, Volume 6, Issue 1, pp 99–110 | Cite as

Individual Mindfulness-Based Cognitive Therapy for People with Diabetes: a Pilot Randomized Controlled Trial

  • Maya J. SchroeversEmail author
  • K. Annika Tovote
  • Joost C. Keers
  • Thera P. Links
  • Robbert Sanderman
  • Joke Fleer


Diabetes mellitus is a highly prevalent chronic health condition that places patients at greater risk for psychological problems. Yet, there is still a lack of empirical evidence to support the use of psychological interventions in patients with diabetes. In this trial, we examined the feasibility of a novel intervention: individual mindfulness-based cognitive therapy (I-MBCT), an adaptation of the well-known group MBCT. We examined the feasibility of screening, recruiting, randomizing, and retaining patients into the study and their acceptability of I-MBCT. Descriptive analyses were performed to explore changes in patients' functioning over time, comparing those receiving I-MBCT with those in the waitlist control group. A sample of consecutive patients with diabetes was screened on psychological symptoms and when reporting elevated levels of symptoms, approached for the intervention trial. Patients completed self-report questionnaires pre- and postintervention regarding psychological functioning (i.e., depressive symptoms, diabetes-related distress), mindfulness (i.e., act with awareness, accept without judgment), and attention regulation. In total, 499 patients were approached, of whom 347 patients filled out the screening questionnaire. Of these, 38 patients were eligible, and 24 were randomized in I-MBCT (n = 12) or waitlist (n = 12). Two of the 12 patients assigned to I-MBCT dropped out of the intervention. Most patients were very satisfied with I-MBCT. Preliminary analyses suggest that, compared to controls, patients receiving I-MBCT reported significant reductions in depressive symptoms and diabetes-related distress and improvements in act with awareness and attention regulation. This is the first RCT on individual-based MBCT, providing encouraging evidence for its feasibility and acceptability. Preliminary findings also suggest that I-MBCT may be associated with improvements in psychological functioning, which support larger trials on this alternative form of mindfulness-based therapy.


