CBT and MI: Interventions for Diabetic Patients and Health Outcomes

This paper delves into the application of Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI) as interventions for individuals with diabetes, a chronic illness. It begins by categorizing health issues into acute, chronic, and terminal illnesses, highlighting the unique challenges associated with each. The paper then focuses on diabetes, discussing its different types, the physiological impact of high blood sugar, and the emotional and psychological burdens faced by diabetic patients, such as anxiety, loneliness, guilt, fear, and helplessness. Recognizing that diabetes is incurable, the paper emphasizes the importance of counseling as a psychotherapeutic intervention to help patients cope with their condition. The paper then explores CBT and MI as effective counseling approaches, aiming to help diabetic individuals manage their condition and improve their quality of life by developing coping skills and addressing emotional and psychological challenges. The paper provides insights into how these interventions can be used to address the emotional and psychological challenges faced by diabetic patients, ultimately promoting better health outcomes and a more fulfilling life.

CBT AND MI INTERVENTIONS FOR DIABETIC CONDITION 1
Cognitive Behavioral Therapy and Motivational Interviewing for a Diabetic Person
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Cognitive Behavioral Therapy and Motivational Interviewing for a Diabetic Person
Despite the advanced research and innovations in the field of medicine, people suffering
from different types of infections have continued to suffer. Not because the new medications are
ineffective but because infections have extensive impacts which demand more than mere
treatments. For instance, a person suffering from a chronic illness such as depression will require
combined efforts of antidepressants medication and talk therapy. Meanwhile, reliance on
antidepressants alone can achieve very little when it comes to improving the health status of a
depressed person. This paper examines the role of CBT and MI, the two approaches of
counseling to complement medication when dealing with diabetic people.
Health issues are classified into three categories, acute, chronic and terminal health
issues. This categorization is based on how sudden and severe an illness is. Acute illness is a
health issue which suddenly occurs with rapid onset. The complications associated with acute
illnesses resolve faster on their own without medical interventions. However, acute conditions
sometimes tend to be so severe that survival rates for the victims are minimal if medical attention
is not sought with urgency (Machado et al, 2017, p.296). A heart attack is a good example of an
acute illness because it has a rapid onset and acts within a very short time that either result in
death if not stabilized urgently. In the second category, chronic illness, the disease has slow
progression which keeps on building up until it becomes a long-lasting problem.
There is some back and forth between acute and chronic illnesses. This is because
patients tend to develop long-lasting chronic illnesses following sudden injuries which fall under
the acute category. Likewise, chronic illnesses increase the chances of a patient to experience
acute illnesses. However, there are some identical differences between acute and chronic

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illnesses. For instance, an acute disease implies that it has escalated within a short duration or has
a recent onset (Lau et al, 2016, p.172). Quantitation of “short” and “recent” time varies from one
disease to another and the context. Acute is always qualitative, in contrast with chronic which
means long-lasting. Acute is also used to mean that the disease is severe and has a sudden onset,
where severity and suddenness are both established aspects in the meaning.
The third classification of health issues is a terminal illness. Terminal illnesses which are
also known as end-stage illnesses refer to the incurable diseases which cannot be adequately
treated and hence reasonably expected to cause the death. Mainly, the disease is said to be
terminal if it progresses until death with no hope of recovery, irrespective of the treatment.
People who have such illnesses are known as terminal patients. According to research by
(Avedzi et al, 2016, p.26), the life expectancy of a terminal patient is unpredictable. For that
matter, after diagnosis terminal patients are advised on the disease management. Disease
management may include hospice care, counseling, continued treatment and physician-assisted
suicide. Decisions on terminal disease management are made by the patient or family members.
After diagnosis, lifestyles of people with terminal diseases vary largely depending on
effectiveness of management decisions. Also, there may be living restrictions depending on
health conditions of a patient (Nowlan et al, 2016, p.216). Oftentimes, people who suffer from
terminal diseases experience depression and anxiety associated with the oncoming death.
Diabetes falls under the category of terminal illnesses because it has been proved incurable.
However, to enable diabetic people to live long, counseling has been proposed as an effective
psychotherapeutic intervention because of its ability to alleviate some of the burdens associated
with the disease (Petrak et al, 2015, p.770).

