Effectiveness of compassion-focused therapy in alexithymia, adaptive behavior, treatment adherence, and biological factors in patients with type 2 diabetes

Document Type : Original Article


1 Ph.D. Student, Department of Psychology, Kish International branch, Islamic Azad University, Kish island, Iran

2 shahid chamran university

3 Associate Professor, Department of Psychology, Ahvaz branch, Islamic Azad University, Ahvaz, Iran

4 Professor, Department of Psychology, Kish International branch, Islamic Azad University, Kish, Iran

5 Assistant Professor, Department of Internal Medicine, Diabetes Research Center, Health Research Institute, Jundishapur University of Medical Sciences, Ahvaz, Iran


Background and Objective: The diabetic patients experience a plethora of emotional problems besides physiological physical problems, which can affect the course of their disease. Therefore, the purpose of the present study was to investigate the effectiveness of compassion focused therapy (CFT) on alexithymia, adaptive behavior, treatment adherence, and Blood sugarof patients with type 2 diabetes.
Materials and Methods: In this research, a quasi-experimental design with pretest-posttest and control group was adopted. The study population includes patients with type 2 diabetes in Ahvaz in 2020 that referred to my center. The sample size (n=30) was selected using availability sampling method, who were randomly and equally assigned to experimental (CFT), and control group. To collect research data, the Toronto Alexithymia Scale, the Psychosocial Adjustment with Illness Scale, the Treatment Adherence Questionnaire, and the Blood sugar test were used. The CFT group received 8 sessions of intervention (each for 2 h). Multivariate analysis of covariance was used to data analysis.
Results: The results showed that CFT had a significant effect on alexithymia (F=9/27, p=0/006), adaptive behavior (F=6/75, p=0/016), and treatment adherence (F=15/26, p=0/001) of patients with type 2 diabetes in the post-test. There was no significant difference between the experimental and control groups in Blood sugartest (F=0/08, p=0/786).
Conclusion: Based on the findings, it can be concluded that CFT is effective in increasing the level of adaptive behavior and adherence to treatment.


