Publication Date




Embargo Period


Degree Name

Master of Science (MS)


Psychology (Arts and Sciences)

Date of Defense


First Committee Member

Neil Schneiderman

Second Committee Member

Maria M. Llabre

Third Committee Member

Marc Gellman

Fourth Committee Member

Ronald Goldberg


Stress may have an important role in the development of type 2 diabetes (T2D) and its complications (Black, 2006). Individuals with T2D who experience higher levels of stress also tend to experience poorer glycemic control and more exacerbated diabetes related complications than less stressed counterparts (Surwit & Schneider, 1993). Obesity has also been linked to T2D as those with a higher BMI are at greater risk for developing the disease and disease-related comorbidities (Astrup & Finer, 2000; Moore, Wilson, D’Agostino, Finkle & Elliso, 2000). Lifestyle modification interventions, designed for individuals with or at risk for developing T2D, have primarily focused on reducing weight via dietary and physical activity interventions (Wolf et al., 2004; Lifshitz & Hall, 2002; Tuomilehto et al., 2001; Lindström et al., 2006). Little research has been done examining effects of stress management in combination with diet and exercise modification on improved glycemic control and weight loss in individuals with T2D (Wadden, 2006). The first primary aim of this study is to determine the effect of a lifestyle modification intervention involving diet, exercise and stress management on reducing stress in patients with T2D. The second aim is to examine associations between stress reduction and weight loss and stress reduction and glycemic control in individuals with T2D. We studied 111 socio-economically disadvantaged, mostly minority (85% Hispanic, 10% African American) adults (mean age: 55 years; 58% women) with T2D recruited for the Community Approach to Lifestyle Modification for Diabetes (CALM-D) study who were randomized to a 17 session 12 month lifestyle intervention or usual care. Participants in both groups were assessed at baseline, 6 months and 12 months post-randomization. Stress was measured using the Perceived Stress Scale (PSS). Glycemic control was assessed using glycosylated hemoglobin (HbA1c). Relative to usual care, the intervention resulted in significant decreases in PSS (β = -.515, SE = .220, p < .05), controlling for age and gender. There was no association between change is PSS and change in HbA1c in the control group (β =.038, SE =.037, p =.301) or the intervention group (β =.013, SE =.022, p =.568). Similarly, there was no association between change in PSS and change in weight in the control group (β = -.117, SE = .09, p =.192) or the intervention group (β =.167, SE =.096, p =.081). However, there was a trend in the relationship between change in stress and change in weight in the intervention group, suggesting a possible relationship between stress and weight loss in the intervention group but not in the control group. Future research is needed in a larger sample to elucidate the relationships between decreases in perceived stress and changes in weight and glycemic control.


Type 2 Diabetes; perceived stress; lifestyle modification intervention; randomized control trial; weight loss; glycemic control