Abstract
Background & Objectives: Diabetes is a progressive and chronic metabolic disorder. Type 2 diabetes is the result of the body's ineffective use of insulin. However, emotions play an important role in controlling this disease. Previous studies on emotion regulation have focused more on the relationship between emotion regulation components and approaches to mental health. Its effectiveness has been addressed less. This gap is more evident in diabetes. This study investigated the efficacy of emotion regulation training on hypoglycemia fear and experiential avoidance in type 2 diabetic patients.
Methods: The present study was quasi–experimental with a pretest–posttest design and a control group. The statistical population of this study included 1250 type 2 diabetic patients covered by the Charity Association for the Protection of Diabetic Patients in Tehran City, Iran, in 2021. Among them, 40 eligible volunteer patients who met the inclusion criteria were selected by purposeful sampling and were randomly assigned to the experimental and control groups. The inclusion criteria were as follows: residing in Tehran during the therapy sessions, passing at least six months since the disease onset, not using other psychological and psychiatric services simultaneous with this study, being able to attend the therapy sessions, being able to read and write, lacking serious sensory, neurological or psychological diseases like migraine, hearing and vision problems and personality disorders. The exclusion criteria were disobeying the group regulation in the first session and the absence of more than therapy sessions.
The instruments used in this study were the Fear of Hypoglycemia Scale (Cox et al. 1987), which has 28 items. Cox et al. examined the validity of the original version of this questionnaire through the test–retest method. They reported the validity coefficients as 0.85 for the whole questionnaire, 0.76 for the behavior subscale, and 0.64 for anxiety subscale. Another tool was the Experiential Avoidance Questionnaire (Gamz et al. 2011), with 62 questions and six components. Its Cronbach alpha coefficient was 0.92 for the whole questionnaire. The therapy sessions protocol was established based on Gross and Thompson's (2007) approach. The experimental group participated in eight 1.5–hour sessions, training the emotion regulation program, but the control group did not receive any intervention. The obtained data were analyzed using analysis of covariance in SPSS22 software.
Results: The results of the data analysis showed that emotion regulation training reduced the fear of hypoglycemia and experimental avoidance of diabetic patients in the experimental group compared to the control group (p<0.001). By pretest control, the significant levels of all tests indicate a significant difference between type 2 diabetic patients in the experimental group and at least one of the variables of hypoglycemia fear, experiential avoidance (p<0.001). The effect or difference is equal to 0.87. In other words, emotional regulation training has reduced the fear of hypoglycemia and experiential avoidance of type 2 diabetic patients in the experimental group according to the mean fear of hypoglycemia and experiential avoidance of type 2 diabetes in the experimental group compared to the mean of the control group in the posttest stage. The effect or difference rates for fear of hypoglycemia and experiential avoidance were 0.74 and 0.78, respectively. In other words, 74% and 78% of individual differences in the posttest scores of hypoglycemia fear and experiential avoidance in type 2 diabetic patients are related to the effect of emotional regulation training.
Conclusion: Based on the current study results, teaching emotion regulation improves and controls fear of hypoglycemia and reduces experiential avoidance. Therefore, this therapeutic method is recommended to reduce the fear of hypoglycemia and experiential avoidance. It can be considered in designing psychological therapies for patients with type 2 diabetes.