding a peer-reviewed ACT trainer through the Association for Contextual Behavioral Science, and inquiring directly to see if they have experience working with others living with diabetes.

“If they have experience working with chronic conditions like diabetes,” she said, “that can make the therapy more effective.”

More resources for mental health and diabetes:

• Finding Hope After a Diabetes Diagnosis
• DStigmatize: A Movement to End Diabetes Stigma
• Join the Spoonful of Laughter Movement to Address Stigma with Comedy

Photo credits: iStock (top); courtesy source (headshots).