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Stress-Reducing Psychological Interventions as Adjuvant Therapies for Diabetic Chronic Wounds


Isadora Pombeiro, João Moura, Maria Graça Pereira and Eugénia Carvalho*  


Background: Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus and a leading cause of lower limb amputation. Interventions to reduce psychological stress may have the potential to improve self-care and greatly reduce the morbidity and mortality associated with DFU. This review is focused on the consequences of psychological stress in wound healing and reflects on the effects of currently used psychological stress-reducing interventions in patients with DFU, proposing new applications for currently used stress-reduction interventions.

Results: Stress is a natural and fundamental survival mechanism that becomes harmful when chronic. DFU is associated with high levels of anxiety and chronic psychological stress. Chronic stress induced cortisol and adrenaline release impairs wound healing, independently of the stressor. Psychological stress-reducing interventions, such as relaxation with guided imagery, biofeedback-assisted relaxation, mindfulness-based strategies, and hypnosis can lead to a reduction in perceived stress and improve wound healing, by reducing wound inflammation and pain, while improving glycemic control. All stress reduction interventions also lead to pain relief and improved patient’s quality of life.


Diabetes mellitus, diabetic wound healing, diabetic foot ulcer, psychological stress, psychological stress reducing interventions, hypnosis and muscle relaxation.


Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, School of Psychology, Department of Applied Psychology, University of Minho, Braga, Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra

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