Anthony A. Hains

The impact of cognitive distortions, stress, and adherence on metabolic control in youths with type 1 diabetes.

PURPOSE To investigate the role of cognitive distortions in the relationship between adherence behavior, diabetes-specific stress, general stress, and metabolic control. METHODS Obtained questionnaire data, glucometer readings, and glycosylated hemoglobin (HbgA(1c)) assays from 143 youths (11-18 years old) with type 1 diabetes. Examined path model of relationships between cognitive distortions, stress, adherence behavior, and metabolic control. Data were analyzed using path analysis. RESULTS Higher levels of negative cognitive distortions were associated with more stress (both diabetes-specific and general). Higher levels of general stress then led to less adherent behavior and subsequently poorer metabolic control (higher HbgA(1c)). More diabetes-specific stress also led to poorer metabolic control, as well as general stress. CONCLUSIONS The findings indicate an indirect role of negative cognitive distortions in metabolic control. The current findings suggest that instead of the proposed direct link between cognitive distortions and adherence behavior, an indirect relationship may exist through stress.

A Stress Management Intervention for Adolescents With Type I Diabetes

PURPOSE The purpose of this project was to examine the effectiveness of a stress management training program in helping adolescents with diabetes cope with stress. METHODS Youths who displayed evidence of metabolic control problems received training in the use of both cognitive-restructuring and problem-solving strategies. Treatment impact was assessed on measures of coping, anxiety level, diabetes-specific stress, and metabolic control. RESULTS Analyses of covariance showed no differences between the training group and a control group at posttest and follow-up. However, the small sample size and within-group variability may have precluded finding significant results. Therefore, within-group comparisons were conducted, and improvements were found in the training group on pretest to posttest and pretest to follow-up comparisons for anxiety, stress, and coping measures. No differences were found in the control group. CONCLUSIONS Results suggest that the intervention had some positive impact, although this interpretation must be considered preliminary. Future research should replicate this study and explore the applicability and effectiveness of this intervention in specific populations.

Cognitive behavioral interventions for sexually abused children exhibiting PTSD symptomatology

This investigation examined the effectiveness of a cognitive behavioral intervention with 4 sexually abused children exhibiting posttraumatic stress disorder (PTSD), using a multiple baseline design. Participants ranged in age from 8 to 10 years. Intervention effectiveness was measured with pre-, post-, and 3-month follow-up assessments of PTSD symptomatology and affective (depression and anxiety) measures. In addition, these instruments were administered during baseline and prior to each treatment session. The intervention focused on the training of relaxation skills, positive self-talk, and cognitive restructuring. All 4 participants reported decreases in their PTSD symptomatology. The 3 participants who had elevated levels of depression and anxiety during baseline showed decreases with treatment. The results of this study suggest that cognitive behavioral techniques can be an effective approach for working with this population.

Contextual assessment of problematic situations identified by insulin pump using adolescents and their parents

For youth with type 1 diabetes mellitus (T1DM) using insulin pumps, maintaining metabolic control through appropriate selfcare is a complex biopsychosocial process reciprocally influenced by individual, familial, social, and technological variables. Adolescents (n 20) with T1DM using insulin pumps and their parents (n 34) were interviewed to determine (a) the most frequent and difficult situations faced by adolescents and their parents, (b) how the frequency and difficulty of these situations vary as a function of the respondent, the nature (content) of the problem, and the systemic context(s) in which problems occur, and (c) the relationship between the average difficulty rating and the youth’s metabolic control. The most frequently reported problematic situations were T1DM self-care. For youth these problems were predominantly related to social and peer contexts; parents identified problems primarily related to the family context. Implications and additional analyses are reported.

Improving adherence in social situations for adolescents with type 1 diabetes mellitus (T1DM): a pilot study.

AIMS Management of type 1 diabetes mellitus (T1DM) involves adherence to complex daily behaviors. Some adolescents have difficulty maintaining these regimens within social contexts due to peer pressure and apprehension about being singled out (Wysocki et al., 2003 [1]). Previous research suggests that negative social attributions have a role in adherence difficulties (Hains et al., 2006 [6]). This pilot study examined a cognitive-behavioral intervention geared towards challenging and restructuring negative thinking patterns. METHODS Ten adolescents with T1DM and HbA1c readings greater then 7.0% were recruited from a large, Midwestern Childrens Hospital. The intervention consisted of a 1-h session followed by three weekly phone calls, which focused on cognitive restructuring and problem-solving training. Measures of diabetes-related stress and concerns surrounding self-care in social situations were completed by the adolescents pre- and post-intervention and at one-month follow-up. RESULTS A series of repeated measure ANOVAS did not reveal significant differences between pre-intervention and follow-up scores across measures. CONCLUSIONS While there were no significant differences between pre-intervention and follow-up scores, the results highlight some important trends. Specifically, preliminary results suggest that the trends in individual scores indicate that problem-solving may be helpful for improving adherence in social situations.

