OBJECTIVEDepression is a common comorbidity of diabetes, undesirably affecting patients' physical and mental functioning. Psychological interventions are effective treatments for depression in the general population as well as in patients with a chronic disease. The aim of this study was to assess the efficacy of individual mindfulnessbased cognitive therapy (MBCT) and individual cognitive behavior therapy (CBT) in comparison with a waiting-list control condition for treating depressive symptoms in adults with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODSIn this randomized controlled trial, 94 outpatients with diabetes and comorbid depressive symptoms (i.e., Beck Depression Inventory-II [BDI-II] ‡14) were randomized to MBCT (n = 31), CBT (n = 32), or waiting list (n = 31). All participants completed written questionnaires and interviews at pre-and postmeasurement (3 months later). Primary outcome measure was severity of depressive symptoms (BDI-II and Toronto Hamilton Depression Rating Scale). Anxiety (Generalized Anxiety Disorder 7), well-being (Well-Being Index), diabetes-related distress (Problem Areas In Diabetes), and HbA 1c levels were assessed as secondary outcomes. RESULTSResults showed that participants receiving MBCT and CBT reported significantly greater reductions in depressive symptoms compared with patients in the waitinglist control condition (respectively, P = 0.004 and P < 0.001; d = 0.80 and 1.00; clinically relevant improvement 26% and 29% vs. 4%). Both interventions also had significant positive effects on anxiety, well-being, and diabetes-related distress. No significant effect was found on HbA 1c values. CONCLUSIONSBoth individual MBCT and CBT are effective in improving a range of psychological symptoms in individuals with type 1 and type 2 diabetes.

Diabetes mellitus is a highly prevalent chronic health condition that places patients at greater risk for psychological problems. Yet, there is still a lack of empirical evidence to support the use of psychological interventions in patients with diabetes. In this trial, we examined the feasibility of a novel intervention: individual mindfulness-based cognitive therapy (I-MBCT), an adaptation of the well-known group MBCT. We examined the feasibility of screening, recruiting, randomizing, and retaining patients into the study and their acceptability of I-MBCT. Descriptive analyses were performed to explore changes in patients' functioning over time, comparing those receiving I-MBCT with those in the waitlist control group. A sample of consecutive patients with diabetes was screened on psychological symptoms and when reporting elevated levels of symptoms, approached for the intervention trial. Patients completed self-report questionnaires pre-and postintervention regarding psychological functioning (i.e., depressive symptoms, diabetes-related distress), mindfulness (i.e., act with awareness, accept without judgment), and attention regulation. In total, 499 patients were approached, of whom 347 patients filled out the screening questionnaire. Of these, 38 patients were eligible, and 24 were randomized in I-MBCT (n=12) or waitlist (n=12). Two of the 12 patients assigned to I-MBCT dropped out of the intervention. Most patients were very satisfied with I-MBCT. Preliminary analyses suggest that, compared to controls, patients receiving I-MBCT reported significant reductions in depressive symptoms and diabetesrelated distress and improvements in act with awareness and attention regulation. This is the first RCT on individual-based MBCT, providing encouraging evidence for its feasibility and acceptability. Preliminary findings also suggest that I-MBCT may be associated with improvements in psychological functioning, which support larger trials on this alternative form of mindfulness-based therapy.

The present study suggests that caregiving stress is an important factor in understanding parental adjustment to childhood cancer. This offers possibilities for developing interventions aimed at preventing caregiving stress, and strengthening mothers' confidence in their ability to provide good care.