Diabetes Depression Mindfulness Therapy Intervention Randomized controlled trial 


  1. Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes—a meta-analysis. Diabetes Care, 24, 1069–1078.PubMedCrossRefGoogle Scholar
  2. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45.PubMedCrossRefGoogle Scholar
  3. Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342.PubMedCrossRefGoogle Scholar
  4. Beltman, M. W., Voshaar, R. C., & Speckens, A. E. (2010). Cognitive–behavioral therapy for depression in people with a somatic disease: meta-analysis of randomized controlled trials. The British Journal of Psychiatry, 197(1), 11–19.PubMedCrossRefGoogle Scholar
  5. Bohlmeijer, E., ten Klooster, P. M., Fledderus, M., Veehof, M., & Baer, R. (2011). Psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form. Assessment, 18(3), 308–320.PubMedCrossRefGoogle Scholar
  6. Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms, and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31(1), 23–33.PubMedCrossRefGoogle Scholar
  7. Centers for Disease Control and Prevention (CDC). (2011). National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: US Department of Health and Human Services. Available at
  8. Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. Journal of Alternative and Complementary Medicine, 15(5), 593–600.CrossRefGoogle Scholar
  9. Crane, R. (2009). Mindfulness-based cognitive therapy. East Sussex: Routledge.Google Scholar
  10. Diehl, M., Semegon, A. B., & Schwarzer, R. (2006). Assessing attention control in goal pursuit: a component of dispositional self-regulation. Journal of Personality Assessment, 86(3), 306–317.PubMedCentralPubMedCrossRefGoogle Scholar
  11. Diehr, P. H., Derleth, A. M., McKenna, S. P., Martin, M. L., Bushnell, D. M., Simon, G., et al. (2006). Synchrony of change in depressive symptoms, health status, and quality of life in persons with clinical depression. Health and Quality of Life Outcomes, 4, 27.PubMedCentralPubMedCrossRefGoogle Scholar
  12. Fjorback, L. O., Arendt, M., Ornbol, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124, 102–119.PubMedCrossRefGoogle Scholar
  13. Fleer, J., Tovote, K. A., Keers, J. C., Links, T. P., Sanderman, R., Coyne, J. C., et al. (2013). Screening for depression and diabetes-related distress in a diabetes outpatient clinic. Diabetic Medicine, 30, 88–94.PubMedCrossRefGoogle Scholar
  14. Foley, E., Baillie, A., Huxter, M., Price, M., & Sinclair, E. (2010). Mindfulness-based cognitive therapy for individuals whose lives have been affected by cancer: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 78(1), 72–79.PubMedCrossRefGoogle Scholar
  15. Griffiths, K., Camic, P. M., & Hutton, J. M. (2009). Participant experiences of a mindfulness-based cognitive therapy group for cardiac rehabilitation. Journal of Health Psychology, 14(5), 675–681.PubMedCrossRefGoogle Scholar
  16. Grossman, P., Kappos, L., Gensicke, H., D'Souza, M., Mohr, D. C., Penner, I. K., et al. (2010). MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial. Neurology, 75(13), 1141–1149.PubMedCentralPubMedCrossRefGoogle Scholar
  17. Grossman, P., Tiefenthaler-Gilmer, U., Raysz, A., & Kesper, U. (2007). Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychotherapy and Psychosomatics, 76(4), 226–233.PubMedCrossRefGoogle Scholar
  18. Hartmann, M., Kopf, S., Kircher, C., Faude-Lang, V., Djuric, Z., Augstein, F., et al. (2012). Sustained effects of a mindfulness-based stress-reduction intervention in type 2 diabetic patients design and first results of a randomized controlled trial (the Heidelberger Diabetes and Stress-Study). Diabetes Care, 35, 945–947.PubMedCentralPubMedCrossRefGoogle Scholar
  19. Hermanns, N., Kulzer, B., Krichbaum, M., Kubiak, T., & Haak, T. (2006). How to screen for depression and emotional problems in patients with diabetes: comparison of screening characteristics of depression questionnaires, measurement of diabetes-specific emotional problems, and standard clinical assessment. Diabetologia, 49(3), 469–477.PubMedCrossRefGoogle Scholar
  20. Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.PubMedCentralPubMedCrossRefGoogle Scholar
  21. Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. NY: Delacorte. 1990.Google Scholar
  22. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.Google Scholar
  23. Lamers, F., Jonkers, C. C., Bosma, H., Knottnerus, J. A., & van Eijk, J. T. (2011). Treating depression in diabetes patients: does a nurse-administered minimal psychological intervention affect diabetes-specific quality of life and glycaemic control? A randomized controlled trial. Journal of Advanced Nursing, 67(4), 788–799.PubMedCrossRefGoogle Scholar
  24. Lau, M. A., Colley, L., Willett, B. R., & Lynd, L. D. (2012). Employee's preferences for access to mindfulness-based cognitive therapy to reduce the risk of depressive relapse-a discrete choice experiment. Mindfulness, 3, 318–326.CrossRefGoogle Scholar
  25. Ledesma, D., & Kumano, H. (2009). Mindfulness-based stress reduction and cancer: a meta-analysis. Psycho-Oncology, 18(6), 571–579.PubMedCrossRefGoogle Scholar
  26. Lin, E. H., Katon, W., Von Korff, M., Rutter, C., Simon, G. E., Oliver, M., et al. (2004). Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care, 27, 2154–2160.PubMedCrossRefGoogle Scholar
