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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
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.
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.
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.
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.
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.
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.
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 www.cdc.gov/diabetes/pubs/factsheet11.htm.
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.
Crane, R. (2009). Mindfulness-based cognitive therapy. East Sussex: Routledge.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. NY: Delacorte. 1990.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.
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.
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.
Ledesma, D., & Kumano, H. (2009). Mindfulness-based stress reduction and cancer: a meta-analysis. Psycho-Oncology, 18(6), 571–579.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Schroevers, M.J. & Fleer, J. (2009). Treatment protocol for individual mindfulness: a training for people with diabetes. Unpublished manual
Schwarzer, R., Diehl, M. & Schmitz, G. S. The self-regulation scale. Retrieved March 12th 2009 from http://userpage.fu-berlin.de/∼health/selfreg.htm
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.
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.
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.
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.
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.
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.
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.
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.
Williams, J. M. G. (2008). Mindfulness, depression, and modes of mind. Cognitive Therapy and Research, 32(6), 721–733.
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.
About this article
Cite this article
Schroevers, M.J., Tovote, K.A., Keers, J.C. et al. Individual Mindfulness-Based Cognitive Therapy for People with Diabetes: a Pilot Randomized Controlled Trial. Mindfulness 6, 99–110 (2015). https://doi.org/10.1007/s12671-013-0235-5
- Randomized controlled trial