In This Issue

A treatment outcome study of acceptance and commitment therapy with type 1 pediatric diabetes patients

Techniques might encourage clients to fully experience their condition instead of attempting to ignore, eliminate or avoid aspects of this experience

By Kerry Prout, BA
Background and Purposes

A diagnosis of diabetes mellitus can increase long-term risk for various serious health problems. In addition to future health risks, successful treatment of pediatric diabetes involves adherence to a complex medical regimen. Research on pediatric diabetes care and regimen adherence in youth with diabetes has suggested several important components in diabetes management, including the presence of family involvement and effective coping skills (Weijman et al., 2005; La Greca et al., 1990).

In particular, research regarding the promotion of effective coping skills for individuals with diabetes has found that avoidant coping styles were related to less blood glucose monitoring (Weijman et al., 2005). Data has suggested that promoting disease-related acceptance might have the potential to produce positive outcomes if incorporated into diabetes care (Gregg et al., 2007; Weijman et al., 2005). For example, acceptance-based coping might utilize techniques that encourage clients to fully experience their condition instead of attempting to ignore, eliminate, or avoid aspects of this experience (Gregg et al., 2007; Weijman et al., 2005).

While research has found interventions that are probably efficacious in promoting regimen adherence in pediatric diabetes patients, these treatments do not incorporate acceptance-based coping, which data has suggested could lead to positive outcomes (Gregg et al., 2007; Weijman et al., 2005).

Acceptance and Commitment Therapy (ACT) (Hayes et al., 1999) is an intervention that utilizes acceptance-based coping and aims to promote psychological flexibility. ACT works to promote flexibility through the implementation of strategies designed to promote present awareness of internal and external events, acceptance of internal events, and movement towards what matters to the patient. Therapeutic strategies outlined in ACT might be a way to intervene with diabetes care and simultaneously target issues relating to regimen adherence, diabetes-related acceptance, and family management issues.

Although ACT has not yet been used in published studies with pediatric diabetes, ACT has been implemented with positive outcomes with other childhood conditions, such as chronic pain, as well as several adult medical conditions, including type 2 diabetes (Gregg et al., 2007; Wicksell et al., 2007; Wicksell et al., 2005).

The current study has been designed to evaluate a treatment approach that combines Acceptance and Commitment Therapy and parent involvement with youth diagnosed with type 1 diabetes in order to determine if potential benefits, such as increased medical regimen adherence and increased acceptance of diabetes condition, will emerge as a result of treatment intervention.

Design and Methods

The current project will be conducted using a multiple baseline design to control for the possible effects of time-based confounding variables in evaluation of treatment outcomes of the pediatric diabetes protocol. The baseline will be held for treatment effects.

Up to eight participants between the ages of 8 to 18 years who have been diagnosed with pediatric diabetes mellitus type 1 for a minimum of three months and their parents (mother, father, or legal guardian) will participate in the study. Inclusion criteria requires each youth participant is not currently receiving other treatment targeting regimen adherence behaviors, has not had any psychological problems within the past year, and is currently using a glucometer and will be able/willing to bring this to each treatment session. All potential parent participants answer initial phone interview questions to assess current adherence to medical regimen and associated interference with daily functioning of their children with diabetes. Participants whose responses express concern with regard to their child’s compliance with diabetes regimen adherence will be included in the current study. Treatment will consist of six to eight therapy sessions (including an intake interview).

Study measures include a Demographics Questionnaire, the Acceptance and Action Diabetes Question (AADQ), the Avoidance and Fusion Questionnaire for Youth (AFQ-Y), self-reported Hemoglobin A1C values, weekly glucometer information (including number of checks and value), and parent and youth weekly self-report dietary adherence rating.

Potential Clinical/Research Implications

The potential clinical implications of this study include the promotion of medical regimen adherence in youth with pediatric diabetes as well as possible improvements in disease-related acceptance. Clinically, the intervention might provide empirical evidence for the benefit of intervening with these youth in order to promote acceptance-based coping and psychological flexibility.

Advisor: Clint Field, PhD

References

Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Counseling and Clinical Psychology, 75, 336-343.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behavior Research and Therapy, 44, 1-25.

La Greca, A. M., Follansbee, D., & Skyler, J. S. (1990). Developmental and behavioral aspects of diabetes management in youngsters. Children’s Health Care, 19, 132-139.

Weijman, I., Ros, W., Rutten, G., Schaufeli, W. B., Schabracq, M. J., & Winnubst, J. A. M. (2005). The role of work-related and personal factors in diabetes self-management. Patient Education and Counseling, 59, 87-96.

Wicksell, R. K., Melin, L., & Olsson, G. L. (2007). Exposure and acceptance in the rehabilitation of adolescents with idiopathic chronic pain - a pilot study. European Journal of Pain, 11, 267- 274.

Wicksell, R. K., Dahl, J., Magnusson, B., & Olsson, G. L. (2005). Using acceptance and commitment therapy in the rehabilitation of an adolescent female with chronic pain: A case example. Cognitive and Behavioral Practice, 12, 415-423.