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Biofeedback and Self-regulation

, Volume 10, Issue 3, pp 241–254 | Cite as

Emotional stress and diabetic control: A postulated model for the effect of emotional distress upon intermediary metabolism in the diabetic

  • Michael B. Evans
Article

Abstract

The findings of a number of clinical investigators across a wide variety of situations and using a wide variety of observational procedures agree on the disruptive effects of emotional distress upon diabetic control. An integrative model of coordinated neural and hormonal reactions to emotional stress and their additive and potentiating effects on intermediary metabolism in proposed. The end result of these effects, as part of a general fight/flight or defense-alarm reaction, is a strong energy mobilization response (namely, a sharp rise in blood glucose and free fatty acid levels resulting in increased levels of serum cholesterol, triglycerides, and ketone bodies), which the diabetic cannot readily counterregulate. It is further proposed that increased diabetic control, together with lower insulin requirements, may result from the inclusion of stress management procedures as an adjunct to traditional medical treatment. The findings of a large number of investigators supporting these propositions are presented and discussed.

Descriptor Key Words

stress diabetes diabetic control stress and diabetes intermediary metabolism stress and intermediary metabolism 

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References

  1. Bakal, D. A. (1979).Psychology and medicine. New York: Springer.Google Scholar
  2. Baker, L., Kaye, R., & Haque, N. (1967). Studies on metabolic homeostasis in juvenile diabetes mellitus. II. Role of catecholamines.Diabetes, 16 504.Google Scholar
  3. Beisswenger, P. J., & Spiro, R. G. (1973). Studies on the human glomerular basement membranc. Composition, nature of the carbohydrate units and chemical changes in diabetes mellitus.Diabetes, 22 180.Google Scholar
  4. Benson, H. (1975).The relaxation response. New York: William Morrow.Google Scholar
  5. Benson, H. (1978). The Relaxation Response; An innate capacity for dealing with stress. New York: BMA Audio Cassette.Google Scholar
  6. Chase, H. P., & Jackson, G. G. (1981). Stress and sugar control in children with insulin dependent diabetes mellitus.Journal of Pediatrics, 98(6), 1011–1013.Google Scholar
  7. Clarke, B. F. (1979). The management of maturity-onset diabetes: Clinical experience with chlorpropamide. In R. Levine (Ed.),Individualizing therapy in maturity-onset diabetes. New York: Science and Medicine Publishing Company.Google Scholar
  8. Ellenberg, M. (1979). When diet fails: Individualizing therapy with hypoglycemic agents. In R. Levine (Ed.),Individualizing therapy in maturity-onset diabetes. New York: Science and Medicine Publishing Company.Google Scholar
  9. Everly, G. S., & Rosenfeld, R. (1981).The nature and treatment of the stress response. New York: Plenum Press.Google Scholar
  10. Farhion, S. (1982).Biobehavioral treatment of essential hypertension. Report to National Institute of Health.Google Scholar
  11. Foa, P. P., & Galansino, G. (1962).Glucagon: Chemistry and function in health and disease. Springfield, Illinois: Charles C Thomas.Google Scholar
  12. Fowler, J. E., Budzynski, T. H., & VandenBergh, R. L. (1976). Effects of an EMG biofeedback relaxation program on the control of diabetes.Biofeedback and Self-Regulation, 1 105–112.Google Scholar
  13. Ganong, W. F. (1979).Review of medical physiology. Los Altos: Lange Medical Publications.Google Scholar
  14. Greydanus, D. E., & Hofmann, A. D. (1979). Psychological factors in diabetes mellitus; A review of the literature with emphasis on adolescence.American Journal of Diseases of Children, 133 1031–1075.Google Scholar