Attributions of Teacher Reactions to Diabetes Self-care Behaviors

OBJECTIVE This study had two objectives: examine relationships among negative attributions of teacher reactions, anticipated adherence difficulties, teacher support, diabetes stress, and metabolic control; and develop questionnaires to test these relationships. METHODS One hundred and two youths with type 1 insulin-dependent diabetes completed instruments measuring attribution of teacher reactions, anticipated adherence, teacher support, and diabetes stress. Metabolic control was measured by percentage of hemoglobin A(1c). RESULTS Structural equation modeling demonstrated that negative attributions had direct effects on anticipated adherence difficulties and diabetes stress. Diabetes stress had a direct effect on metabolic control. Negative attributions had a significant indirect effect on metabolic control through associations with diabetes stress. Teacher support moderated the path between negative attributions and anticipated adherence difficulties. CONCLUSIONS Youths making negative attributions about teachers reactions are likely to find adherence difficult in school situations and have increased stress. Results are discussed in terms of a social information processing model of adjustment and practical applications.

A Cognitive Behavioral Adherence Intervention for Adolescents with Type 1 Diabetes

This study examined the impact of a cognitive behavioral intervention for nonadherent adolescents with type 1 diabetes. Six youths having problems following the diabetes regimen received training in cognitive restructuring and problem solving during individual sessions. A multiple baseline design across participants was used. Treatment effectiveness was assessed through 24-hr recall adherence interviews with adolescents and frequency of testing data was downloaded from glucose meters. Data was also collected for diabetes-specific stress. Five youths displayed improvement on at least one self-care behavior. Furthermore, the results suggest that the cognitive behavioral intervention was effective in diminishing diabetes-related stress in two participants. Cognitive behavioral interventions show promise for increasing self-care behaviors among nonadherent youths with type 1 diabetes. However, individual youths varied in their response to treatment. Further research is needed in developing procedures to better meet the needs of youths, improve youth participation, and enhance treatment effectiveness.

Adolescents and Type 2 Diabetes Mellitus: A Qualitative Analysis of the Experience of Social Support

Objective. Research on how adolescents with type 2 diabetes mellitus (T2DM) understand and use social support is limited. Therefore, we explored how adolescents with T2DM experience and perceive social support. Methods. Adolescents with T2DM were interviewed, and data were qualitatively analyzed using Consensual Qualitative Research methodology. Results. Four themes emerged: support for nondiabetes and diabetes-specific behaviors, feelings of belonging, and disclosure. All participants expressed emotional and self-care-specific support. For some, disclosure and a sense of belonging with others who had diabetes often led to support elicitation. Participants also expressed a fear of disclosing their diabetes to others. Discussion. Adolescents with T2DM value tangible and emotional support for behaviors both related and not related to diabetes. Fear of disclosure was a typical experience with disclosure often limited to close friends and family. Recommendations for health professionals to assist adolescents in promoting appropriate disclosure and means of requesting support are discussed.

Experiencing Type 2 Diabetes Mellitus Qualitative Analysis of Adolescents’ Concept of Illness, Adjustment, and Motivation to Engage in Self-Care Behaviors

Purpose The purpose of this study was to explore the perspectives of adolescents diagnosed with type 2 diabetes mellitus (T2DM) in terms of how youths conceptualized the effect of T2DM on daily life, adjustment to the illness, and motivation related to diabetes self-care management. The aims of the study were to gather essential information in order to develop appropriate intervention techniques and inform future studies intended to understand the psychosocial experiences of youths with T2DM. Methods Eight adolescents diagnosed with T2DM were recruited from an outpatient pediatric diabetes clinic at a Midwestern children’s hospital. A qualitative interview was developed, which was scheduled to last about 30 to 45 minutes. Data were analyzed using the consensual qualitative research methodology, wherein qualitative coders developed core ideas and themes related to the adolescent experience of T2DM. Results Three main themes were identified, including how the youths conceptualized the impact of T2DM, adjustment to self-care, and motivation to perform self-care behaviors. Knowledge related to the cause of T2DM and adjustment to completing self-care behaviors was varied among youths. Few adolescents spoke about motivation sources, although when mentioned, it typically involved witnessing negative health consequences in family members or friends with T2DM. Conclusions The data represent essential initial information related to youths with T2DM, which will help guide in developing future studies designed to understand the psychosocial experiences of youths with T2DM and appropriate intervention techniques. Future research that aims to increase internal and external motivation may be able to subsequently impact adherence to self-care behaviors.

Impact of Diabetes Disclosure on Perceptions of Eating and Self-Care Behaviors:

PURPOSE This study investigated whether disclosure of diabetes and gender influenced perceptions of eating and self-care behaviors. METHODS A vignette was developed in which a hypothetical friend engaged in diabetes self-care behaviors during a meal. Respondents (231 young adults) read vignettes that varied according to a 2 x 2 design (male vs female, preventative disclosure vs nondisclosure of diabetes). Participants answered 12 questions, which resulted in 2 factors: concern for friend and encourage professional help. RESULTS Significantly higher scores resulted on the concern for friend and encourage professional help factors when diabetes was not disclosed. Female characters also received significantly higher scores on the concern for friend factor. CONCLUSIONS Individuals with diabetes who choose to disclose their illness may prevent negative or incorrect perceptions related to self-care and eating behaviors, and may have a decreased likelihood that a true eating disorder would be identified by others.