The Effectiveness of Cognitive-Behavioral Therapy on Recurrent Negative Thoughts, Anxiety Sensitivity, and Emotional Adjustment in Diabetic Neuropathy Pain

Document Type : Original Research

Authors
F. Madani 1
N. Haghighat Bayan 2
M. Mahmoudi 3
F. Saeedi Moghadam 4
V. Savabi Niri 5
1 M.A in Clinical Psychology, Shahre Qods Branch, Islamic Azad University, Tehran, Iran
2 Ph.D. in Clinical Psychology, Islamic Azad University, Roudehen Branch, Roudehen, Iran
3 M.A. in General Psychology, Zahedan University, Zahedan, Iran.
4 M.A in General Psychology, Payame Noor University, Zarrinshahr Branch, Zarrinshahr, Iran
5 M.A in Clinical Psychology, Islamic Azad University, Ardabil Branch, Ardabil, Iran
10.22034/IJMPP.10.1.1177
Abstract
Aims: Diabetic Neuropathy Pain (DNP) is a chronic condition that arises from nerve damage caused by prolonged hyperglycemia. It leads to burning, tingling, and sharp pain, primarily in the extremities. This study examines the effectiveness of Cognitive-Behavioral Therapy (CBT) in mitigating recurrent negative thoughts, reducing anxiety sensitivity, and enhancing emotional adjustment in individuals with DNP.

Method and Materials: The study employed a quasi-experimental pre-test-post-test design with a control group, involving 36 patients with DNP from Ardabil clinics located in Ardabil, Iran in 2024. Patients were purposively sampled and randomly assigned to intervention (n = 18) and control (n = 18) groups. The intervention group underwent eight 90-minute CBT sessions, while the control group received no intervention. Data were gathered using the Repetitive Negative Thinking Questionnaire, Anxiety Sensitivity Index-3, and Emotional Adjustment Measure. The collected data were analyzed using MANCOVA in SPSS-27.

Findings: The results demonstrated that CBT significantly improves emotional adjustment (F = 49.46) and reduces recurrent negative thoughts (F = 45.41), as well as physical (F = 52.27), cognitive (F = 59.61), and social dimensions of anxiety sensitivity (F = 38.34) in individuals with DNP (P < 0.001).

Conclusion: The findings highlight CBT's transformative impact on the psychological resilience of DNP patients, fostering adaptive emotional regulation and diminishing maladaptive thought patterns. By addressing the interconnected dimensions of anxiety sensitivity and emotional adjustment, CBT offers a pathway to holistic pain management, emphasizing its potential as a cornerstone in the psychological care of chronic pain conditions.

