Comparison of the Effectiveness of Values-Based Behavioral Activation and Mindfulness in Reducing Health Anxiety in Patients with Diabetes

Arezo Safaryani; Alireza Jafari; Mehrdad Sabet

Authors

Arezo Safaryani Department of Health Psychology, Ki.C., Islamic Azad University, Kish, Iran Author https://orcid.org/0000-0003-3890-4294
Alireza Jafari Department of Clinical Psychology, Ki.C., Islamic Azad University, Kish, Iran https://orcid.org/0000-0001-9968-8578
Mehrdad Sabet Department of Psychology, Ro.C., Islamic Azad University, Roudehen, Iran Author https://orcid.org/0000-0003-3890-4294

Keywords:

values-based behavioral activation, mindfulness, health anxiety, patients with diabetes

Abstract

The present study aimed to compare the effectiveness of values-based behavioral activation and mindfulness in reducing health anxiety among patients with diabetes. This study employed a quasi-experimental design with pretest, posttest, and follow-up assessments and a control group. The statistical population comprised all women with diabetes who attended healthcare centers in Mianeh County during 2024–2025. Among them, 45 participants who met the study inclusion criteria were selected through purposive sampling and randomly assigned to three groups of 15 participants each: the first experimental group (values-based behavioral activation), the second experimental group (mindfulness), and the control group. The interventions were administered three sessions per week over a one-month period. The research instrument included the Health Anxiety Questionnaire. Data were analyzed using mixed-design analysis of variance and the Bonferroni post hoc test. The results indicated that, compared with the control group, both interventions significantly increased the use of problem-focused coping mechanisms and decreased emotion-focused and avoidant coping mechanisms. Furthermore, both approaches significantly reduced health anxiety and increased overall health-promoting behaviors, including the subscales of nutrition, physical activity, health responsibility, stress management, interpersonal support, and self-actualization. The effects of both interventions were maintained at the two-month follow-up. For most variables, no significant difference was observed between the effectiveness of the two interventions; however, for certain dimensions of health-promoting behaviors, including the total score and nutrition, values-based behavioral activation demonstrated greater effectiveness than mindfulness. Based on these findings, it can be concluded that both values-based behavioral activation and mindfulness are effective interventions for improving the psychological and health-related functioning of patients with diabetes. By improving coping styles, reducing health-related concerns, and promoting healthy behaviors, these interventions may be used as beneficial adjunctive treatments alongside the medical management of diabetes.

Downloads

Download data is not yet available.

References

1. Arambewela MH, Somasundaram NP, Pradeep Ranjan Jayasekara HB, Kumbukage MP, Sarath Jayasena PM, Priyanka Hemanthi Chandrasekara CM. Prevalence of chronic complications, their risk factors, and the cardiovascular risk factors among patients with type 2 diabetes attending the diabetic clinic at a tertiary care hospital in Sri Lanka. Journal of Diabetes Research. 2018;2018:1-10. doi: 10.1155/2018/4504287.

2. Skjelbred T, Warming PE, Behr ER, Køber L, Pedersen-Bjergaard U, Winkel BG, et al. Diabetes and sudden cardiac death: A Danish nationwide study. European Heart Journal. 2026;47(21):2644-56. doi: 10.1093/eurheartj/ehaf826.

3. Hapunda G. Coping strategies and their association with diabetes specific distress, depression and diabetes self-care among people living with diabetes in Zambia. BMC Endocrine Disorders. 2022;22(1):215. doi: 10.1186/s12902-022-01131-2.

4. Anggeria E, Harahap RF, Silalahi KL, Hanum P, Silaban VF. The effectiveness of Diabetes Self-Management Education (DSME) with self-acceptance and self-care for diabetes mellitus patients. Indian Journal of Forensic Medicine & Toxicology. 2022;16(3):140-4. doi: 10.37506/ijfmt.v16i3.18270.

5. Sukarno A, Bahtiar B. The Effectiveness of Cognitive Behavior Therapy on Psychological Stress, Physical Health, and Self-Care Behavior among Diabetes Patients: A Systematic Review. Health Education and Health Promotion. 2022;10(3):531-7.

6. Tyrer P, Tyrer H. The departure of hypochondriasis is no loss. Australian & New Zealand Journal of Psychiatry. 2014;48:772-3. doi: 10.1177/0004867414540755.

7. Leal PC, Goes TC, da Silva LCF, Teixeira-Silva F. Trait vs. state anxiety in different threatening situations. Trends in Psychiatry and Psychotherapy. 2017;39:147-57. doi: 10.1590/2237-6089-2016-0044.

