Journal of Fundamentals Mashhad University Psychiatry and Behavioral Sciences of Mental Health of Medical Sciences Research Center lagigirO Article The effect of Lazarus multimodal therapy on depression, anxiety, and blood glucose control in women with type 2 diabetes Hassan Derakhshan Shahrabad1; Mohammad Hossein Bayazi2; Zahra Zafari3; Saeed Teimouri4; *Farzaneh Rajabzadeh5 1M.Sc.in clinical psychology, Mashhad University of Medical Sciences, Mashhad, Iran 2Ph.D.of psychology, Torbat-e-Jam Branch, Islamic Azad University, Torbat-e-Jam, Iran 3Iran 4Iran 5M.Sc.in clinical psychology, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Abstract Introduction: Considering the interactions between depression and anxiety on the increase in blood glucose in diabetic patients and the need for intervention to improve these variables, the aim of this study was to investigate the effectiveness of Lazarus multimodal therapy on reducing the symptoms of depression, anxiety and glycemic control in women with type 2 diabetes. Materials and Methods: In this study, which was performed on women with type 2 diabetes with high score in depression and anxiety and glycosylated hemoglobin (HbA1C) level more than 7%, 24 subjects who entered the study were selected by convenient method and they were randomly assigned into two groups of experimental and control (each group included 12 subjects). Research instrument include Beck Depression Inventory-II, Beck Anxiety Inventory and glycosylated hemoglobin. The experimental group was trained at Lazarus multimodal psychotherapy group workshop for three months (12 weekly ninety-minute sessions) in the spring and summer of 2016 at Samen Health Center- Mashhad. The control group was in the waiting list. Also, multivariate analysis of covariance analysis was used to analyze the data through SPSS software. Results: The results of this study showed that Lazarus multidimodal therapy significantly (P=0.001) reduced the symptoms of depression, anxiety and decreased blood glucose levels in women with type 2 diabetes compared to control group. Conclusion: Totally based on the findings, Lazarus multidimodal therapy can be effective to reduce the symptoms of anxiety, depression and physical symptoms among diabetic patients. Keywords: Anxiety, Blood glucose, Depression, Lazarus multidimodal therapy, Type 2 diabetes () Please cite this paper as: Derakhshan Shahrabad H, Mohammad Hossein Bayazi MH, Zafari Z, Teimouri S, Rajabzadeh F. The effect of Lazarus multimodal therapy on depression, anxiety, and blood glucose control in women with type 2 diabetes. Journal of Fundamentals of Mental Health 2018 Jul-Aug; 20(4): 302-9. *Corresponding Author: Psychiatry and Behavioral Sciences Research Center, Ibn-e-Sina hospital, Mashhad, Iran [email protected] Received: May. 18, 2017 Accepted: Jan. 09, 2018 Fundamentals of Mental Health, 2018 Jul-Aug http://jfmh.mums.ac.ir 302 LAZARUS MULTIMODAL THERAPY AND DIABETES DERAKHSHAN, ET AL. Introduction use in peripheral circulation and affects on Diabetes involves a group of metabolic self-care activities negatively (6). diseases which indicated by high levels of Researches have also been conducted on glucose due to varying degrees of body the level of mental health in diabetic resistance to insulin or dysregulation of patients, including the research of Sadeghi insulin secretion. Type 1 and type 2 Movahed, Molavi andSharghi, which diabetes are two main forms of the disease, showed that 54% of people with diabetes and type 2 diabetes concludes are suspected of having mental disorders. approximately 85% to 90% of the cases Women are also more likely to be exposed (1). to a variety of mental health problems, The classic symptoms of the disease including depression and anxiety, due to include excessive thirst, urinary frequency physical and cultural issues, especially and excessive hunger. 90% of people with with physical illness such as diabetes (4). diabetes have type 2 diabetes and 10% It seems that there is a two-way have type 1 diabetes mellitus and relationship between physical illness and gestational diabetes, respectively. psychological trauma. The domain in glycosylated hemoglobin (HbA1C) test, is psychology of health, called a very common blood test which is neuropsychological immunology, effective in screening diabetics and shows addresses how psychological factors how well patients have been successful in change the immune system and ultimately controlling diabetes (2). increases the risk of disease. There are The spread of the disease as one of the several cases that show how depression, chronic diseases is due to the consequences helplessness, frustration, and stressful of industrialization and changes in the events of life can lead to