Self-Compassion, Adaptive Reactions and Health Behaviours Among Adults With Prediabetes and Type 1, Type 2 and Gestational Diabetes: A Scoping Review

Abstract

Engaging in health-promoting behaviours has health benefits for people with prediabetes or diabetes. People experience negative affect after diagnoses, which can impede self-regulation of health behaviours. Self-compassion, extending care to oneself in difficult times, can mitigate negative affect and promote self-regulation. This scoping review explored the relationship between self-compassion and adaptive affect, self-regulation and engagement in health-promoting/management behaviours among people with prediabetes or diabetes. We conducted a scoping literature search from 6 databases for studies and conference abstracts. Randomized controlled trials and cross-sectional, longitudinal, observational and qualitative designs focused on self-compassion were included. Eligible studies included adults with diabetes (prediabetes, type 1, type 2 and gestational), measured self-compassion using a validated Self-Compassion Scale (quantitative) or included the 3 components (qualitative) and investigated: negative affect, health promoting/management behaviours and/or self-regulation. After deduplication, 5,338 quantitative and 953 qualitative abstracts, and 18 conference proceedings were screened leaving 35 articles. Full-text screening retained 11 eligible studies (6 cross-sectional studies, 2 randomized controlled trials, 2 longitudinal studies and 1 qualitative study). Higher self-compassion was associated with decreased negative affect in 9 studies and was positively associated with well-being in 1 cross-sectional study. Self-compassion led to decreased negative affect and improved blood glucose in 2 interventions. Five studies found positive associations between self-compassion and health-promoting/management behaviours. One qualitative study found self-compassion to benefit affective reactions, health-promoting behaviours and self-regulation. This review shows that self-compassion is linked to adaptive behavioural and affective responding among people with prediabetes and diabetes, and the need for more research on self-compassion and self-regulation in these populations.

Résumé

L’adoption de comportements favorables à la santé a des avantages pour la santé des personnes atteintes de prédiabète ou de diabète. Après le diagnostic, ces personnes font l’expérience d’un affect négatif qui peut nuire à l’auto-régulation des comportements liés à la santé. L’auto-compassion, c’est-à-dire le fait de prendre soin de soi-même dans les moments difficiles, peut atténuer l’affect négatif et favoriser l’auto-régulation. La présente étude de portée a permis d’explorer la relation entre l’auto-compassion et l’affect adaptatif, l’auto-régulation et l’adoption de comportements favorables à la santé/de prise en charge au sein des personnes atteintes de prédiabète et de diabète. Nous avons effectué une recherche de littérature de portée dans 6 banques de données pour trouver des études et des résumés de conférences. Nous avons sélectionné les essais cliniques à répartition aléatoire RCT et les études transversales, longitudinales, observationnelles et qualitatives qui portaient sur l’auto-compassion. Les études admissibles regroupaient des adultes atteints de diabète (prédiabète, diabète de type 1, de type 2 et gestationnel), permettait d’évaluer l’auto-compassion à l’aide d’une échelle validée sur l’auto-compassion (quantitative) ou portaient sur les 3 composantes (qualitatives), et permettait d’examiner : l’affect négatif, les comportements favorables à la santé/de prise charge et/ou l’auto-régulation. Après la déduplication, nous avons filtré 5,338 résumés quantitatifs, 953 résumés qualitatifs et 18 actes de conférences pour ne conserver que 35 articles. Après le filtrage des textes intégraux, 11 études étaient admissibles (6 études transversales, 2 essais cliniques à répartition aléatoire, 2 études longitudinales et 1 étude qualitative). Une plus grande auto-compassion était associée à la diminution de l’affect négatif dans 9 études et était associée de manière positive au bien-être dans 1 étude transversale. L’auto-compassion entraînait la diminution de l’affect négatif et permettait d’améliorer la glycémie dans 2 interventions. Cinq études ont montré des associations positives entre l’auto-compassion et les comportements favorables à la santé et de prise en charge. Une étude qualitative a montré que l’auto-compassion permettait d’améliorer les réactions affectives, les comportements favorables à la santé et l’auto-régulation. Cette revue montre que l’auto-compassion est liée à la réponse comportementale et affective adaptative des personnes atteintes de prédiabète et de diabète, et la nécessité de faire plus de recherches sur l’auto-compassion et l’auto-régulation dans ces populations.

Introduction

Rates of prediabetes and diabetes are rising globally (1) and are associated with adverse health conditions, such as cardiovascular (2) and kidney (3) diseases. Prediabetes has been commonly defined by glucose regulation that is impaired but has not yet reached set diabetes cutoffs for blood glucose levels (i.e. ≥11 mmol/L 2 h after a glucose dose of 75 g or ≥7.0 mmol/L when fasted) (4). One-half of individuals diagnosed with prediabetes eventually develop type 2 diabetes (5). Furthermore, most type 1 diabetes diagnoses occur during adulthood (6). Diabetes prevention and management involves engaging in health-promoting behaviours. According to the National Institute for Health and Care Excellence (7), exercise, nutrition, blood glucose monitoring and medication adherence are important health-promoting behaviours used to manage/reduce the risk of diabetes; however, adherence to these behaviours is low (8). Low adherence rates have been associated with further health complications including low psychological well-being (6) and mortality (9). It is important to identify factors associated with health behaviours that can aid in the prevention and management of both prediabetes and diabetes in adulthood to improve disease management and quality of life for these individuals.

