WASHINGTON -- Increasing evidence suggests that patients with chronic conditions such as diabetes and heart disease who receive coping skills training do better physically and mentally, Redford B. Williams, M.D., said at the annual meeting of the American Association of Diabetes Educators.
Stress and the negative emotions that diabetes engenders can impair control of the disease and increase the risk for major complications, as well as increase the risk of death after myocardial infarction. The exact mechanisms aren't known, but are likely related to changes in sympathetic nervous system activity and cortisol secretion, which could in turn increase depression and lead to noncompliance, said Dr. Williams, director of the Behavioral Medicine Research Center at Duke University, Durham, N.C.
On the positive side, randomized trials have shown that coping skills training--also known as stress reduction, stress management, or a host of other names--reduces psychosocial risk factors and biomarkers of stress such as blood pressure and vascular reactivity. This training may improve metabolic control in diabetic patients, said Dr. Williams, who is also professor of psychiatry, medicine, and psychology at Duke.
"It's not a substitute for diet, exercise, glucose monitoring, and medications," he said. "Managing the stress of everyday life is another leg of the stool of good diabetes management."
Among the coping skills programs for which positive data are emerging is Williams LifeSkills Inc., founded by Dr. Williams and his wife, Virginia P. Williams, Ph.D. He serves as chairman of the organization, and she is president. (See box.)
Among 60 patients who had undergone coronary artery bypass grafting, 30 were randomized to receive six sessions of LifeSkills training; the other 30 listened to a 1-hour lecture on the effects of stress on the heart. Baseline scores on the Center for Epidemiological Studies Depression Scale (CES-D) were 11.1 in the intervention group and 13.7 in the control group, which was not significantly different.
After the intervention, the mean CES-D score in the LifeSkills group dropped to 7.2, while it rose to 16.9 in the control group, a significant difference. At 3 months, the CES-D score in the controls had risen to 17.6, which is considered clinical depression, while it had dropped even further, to 4.3, in the LifeSkills group.
Similar differences were seen in questionnaire measures of trait anger, perceived stress, satisfaction with social support, and satisfaction with life. In all cases, the LifeSkills group improved even further at 3 months while the controls worsened with time.
Such findings suggest that when it comes to patients with heart disease or diabetes, "we don't need to label patients as depressed or anxious. Everybody needs this kind of training," Dr. Williams said.
Systolic blood pressure (SBP) fell among those who received LifeSkills training, from a mean of 122.3 mm Hg at baseline to 118.7 mm Hg post intervention to 118.3 mm Hg at 3 months. In contrast, among control patients, SBP rose from 118.8 mm Hg at baseline to 124.1 mm Hg post intervention to 126.9 mm Hg at 3 months.
Similarly, resting heart rate in the LifeSkills group dropped from 72.1 beats per minute to 65.2 post intervention and 65.4 at 3 months. In the controls, resting heart rate remained essentially the same throughout (73.8 to 73.6 to 74.9 bpm).
Systolic blood pressure reactivity to anger recall--that is, the increase that occurs when a patient is reminded of a previous anger-inducing situation--also differed between the groups, dropping from 26.1 mm Hg at baseline to 16 mm Hg post intervention to 11. …