Examining the Effect of a Novel Stress Reduction Intervention on the Control of Prediabetes: A Feasibility Study

Abstract

Background

Prediabetes is a major risk factor for type 2 diabetes (T2D) and cardiovascular disease. Although prediabetes is associated with chronic stress-related behavioral and physiological maladaptation, few studies have focused on chronic psychological stress.

Purpose

This study aimed to examine the feasibility and preliminary outcomes of Emotional Awareness and Expression Treatment (EAET) adopted and implemented among adults with high risk for prediabetes.

Method

This study used a prospective, within-subjects, repeated measures, uncontrolled design with a 4-week virtual intervention period and three measurement points for all participants: baseline, 3 months from baseline, and 6 months from baseline. Forty individuals were screened for prediabetes, and sixteen were eligible to participate. Divided into three groups, participants received four weekly virtual sessions of EAET. Glycated hemoglobin (A1C) and insulin secretion (C-peptide) were measured at baseline, 3- and 6-month periods in addition to self-reported eating habits, physical activity, and perceived stress.

Results

Twelve participants completed all sessions and were fully engaged in the intervention sessions. Across the study period, participants’ perceived stress and unhealthy eating habits decreased significantly. Glycated hemoglobin (A1C) showed a non-significant drop at 6 months, but the average C-peptide concentration, exercise frequency, and exercise duration increased significantly.

Conclusions

The EAET stress reduction intervention is feasible and showed promising results in reducing stress and decreasing risk factors for T2D. EAET can be further developed to reduce the incidence and prevalence of T2D, which could lead to a significant decrease in the direct and indirect health and cost burdens of T2D.

Keywords

EAET prediabetes intervention chronic stress reduction

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References

Alipour

Noorbala

Yazdanfar

Agah Heris

(2022). The effectiveness of emotional disclosure intervention on declining stress and inhibition among psychosomatic patients. Journal of Jahrom University of Medical Sciences, 9(2), 41–47. http://doi.org/10.29252/jmj.9.2.41

American Diabetes Association. (2024). 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes-2024. Diabetes Care, 47(Supplement_1), S20–S42. http://doi.org/10.2337/dc24-S002

Andreou

Alexopoulos

E. C.

Lionis

Varvogli

Gnardellis

Chrousos

G. P.

Darviri

(2011). Perceived stress scale: Reliability and validity study in Greece. International Journal of Environmental Research and Public Health, 8(8), 3287–3298. http://doi.org/10.3390/ijerph8083287

Anton

S. D.

Miller

P. M.

(2005). Do negative emotions predict alcohol consumption, saturated fat intake, and physical activity in older adults? Behavior Modification, 29(4), 677–688. https://doi.org/10.1177/0145445503261164

Bansal

(2015). Prediabetes diagnosis and treatment: A review. World Journal of Diabetes, 6(2), 296. http://doi.org/10.4239/wjd.v6.i2.296

Block

Azar

K. M. J.

Romanelli

R. J.

Block

T. J.

Palaniappan

L. P.

Dolginsky

Block

C. H.

(2016). Improving diet, activity and wellness in adults at risk of diabetes: Randomized controlled trial. Nutrition & Diabetes, 6(9), e231–e231. http://doi.org/ 10.1038/nutd.2016.42

Bowen

D. J.

Kreuter

Spring

Cofta-Woerpel

Linnan

Weiner

Bakken

Kaplan

C. P.

Squiers

Fabrizio

Fernandez

(2009). How we design feasibility studies. American Journal of Preventive Medicine, 36(5), 452–457. https://doi.org/10.1016/j.amepre.2009.02.002

Brannick

Dagogo-Jack

(2018). Prediabetes and cardiovascular disease: Pathophysiology and interventions for prevention and risk reduction. Endocrinology and Metabolism Clinics, 47(1), 33–50. http://doi.org/ 10.1016/j.ecl.2017.10.001

Burg

M. M.

Schwartz

J. E.

Kronish

I. M.

Diaz

K. M.

Alcantara

Duer-Hefele

Davidson

K. W.

(2017). Does stress result in you exercising less? Or does exercising result in you being less stressed? Or is it both? Testing the bi-directional stress-exercise association at the group and person (N of 1) level. Annals of Behavioral Medicine, 51(6), 799–809. https://doi.org/10.1007/s12160-017-9902-4

10.

Burger

A. J.

Lumley

M. A.

Carty

J. N.

Latsch

D. V.

Thakur

E. R.

Hyde-Nolan

M. E.

Hijazi

A. M.

Schubiner

(2016). The effects of a novel psychological attribution and emotional awareness and expression therapy for chronic musculoskeletal pain: A preliminary, uncontrolled trial. Journal of Psychosomatic Research, 81, 1–8. https://doi.org/10.1016/j.jpsychores.2015.12.003

11.

