Building Competency in Diabetes Education THE ESSENTIALS

FOUNDATIONS OF DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT| 2-59

concentration, improved coping skills for existing conditions involving pain, and improved self-management behaviours (170,174). One meta-analysis found that mindfulness behaviour therapy (MBT) was effective for reducing anxiety, depression and stress, although its effect on physical parameters was not as clear (175). Abbott et al. found that MBT, MBSR and mindfulness-based cognitive therapy (MBCT) all had psychological benefits across all methods studied, but the effect on clinical parameters, such as blood pressure, albuminuria and stress hormones, was mixed (176). Further research is needed to determine the effect of these interventions on clinical parameters, such as glycemic control. In the Dia Mind study (using MBCT), beneficial effects were noted for emotional distress, perceived stress, anxiety and depressive symptoms in people with diabetes, with lowered level of emotional well-being. These effects were sustained at six months (177). When technology was used to support mindfulness practice, it was found that those who were more mindful were less likely to have physiological signs of stress, and less depressive symptoms (171). One study was seeking to determine which factors could determine who would best respond to MBCT. Their findings indicate that MBCT in diabetes seems to work for most patients, however, there was a lower decrease for depressive symptoms in males, and patients high in extraversion characteristics benefitted less from MBCT (173). So, although it is difficult to compare these ‘mindful interventions’, there does seem to be a consensus that, when a component of mindfulness-based therapy is used, the participants experience a greater sense of well-being through the reduction of anxiety, depression and stress (175).

MBSR is firmly rooted in principles of mind-body medicine, and offers itself to anyone who wishes to learn to enhance his or her own health. Further, the capacity to be mindful lies in all human beings (168).

The Transtheoretical Model of Change The Transtheoretical Model of Change (TTM) may offer a comprehensive framework for SME and SMS planning and implementation that is congruent with the empowerment approach and major educational models. Prochaska and Di Clemente first described this model when seeking to integrate existing behaviour change theories described above (178). They believed