The effect of Lazarus multimodal therapy on depression, anxiety, and blood glucose control in women with type 2 diabetes

Document Type : Research Paper


1 clinical psychology, Mashhad University of Medical Sciences, Mashhad, Iran

2 Ph.D.of psychology, Torbat-e-Jam Branch, Islamic Azad University, Torbat-e-Jam, Iran

3 Iran

4 clinical psychology, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: Considering the interactions between depression and anxiety on the increase in blood glucose in diabetic patients and the need for intervention to improve these variables, the aim of this study was to investigate the effectiveness of Lazarus multimodal therapy on reducing the symptoms of depression, anxiety and glycemic control in women with type 2 diabetes.
Materials and Methods: In this study, which was performed on women with type 2 diabetes with high score in depression and anxiety and glycosylated hemoglobin (HbA1C) level more than 7%, 24 subjects who entered the study were selected by convenient method and they were randomly assigned into two groups of experimental and control (each group included 12 subjects). Research instrument include Beck Depression Inventory-II, Beck Anxiety Inventory and glycosylated hemoglobin. The experimental group was trained at Lazarus multimodal psychotherapy group workshop for three months (12 weekly ninety-minute sessions) in the spring and summer of 2016 at Samen Health Center- Mashhad. The control group was in the waiting list. Also, multivariate analysis of covariance analysis was used to analyze the data through SPSS software.
Results: The results of this study showed that Lazarus multidimodal therapy significantly (P=0.001) reduced the symptoms of depression, anxiety and decreased blood glucose levels in women with type 2 diabetes compared to control group.
Conclusion: Totally based on the findings, Lazarus multidimodal therapy can be effective to reduce the symptoms of anxiety, depression and physical symptoms among diabetic patients.


  1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2007; 30: 42-7.
  2. Cobden DS. Relationships among self-management, patient perceptions of care, and health economic outcomes for decision-making and clinical practice in type 2. Diabetes 2012; 13(1): 138-47.
  3. Kiyosh M. [Diabetes prevention and relief lack of blood sugar by traditional nutrition]. Ehsani, Khansari and Darvishali. (translators). Tehran: Motarjem; 2004. (Persian)
  4. Trurji P, Enright S. [Anxiety and stress]. Pezhman M. (translator). Isfahan: Ghazal; 2003. (Persian)
  5. Hosseini A, Haghdadi Gh. [Diabetes mellitus with stress, mood and personality]. 8th Congress and Diabetes Training. Qazvin University of Medical Sciences 2003; 68. (Persian)
  6. Davidon MB. Diabetes mellitus diagnosis and treatment. 3rd New York: Living Stone; 1991: 404-15.
  7. Schultz D. [Personality theories]. Seyyed Mohammadi Y. (translator). Tehran: Arasbaran; 2008. (Persian)
  8. Kesselring J, Beer S. Symptomatic therapy and neuro-rehabilitation in multiple sclerosis. Lancent Neural 2005; 4: 643-52.
  9. Janbozorgi M, Nouri N. [Methods of treatment for anxiety and stress]. Tehran: Samt; 2004. (Persian)
  10. Dryden W, Mytton J. Four Approaches to counseling and psychotherapy. London: Routledge; 2002.
  11. Janbozorgi M. [The effect of short term psychotherapy with a religious orientation to control stress and anxiety]. MS. Dissertation. Kharazmi University, Tehran, 2007. (Persian)
  12. Raesian AS, Golzari M, Borjali A. [Effectiveness of hope therapy on reducing depressive symptoms and preventing of relapse in cure-seeker women with dependency to narcotic drugs]. Research in addiction 2001; 5: 21-40. (Persian)
  13. Kaviani H, Ahmadi Abhari AS, Nazari H, Hormozi K. [Prevalence of depressive disorders in Tehran resident population]. Tehran University of Medical Sciences journal 2002; 60(5): 393-9. (Persian)
  14. American Diabetes Association. Economic costs of diabetes in the U.S. in 2007. Diabetes Care 2008; 31: 596-615.
  15. Larsen ML, Horder M, Mogensen EF. Effect of long-term monitoring of glycosylated hemoglobin levels in insulin-dependent  diabetes mellitus. N Engl J Med 1990; 323: 1021-5.
  16. Brook C, Clayton P, Brown R. Brook's clinical pediatric endocrinology. Oxford: Blackwell; 2006.
  17. Biabangard E. [Effectiveness of Lazarus multimodal therapy, Elice rational emotional therapy and relaxation on decreasing students test anxiety. Iranian journal of psychiatry and clinical psychology 2003; 8(3): 36-42. (Persian)
  18. Khazraee Vijafar A, Janbozorgi M, Alipour A. [The efficacy of Lazarus multimadal therapy on stress decline and enhancing health indices in war affected individuals with osteomyelitis]. Iranian journal of war and public health 2010; 2(2): 39-45. (Persian)
  19. Boardway RH, Delamater AM, Tomakowsky J, Gutai JP. Stress management training for adolescents with diabetes. J Pediatr Psychol 1993; 18(1): 29-45.
  20. Ellis DA,  Frey MA,  Naar-King S,  Templin T,  Cunningham PB,  Cakan N. The effects of multi systemic therapy on diabetes stress among adolescents with chronically poorly controlled type1 diabetes. Pediatrics 2005; 116(6)
  21. Abazari F. [The effectiveness of Lazarus multimodal consultation on depression in women in Tehran]. MS. Dissertation. Tehran: Allameh Tabataba'i University, 2006. (Persian)
  22. Soltani-Khorshid H. [Effectiveness of group training Lazarus multimodal approach to women's marital satisfaction on members of the Basij Sabzdasht in the city of Robat Karim]. MS. Dissertation. Tehran: Allameh Tabataba'i University, 2010. (Persian)
  23. Mehrani B. [Review the effectiveness of Lazarus multimodal on the emotional maturity of female students in third grade education area Mallard]. MS. Dissertation. Tehran: Allameh Tabataba'i University; 2009. (Persian)
  24. Palizgir M, Bakhtiyari M, Esteghamati A. [Comparison between cognitive-behavioral therapy and psychoeducational therapy on blood sugar control in depressed patients with type 2 diabetes]. Qom University Medical Sciences journal 2014; 8(3): 18-23. (Persian)
  25. Sartippour M, Attari A, Amini M, Haghighi S. [The effect of stress tolerance on short term glucose control in type 1 diabetic patients]. Journal of research in Medical Sciences 2003; 8(3): 66-76. (Persian)
  26. Bahramkhani M, Janbozorgi M, Alipour A. [Effectiveness of Lazarus multimodal therapy on expanded disability status in patients with multiple sclerosis]. Journal of fundamentals of mental health 2011; 13: 47-136. (Persian)
  27. Foroghi Z, Kermanshahi S, Mohammadi E, Rajab A. [Effectiveness of Benson relaxation therapy on diabetes control in diabetic patients]. Journal of Sabzevar University of Medical Sciences 2001; 8(3): 85-96. (Persian)