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A person is said to be diabetic if the blood sugar or blood glucose is too high. Blood
sugar is the main source of energy in the body that is extracted from the food eaten. For this
sugar to be regulated, a hormone called insulin which is secreted by the pancreas is used. Insulin
maintains normal blood sugar in the body by helping glucose from the food get into the cells to
be used for energy purposes (Newby et al, 2017, p.157). A person becomes diabetic if the body
does not make enough or any insulin or if it does not use insulin well and hence it stays in the
blood and does not reach the cells. Over time, the glucose levels in the blood become too high
and that’s when a person is said to be diabetic. Current research has indicated that diabetes does
not have a cure, but a diabetic person can manage the condition and stay healthy.
There are three common types of diabetes, which are Type 1 diabetes, Type 2 diabetes,
and gestational diabetes. A person is said to have Type 1diabetes if the body does not make
enough insulin or does not make any insulin at all. As a result, the immune system tends to attack
and destroy the cells which make the insulin in the pancreas. This type of diabetes is common
among children and young adults (Young-Hyman et al, 2016, p.2140). People suffering from this
type of diabetes are required to take insulin on a daily basis to stay alive. Type2 diabetes occurs
when the body does not make or utilize the insulin as expected. Mainly, it occurs often among
middle-aged and older people. It is a common type of diabetes. The third type is gestational
diabetes, which commonly develops some women when they are pregnant. Mostly, it disappears
after the baby is born. People with diabetes tend to develop problems such as stroke, kidney
failure, heart diseases, nerve damage, and eye problems (Shomaker et al, 2017, p.66).
As mentioned above, diabetes lies in the category of terminal illnesses. That implies that
people who fall victims cannot be treated adequately and hence reasonably waits for their death.
The fact that diabetic people know they will soon die makes them lead very miserable lives, full

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of emotional fluctuations. For instance, diabetes has been proved to increase the anxiety level
among the victims (Johnsen and Friborg, 2015, p.747). The anxiety is associated with the
suspicion on when the next episode may hit a person. Victims are also anxious over dealing with
those who take care of their welfare getting them to understand their conditions. Also, anxiety
tends to get over the victims when walking down the street or being on their own for long by
imagining their situation if they encounter their next episode or collapse. Anxiety is also
observed on the victims of diabetes when going to unfamiliar places by doubting whether they
will be able to access the right type of diet or conditions prescribed by the doctors (Powers et al,
2017, p.50).
Diabetic people at their final stages tend to feel loneliness (an intense feeling of
isolation). This is especially in consideration to the fact that at the final stages of diabetes, the
victims are not able to move from one place to another so they tend to spend their entire time in
bed (Hermanns et al, 2015, p.555). Since people must attend to their daily activities, they are left
alone or under the care of one person. In a case where the victim was a socially active person, the
inability to walk around and meet friends and relatives worsens their health status. According to
them, they think they are being isolated when they most need support from friends and relatives
which is a very difficult emotional blow.
Parents who are diagnosed with diabetes tend to develop a feeling of guilt when they
remember that they will soon die and leave their children as orphans. In most of the cases, they
tend to perceive the illness as their own mistake which affects their innocent children. For most
of them, the condition worsens when they reach a stage where they can no longer support their
children either physically, financially or even emotionally (Seyffert et al,2016). Also, when they

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consider the cost of their treatment, they tend to take themselves as a burden to their families and
relatives.
Diabetic people tend to live in fear. They are afraid because they cannot predict what the
future holds for them. Although they may not wish to live their entire life in pain and medication,
they tend to fear death. If they are parents, they also fear that they may have passed down some
faulty genes to them and that they may also undergo the same suffering in the future. They also
fear that when they live long, they will become more of a burden to their families and the loved
ones through treatment and caregiving (Hagger et al,2016, p.9).
Diabetic people have also been reported to develop a feeling of helplessness. Most of
them tend to have had an active life before being diagnosed with the disease. When they recall
the activities and tasks they could engage in and the ideas they may have which they cannot
accomplish because of their health status they feel helpless. In the case where the victim is a
parent, watching the children report late to school because they don’t have someone who can
wake and prepare them early enough facilitates the feeling of helplessness (American Diabetes
Association, 2017, p.5). This is closely followed by the feeling of grief, an immense sense of old
self and all the previous capabilities. They tend to feel that their lives have been robbed which
essentially gets them into a mourning state.
For a diabetic person to retain his health and live long, he must develop coping skills.
Coping skills are the different ways people learn to deal with various emotions or feelings. Each
person copes with negative emotions and feelings differently. However, with time people tend to
construct strategies that they think are right. Some of the important coping skills for a person
suffering from diabetes are meditation and relaxation, physical activities and exercises, spending

