The study by Tovote et al. (1) was the first randomized clinical trial to examine the effectiveness of individual mindfulness-based cognitive therapy in reducing depressive symptoms in patients with diabetes. However, the researchers did not account for the racial/ethnic background of the participants. Compared with the general population, African Americans are disproportionately affected by diabetes and diabetes-related complications. For some African Americans, the stress of diabetes compounded by higher levels of chronic life stressors (e.g., financial insecurity, low education level, lack of health care) makes them particularly vulnerable to complications from the synergistic effects of obesity, diabetes, and cardiovascular disease (2). A mindful eating pilot intervention for adults with diabetes revealed improvements in depressive symptoms, outcome expectations, nutrition and eating-related self-efficacy, and cognitive control and disinhibition of control regarding eating behaviors (3). However, this intervention did not measure these outcomes in an African American sample. We propose that mindfulness-based behavioral interventions may be a beneficial technique to promote diabetes self-care management among African Americans.
Depression is a commonly recognized psychological barrier of adherence to recommended health behaviors. Mindfulness-based interventions have been used to decrease depression relapse (4). The aim of intensive training in mindfulness meditation is to increase awareness of present moment-to-moment experiences. The ability to distance oneself and simply witness thoughts and emotions helps the individuals identify habitual patterns and see their thoughts as “discrete mental events” that do not define them (4). The clarity associated with this approach helps break the cycle of negative self-perpetuating cognitive routines (i.e., ruminative thinking linked to depression) and decreases automatic reactions, thereby reducing perceived stress and stress-related physiological responses and health behaviors (i.e., smoking, drinking alcohol, overeating).
Assessing the effectiveness of mindfulness-related interventions in an African American population is important due to the high prevalence of diabetes and specific barriers to self-management behaviors, including fears of the pain associated with glucose monitoring, lack of self-control over dietary habits, and perceived lack of personal control over diabetes (5). Chlebowy et al. (5) used focus groups to investigate the facilitators and barriers to self-management of diabetes among African Americans and reported that the participants were overwhelmed by the amount of time needed to manage diabetes and perceived a lack of internal control to overcome the barriers to adhere to self-management protocols. Engagement in mindfulness-oriented tasks may potentially alter negative perceptions of personal control and emotional regulation among African Americans with diabetes.
Attempts to avoid cognitive awareness, or an individual’s thoughts, may influence engagement in unhealthy behaviors. However, individuals can reframe how they perceive and cope with threatening situations, like ongoing management of a chronic illness, through mindfulness interventions. Based on this information, diabetes prevention researchers should explore the various ways in which mindfulness-based reduction interventions can improve self-care management among African Americans with diabetes.
Article Information
Duality of Interest. No potential conflicts of interest relevant to this article were reported.
The authors of the cited article felt a response was not needed.
