Effets de l’approche de réduction du stress Mindfulness Based Stress Reduction (MBSR) sur la santé psychique (stress, anxiété, dépression) et le mode de coping chez des patients diabétiques : une étude pilote contrôlée et randomisée

Abstract

The Mindfulness Based Stress Reduction (MBSR) therapeutic approach, based on a form of mindfulness, is part of the third wave of behavioral and cognitive therapies and has resulted in numerous research studies. Research in France on this psychotherapeutic approach is mainly focused on treating chronic diseases, pain and stress in the workplace. This study aims to test the impact of this therapeutic approach on psychic health (stress, anxiety, depression and coping modes) among a type 1 diabetic population with the goal of increasing their capacity to combat stress. The following hypotheses were made: treatment based on the MBSR approach should contribute to a reduction in the mean scores of stress, anxiety and depression. On the contrary, we assume that treatment based on MBSR should lead patients to resort to more effective adjustment strategies and to reduce the use of aversive strategies such as blame. In this protocol, the patient's level of stress (PSS), anxiety and depression (HAD), and use of coping strategies (Brief cop) are evaluated at three different moments. A pretest was done for the two groups (groups A and B) and a second evaluation was carried out after group A benefited from a mindfulness training that group B had not yet received. The technique of the waiting list was chosen for the second evaluation since the measure was taken after group B benefited from the same mindfulness training as group A. Seventeen subjects agreed to participate in this study (10 subjects in group A and seven subjects in group B). The inclusion criteria were: the subjects had to accept the framework of the research for a determined period, had to have a pathology of type 1 diabetes for at least 10 years, and not suffer from major psychological troubles. They were also required to give their fully informed consent concerning the objectives of the study and to adhere to the principle of the treatment. The patients with multiple physical pathologies in addition to type 1 diabetes, as well as the patients who had already followed a psychotherapeutic treatment whose aim was similar to that of this study, were excluded. In addition, after the MBSR training, the patients were asked to do exercises at home, and those who did not comply with this request were also excluded from the study. The results show a positive effect of MBSR on some of the indicators (perceived stress, anxiety and copy modes). A significant statistical decrease in the score for perceived stress on the PSS scale was observed before and after mindfulness training. Likewise, a significant drop in the scores for anxiety on the HAD scale was observed. Moreover, the participants show an increased use of coping strategies such as active coping, planning, positive reinterpretation, expression of feelings, and acceptance. In the same vein, the results show a significant decrease in the use of blame and denial. This study suggests orientations concerning the potential efficacy of the MBSR approach on patients’ psychic health by activating their potential and resources to confront and combat their disease. MBSR proves to be a pertinent tool for managing stress in a diabetic population and for increasing patients’ autonomy in the combat against this disease. In view of the stakes involved in this disease, this study should be replicated in order to verify the interest of this approach.