The effectiveness of intensive short-term dynamic psychotherapy (ISTDP) on distress tolerance and resilience in type 2 diabetic patients

Hosseini, Seyed Mohsen; Aleyasin, Seyed Ali

doi:10.22034/27.2.103

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Volume 27, Issue 2 (7-2025)

EBNESINA 2025, 27(2): 103-112

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The effectiveness of intensive short-term dynamic psychotherapy (ISTDP) on distress tolerance and resilience in type 2 diabetic patients

Seyed Mohsen Hosseini

, Seyed Ali Aleyasin ^*

Department of Clinical Psychology, Ashtian Branch, Islamic Azad University, Ashtian, Iran , ali.aleyasin@iau.ac.ir

Keywords: psychotherapy, psychologic stress, Psychological Adaptation, resilience, type 2 diabetes

Full-Text [PDF 1508 kb] (72 Downloads) | Abstract (HTML) (234 Views)

Type of Study: Original | Subject: Military Psychiatry
Received: 2025/05/12 | Revised: 2025/09/29 | Accepted: 2025/07/12 | Published: 2025/07/13

Extended Abstract: (55 Views)

Introduction

Diabetes is one of the most prevalent endocrine disorders worldwide, including in our country. As a chronic metabolic disease, it is characterized by abnormalities in carbohydrate, protein, and fat metabolism. Beyond its physical manifestations, diabetes imposes significant psychological stress, which complicates treatment and disease management. Research indicates that many psychological challenges faced by patients stem from the demands of diabetes, such as dietary restrictions, reduced mobility, frequent blood sugar monitoring, daily insulin injections, chronic complications, hospitalizations, and concerns about life expectancy. These challenges often arise from inadequate self-care skills, underscoring the need for effective adaptation and adherence to a structured lifestyle [1, 2].
Resilience–the ability to adapt positively to stress or adversity, such as living with a chronic illness–plays a crucial role in diabetes management. It fosters a healthier attitude toward lifestyle changes and eases the adaptation process. Evidence suggests that across various diseases, including diabetes, an individual’s perception of their condition–its nature, consequences, controllability, duration, and causes–significantly influences healthy behaviors and psychological well-being. Resilience enhances the capacity to cope with stress and adversity, making it a vital trait for individuals with chronic diseases [2-5].
Distress tolerance, defined as the ability to endure psychological discomfort [6], is another critical factor. Individuals with low distress tolerance often struggle to manage their emotions, leading to denial or suppression of distress [7]. This inability exacerbates psychological challenges, highlighting distress tolerance as a key psychological characteristic in diabetes care. Given that the medical model alone fails to address many diabetes-related needs, psychological interventions have emerged as effective complements to medical treatments, improving disease control [8].
Type 2 diabetes patients may particularly struggle with distress tolerance and resilience. Studies report lower levels of these traits among diabetic patients, along with psychological well-being issues, necessitating further research in this area [9, 10]. Short-term dynamic psychotherapy (ISTDP) has shown promise as a treatment for such conditions. However, a gap remains in understanding its impact on the psychological well-being of type 2 diabetes patients. This study aimed to investigate the effectiveness of ISTDP in enhancing distress tolerance and resilience in this population.

Methods

This quasi-experimental study employed a pre-test-post-test design with experimental and control groups. The study population consisted of type 2 diabetes patients, aged 20 to 65, recruited from medical centers and hospitals in Qom between March 2024 and March 2025. Based on prior research, expert recommendations, and sample size guidelines for small populations (Krejcie & Morgan -1970), 30 participants were selected (15 per group) using purposive and convenience sampling. Inclusion criteria included a diabetes diagnosis of at least one year, no substance or alcohol use, informed consent, and a minimum age of 20. Exclusion criteria included unwillingness to continue or missing more than two therapy sessions.
Data were collected using the Distress Tolerance Scale (Simons & Gaher, 2005) [11] and the Connor-Davidson Resilience Scale (2003) [12]. The experimental group received eight 90-minute ISTDP sessions, while the control group received no intervention. Data were analyzed using inferential statistics at a significance level of 0.05 [15].

Results

Post-intervention, the experimental group exhibited significant increases in distress tolerance and resilience scores (p< 0.01), while the control group showed no notable changes.
To evaluate the intervention’s effectiveness, the study assessed both statistical significance, using analysis of covariance (ANCOVA), and effect size. The effect size was measured using η² (eta squared) within the ANCOVA framework.
For the distress tolerance variable, the η² value was 0.38, which, according to Cohen’s (1988) classification, represents a large effect size. Similarly, the η² value for resilience was 0.41, also indicating a large effect (Cohen’s guidelines define η² values as follows: 0.01 corresponds to a small effect, 0.06 to a medium effect, and 0.14 or higher to a large effect). These results confirm that the intervention’s impact was not only statistically significant but also clinically substantial, highlighting its practical importance in enhancing distress tolerance and resilience among participants.
These findings suggest that ISTDP effectively enhances patients’ ability to regulate negative emotions, cope with psychological stress, and improve adaptive flexibility. Overall, ISTDP positively influenced key psychological indicators linked to better adjustment in type 2 diabetes patients.

Discussion and Conclusion

This study underscores the potential of psychotherapeutic interventions like ISTDP as adjuncts to medical treatment for type 2 diabetes. Improved distress tolerance helps patients manage illness-related stress without resorting to maladaptive behaviors (e.g., medication non-adherence or emotional eating) [2, 15-18]. Similarly, heightened resilience fosters greater motivation and persistence in adhering to lifestyle changes and treatment plans [6]. Clinically, integrating such interventions into diabetes care could significantly enhance patients’ quality of life and long-term outcomes [18].
However, limitations include the small sample size and geographic restriction to one city, which may affect generalizability. Future research should involve larger, more diverse populations and include long-term follow-ups to assess ISTDP’s sustained effects.

Ethical Considerations

The study adhered to ethical guidelines, with informed consent obtained from all participants. Confidentiality was maintained, and data were used solely for research purposes. This research has been approved by the Research Ethics Working Group of the Islamic Azad University, Arak Branch, with the code IAU.ARAK.REC.1403.360.

Funding

There is no funding support.

Authors’ Contribution

All authors equally contributed to the conceptualization, design, implementation, and writing of the manuscript. All authors reviewed and approved the final version of the paper.

Conflict of Interest

Authors declared no conflict of interest.

Acknowledgments

The authors sincerely appreciate the cooperation of all patients who participated in the study and gratefully acknowledge the support of the healthcare staff and diabetes treatment centers in Qom, whose assistance was invaluable for conducting this research.

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Hosseini S M, Aleyasin S A. The effectiveness of intensive short-term dynamic psychotherapy (ISTDP) on distress tolerance and resilience in type 2 diabetic patients. EBNESINA 2025; 27 (2) :103-112
URL: http://ebnesina.ajaums.ac.ir/article-1-1399-en.html

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