Proposing an Acceptance and Commitment Therapy Intervention to Promote Improved Diabetes Management in Adolescents: A Treatment Conceptualization

By Hadlandsmyth, Katherine; White, Kamila S. et al. | The International Journal of Behavioral Consultation and Therapy, Winter 2013 | Go to article overview

Proposing an Acceptance and Commitment Therapy Intervention to Promote Improved Diabetes Management in Adolescents: A Treatment Conceptualization


Hadlandsmyth, Katherine, White, Kamila S., Nesin, April E., Greco, Laurie A., The International Journal of Behavioral Consultation and Therapy


Pediatric diabetes is prevalent (Centers for Disease Control and Prevention, 2008) and can be challenging to manage (Wysocki, Greco, & Buckloh, 2003). Further, management tends to deteriorate during adolescence (Anderson & Laffel, 1996; Insabella, Grey, Knafl, & Tamborlane, 2007; Bryden et al., 2001; La Greca, Follansbee, & Skyler, 1990).

Type 1 diabetes mellitus (DM1) is among the most common pediatric chronic illnesses, occurring in approximately one in every 500-600 youths (Centers for Disease Control and Prevention, 2008). Additionally, rates of pediatric Type 2 diabetes mellitus (DM2) are on the rise (Laron, 2002) and represent 10-20% of new cases of pediatric diabetes (American Diabetes Association, 2000). Diabetes management aims to maintain normal, or near-normal, Hemoglobin A1C (HbA1c; a marker of blood glucose) levels, which can reduce the risks of complications to levels equivalent to the general population (Wysocki et al., 2003). Regulating HbA1c involves intensive daily management, which can include monitoring blood glucose levels multiple times per day and multiple insulin injections or the use of an insulin pump, in addition to careful dietary management utilizing carbohydrate counting, and physical activity level management (Wysocki et al., 2003). Further, a certain degree of flexibility in diabetes management may prove beneficial, such as matching insulin doses to carbohydrate intake and adjusting for exercise, without increasing hypoglycemic episodes (Lowe, Linjawi, Mensch, James, & Attia, 2008). As such, diabetes can be challenging to manage, requiring a complex set of self-management tasks (Lowe et al., 2008; Wysocki et al., 2003), and management tends to deteriorate during adolescence (Anderson & Laffel, 1996; Bryden et al., 2001; Insabella,et al., 2007; La Greca, et al., 1990).

Psychosocial interventions may facilitate improved diabetes management (Murphy, Rayman, & Skinner, 2006; Peyrot & Rubin, 2007).

* Psychosocial Interventions for Pediatric Diabetes

This section will review a few key findings from the extensive body of work on psychosocial interventions for pediatric diabetes. Pediatric DM1 psychosocial intervention studies have examined a number of different outcome measures and interventions (Murphy, et al., 2006; Peyrot & Rubin, 2007). These studies have included physiological measures of glycemic control (HbA1c), self-reported diabetes-related behaviors, quality of life, psychiatric symptoms, individual psychological variables, various aspects of peer and family relationships, and measures of social support (Murphy, et al., 2006; Peyrot & Rubin, 2007). Many of these studies included HbA1c, the primary marker of glycemic control, as an indicator of disease management. Most of the studies from a recent review, had similar, small, effect sizes for decrease of HbA1c (mean across studies: d = 0.11; median: d = 0.17; Murphy et al., 2006). A meta-analysis indicated large effect sizes (0.88) across a number of outcome variables for psychological interventions with pediatric patients with DM1 (or cystic fibrosis: the two illness categories were grouped together and included five studies on pediatric DM1 and two studies on cystic fibrosis; Beale, 2006). The outcome variables assessed in the meta-analysis were similar to those outlined above; however, only one study in this meta-analysis included HbA1c as an outcome variable, and an effect size was not available for this study (Beale, 2006).

Intervention studies aimed at improving management of DM1 have examined cognitive-behavior therapy (CBT), family therapy, peer group interventions, motivational interviewing, home visits, stress management training, coping skills training, telephone support, and problem solving (Murphy et al., 2006; Peyrot & Rubin, 2007). Compared to other outcome measures, coping skills training has been shown to improve quality of life (Delamater et al. …

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