Peer-delivered Cognitive Behavioral Therapy-based Intervention Reduced Depression and Stress in Community Dwelling Adults With Diabetes and Chronic Pain: A Cluster Randomized Trial

Ann Behav Med. 2021 Oct 4;55(10):970-980. doi: 10.1093/abm/kaab034.


Background: Finding effective, accessible treatment options such as professional-delivered cognitive behavioral therapy (CBT) for medically complex individuals is challenging in rural communities.

Purpose: We examined whether a CBT-based program intended to increase physical activity despite chronic pain in patients with diabetes delivered by community members trained as peer coaches also improved depressive symptoms and perceived stress.

Methods: Participants in a cluster-randomized controlled trial received a 3-month telephonic lifestyle modification program with integrated CBT elements. Peer coaches assisted participants in developing skills related to adaptive coping, diabetes self-management goal-setting, stress reduction, and cognitive restructuring. Attention controls received general health advice with an equal number of contacts but no CBT elements. Depressive symptoms and stress were assessed using the Centers for Epidemiologic Studies Depression and Perceived Stress scales. Assessments occurred at baseline, 3 months, and 1 year.

Results: Of 177 participants with follow-up data, 96% were African Americans, 79% women, and 74% reported annual income <$20,000. There was a significant reduction in perceived stress in intervention compared to control participants at 3-months (β = -2.79, p = .002 [95% CI -4.52, -1.07]) and 1 year (β = -2.59, p < .0001 [95% CI -3.30, -1.87]). Similarly, intervention participants reported significant decreases in depressive symptoms at 3-months (β = -2.48, p < .0001 [95% CI -2.48, -2.02]) and at 1 year (β = -1.62, p < .0001 [95% CI -2.37, -0.86]).

Conclusions: This peer-delivered CBT-based program improved depressive symptoms and stress in individuals with diabetes and chronic pain. Training community members may be a feasible strategy for offering CBT-based interventions in rural and under-resourced communities.

Clinical trial registration: NCT02538055.

Keywords: Cognitive behavioral therapy; Community health worker; Depression; Diabetes; Rural.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Chronic Pain* / therapy
  • Cognitive Behavioral Therapy*
  • Cognitive Restructuring
  • Depression / complications
  • Depression / therapy
  • Diabetes Mellitus*
  • Female
  • Humans
  • Independent Living
  • Male

Associated data