Keywords

Subjects

1. Rosenberger DC, Blechschmidt V, Timmerman H, Wolff A, Treede RD. Challenges of neuropathic pain: focus on diabetic neuropathy. J Neural Transm. 2020;127(4):589-624.
2. Feldman EL, Nave KA, Jensen TS, Bennett DL. New horizons in diabetic neuropathy: mechanisms, bioenergetics, and pain. Neuron. 2017;93(6):1296-313.
3. Themistocleous AC, Ramirez JD, Shillo PR, Lees JG, Selvarajah D, Orengo C, et al. The Pain in Neuropathy Study (PiNS): a cross-sectional observational study determining the somatosensory phenotype of painful and painless diabetic neuropathy. Pain. 2016;157(5):1132-45.
4. Jensen TS, Karlsson P, Gylfadottir SS, Andersen ST, Bennett DL, Tankisi H, et al. Painful and non-painful diabetic neuropathy, diagnostic challenges and implications for future management. Brain. 2021;144(6):1632-45.
5. Marchesi N, Fahmideh F, Pascale A, Allegri M, Govoni S. Neuropathic pain in aged people: an unresolved issue open to novel drug approaches, focusing on painful diabetic neuropathy. Curr Neuropharmacol. 2024;22(1):53-64.
6. Dludla PV, Nkambule BB, Cirilli I, Marcheggiani F, Mabhida SE, Ziqubu K, et al. Capsaicin, its clinical significance in patients with painful diabetic neuropathy. Biomed Pharmacother. 2022;153:113439.
7. D’Souza RS, Barman R, Joseph A, Abd-Elsayed A. Evidence-based treatment of painful diabetic neuropathy: a systematic review. Curr Pain Headache Rep. 2022;26(8):583-94.
8. Sheykhangafshe FB, Farahani H, Dehghani M, Fathi-Ashtiani A. Examining Alexithymia and Post-Traumatic Stress Disorder across Different Levels of Chronic Pain in Patients. IJMPP 2024; 9 (2): 1026-1033.
9. Clarke D, Goosen T. The mediating effects of coping strategies in the relationship between automatic negative thoughts and depression in a clinical sample of diabetes patients. Pers Individ. Differ. 2009;46(4):460-4.
10. Özen AT, Düzalan ÖB, Yalçın B. Metaphoric perceptions of individuals with diabetes in Turkey: A content analysis. Belitung Nurs J. 2024;10(1):31-40.
11. Kulkarni S, Patil V, Kashikar R, Deshpande R, Dole K. Social determinants of diabetic retinopathy and impact of sight-threatening diabetic retinopathy: A study from Pune, India. Indian J Ophthalmol. 2023;71(2):358-62.
12. Li S, Fang L, Lee A, Hayter M, Zhang L, Bi Y, Wu X, Liu L, Zhang H, Yuan Y, Gong W. The association between diabetes‐related distress and fear of hypoglycaemia in patients with type 2 diabetes mellitus: a cross‐sectional descriptive study. Nurs Open. 2021;8(4):1668-77.
13. Lindgreen P, Willaing I, Clausen L, Ismail K, Grønbæk HN, Andersen CH, et al. “I Haven’t Told Anyone but You”: Experiences and Biopsychosocial Support Needs of People With Type 2 Diabetes and Binge Eating. Qual Health Res. 2024;34(7):621-34.
14. Wijk I, Amsberg S, Johansson UB, Livheim F, Toft E, Anderbro T. Impact of an Acceptance and Commitment Therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels: a randomised controlled trial. BMJ open. 2023;13(12):e072061.
15. Sieberg CB, Taras C, Gomaa A, Nickerson C, Wong C, Ward C, et al. Neuropathic pain drives anxiety behavior in mice, results consistent with anxiety levels in diabetic neuropathy patients. Pain rep. 2018;3(3):e651. doi: 10.1097/PR9.0000000000000651
16. Kec D, Rajdova A, Raputova J, Adamova B, Srotova I, Nekvapilova EK, et al. Risk factors for depression and anxiety in painful and painless diabetic polyneuropathy: a multicentre observational cross‐sectional study. Eur J Pain. 2022;26(2):370-89.
17. Naranjo C, Del Reguero L, Moratalla G, Hercberg M, Valenzuela M, Failde I. Anxiety, depression and sleep disorders in patients with diabetic neuropathic pain: a systematic review. Expert Rev Neurother. 2019;19(12):1201-9.
18. Rees G, Xie J, Fenwick EK, Sturrock BA, Finger R, Rogers SL, Lim L, Lamoureux EL. Association between diabetes-related eye complications and symptoms of anxiety and depression. JAMA Ophthalmol. 2016;134(9):1007-14.
19. Nathan HJ, Poulin P, Wozny D, Taljaard M, Smyth C, Gilron I, et al. Randomized trial of the effect of mindfulness-based stress reduction on pain-related disability, pain intensity, health-related quality of life, and A1C in patients with painful diabetic peripheral neuropathy. Clin Diabetes. 2017;35(5):294-304.
20. Zhang Y, Zhang S, Pan L, Wang B, Sun Y, Gao L, et al. Painful Diabetic Peripheral Neuropathy Study of Chinese Outpatients (PDNSCOPE): a multicentre cross-sectional registry study of clinical characteristics and treatment in Mainland China. Pain Ther. 2021;10(2):1355-73.
21. Verriotis M, Peters J, Sorger C, Walker SM. Phenotyping peripheral neuropathic pain in male and female adolescents: pain descriptors, somatosensory profiles, conditioned pain modulation, and child–parent reported disability. Pain. 2021;162(6):1732-48.