disease with a lifestyle of people such as high-fat and change in immunity (7). high-calorie foods, obesity, low physical Goldman's group suggests psychological activity, high blood pressure and high and psychotherapy interventions for cholesterol, and anxiety and depression (3). depressive symptoms in these patients. Following Holmes and Rahe's work in Methods such as cognitive-behavioral 1967 and expressing stressful life events as therapy, relaxation training, stressless one of the risk factors for diseases and training, insightful psychotherapy, providing a bio-psycho-social model by supportive treatment and symptomatic Engel, clinical experts and researchers treatment, and neurological rehabilitation consider to the role of psychosocial factors are among the methods that have been in the emergence, exacerbation, or control implemented in the area of the problems of and prevention diseases more than ever (4). these patients and none of which do not Research evidences suggest a high pay attention to all aspects of problems and frequency of stressful events among symptoms (8). One of the psychotherapy diabetic patients compared with other techniques that take into account the patients, and there is a high probability of dimensions of health definition is Lazarus developing various psychiatric problems, multimodal therapy. This kind of therapy is including depression and anxiety in these successfully used in a wide range of patients (5). Stress contributes to secretion disorders and problems (9). of epinephrine and cortisol in the body, Lazarus believes that human personality and ultimately leads to an increase in blood can be described entirely through seven glucose levels. Stress also disrupts insulin dimensions (behavior, emotion, sensory receptions, imaging, cognition, Fundamentals of Mental Health, 20(4), Jul-Aug 2018 302-9 LAZARUS MULTIMODAL THERAPY AND DIABETES DERAKHSHAN, ET AL. interpersonal relationships, and drug- active records and symptoms of biological). Although these dimensions are depression, anxiety and glycosylated described in isolation, they are really hemoglobin more than 7%. The sampling interacting with each other, and any human method was convenient method. In this experience can be conceived with respect way, out of the 48 people who expressed to a dimension that is related to other their willingness to participate in the dimensions, and if a change in one research, 24 cases were selected and randomly assigned into two groups of dimension occurs it affects on the other experimental and control (each group: 12 dimensions (10). Accordingly, in this cases). Four patients refused so they were method, seven dimensions are evaluated excluded from the two groups. The separately, but interacting with each other, experimental group with 10 cases started and therapy has a vision about significant group therapy sessions and 12 ninety- relationship with these dimensions (9). minute sessions were held weekly in the Since multifocal treatment has had a very spring and summer of 2014 at Samen significant effect on cognitive-behavioral Health Center. In order to observe the management, all disorders that can be ethics of the control group, they were treated with cognitive-behavioral therapy placed on the waiting list, and after that, a are also treated through multidisciplinary series of sessions were held for them. At therapy (11). the end of the treatment, the anxiety and On the other hand, as mentioned earlier, depression questionnaires and the level of many of these patients are easily blood glucose were taken from both groups experience depression, hopeless, anxiety in the post-test, and finally the information and stress so they cause discomfort for analysis was done. themselves and their relatives. In this The inclusion criteria were: diabetic situation, conscious living, acceptance of women aged 20-40 years, high score in situation and dealing with anxiety and anxiety, depression and glycosylated stress from the disease certainly have an hemoglobin above 7%, having minimum effective role in reducing the short-term mediate school education, at least 6 months and long-term complications and proper from the onset of group therapy, and control of diabetes. Therefore, it seems that informed consent to participate in research. the discussion regarding the attention and Exclusion criteria included: severe impact of the basic concepts of Lazarus psychiatric disorders such as psychosis, therapy (behavior, emotion, feeling, mental bipolar disorder, and personality disorders, imagery, cognition, interpersonal relations co-opted companies in other therapeutic and medications) on diabetes and the programs, and received individual reduction of stresses of a diabetic patient counseling