Butkowski

E. G.

Jelinek

H. F.

(2017). Hyperglycaemia, oxidative stress and inflammatory markers. Redox Report, 22(6), 257–264. https://doi.org/10.1080/13510002.2016.1215643

12.

Centers for Disease Control and Prevention. (2022). Prediabetes: Your chance to prevent type 2 diabetes. Retrieved January 15, 2024, from https://www.cdc.gov/diabetes/basics/prediabetes.html

13.

Chailurkit

L. O.

Jongjaroenprasert

Chanprasertyothin

Ongphiphadhanakul

(2007). Insulin and C-peptide levels, pancreatic beta cell function, and insulin resistance across glucose tolerance status in Thais. Journal of Clinical Laboratory Analysis, 21(2), 85–90. https://doi.org/10.1002/jcla.20138

14.

Cohen

Kamarck

Mermelstein

(1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396. https://doi.org/10.2307/2136404

15.

De Matos

M. A.

de Oliveira Ottone

Duarte

T. C.

da Matta Sampaio

P. F.

Costa

K. B.

Fonseca

C. A.

Neves

M. P. C.

Schneider

S. M.

Moseley

Coimbra

C. C.

de Castro Magalhães

Amorim

F. T.

(2014). Exercise reduces cellular stress related to skeletal muscle insulin resistance. Cell Stress and Chaperones, 19(2), 263–270. http://doi.org/10.1007/s12192-013-0453-8

16.

Ferrannini

Gastaldelli

Iozzo

(2011). Pathophysiology of prediabetes. Medical Clinics, 95(2), 327–339. http://doi.org/10.1016/j.mcna.2010.11.005

17.

Ford

E. S.

Zhao

(2010). Pre-diabetes and the risk for cardiovascular disease: A systematic review of the evidence. Journal of the American College of Cardiology, 55(13), 1310–1317. https://doi.org/10.1016/j.jacc.2009.10.060

18.

Gonzalez

M. J.

Miranda-Massari

J. R.

(2014). Diet and stress. Psychiatric Clinics, 37(4), 579–589. http://doi.org/10.1016/j.psc.2014.08.004

19.

Gross

J. J.

Jazaieri

(2014). Emotion, emotion regulation, and psychopathology: An affective science perspective. Clinical Psychological Science, 2(4), 387–401. https://doi.org/10.1177/2167702614536164

20.

Qiao

Xiong

Liu

Shen

(2020). Association between dietary quality and prediabetes based on the diet balance index. Scientific Reports, 10(1), 3190. https://doi.org/10.1038/s41598-020-60153-9

21.

Hegde

S. V.

Adhikari

Shetty

Manjrekar

D'Souza

(2013). Effect of community-based yoga intervention on oxidative stress and glycemic parameters in prediabetes: A randomized controlled trial. Complementary Therapies in Medicine, 21(6), 571–576. https://doi.org/10.1016/j.ctim.2013.08.013

22.

Hsu

M. C.

Schubiner

Lumley

M. A.

Stracks

J. S.

Clauw

D. J.

Williams

D. A.

(2010). Sustained pain reduction through affective self-awareness in fibromyalgia: A randomized controlled trial. Journal of General Internal Medicine, 25, 1064–1070. https://doi.org/10.1007/s11606-010-1418-6

23.

Ighodaro

O. M.

(2018). Molecular pathways associated with oxidative stress in diabetes mellitus. Biomedicine & Pharmacotherapy, 108, 656–662. https://doi.org/10.1016/j.biopha.2018.09.058

24.

Jadhav

R. A.

Hazari

Monterio

Kumar

Maiya

A. G.

(2017). Effect of physical activity intervention in prediabetes: A systematic review with meta-analysis. Journal of Physical Activity and Health, 14(9), 745–755. https://doi.org/10.1123/jpah.2016-0632

25.

Jones

A. G.

Hattersley

A. T.

(2013). The clinical utility of C-peptide measurement in the care of patients with diabetes. Diabetic Medicine, 30(7), 803–817. https://doi.org/10.1123/jpah.2016-0632

26.

Lazarus

R. S.

(2006). Emotions and interpersonal relationships: Toward a person-centered conceptualization of emotions and coping. Journal of Personality, 74(1), 9–46. https://doi.org/10.1111/j.1467-6494.2005.00368.x

27.

Lee

E. H.

(2012). Review of the psychometric evidence of the perceived stress scale. Asian Nursing Research, 6(4), 121–127. https://doi.org/10.1016/j.anr.2012.08.004

28.

