Psychopathology and psychotherapeutic intervention in diabetes: particularities, challenges, and limits

Diabetes is a problem of great public health importance, creating a considerable burden to the affected individuals and society. The psychological approach of this disease implies the early acknowledging of behavioral symptoms and the construction of effective psychotherapeutic interventions. Regarding the psychological symptoms, cognitive malfunctions in diabetes include a slowing of information processing, attention, memory, and concentration, which, in turn, can significantly diminish motivation for therapy, compliance, and ability for self-care. Restrictions pertaining to daily activities, risks of treatment itself and the perceived inability to control the disease can furthermore reduce the perceived quality of life of these patients. Depression can complicate the picture, by a supplementary decrease in compliance and an increase of care expenses. A proper management of diabetes involves a joint action of the patient, physician, and the psychologist. A better self-care can include commuting from passive to active coping, getting informed, maintaining realistic hopes, and long-term thinking. Physicians can express more consistent empathy, thereby increasing confidence. A substantial gain can be brought by considering variables involved in modulating compliance (e.g. the patient's representations of gains and losses, group norms, ability vs. desire of control). Psychotherapeutic interventions include techniques such as counseling, cognitive-behavioral therapy, relaxation, hypnosis, and family therapy.