8. Mahmoudzadeh S, Rajabi S. Comparing mindfulness and health anxiety in women with breast cancer and healthy individuals. Health System Research. 2022;18(4):314-20.

9. Alipour Picha H, Abbasi G, Hassanzadeh R. The effect of cognitive behavioral therapy integrated with mindfulness on health anxiety and death obsession in patients with COVID-19. Nursing Management. 2023;12(2):33-45.

10. Kordani S, Dashtbozorgi Z. The effect of positive mindfulness training on health anxiety, happiness, and health adjustment among nurses during the COVID-19 pandemic. Psychiatric Nursing. 2022;10(3):53-64.

11. Kanter JW, Puspitassari A, Santos M, Nagy G. Social work and behavioral activation. In: Boone MS, editor. Mindfulness and acceptance in social work. Oakland, CA: New Harbinger Publications; 2014. p. 101-22.

12. McCauley E, Schloredt KA, Gudmundsen GR, Martell CR, Dimidjian S. Behavioral activation with adolescents: A clinician's guide: Guilford Publications; 2016.

13. Tindall L, Mikocka-Walus A, McMillan D, Wright B, Hewitt C, Gascoyne S. Is behavioural activation effective in the treatment of depression in young people? A systematic review and meta-analysis. 2017. doi: 10.1111/papt.12121.

14. Azad M, Bagherzadeh Golmakani Z, Mansouri A, Doustkam M. Comparing the effectiveness of behavioral activation and metacognitive therapies on body image concerns, anxiety, and depression in patients with psoriasis. Disability Studies. 2022;12.

15. Rezapour H, Bahramipour Isfahani M, Torkan H. Comparing the effectiveness of behavioral activation and state relaxation therapies on antisocial core beliefs and social problem solving in male adolescents with high social anxiety. Social Psychology Research. 2023;13(50):77-92.

16. Nikpour, Shamsaei M. Spiritual behaviorism: An integrative model for controlling eating behavior. 7th National Congress on the Prevention and Treatment of Obesity in Iran2019.

17. Egede LE, Davidson TM, Knapp RG. HOME DM-BAT: Home-based diabetes-modified behavioral activation treatment for low-income seniors with type 2 diabetes—study protocol for a randomized controlled trial. Trials. 2021;22:787. doi: 10.1186/s13063-021-05744-1.

18. Naik AD, Hundt NE, Vaughan EM. Effect of Telephone-Delivered Collaborative Goal Setting and Behavioral Activation vs Enhanced Usual Care for Depression Among Adults With Uncontrolled Diabetes: A Randomized Clinical Trial. JAMA Network Open. 2019;2(8):e198634. doi: 10.1001/jamanetworkopen.2019.8634.

19. Ahmadi R, Leilabadi L, Salehi M. Comparison of the effectiveness of acceptance and commitment therapy (ACT) and behavioral activation therapy (BAT) on quality of life and self-care behaviors in patients with type 2 diabetes. International Journal of Education and Cognitive Sciences. 2025;6(4):1-12. doi: 10.61838/kman.pdmd.513.

20. Khadem Hosseini M, Merati A, Piryaei H, Roshanaei K. Comparing the effectiveness of bibliotherapy, behavioral activation therapy, and mindfulness-based cognitive therapy on psychological distress in women with type 2 diabetes: A quasi-experimental study. Journal of Nursing and Midwifery. 2024;22(2):146-60.

21. Marais GAB, Lantheaume S, Fiault R, Shankland R. Mindfulness-Based Programs Improve Psychological Flexibility, Mental Health, Well-Being, and Time Management in Academics. European Journal of Investigation in Health, Psychology and Education. 2020;10(4):1035-50. doi: 10.3390/ejihpe10040073.

22. Matiz A, Fabbro F, Paschetto A, Cantone D, Paolone AR, Crescentini C. Positive impact of mindfulness meditation on mental health of female teachers during the COVID-19 outbreak in Italy. International Journal of Environmental Research and Public Health. 2020;17(18). doi: 10.3390/ijerph17186450.

23. Wu X, Hayter M, Lee AJ, Zhang Y. Nurses' experiences of the effects of mindfulness training: A narrative review and qualitative meta-synthesis. Nurse Education Today. 2021;100:104830. doi: 10.1016/j.nedt.2021.104830.

24. Antonova E, Schlosser K, Pandey R, Kumari V. Coping with COVID-19: Mindfulness-based approaches for mitigating mental health crisis. Frontiers in Psychiatry. 2021;12:563417. doi: 10.3389/fpsyt.2021.563417.