Wan

Geng

Zhu

Qiu

Liu

(2023). Associations of healthy dietary patterns with mortality among people with prediabetes. European Journal of Nutrition, 62(3), 1377–1387. https://doi.org/10.1007/s00394-022-03078-5

29.

Lindström

Peltonen

Eriksson

J. G.

Ilanne-Parikka

Aunola

Keinänen-Kiukaanniemi

Uusitupa

Tuomilehto

, & Finnish Diabetes Prevention Study (DPS). (2013). Improved lifestyle and decreased diabetes risk over 13 years: Long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia, 56(2), 284–293. https://doi.org/10.1007/s00125-012-2752-5

30.

Loerz

Maser

(2017). The cortisol-activating enzyme 11β-hydroxysteroid dehydrogenase type 1 in skeletal muscle in the pathogenesis of the metabolic syndrome. The Journal of Steroid Biochemistry and Molecular Biology, 174, 65–71. https://doi.org/10.1016/j.jsbmb.2017.07.030

31.

Luc

Schramm-Luc

Guzik

T. J.

Mikolajczyk

T. P.

(2019). Oxidative stress and inflammatory markers in prediabetes and diabetes. Journal of Physiology & Pharmacology, 70(6), 809–824. http://doi.org/10.26402/jpp.2019.6.01

32.

Lumley

M. A.

Cohen

J. L.

Stout

R. L.

Neely

L. C.

Sander

L. M.

Burger

A. J.

(2008). An emotional exposure-based treatment of traumatic stress for people with chronic pain: Preliminary results for fibromyalgia syndrome. Psychotherapy: Theory, Research, Practice, Training, 45(2), 165. https://doi.org/10.1037/0033-3204.45.2.165

33.

Lumley

M. A.

Schubiner

(2019). Emotional awareness and expression therapy for chronic pain: Rationale, principles and techniques, evidence, and critical review. Current Rheumatology Reports, 21(7), 1–8. https://doi.org/10.1007/s11926-019-0829-6

34.

Lumley

M. A.

Schubiner

Lockhart

N. A.

Kidwell

K. M.

Harte

Clauw

D. J.

Williams

D. A.

(2017). Emotional awareness and expression therapy, cognitive-behavioral therapy, and education for fibromyalgia: A cluster-randomized controlled trial. PAIN, 158(12), 2354–2363. http://doi.org/10.1097/j.pain.0000000000001036

35.

Miller

G. E.

Chen

Parker

K. J.

(2011). Psychological stress in childhood and susceptibility to the chronic diseases of aging: Moving toward a model of behavioral and biological mechanisms. Psychological Bulletin, 137(6), 959–997. https://doi.org/10.1037/a0024768

36.

Monazamitabar

Ahmadi Tahoor Soltani

Bagherian Sararoodi

Behboodi

(2015). The effectiveness of writing emotional disclosure on the reduction of depression, anxiety, and stress among veterans with post-traumatic stress disorder. Ebnesina, 17(3), 54–58. http://ebnesina.ajaums.ac.ir/browse.php?a_code=A-10-137-1&slc_lang=en&sid=1

37.

Morris

Moore

Morris

(2011). Stress and chronic illness: The case of diabetes. Journal of Adult Development, 18, 70–80. https://doi.org/10.1007/s10804-010-9118-3

38.

National Center for Complementary and Integrative Health. (2022). Stress. Retrieved February 16, 2024, from https://www.nccih.nih.gov/health/stress

39.

K. J.

Han

H. S.

Kim

M. J.

Koo

S. H.

(2013). Transcriptional regulators of hepatic gluconeogenesis. Archives of Pharmacal Research, 36, 189–200. https://doi.org/10.1007/s12272-013-0018-5

40.

Ortiz

Kluwe

Odei

J. B.

Tcheugui

J. B. E.

Sims

Kalyani

R. R.

Joseph

J. J.

(2019). The association of morning serum cortisol with glucose metabolism and diabetes: The Jackson heart study. Psychoneuroendocrinology, 103, 25–32. https://doi.org/10.1016/j.psyneuen.2018.12.237

41.

Perreault

Pan

Mather

K. J.

Watson

K. E.

Hamman

R. F.

Kahn

S. E.

, & Diabetes Prevention Program Research Group. (2012). Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: Results from the Diabetes Prevention Program Outcomes Study. Lancet (London, England), 379(9833), 2243–2251. https://doi.org/10.1016/S0140-6736(12)60525-X

42.

Radenbach

Reiter

A. M.

Engert

Sjoerds

Villringer

Heinze

H. J.

Deserno

Schlagenhauf

(2015). The interaction of acute and chronic stress impairs model-based behavioral control. Psychoneuroendocrinology, 53, 268–280. https://doi.org/10.1016/j.psyneuen.2014.12.017

43.