22. Noh GO, Park KS. Effects of aroma self-foot reflexology on peripheral neuropathy, peripheral skin temperature, anxiety, and depression in gynaecologic cancer patients undergoing chemotherapy: A randomised controlled trial. Eur J Oncol Nurs. 2019;42:82-9.
23. Yalcin I, Barthas F, Barrot M. Emotional consequences of neuropathic pain: insight from preclinical studies. Neurosci Biobehav Rev. 2014;47:154-64.
24. Zheng YH, Ren CY, Shen Y, Li JB, Chen MW. A cross-sectional study on the correlation between inflammatory cytokines, negative emotions, and onset of peripheral neuropathy in type 2 diabetes. Neuropsychiatr Dis Treat. 2020:2881-90.
25. Heydarian SM, Amiri M, Jani HT. The effectiveness of self-control and communication skills on emotional regulation, perceived pain severity and selfcare behaviors in diabetic neuropathy. J Fundam Ment Health. 2018;20(6), 377-387.
26. Yang L, Lu J, Guo J, Chen J, Xiong F, Wang X, et al. Ventrolateral periaqueductal gray astrocytes regulate nociceptive sensation and emotional motivation in diabetic neuropathic pain. J Neurosci. 2022;42(43):8184-99.
27. Gierthmühlen J, Böhmer J, Attal N, Bouhassira D, Freynhagen R, Haanpää M, Hansson P, Jensen TS, Kennedy J, Maier C, Rice AS. Association of sensory phenotype with quality of life, functionality, and emotional well-being in patients suffering from neuropathic pain. Pain. 2022;163(7):1378-87.
28. Twiddy H, Frank B, Alam U. A consideration of the psychological aspects to managing patients with painful diabetic neuropathy: An insight into pain management services at a tertiary centre in the UK. Diabetes Ther. 2021;12(2):487-98.
29. Bai Y, Ma JH, Yu Y, Wang ZW. Effect of cognitive-behavioral therapy or mindfulness therapy on pain and quality of life in patients with diabetic neuropathy: A systematic review and meta-analysis. Pain Manag Nurs. 2022;23(6):861-70.
30. Higgins DM, Heapy AA, Buta E, LaChappelle KM, Serowik KL, Czlapinski R, et al. A randomized controlled trial of cognitive behavioral therapy compared with diabetes education for diabetic peripheral neuropathic pain. J Health Psychol. 2022;27(3):649-62.
31. Li C, Hou W, Ding D, Yang Y, Gu S, Zhu Y. Evidence mapping based on systematic reviews of cognitive behavioral therapy for neuropathic pain. Neural Plast. 2023;2023(1):2680620. doi: 10.1155/2023/2680620
32. Li Y, Storch EA, Ferguson S, Li L, Buys N, Sun J. The efficacy of cognitive behavioral therapy-based intervention on patients with diabetes: A meta-analysis. Diabetes Res Clin Pract. 2022;189:109965.
33. Racaru S, Sturt J, Celik A. The effects of psychological interventions on diabetic peripheral neuropathy: a systematic review and meta-analysis. Pain Manag Nurs. 2021;22(3):302-11.
34. van Laake-Geelen CC, Smeets RJ, Quadflieg SP, Kleijnen J, Verbunt JA. The effect of exercise therapy combined with psychological therapy on physical activity and quality of life in patients with painful diabetic neuropathy: a systematic review. Scand J Pain. 2019;19(3):433-9.
35. Dong N, Wang X, Yang L. The short-and long-term effects of cognitive behavioral therapy on the glycemic control of diabetic patients: a systematic review and meta-analysis. Biopsychosoc Med. 2023;17(1):18. doi: 10.1186/s13030-023-00274-5.
36. Yu Z, An Q, Hawkins J, Zhang A. Cognitive Behavioral Therapy for Depression Among Chinese Diabetes Patients: A Systematic Review and Meta-Analysis. Res Soc Work Pract. 2024;34(3):277-92.
37. Saxena AK, Bhardwaj N, Chilkoti GT, Malik A, Thakur GK, Bajaj M, et al. Modulation of mRNA expression of IL-6 and mTORC1 and efficacy and feasibility of an integrated approach encompassing cognitive behavioral therapy along with pregabalin for management of neuropathic pain in postherpetic neuralgia: a pilot study. Pain Med. 2021;22(10):2276-82.
38. McEvoy PM, Mahoney AE, Moulds ML. Are worry, rumination, and post-event processing one and the same? Development of the Repetitive Thinking Questionnaire. J Anxiety Disorder. 2010;24(5):509-19.
39. Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, et al. Robust dimensions of anxiety sensitivity: Development and initial validation of the anxiety sensitivity index-3. Psychol Assess. 2007; 19(2):176-188.
40. Rubio VJ, Aguado D, Hontangas PM, Hernández JM. Psychometric properties of an emotional adjustment measure: An application of the graded response model. Eur J Psychol Assess. 2007;23(1):39-46.
41. Wright JH, Brown GK, Thase ME, Basco MR. Learning cognitive-behavior therapy: An illustrated guide. American Psychiatric Pub; 2017. doi:10.1176/appi.books.9781615374823
International Journal of Musculoskeletal Pain Prevention
Volume 10, Issue 1
February 2025
Pages 1177-1186