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time with friends or personal hobbies and finding humor (Hilliard, Powell and Anderson, 2016,
p.590). There are however some diabetic people who cannot cope on their own. Such kinds of
victims are assisted through regular counseling.
Counseling is the interactive session held between a client who has health issues and a
counselor with the aim of motivating and helping the client to cope with his situation. Issues
faced by clients can be cultural, social or emotional and the counselor is supposed to approach
them in a holistic manner (Schroevers et al, 2015, p.100). Counseling is also seen as the process
that occurs when a counselor and client set some time to explore the difficulties faced by the
client, which may be emotional feelings or stressful. It is also seen as an act of helping a client to
see things more clearly or from a different point of view. According to this definition, counseling
enables clients to focus on their behavior, emotions, and experiences to facilitate positive change.
In most cases, counseling and talk therapy are used interchangeably. This is because they
have some similarities. For instance, a talk therapy which is an alternate name for the various
forms of psychotherapy emphasize on the importance of patients or clients speaking with a
therapist as the main approach of expressing or resolving issues. The main aim of counseling on
diabetic people is to help them recognize the opportunities available and lead more rewarding
and satisfying lives (Ingersoll et al, 2015, p.103). A counselor who is taking care of a diabetic
person may also get involved in resolving specific problems and making decisions which help
the client cope when in a crisis situation. A counselor may also help diabetic people resolve
negative feelings and emotions by encouraging them to raise self-awareness. To achieve all this,
they are required to work with client feelings, perceptions or thoughts and be aware of their
external as well as internal feelings.

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Counseling can be achieved in two different approaches, a brief approach, and long term
therapy. However, a brief approach is the most effective in the case of a diabetic person. A brief
approach which is also known as brief therapy is a time-limited counseling approach (10-20
sessions) which focuses on helping diabetic people resolve or effectively manage their emotional
problems or challenges and make desired changes (Shahar et al, 2016, p.14). This is a solution-
oriented therapy with sessions which are more geared towards here-and-now aspects of the
challenges than exploring the historical materials. Goal setting is the hallmark in this approach,
where therapists or counselors are more active in sessions than in the long term therapy.
Long-term therapy which is typically known as psychotherapy is a therapy that exceeds
the normal time allotted for the treatment of the most psychological problem. Based on that fact,
the “long term” idea is defined as the treatment episode that exceeds 12 sessions. However, there
is no standard treatment duration in this approach. Evidence has ranked short-term therapy as a
more effective approach for people experiencing psychological distress (O’Dea et al, 2015).
The brief approach is hence more preferred because of its benefits on the side of clients.
For instance, it has proved to be more attractive to clients because of its tendency to take a much
shorter time than long-term therapy. This is based on the fact that it is undoubtedly clear when
the sessions have been completed. If the long term goals have been achieved, which is easy to
determine because they are measurable and concrete, then the sessions are called off and
treatment ends (Miller and Akohoue, 2017, p.57). Most often, people who practice brief therapy
take cognitive behavioral therapy and motivation interview as the main approaches.
Cognitive behavioral therapy which is abbreviated as CBT is a form of counselling that
treats and increases happiness through modification of behaviors, thoughts, and emotions. Unlike

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the traditional approach which analyses the childhood wounds in order to get to the root cause of
psychological problems, CBT’s main focus is on a solution, encouraging patients to deal with
distorted emotions and helping them manage destructive behavioral patterns (Sebire et al, 2018,
p.204). CBT draws from the fact that perceptions and thoughts influence the overall feelings,
emotions, and behavior. For instance, feeling distressed distorts the reality perception of a
person. For diabetic people, CBT will enable the counselor to identify their harmful thoughts and
feelings and assess whether they accurately depict reality if they are not then strategies to
challenge and overcome them will need to be employed.
During the CBT, the diabetic client will have one session with a therapist every two
weeks. The course of counseling will be lasting for seven to twenty five sessions, with each
session lasting between 30 to 40 minutes. In each session, the patient works with a therapist to
break down his problems, such as physical feelings, thoughts and actions (Newton,
Asimakopoulou and Scambler, 2015). Collaboratively, the client and therapist will analyze the
areas identified to determine whether they are unhelpful or unrealistic, and determine the impacts
they have on the client side. The therapist will then be in a position to help the client work out on
how to change the unhelpful feelings, emotions, and behaviors. After working out on what he
can change, the therapist will then ask the client to practice those changes in his daily life (Zhao
et al, 2017, p.820). This therapy will teach the client to apply skills that he will have learned over
the counseling period in daily life. It will also help the client manage the emotional and
behavioral challenges faced and stop him from having negative impacts in his life, even after the
course of counseling.
From the paragraph above, it has been revealed that CBT draws on the fact that feelings
thoughts, human actions and physical sensations are intertwined and negative thoughts and