Ray

S. A.

(2024). The perceived stress scale (PSS) score assessment method for stress reduction: An overview. Compassionate AI Research, 3(9), 55–61.

44.

Rosmond

(2003). Stress induced disturbances of the HPA axis: A pathway to Type 2 diabetes? Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 9(2), RA35–RA39. https://www.altmetric.com/details/1672809

45.

Siyu

Hong

Qun

Hua

Kang

Yibiao

Wenping

Qian

Xiaonan

(2020). Effects of exercise training combined with psychological intervention compared to exercise training alone in prediabetes subjects. Journal of Public Health, 42(2), 388–394. https://doi.org/10.1093/pubmed/fdaa024

46.

Tryon

M. S.

Carter

C. S.

DeCant

Laugero

K. D.

(2013a). Chronic stress exposure may affect the brain's response to high calorie food cues and predispose to obesogenic eating habits. Physiology & Behavior, 120, 233–242. https://doi.org/10.1016/j.physbeh.2013.08.010

47.

Tryon

M. S.

DeCant

Laugero

K. D.

(2013b). Having your cake and eating it too: A habit of comfort food may link chronic social stress exposure and acute stress-induced cortisol hyporesponsiveness. Physiology & Behavior, 114, 32–37. http://doi.org/10.1016/j.physbeh.2013.02.018

48.

U.S. Department of Health and Human Services. (2019, May). Pain management best practices inter-agency task force report: Updates, gaps, inconsistencies, and recommendations. https://www.hhs.gov/sites/default/files/pain-mgmt-best-practices-draft-final-report-05062019

49.

Wallace

D. D.

Barrington

Albrecht

Gottfredson

Carter-Edwards

Lytle

L. A.

(2022). The role of stress responses on engagement in dietary and physical activity behaviors among Latino adults living with prediabetes. Ethnicity & Health, 27(6), 1395–1409. https://doi.org/10.1080/13557858.2021.1880549

50.

Woods-Giscombe

C. L.

Gaylord

S. A.

Brintz

C. E.

Bangdiwala

S. I.

Buse

J. B.

Mann

J. D.

Lynch

Phillips

Smith

Leniek

Young

Al-Barwani

Yoo

Faurot

(2019). A mixed-methods, randomized clinical trial to examine feasibility of a mindfulness-based stress management and diabetes risk reduction intervention for African Americans with prediabetes. Evidence-Based Complementary and Alternative Medicine, 2019, 1–16. https://doi.org/10.1155/2019/3962623

51.

Xia

Lopes

Chen

Roth

Zinzow

Jones

Zhang

Shi

Jindal

(2022). A feasibility study on low-dose mindfulnessbased stress reduction intervention among prediabetes and diabetes patients. Complementary Therapies in Medicine, 65, 1–17. 102810. https://doi.org/10.1016/j.ctim.2022.102810

52.

Yarns

B. C.

Lumley

M. A.

Cassidy

J. T.

Steers

W. N.

Osato

Schubiner

Sultzer

D. L.

(2020). Emotional awareness and expression therapy achieves greater pain reduction than cognitive behavioral therapy in older adults with chronic musculoskeletal pain: A preliminary randomized comparison trial. Pain Medicine, 21(11), 2811–2822. https://doi.org/10.1093/pm/pnaa145

53.

Yau

J. W.

Thor

S. M.

Ramadas

(2020). Nutritional strategies in prediabetes: A scoping review of recent evidence. Nutrients, 12(10), 2990. https://doi.org/10.3390/nu12102990

54.

Yin

Shao

Liu

Wang

Zhang

Leng

Tian

Yang

(2017). C-peptide levels and the risk of diabetes and pre-diabetes among Chinese women with gestational diabetes. Journal of Diabetes and its Complications, 31(12), 1658–1662. https://doi.org/10.1016/j.jdiacomp.2017.08.006

55.

Zaehringer

Jennen-Steinmetz

Schmahl

Ende

Paret

(2020). Psychophysiological effects of downregulating negative emotions: Insights from a meta-analysis of healthy adults. Frontiers in Psychology, 11, 470. https://doi.org/10.3389/fpsyg.2020.00470

56.

Zhang

Gregg

E. W.

Williamson

D. F.

Barker

L. E.

Thomas

Bullard

K. M.

Imperatore

Williams

D. E.

Albright

A. L.

(2010). A1c level and future risk of diabetes: A systematic review. Diabetes Care, 33(7), 1665–1673. https://doi.org/10.2337/dc09-1939