  27. Lustman, P. J., Anderson, R. J., Freedland, K. E., de Groot, M., Carney, R. M., & Clouse, R. E. (2000). Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care, 23, 934–942.PubMedCrossRefGoogle Scholar
  28. Lustman, P. J., Griffith, L. S., Freedland, K. E., Kissel, S. S., & Clouse, R. E. (1998). Cognitive behavior therapy for depression in type 2 diabetes mellitus. A randomized, controlled trial. Annals of Internal Medicine, 129(8), 613–621.PubMedCrossRefGoogle Scholar
  29. Nyklicek, I., & Kuijpers, K. F. (2008). Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: is increased mindfulness indeed the mechanism? Annals of Behavioral Medicine, 35(3), 331–340.PubMedCentralPubMedCrossRefGoogle Scholar
  30. Polonsky, W. H., Anderson, B. J., Lohrer, P. A., Welch, G., Jacobson, A. M., Aponte, J. E., et al. (1995). Assessment of diabetes-related distress. Diabetes Care, 18(6), 754–760.PubMedCrossRefGoogle Scholar
  31. Pradhan, E. K., Baumgarten, M., Langenberg, P., Handwerger, B., Kaplan Gilpin, A., Magyari, T., et al. (2007). Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis and Rheumatism, 57, 1134–1142.PubMedCrossRefGoogle Scholar
  32. Radloff, L. S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  33. Rosnow, R. L., & Rosenthal, R. (1996). Computing contrasts, effect sizes, and counternulls on other people's published data: general procedures for research consumers. Psychological Methods, 1, 331–340.CrossRefGoogle Scholar
  34. Rustad, J. K., Musselman, D. L., & Nemeroff, C. B. (2011). The relationship of depression and diabetes: pathophysiological and treatment implications. Psychoneuroendocrinology, 36(9), 1276–1286.PubMedCrossRefGoogle Scholar
  35. Schneider, S., Moyer, A., Knapp-Oliver, S., Sohl, S., Canella, D., & Targhetta, V. (2010). Pre-intervention distress moderates the efficacy of psychosocial treatment for cancer patients: a meta-analysis. Journal of Behavioral Medicine, 33(1), 1–14.PubMedCentralPubMedCrossRefGoogle Scholar
  36. Schroevers, M.J. & Fleer, J. (2009). Treatment protocol for individual mindfulness: a training for people with diabetes. Unpublished manualGoogle Scholar
  37. Schwarzer, R., Diehl, M. & Schmitz, G. S. The self-regulation scale. Retrieved March 12th 2009 from∼health/selfreg.htm
  38. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press.Google Scholar
  39. Unnebrink, K., & Windeler, J. (2001). Intention-to-treat: methods for dealing with missing values in clinical trials of progressively deteriorating diseases. Statistics in Medicine, 20, 3931–3946.PubMedCrossRefGoogle Scholar
  40. Van der Feltz-Cornelis, C. M., Nuyen, J., Stoop, C., Chan, J., Jacobson, A. M., Katon, W., et al. (2010). Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis. General Hospital Psychiatry, 32, 380–395.PubMedCrossRefGoogle Scholar
  41. Van Scheppingen, C., Schroevers, M. J., Smink, A., van der Linden, Y. M., Mul, V. E., Langendijk, J. A., et al. (2011). Does screening for distress efficiently uncover meetable unmet needs in cancer patients? Psycho-Oncology, 20, 655–663.PubMedCrossRefGoogle Scholar
  42. Van Son, J., Nyklicek, I., Pop, V. J., Blonk, M. C., Erdtsieck, R. J., Spooren, P. F., et al. (2013). The effects of a mindfulness-based intervention on emotional distress, quality of life, and HbA1c in outpatients with diabetes (DiaMind): a randomized controlled trial. Diabetes Care, 36(4), 823–830.PubMedCentralPubMedCrossRefGoogle Scholar
  43. Veehof, M. M., Ten Klooster, P. M., Taal, E., Westerhof, G. J., & Bohlmeijer, E. T. (2011). Psychometric properties of the Dutch five facet mindfulness questionnaire (FFMQ) in patients with fibromyalgia. Clinical Rheumatology, 30(8), 1045–1054.PubMedCentralPubMedCrossRefGoogle Scholar
  44. Welch, G., Weinger, K., Anderson, B., & Polonsky, W. H. (2003). Responsiveness of the problem areas in diabetes (PAID) questionnaire. Diabetic Medicine, 20(1), 69–72. A Journal of the British Diabetic Association.PubMedCrossRefGoogle Scholar
  45. Welch, G. W., Jacobson, A. M., & Polonsky, W. H. (1997). The problem areas in diabetes scale. An evaluation of its clinical utility. Diabetes Care, 20(5), 760–766.PubMedCrossRefGoogle Scholar
  46. Williams, J. M. G. (2008). Mindfulness, depression, and modes of mind. Cognitive Therapy and Research, 32(6), 721–733.CrossRefGoogle Scholar
  47. Würtzen, H, Dalton, S.O., Andersen, K.K., Elsass, P., Flyger, H.L. Sumbundu, A., & Johansen, C. (2012). Who participates in a randomized trial of mindfulness-based stress reduction (MBSR) after breast cancer? A study of factors associated with enrollment among Danish breast cancer patients. Psychooncology, May 16. doi:  10.1002/pon.3094.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Maya J. Schroevers
    • 1
    Email author
  • K. Annika Tovote
    • 1
  • Joost C. Keers
    • 2
  • Thera P. Links
    • 3
  • Robbert Sanderman
    • 1
  • Joke Fleer
    • 1
  1. 1.Section Health PsychologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
  2. 2.Research InstituteMartini Medical CenterGroningenThe Netherlands
  3. 3.Department of EndocrinologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands

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