25. Alikhah S, Akbari Govabari B, Abolghasemi A. The effectiveness of mindfulness-based cognitive therapy on resilience and body image in patients with skin disorders in interaction with emotional reactivity. Islamic Lifestyle Centered on Health. 2023;7(2):94-103.

26. Kishita N, Takei Y, Stewart I. A meta-analysis of third wave mindfulness-based cognitive behavioral therapies for older people. International Journal of Geriatric Psychiatry. 2017;32(12):1352-61. doi: 10.1002/gps.462.

27. Jiang S, Pan X, Li H, Su Y. Global trends and developments in mindfulness interventions for diabetes: A bibliometric study. Diabetology & Metabolic Syndrome. 2024;16(1):43. doi: 10.1186/s13098-024-01288-x.

28. Fisher V, Li WW, Malabu U. The effectiveness of mindfulness-based stress reduction (MBSR) on the mental health, HbA1C, and mindfulness of diabetes patients: A systematic review and meta-analysis of randomised controlled trials. Applied Psychology: Health and Well-Being. 2023;15(4):1733-49. doi: 10.1111/aphw.12441.

29. Hamasaki H. The effects of mindfulness on Glycemic Control in people with diabetes: An overview of systematic reviews and meta-analyses. Medicines. 2023;10(9):53. doi: 10.3390/medicines10090053.

30. Ee CC, Al-Kanini I, Armour M, Piya MK, McMorrow R, Rao VS, et al. Mindfulness-based interventions for adults with type 2 diabetes mellitus: A systematic review and meta-analysis. Integrative Medicine Research. 2025;14(2):101138. doi: 10.1016/j.imr.2025.101138.

31. Wang H, Ge L, Yan Yan Kwok J, Zhang Z, Wiley J, Guo J. A blended mindfulness-based stress reduction program to improve diabetes self-management among people with type 2 diabetes mellitus: A mediation effect analysis. Annals of Behavioral Medicine. 2025;59(1):kaae075. doi: 10.1093/abm/kaae075.

32. Tsai CC, Yu HI, Chen MF. The Effectiveness of a Mindfulness-Based Healthy Lifestyle Program for Older Adults With Type 2 Diabetes. Journal of Applied Gerontology. 2025:07334648251395792. doi: 10.1177/07334648251395792.

33. Godage P, Giggins OM, Doyle J, Byrne A. Integrating psychological support into gestational diabetes self-management: Development of a user-centred digital mindfulness programme. Women's Health. 2026;22:17455057261473448. doi: 10.1177/17455057261473448.

34. Rizzo JM, Schwartz RC. The effect of mindfulness, psychological flexibility, and emotional intelligence on self-efficacy and functional outcomes among chronic pain clients. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy. 2021;51(2):109-16. doi: 10.1007/s10879-020-09481-5.

35. Dafei M, Zarei Mahmoudabadi H, Dehghani A, Moradi Mahmoudabadi F. The effect of mindfulness-based cognitive therapy on health-promoting behaviors in students with premenstrual syndrome: A randomized clinical trial. Journal of Mazandaran University of Medical Sciences. 2021;31(197):65-80.

36. Shojaei F, Jabal Ameli S, Latifi Z, Siavash M. Comparing self-healing and cognitive behavioral therapy integrated with mindfulness on health-promoting lifestyles in patients with type 2 diabetes: A clinical trial. Journal of Gorgan University of Medical Sciences. 2022;24(3):8-16.

37. Herman PM, Anderson ML, Sherman KJ, Balderson BH, Turner JA, Cherkin DC. Cost-effectiveness of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care among adults with chronic low-back pain. Spine. 2017;42(20):1511. doi: 10.1097/BRS.0000000000002344.

38. Strauss C, Gu J, Pitman N, Chapman C, Kuyken W, Whittington A. Evaluation of mindfulness-based cognitive therapy for life and a cognitive behavioural therapy stress-management workshop to improve healthcare staff stress: Study protocol for two randomised controlled trials. Trials. 2018;19(1):209. doi: 10.1186/s13063-018-2547-1.

39. Mehraban S, Khalilzadeh N, Sharifi M, Asmeri Bordezard Y. The effectiveness of group spirituality therapy in facilitating posttraumatic growth in women with breast cancer. Research on Religion and Health. 2020;1(36):7-17.

40. Rabiepour F, Hosseini Nasab SD, Salari A. Comparing the effectiveness of cognitive rehabilitation therapy and mindfulness-based therapy on anxiety in patients with hypertension: A randomized clinical trial. Disability Studies. 2022;12.