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1. Acceptance and commitment Therapy for Depression. Society of Clinical Psychology: American Psychological Association, Division 12. Retrieved from http://www.div12.org/PsychologicalTreatments/index.html

2. Harris, R. (2006). Embracing your Demons: An Overview of Acceptance and Commitment Therapy. Psychotherapy in Australia, 12(4).

3. Dahl, J., Wilson, K.G. & Nilsson, A. (2004). Acceptance and Commitment Therapy and the Treatment of Persons at Risk for Long-Term Disability Resulting from Stress and Pain Symptoms: A Preliminary Randomized Trial. Behavior Therapy 35, 785-801.

4. Zettle, R.D. & Hayes, S.C. (1986). Dysfunctional Control by Client Verbal Behavior: The Context of Reason-Giving. The Analysis of Verbal Behavior 4, 30-38.

5. Bond, F.W. & Bruce, D. (2000). Mediators of Change in Emotion-Focused and Problem-Focused Worksite Stress Management Interventions. Journal of Occupational Health Psychology 5, 156-163.

6. Dalrymple, K.L (2005). Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder: A Pilot Study (Doctoral Dissertation). Drexel University, Philadelphia, PA. Retrieved from http://144.118.25.24/bitstream/1860/612/7/Dalrymple_Kristy.pdfAcceptance and Commitment Therapy (ACT) is a form of behavioral therapy that includes practices of acceptance and mindfulness along with behavior-change strategies that can help in the treatment of depression. Unlike behavioral therapy which emphasizes controlling thoughts and feelings, ACT teaching strategies to observe, accept and embrace these thoughts and feelings.1 Some have found the therapy hard to categorize as it challenges the current western psychological paradigm, preferring instead to describe it as an "existential humanistic cognitive behavioral therapy." 2

How it Works?

ACT does not seek to reduce the symptoms associated with any chronic mental illnes, believing resistance of symptoms to be futile, though symptom reduction is often achieved. 2 Rather, through therapy, clients seek to open to their emotions and thoughts and invest their energies in taking effective action to change their lives.2 ACT therapy, then, are centered around two main focuses: 1) accept experiences outside of the individual's control and 2) take actionable steps towards living a valued and balance life.2

The six core principles of ACT are:2

1) Cognitive diffusion- allows the individual to "step back" from whatever they are experiencing and objectively observe their emotion or thought as merely words and ideas. These words and ideas are not (necessarily) the threatening situations the individual perceives them to be and are indeed separate from the individual themselves.

2) Acceptance- urges the client to openly embrace whatever unpleasant feelings, emotions or thoughts come up.

3) Contact with the present moment- brings the client's awareness to the here-and-now.

4) The observing self- helps the individual to see they they are an objective observer to their emotions and thoughts and the situations the individual perceives are actually separate from the individual themselves.

5) Values- help identify what values are central to the individual.

6) Committed action- helps the individual set goals based on their established meaningful values.

Evidence that it Works?

Results from a formidable study conducted in the 1986 found that acceptance and commitment therapy (ACT), when coupled with cognitive therapy, produced a significant decrease in depression in the study participants.4 (Reduction of depression was determined via the Hamilton Rating Scale for Depression or HAM-D; a reputable means for rating depression.)

In another study, ACT was found to both decrease depression and increase concrete stress-reduction actions taken in by 90 individuals in the workplace. 5 Additionally, stress and psychological health were beneficially affected as a result of exposure to ACT.5

One study conducted on mental health workers in Sweden found that those exposed to four 1-hour sessions per week of acceptance and commitment therapy utilized fewer sick days and fewer medical treatment resources (including physician, specialist and physical therapy visits) than those who were not exposed to ACT.3

Yet another study found that the majority of participants self-reported lower rates of depression and anxiety and 37% of those participants improved so dramatically the change was considered clinically significant (meaning the client no longer meets the criteria for a clinical diagnosis.)6

References:

1 Acceptance and commitment Therapy for Depression. Society of Clinical Psychology: American Psychological Association, Division 12. Retrieved from http://www.psychology.sunysb.edu/eklonsky-/division12/treatments/depression_acceptance.html

2 Harris, R. (2006). Embracing your Demons: An Overview of Acceptance and Commitment Therapy. Psychotherapy in Australia, 12(4).

3 Dahl, J., Wilson, K.G. & Nilsson, A. (2004). Acceptance and Commitment Therapy and the Treatment of Persons at Risk for Long-Term Disability Resulting from Stress and Pain Symptoms: A Preliminary Randomized Trial. Behavior Therapy 35, 785-801.

4 Zettle, R.D. & Hayes, S.C. (1986). Dysfunctional Control by Client Verbal Behavior: The Context of Reason-Giving. The Analysis of Verbal Behavior 4, 30-38.

5 Bond, F.W. & Bruce, D. (2000). Mediators of Change in Emotion-Focused and Problem-Focused Worksite Stress Management Interventions. Journal of Occupational Health Psychology 5, 156-163.

