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Self-compassion improves psychological well-being, self-management in diabetes
In adults with type 1 and type 2 diabetes, a high level of self-compassion predicts a higher psychological well-being and is a predicter for several diabetes self-management behaviors, according to findings from a cross-sectional study in Australia.
“The demands of managing diabetes emphasize the need for self-compassion,” Madeleine Ferrari, DClinPsy, MPhil, a lecturer in the School of Psychology at Australian Catholic University in Strathfield, New South Wales, and colleagues wrote. “High internal locus of control and knowledge may promote persistence at self-management behavior, yet in the event of inevitable hypoglycemia or a health complication, such personal responsibility may turn into self-criticism and self-blame. Clinical psychology research argues these responses weaken a person’s emotional resilience, which in the context of diabetes is likely to weaken one’s ability to recover and persist at their self-management plan in times of crisis.”
Ferrari and colleagues analyzed data from 310 adults with type 1 and type 2 diabetes who completed a series of online questionnaires between May and December 2015 (mean age, 37 years; 81.3% women; 69.7% Australian; 65.5% with type 1 diabetes). Most participants used insulin therapy (44.8%) and diet and exercise (31.6%) for disease management; mean HbA1c for the cohort was 7.7%. Participants completed the 12-item Self-Compassion Scale-Short Form, the 16-item Diabetes Self-Management Questionnaire, the 22-item Well-Being Questionnaire, the Diabetes Family Behavior Checklist and the 18-item Diabetes Locus of Control Scale. Researchers measured three primary outcomes: self-reported HbA1c, self-management behavior and psychological well-being, and used multiple regression models with a backward elimination procedure to identify the predictive value of each variable on diabetes self-care behavior.
Researchers found that self-compassion was positively correlated with higher well-being (r = 0.74), lower HbA1c (r = –0.23) and higher engagement with all self-management behaviors including dietary care (r = 0.36) and physical activity (r = 0.31).
In linear multiple regression analyses with backward elimination, researchers found that self-compassion, high school education, technical and further education and undergraduate education predicted 12.1% of the variance in self-management behavior scores, whereas self-compassion, social support and education predicted 16.1% of the variance in physical activity engagement. Sex, internal locus of control, powerful others locus of control, chance locus of control, self-compassion and technical and further education predicted 60% of the variance in well-being.
In individual regression analyses with only self-compassion as a predictor, researchers found that self-compassion predicted a high proportion of the variance for well-being (r² = 55.1%; P < .001), but a lower proportion for the self-management total score (10.5%) and physical activity engagement (9.2%). Self-compassion also predicted a smaller proportion of the variance for HbA1c (5.1%), health care use (4.1%) and glucose management (1.9%), according to researchers.
The researchers noted that HbA1c was self-reported by participants and 23% did not report HbA1c values.
“Taken together, the present results indicate that self-compassion is a psychological construct that relates to a range of general positive mental and physical outcomes for adults with diabetes,” the researchers wrote. “An internal locus of control was also related to beneficial outcomes; however, these relationships were generally weaker and not present for overall self-management behavior, healthcare use and glucose management. Thus, although developing a high internal locus of control and perceived ability to manage one’s health condition remains relevant and of importance, self-compassion seems to be a more globally relevant construct.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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Ferrari and colleagues examined the use of self-compassion to improve diabetes self-management behaviors, HbA1c outcomes and psychological well-being. The authors described self-compassionate behaviors as treating oneself with kindness, being nonjudgmental toward yourself, feeling connected to common humanity and accepting flaws as part of the human condition. The authors cited a study conducted in New Zealand that found a connection between self-compassion and improved physical health outcome. The current study aimed to replicate the results of the New Zealand study and demonstrate that self-compassion could lead to significant improvement in HbA1C, depression symptoms and diabetes-specific distress. The primary hypothesis of this study was supported. The authors suggested that an intervention of self-compassion can be a simple strategy to foster more adaptive and resilient diabetes health and mental health outcomes.
This study demonstrated that self-compassion can be used as another tool by providers diabetes educators. If your diabetes patients are discouraged by the demands of diabetes self-care and they are struggling with negative emotions, such as anxiety, depression, stress and shame, then self-compassion can be used to teach them skills to self-soothe, recognize and learn from their mistakes and motivate them to succeed. Patients need to start by acknowledging their negative feelings, realize that they are not alone with their feelings and express kindness to themselves. Self-compassion can be seen as an example of the Golden Rule in reverse: Learning to treat yourself as you would treat others in need — with kindness, warmth, and respect.