Academic journal article Journal of Evidence-Based Psychotherapies

Depression and Dysfunctional Beliefs. Predictors of Negative Appraisal of Insulin Treatment

Academic journal article Journal of Evidence-Based Psychotherapies

Depression and Dysfunctional Beliefs. Predictors of Negative Appraisal of Insulin Treatment

Article excerpt

Introduction

The growing number of people with diabetes poses a great concern for the health and quality of life of affected individuals, and places a large burden on health care systems as complications of diabetes can be very serious (e.g., blindness, amputation, kidney failure, heart attack, and even increased risk of cancer) (UK Prospective Diabetes Study (UKPDS) Group, 1998). While newer and more efficient treatments are being developed to better regulate glycemia levels, one of the most efficient treatments is insulin. However, there is a psychological phenomenon that prevents people from benefiting from insulin - refusal of insulin treatment. It is defined as a cognitive and behavioral opposition towards initiating, intensifying insulin or adhering to the recommended regimen, which also includes people with type 1 diabetes, who sometimes omit insulin injections (Brod, Kongsø, Lessard, & Christensen, 2009; Peyrot, Rubin, Kruger, & Travis, 2010). Studies that investigated the percentage of insulin refusal suggest that considerably strong, negative appraisals regarding insulin therapy exist in about one third of the insulin-naïve patients (Peyrot et al., 2005; Polonsky, Fisher, Guzman, Villa-Caballero, & Edelman, 2005).

Several studies (Brod et al., 2009) have investigated the problem of insulin refusal and have highlighted the following explanatory factors: lack of knowledge, cultural taboos and family beliefs, fear of needles and injection pain, fear of hypoglycemia and/or weight gain, interference with daily activities, perception of diabetes as getting worse, feeling like a failure, belief that insulin is causing complications, belief that insulin is associated with a perceived loss of control, perception of diabetes as not serious enough, fear of becoming "addicted to insulin", belief of inability to handle insulin injections, notion that insulin will not be efficient, and lack of trust in the health care team. The majority of these factors fall under the category of cognitive factors, namely beliefs, perceptions, attitudes, most of them not according to scientific realities. Although a large array of factors has been described, there still remains much to be explained.

Depression is another cognitive, behavioral and emotional state that was also found to influence insulin acceptance (Makine et al., 2009). Depression can be regarded as a serious and common complication of diabetes, as a meta-analysis concluded that depression is 2-3 times more prevalent in people with diabetes than in the general population, affecting 10-15% of the diabetes patients (Lustman, Penckofer, & Clouse, 2008). Moreover, depression in diabetes is associated with impaired glycaemic control, and as a consequence depressed diabetes patients are at a higher risk for long-term complications of the disease (Lustman et al., 2008).

As the framework of cognitive-behavioral therapies (in particular, Aaron Beck's Cognitive Behavioral Therapy (Alford & Beck, 1998) and Albert Ellis's Rational Emotive Behavioral Therapy (David, Lynn, & Ellis, 2010; Ellis, 1994) offered predictors for various human behaviors and developed techniques for several psychological disorders (e.g. depression, anxiety, eating behavior, etc.), it could be useful to examine insulin refusal from this perspective.

According to these theories, cognitive processes (perceptions, beliefs, interpretations) are at the root of our emotions and behaviors. When these processes distort reality and/or are illogical, they lead to very intense negative emotions (e.g. depression) and unhealthy behaviors (e.g. refusal of insulin) that can be harmful to one's well-being (e.g. worsening one's health status) and are defined as dysfunctional. At the same time, cognitive processes that stick to reality and logic determine adaptive responses (e.g. accepting insulin) and are defined as functional. Thus, studying the influence of functional and dysfunctional beliefs, and depression on the negative evaluation of insulin treatment is likely to be beneficial. …

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