6 Dalrymple, K.L (2005). Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder: A Pilot Study (Doctoral Dissertation). Drexel University, Retrieved from http://144.118.25.24/bitstream/1860/612/7/Dalrymple_Kristy.pdf

1. Mensing, C. et al. (2006). The Art and Science of Diabetes Self-Management Education. Chicago: AADE

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Being diagnosed with diabetes can be a difficult message to receive. Diabetes requires a look at lifestyle, food choices, medications, blood glucose testing, and all that advice offered by well-meaning family and friends. It can be overwhelming to say the least. Learning how to live well with diabetes takes time and it takes lifestyle adjustments to do it well. Some people are just not up to it on their own. The best support a person with diabetes can get is from medical professionals who really know diabetes, family members who are willing to provide a healthy supportive environment including healthy food choices for everyone in the family, increased physical activity as a norm and a willingness to learn about diabetes together. It is often said “diabetes is a family disease” because it ends up effecting everyone.

Depression affects nearly 40% of those diagnosed with diabetes. It is unclear if depression is a result of high blood glucose levels or from the demand the disease has on the person living with it. Treating the depression becomes an integral part of treating the overall disease of diabetes.

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Inside each muscle cell, tiny agents called glucose transporters migrate to the cell wall to allow in glucose. During and after exercise, these transporters are highly active pulling glucose out of the blood stream at a remarkable rate. Whenever the large muscles in the body, such as the thigh or buttock muscles, are being used, these transporters are actively helping to clear excess glucose out of the blood stream.

The human body is designed to be active, to the tune of walking five miles each day. When our lifestyles have us sitting most of the day (computing, commuting, and watching TV), the glucose transporters get sluggish and lazy. Finding a way to add activity into daily life is an essential part of controlling diabetes. It is recommended to walk 30 minutes most days of the week for general health. To get started three sessions of 10 minutes walks is fine. The transporters respond to any and all activity.

Apple cider vinegar taken at meals appears to help lower post meal blood sugar levels and is certainly a safe, albeit tangy, food to take. Studies have also shown that taking apple cider vinegar before bedtime may improve weight loss.

This much studied vitamin-like substance appears to minimize symptoms of nerve damage (peripheral neuropathy) as a result of high blood glucose levels. Long-term studies as still needed to determine if ALA can slow the progression of neuropathy.

Typical doses of oral ALA are 600mg to 1200 mg per day.

This much studied vitamin-like substance appears to minimize symptoms of nerve damage (peripheral neuropathy) as a result of high blood glucose levels. Long-term studies as still needed to determine if ALA can slow the progression of neuropathy.

Vinegar Apple cider vinegar taken at meals appears to help lower post meal blood sugar levels and is certainly a safe, albeit tangy, food to take. Studies have also shown that taking apple cider vinegar before bedtime may improve weight loss.

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Specific herbal therapies can help lower blood glucose levels and/or treat problems (some of the complications ) of diabetes. These therapies may be referred to as “herbal” or “nutriceuticals”“nutriceuticals.” A tour of the health food store suggests an extensive list of supportive products such as cinnamon, gymnema, fenugreek, bitter melon, ginseng, nopal, aloe vera, banaba, caiapo, bilberry, milk thistle, chromium, vanadium, nicotinamide, alpha lipoic acid, gamma linolenic acid, ginkgo biloba, garlic, vinegar and St John’s Wart. However, many experts agree that although these may not be harmful if taken, their actual benefit on lowering blood glucose levels requires further research, particularly studies with a greater number of study participants.

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Type 2 diabetes is a progressive disease. Simply put, the pancreas over time, perhaps years, the body does not respond adequately to the insulin present. Additionally, though less true of type 2 diabetes than type 1, the pancreas cannot produce enough insulin to accommodate the needs of the body. The need for medication to help the body make insulin, replace missing insulin, or make the body more sensitive to utilizing insulin is considered necessary. Early on in the disease, when it is often not known that diabetes exists, some can become necessary. Some people can control their blood sugars without medication referred to as “diet and exercise controlled”. But virtually everyone many with type 2 diabetes will may need some medication at some point.

The goal of treating diabetes is to come as close to normal blood glucose control as possible. Normal being a fasting sugar around 100 mg/dL or a lab test called a Hemoglobin A1c value of less than 6.5%.

Medications to control blood glucose fall into distinct categories. It may often require two or three medications to reach glucose goals as medications work on different parts of the body involved in glucose control. Guidelines recommend that practitioners begin a person recently diagnosed with diabetes on the medication Metformin at the onset of the disease.

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Symptoms like increased thirst, frequent urination, reoccurring infections can often be indications of diabetes. However, a formal diagnosis of diabetes is through having a fasting lab blood glucose level over 126 mg/dL; or a random lab blood glucose over 200 mg/dL with symptoms of high blood glucose such as increased thirst,frequent urination, reoccuring infections; or a hemoglobin A1c lab value greater than 6.5%.

A diagnosis of prediabetes is a fasting blood glucose of 100 mg/dL - 125 mg/dL.

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The onset of type 2 diabetes is very slow. Abnormal blood glucose slowly increases over time, often over five to ten years. High blood glucose levels are often associated with:

• increased thirst
• frequent urination
• increased hunger
• fatigue
• slow wound healing
• blurred vision
• frequent and reoccurring infections
• areas of darkened skin

The diagnosis of type 2 diabetes very often follows the complaint of a sore that does not heal, a change eye glass prescription or medical or dental attention for an infection. Nearly 40% of people with diabetes suffer from depression. Undiagnosed or untreated depression makes diabetes self care and its demands challenging.