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feelings can trap the client into the vicious cycle. This therapy will hence help a diabetic person
deal with the overwhelming feelings and emotions in a more positive manner, which will involve
breaking them down into smaller parts (Trauer et al, 2015, p.200). Through the few interactions
with a therapist, the person will be shown how to change or handle the negative patterns of the
disease to improve the emotions and feelings. Unlike the long term therapy, the CBT will deal
with the victim’s current problems, rather than focusing on the issues from the past. It will also
improve the client’s state of mind on a daily basis.
When dealing with the diabetic victim, CBT will provide the following benefits; it will
help in compliment medication which may not work effectively when used alone. In addition to
that, it will be completed in a relatively short period of time when compared to long term therapy
(Koffel, Koffel and Gehrman, 2015, p.10). The highly structured nature of this therapy will make
it possible to be administered in different approaches to fit the client needs. Lastly, it will equip
the client with useful and practical strategies that can help him overcome the emotional
challenges.
Despite the benefits of CBT mentioned above, it may not work for a diabetic person
because of various reasons. For instance, if the victim does not commit himself to the process it
will be useless. This is because a therapist can only advise and help the client but cannot make
the problems go away without his co-operation (Zachariae et al, 2016, p.10). Also, in a case
where the client has learning difficulties, he may not stand the chance to benefit from the
program. This is because CBT is structured in nature and may not be suitable for people with
learning difficulties. Finally, if the victim’s ability to change is low, CBT may not work. This is
because CBT only works for patients or clients who are willing to change. The client must have
the capacity to change for CBT to yield useful results (Johnsen and Friborg, 2015, p.747).

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Motivational Interviewing is the second approach which will be used to deal with the
diabetic person. Motivational interviewing is a counseling intervention that assists the patients to
resolve ambivalent insecurities and feelings to find the necessary motivation to change behavior
(Lindson‐Hawley, Thompson and Begh, 2015, p.3). Naturally, it is a practical, empathetic and
short term approach that considers the difficulties undergone when making life changes. It is
achieved through a motivational interviewer encouragement on clients to open up and talk about
their needs for change. In this intervention, the interviewers evoke conversations about behavior
change and commitment. The interviewer listens and reflects on the client’s thoughts to gain
insights on how to motivate them back. Generally, an MI is short-term counseling that requires
one or two sessions, although it can be merged with other long term therapies for effectiveness
(Moyers et al, 2016, p.40).
Motivational interviewing is based on Carl Roger’s client or person-centered approach to
counseling, to help people commit to the difficulties which are experienced before achieving
change (Resnicow et al, 2015, p.649). It is a twofold process whose first goal is to increase the
victim’s level of motivation. The second goal is to enable the victim to make a commitment to
change. As opposed to expressing their desire to change, clients under MI must also express their
commitment loudly in order to prove their ability to make changes. In MI, the main role of a
therapist is to listen than to intervene. Combined with other interventions such as CBT, MI is
very effective when handling people with emotional challenges
Mainly, motivational interviewing addresses the management of physical health issues
such as asthma, diabetes and heart diseases. In the case of diabetes, it will help motivate the
victim to change the behaviors that might be preventing him from making healthier choices
(Magill et al, 2018, p.140). It will also prepare the victim for further more specific types of

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therapies. However, if the diabetic victim is already motivated and prepared to change, this
intervention may not work on him. This is because it works well with people who start off
unmotivated and unprepared to change. Also, it will be less effective if the victim is friendly. It is
appropriate for people who are angry and hostile. They may not commit to change but MI helps
them to move through the emotional changes which are necessary to find motivation.
Cognitive behavioral therapy and motivational interview share some aspects which make
them similar. For instance, both CBT and MI are talk therapies with manuals. They are talk
therapies based on the fact that they emphasize on clients or patients speaking to a therapist as
the main approach to express and resolve issues (Trauer et al, 2015, p.195). The two
interventions share common elements of a therapeutic relationship like empathy and
collaboration. Empathy in both draws the clients or patients closer to the counselor because it
makes them identify with the therapist. Collaboration, on the other hand, encourages all-around
client assistance. When a patient health needs are beyond certain expertise, the client is referred
to the right professionals where he or she can get the necessary assistance.
Both cognitive therapy and motivational interview interventions emphasize client
activities as the basis of change. In other words, they are patient-centered. In both interventions,
the patient’s specific health issues and the desired outcomes act as the driving force behind all
the decisions made during the counseling sessions (Moyers et al, 2016, p.42). The two
approaches offer empirical support for efficiency. This is in consideration of the fact that patients
under distress tend to have peculiar emotions and feelings which require adjustment. Lastly, both
interventions require trained professionals, thus not everyone can offer the services without
training for purposes of competence.