  15. Hinkle, L. E., & Wolf, S. (1950). Studies in diabetes mellitus: Changes in glucose, ketone, and water metabolism during stress.Research Publication of the Association for Research in Nervous and Mental Disease, 29 338.Google Scholar
  16. Hinkle, L. E., & Wolf, S. (1952). The effect of stressful life situations on the concentration of blood glucose in diabetic and nondiabetic humans.Diabetes, 1 383.Google Scholar
  17. Horiuchi, A., Kitamura, S., Tanaka, G., & Matsuoka, K. (1973).A comparative study of quantitative examinations in diabetic neuropathy. Paper presented at the Eighth Congress of the International Diabetes Federation, Brussels, 1973.Google Scholar
  18. Knobil, E., & Hotchkiss, J. (1964). Growth hormones.Annual Review of Physiology, 26 47.Google Scholar
  19. Koch, M. F., & Milnar, G. D. (1974). Psychiatric aspects of patients with unstable diabetes mellitus.Psychosomatic Medicine, 36 57.Google Scholar
  20. Kravitz, A. R., Isenberg, P. H., Shore, M. F., & Barnett, D. M. (1971). Emotional factors in diabetes mellitus. In A. L. Marble, P. White, R. F. Bradley, & L. P. Krall, (Eds.),Joslin's diabetes mellitus (11th ed.). Philadelphia: Lea and Ferbiger.Google Scholar
  21. Levi, L. (1972). Psychosocial stimuli, psychophysiological reactions and disease.Acta Medica Scandinavica, Entire Supplement 528.Google Scholar
  22. Levine, R. (1979). Discussion: Individualizing therapy with hypoglycemic agents. In R. Levine (Ed.),Individualizing therapy in maturity-onset diabetes. New York: Science and Medicine Publishing Company.Google Scholar
  23. Luthe, W., & Schultz, J. H. (1969).Autogenic therapy. Volume II: Medical applications. New York: Grune and Stratton.Google Scholar
  24. MacGillivray, M. H., Bruck, E., & Voorhees, L. (1981). Acute diabetic ketoacidosis in children: Role of the stress hormones.Pediatric Research, 15(2), 99.Google Scholar
  25. Marigo, S., Zanvettor, R., Biagini, G., Manno, R., Del Nevo, G., & Canova, G. (1977). Psychological problems of adult diabetics.Giornale di Clinica Medical, 57(5–6), 216. (Italian)Google Scholar
  26. Mason, J. W. (1972). Organization of psychoendocrine mechanisms. A review and reconsideration of research. In N. S. Greenfield & R. A. Sternbach (Eds.),Handbook of psychophysiology. New York: Holt, Rinehart & Winston.Google Scholar
  27. McGrady, A. V., Yonker, R., Tan, S. Y., Fine, T. H., & Woerner, M. (1981). The effect of biofeedback-assisted relaxation training on blood pressure and selected biochemical parameters in patients with essential hypertension.Biofeedback and Self-Regulation, 6 343–353.Google Scholar
  28. Michon, P., Larcan, A., Huriet, C., Vert, P. M., & Fonder, H. L. (1961). Acidose diabétique psychogène: À propos de deux observations particulièrement démonstratives.Le Diabète, 9 91.Google Scholar
  29. Minuchin, S., Baker, L., & Rosmon, B. (1975). A conceptual model of psychosomatic illness in children: Family organization and family therapy.Archives of General Psychiatry, 32 1031.Google Scholar
  30. Minuchin, S. (1977).Psychosomatic diabetic children and their families. DHEW Publications No. (ADM) 77–477.Google Scholar
  31. Obrist, P. A. (1981).Cardiovascular psychophysiology: A perspective. New York: Plenum Press.Google Scholar
  32. Patel, C. H. (1977). Biofeedback-aided relaxation and meditation in the management of hypertension.Biofeedback and Self-Regulation, 2 1–41.Google Scholar
  33. Patel, C., Marmot, M., & Terry. D. (1981). Controlled trial of biofeedback-aided behavioral methods in reducing mild hypertension.British Medical Journal, 6281 2005–2008.Google Scholar
  34. Peck, F. B., & Peck, F. B. Jr. (1956). Tautologous diabetic coma: A behavior syndrome: Multiple episodes of diabetic coma.Diabetes, 5 44.Google Scholar