Initiating and/or adhering to health-promoting behaviours is challenging because of the self-regulatory effort required (10). For example, to successfully self-regulate a health behaviour, individuals must set a reasonable goal, plan their schedule to accommodate their goal, persist at their goal in the face of barriers and readjust the goal if insufficient progress is made or reinitiate goal pursuit if there is a behaviour lapse (11). Self-regulation is paramount for behaviour maintenance and change, but is a complex process (12). Initiating and/or adhering to health-promoting behaviours can be especially challenging for people with prediabetes or diabetes who must self-regulate these behaviours in the face of a health threat, an experience associated with negative affective reactions, and maintain this self-regulation to achieve long-term disease management. For instance, people diagnosed with prediabetes or diabetes (type 1, type 2 and gestational) have experienced negative emotions relative to their diagnosis, including anger (6), shock and denial (6,13) and shame (14,15), and face a high comorbidity with psychological conditions, such as depression (16). Furthermore, a prediabetes or diabetes diagnosis can lead to uncertainty, fear and anxiety about future prognosis (17). Negative reactions such as these can impair an individual’s ability to self-regulate (18) by impairing decision-making (19), directing focus away from goals (20) and in turn undermining their ability to adhere to health-promoting behaviours. Individuals diagnosed with prediabetes or diabetes may benefit from resources that would reduce the impact of negative affective reactions on their ability to self-regulate and adhere to health-promoting behaviours. One such resource may be the psychological construct of self-compassion.

Self-compassion is the extension of care to oneself in difficult times (10) and has 3 integrated components: mindfulness (vs overidentification), self-kindness (vs self-judgment) and common humanity (vs isolation) (21). Mindfulness is being aware of the present moment in a nonjudgmental manner (21). Self-kindness involves responding to flaws, personal failings and setbacks with support rather than self-criticism (21). Common humanity is the recognition that all humans are imperfect and individuals are not alone in experiencing imperfection, mistakes, setbacks and suffering (21). The Self-Compassion Scale (SCS) created by Neff (22), which is the first available and validated measure of self-compassion, measures the 3 positive domains that represent self-compassionate responding (i.e. mindfulness, self-kindness, common humanity) and corresponding opposing domains (i.e. overidentification, self-judgment, isolation) that measure uncompassionate responding (23). In the context of being self-compassionate while coping with prediabetes or diabetes, people may mindfully relate to their thoughts and emotions in a balanced and nonjudgmental manner (e.g. Coping with diabetes is hard. I am scared about my health and can allow this emotion to be there), kindly provide themselves with what they need in their situation (e.g. It is okay to feel like I am struggling. I will continue trying to take care of myself by being active and eating well) and realize they are not alone in their suffering (e.g. There are many other individuals dealing with diabetes who are feeling the same; I am not alone).

Self-compassion is a skill that can be developed through both simple skill training and interventions (e.g. the 8-week Mindful Self-Compassion course), therefore promoting adaptive self-regulation in a number of ways (24). First, self-compassion is linked with motivation after setbacks (15) and can decrease negative reactions when setbacks (25,26) or health threats (e.g. cardiovascular disease) arise (27,28). For example, in both a meta-analysis across 5 medical samples (i.e. fibromyalgia: n=2, cancer: n=2, chronic fatigue syndrome: n=1) (29), and among an adult community sample (30), self-compassion was associated with engagement in health behaviours through decreasing perceived stress (30), and overall negative affect (31). Moreover, self-compassion fosters an improved desire to treat oneself in a caring way and has been shown to decrease defensiveness and self-derogation that thwart engagement in health behaviours (29). Second, self-compassion promotes a proactive health focus (28), which may lead to goal setting to enhance one’s health and well-being (10). For example, among both an adult community sample (32) and women at risk of cardiovascular disease (28), self-compassion was positively associated with people wanting to improve their health (28,32). Third, self-compassion helps individuals take responsibility for their actions and seek to improve their situation (33). In 2 chronic illness samples (i.e. inflammatory bowel disease, arthritis), higher levels of self-compassion were associated positively with adaptive coping strategies, such as problem-focused strategies and positive reframing, and negatively associated with maladaptive strategies (33). Therefore, self-compassion may facilitate people with diabetes to manage negative emotions (i.e. those associated with their diagnosis, or overall), focus on improving their health and actively cope with their disease. Self-compassion may also indirectly influence disease management through mitigating distress, diabetes-related or otherwise.

Given the links between self-compassion, adaptive self-regulation and engagement in health-promoting behaviours, self-compassion may play a vital role in terms of diabetes prevention and management. Indeed, people recently diagnosed with prediabetes see the value in applying self-compassion to their prediabetes experience; however, these people can also be self-critical about their situation (15). These findings have been extended in research among people with type 1, type 2 or gestational diabetes (34,35), suggesting that these individuals may not relate to themselves with compassion in this context. Alternatively, individuals with prediabetes or diabetes who are self-compassionate may apply less self-blame during disease management lapses (e.g. diabetes complications, failure to adhere to diet/exercise guidelines), allowing them to better cope with their disease.

The purpose of this paper is to conduct and report on a scoping review of the scholarly communications on self-compassion and affective reactions to diagnosis, self-regulation and engagement in health-promoting/management behaviours in adults (≥18 years of age) with prediabetes or diabetes. We aimed to present the current state of quantitative and qualitative knowledge on these topics to provide a summary on what is known and where gaps exist, to direct future research.