  1. Holakouie Naieni K, Mansournia M A, Khodamoradi F, Hosseinkhani Z, Ranjbaran M, Foroozanfar Z, et al. The effect of metabolic syndrome components on HbA1C in type-2 diabetic patients in Qazvin city. sjsph. 2018; 16 (2): 196-205.
  2. Rahimian Bogar SE. Clinical psychology of health. Tehran: Danjeh Publication. 2009.
  3. Mekhtiev TV. Stress, anxiety, depression and erectile dysfunction in patients with diabetes mellitus. Georgian Med News. 2012; 220: 77-81.
  4. de Ornelas Maia ACC, de Azevedo Braga A, Paes F, Machado S, Carta MG, Nardi AE, Silva AC. Comorbidity of depression and anxiety: Association with poor quality of life in type 1 and 2 diabetic patients. Clinical Practice and Epidemiology in Mental Health: CP & EMH. 2013; 12(9): 136-41.
  5. Oraki M, Zare H, Shirazi N, Hasanzadeh Pashang S. The effect of cognitive behavioral anger management training on treatment adherence and glycemic control in patients with type 2 diabetes. Quarterly Journal of Health Psychology. 2013; 1(4): 56-70.
  6. Baigan K, Khoshkonesh A, Habibi Askarabad M, Fallahzade H. Effectiveness of dialectical behavioral group therapy in alexithymia, stress, and diabetes symptoms among type 2 diabetes patients. Journal of Diabetes Nursing. 2016; 4(3): 8-18
  7. Besharat M. The mediation effect of self-regulation on the relationship between attachment styles and alexithymia. Journal of Psychological Achievements. 2013; 20(2); 19-38.
  8. Fekri A, Isazadegan A, Mikaeli F. Comparison of cognitive emotion regulation strategies and alexithymia in individuals with and without essential hypertension. Contemporary Psychology. 2015; 10(1): 85-94.
  9. Porcelli P, Tulipani C, Maiello E, Cilenti G, Todarello O. Alexithymia, coping, and illness behavior correlates of pain experience in cancer patients. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer. 2007; 16(7): 644-650.
  10. Feghhi H, Saadatjoo A, Dastjerdi R. Psychosocial adaptation in patients with type 2 diabetes referring to Diabetes Research Center of Birjand in 2013. Modern Care Journal. 2014; 10(4): 249-256.
  11. Samadzade N, Poursharifi H, Babapour J. The effectiveness of cognitive- behavioral therapy on the psycho-social adjustment to illness and symptoms of depression in individuals with type II diabetes. Clinical Psychology Studies. 2014; 5(17): 77-96.
  12. Peyrot M, McMurry JF, Kruger DF. A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence. Journal of Health and Social Behavior. 1990; 40(2): 141-58.
  13. Hashemi Nazari SS, Bigdelli MA, Khodakarim S, Brodati H. Estimating the effect of direct and indirect factors on glycemic control in type II diabetic patients by path analysis. Iranian Journal of Diabetes and Lipid Disorders. 2016; 15(6): 351-361
  14. Peymannia B, Hamid N, Mhmudalilu M. The effectiveness of ACT matrix with compassion on self-injury behaviors and quality of life of Students with symptoms of Borderline Personality Disorders. Journal of Psychological Achievements. 2018; 25(1): 23-44.
  15. Barghandan S, Akbari B, Khalatbari J, Varaste A. Comparison of the effectiveness of acceptance and commitment therapy and compassion focused therapy on quality of life among female adolescents with high-risk behaviors. Journal of Ilam University of Medical Sciences. 2018; 26(3): 158-168.
  16. Pinto-Gouvia J, Duarte C, Matos M, Fraguas S. The protective role of self-compassion in relation to psychopathology symptoms and quality of life in chronic and in cancer patients. Clinical Psychology & Psychotherapy. 2014; 21(4): 23-311.
  17. Mohamadzadeh Larijan H, Nikravan A, Aeenparast A. The role of hospital intervention in prevention of diabetes in pre-diabetes patients. Payesh. 2019; 18(5): 465-473.
  18. Afshar M, Khorasani L. The effect of group discussion on the quality of life and HbA1C in patients with type II diabetes. Journal of Diabetes Nursing. 2018; 6(3): 508-516.
  19. Bagby RM, Taylor GJ, Parker JDA. The twenty-item Toronto Alexithymia Scale – II. Convergent, discriminant and concurrent validity. Journal of Psychology Research. 1994; 38: 33-40.
  20. Derogatis LR. The Psychosocial Adjustment to Illness Scale (PAIS). Journal of Psychosomatic Research. 1986; 30(1): 77-91.
  21. Seyed Fatemi N, Rafii F, Hajizadeh E, Modanloo M. Psychometric properties of the adherence questionnaire in patients with chronic disease: A mix method study. Koomesh. 2018; 20(2): 179-191
  22. Gilbert P. Compassion-focused treatment (Translated by Esbati M, Feizi A). Tehran:  Ibn Sina Publications. 2018.
  23. Shiralinia K, Cheldavi R, Amanelahi A. The effectiveness of compassion-focused psychotherapy on depression and anxiety of divorced women. Journal of Clinical Psychology. 2018; 10(1): 9-20.
  24. Fares C, Bader R, Ibrahim JN. Impact of alexithymia on glycemic control among Lebanese adults with type 2 diabetes. Journal of Diabetes & Metabolic Disorders. 2019; 18(1): 191-198.
  25. Taher-Karami Z, Hossieni O, Dasht-Bozorgi Z. The effectiveness of compassion-focused therapy on resiliency, self-discrepancy, hope and psychological well-being of menopausal women in Ahvaz. Social Health. 2018; 5(3): 189-197.
  26. Naderiravesh N, Abed Saeedi J, Besharat MA, Darvish Pourkhaki A, Alavi Majd H. A review of the models and theories of adjustment to illness and disability. Payesh. 2014; 13(6): 677-686.
  27. Islam SMS, Lechner A, Ferrari U, Froeschl G, Alam DS, Holle R, Niessen LW. Mobile phone intervention for increasing adherence to treatment for type 2 diabetes in an urban area of Bangladesh: Protocol for a randomized controlled trial. BMC Health Services Research. 2014; 14(1): 1-9.
  28. Zahednezhad H, Poursharifi H, Babapour J. Relationship between health locus of control, slip memory and physician– patient relationship with adherence in type II diabetic patients. Journal of Shahid Sadoughi University of Medical Sciences. 2012; 20(2): 249-258.
  29. Asaadi M, Tirgari A, Hasanzadeh R. Comparative effectiveness relaxation training on anger reduction and Blood sugarcontrol in one and two diabetics patients. Medical Journal of Mashhad University of Medical Sciences. 2013; 56(2): 104-112.