  35. Pelletier, K. R. (1977).Mind as healer, mind as slayer. New York: Dell.Google Scholar
  36. Randle, P. J. (1963). Endocrine control of metabolism.Annual Review of Physiology, 25 291.Google Scholar
  37. Rose, M. I., Firestone, P., Heick, H. M. C., & Faught, A. K. (1983). The effects of anxiety management training on the control of juvenile diabetes mellitus.Journal of Behavioral Medicine, 6 381–395.Google Scholar
  38. Sanders, K., Mills, J., Martin, F. I., & Del Horne, D. J. (1975). Emotional attitudes in adult insulin-dependent diabetics.Journal of Psychosomatic Research, 19 241.Google Scholar
  39. Schade, D. S., & Eaton, R. P. (1980). The temporal relationship between endogenously secreted hormones and metabolic decompensation in diabetic man.Journal of Clinical Endocrinology and Metabolism, 50 131.Google Scholar
  40. Seeburg, K. N., & DeBoer, K. F. (1980). Effects of biofeedback on diabetes.Biofeedback and Self-Regulation, 5 289–293.Google Scholar
  41. Selye, H. (1976).Stress in health and disease. Reading, Mass.: Butterworth's Press.Google Scholar
  42. Shamoon, H., Hendler, R., & Sherwin, R. S. (1980). Altered responsiveness to cortisol, epinephrine, and glucagon in insulin-infused juvenile-onset diabetes.Diabetes, 29 284.Google Scholar
  43. Shapiro, A. P., Schwartz, G. E., Ferguson, D. C., Redmond, D. P., & Weiss, A. M. (1977). Behavioral methods in the treatment of hypertension: A review of their clinical status.Annals of Internal Medicine, 86 626–636.Google Scholar
  44. Shapiro, D. H. (1980).Meditation: A scientific and personal exploration. New York: Aldine.Google Scholar
  45. Spiro, R. G., & Spiro, M. J. (1971). Effects of diabetes on the biosynthesis of the renal glomerular basement membrane.Diabetes, 20 641.Google Scholar
  46. Stearns, S. (1959). Self-destructive behavior in young patients with diabetes mellitus.Diabetes, 8 379.Google Scholar
  47. Suinn, R. (1975). Anxiety management training for general anxiety. In R. Suinn, & R. Weigel, (Eds.),The innovative psychological therapies. New York: Harper & Row.Google Scholar
  48. Surwit, R. S., & Feinglos M. N. (1983). The effects of relaxation on glucose tolerance in non-insulin dependent diabetes.Proceedings of the 14th Meeting of the Biofeedback Society of America, Denver.Google Scholar
  49. Tepperman, J. (1973).Metabolic and endocrine physiology (3rd ed.). Chicago: Year Book Medical Publishers.Google Scholar
  50. Turkat, I. D. (1982a). The use of EMG biofeedback with insulin-dependent diabetic patients.Biofeedback and Self-Regulation, 7 301–304.Google Scholar
  51. Turkat, I. D. (1982b). Glycosylated hemoglobin levels in anxious and non-anxious diabetic patients.Psychosomatics, 23 1056–1058.Google Scholar
  52. Vandenberg, R. L. (1966). Effects of hypnotically induced emotional stress on carbohydrate and lipid metabolism in a patient with diabetes mellitus.Psychosomatic Medicine, 28 382.Google Scholar
  53. Well, W. B., & Sussman, M. B. (1961). Behavior, diet, and glycosuria of diabetic children in summer camp.Pediatrics, 27 118.Google Scholar
  54. Whitehouse, F. W. (1979). Diabetes mellitus: An overview, In B. A. Hamburg, L. F. Lipsett, G. E. Inoff, & A. L. Drash (Eds.),Behavioral and psychosocial issues in diabetes. Washington, D.C.: National Institutes of Health.Google Scholar
  55. Williams, R. H. (1968).Textbook of endocrinology. Philadelphia: W. B. Saunders.Google Scholar
  56. Wolf, S., & Berle, B. B. (Eds.). (1975).Dilemmas in diabetes. New York: Plenum Press.Google Scholar

Copyright information

© Plenum Publishing Corporation 1985

Authors and Affiliations

  • Michael B. Evans
    • 1
  1. 1.Center for Stress and Coping, P.C.Oak Brook

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