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Behavioral and Psychosocial Interventions in Diabetes

A conceptual review

¹ Department of Sociology, Loyola College, Baltimore, Maryland
² Department of Medicine, Johns Hopkins University, Baltimore, Maryland
³ Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland

Address correspondence and reprint requests to Mark Peyrot, PhD, Professor, Department of Sociology, Loyola College, 4501 North Charles St., Baltimore, MD 21210-2699. E-mail: mpeyrot@loyola.edu

Abbreviations: CBT, cognitive behavioral therapy • DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th edition

The first 300 words of the full text of this article appear below.

A major task of diabetes care providers is to support patients in performing necessary self-care behaviors using well-accepted strategies such as recommending effective self-care regimens and educating patients in their use. Also critical are behavioral interventions that help patients implement self-care regimens in the face of life's exigencies.

The purpose of this article is to identify key behavioral/psychosocial interventions available to diabetes care providers. We present a conceptual framework for organizing the application of these interventions, focusing on practical interventions that can be implemented by a typical health care provider, including referral to a behavioral/psychosocial specialist where this seems the most practical choice.

ISSUES OF PRACTICALITY—

A typical office visit lasts only 15 min (1). Therefore, feasibility is an important consideration in evaluating patient care recommendations. The strategies we propose should be no more time-consuming than these approaches, which are highly recommended for their feasibility. A previously demonstrated, effective counseling strategy for weight loss can be maintained by 15-min visits (2). A behavior change support approach, the 5As (ask, advise, assess, assist, arrange) Model, is estimated to take less than half the time of a normal office visit (3). An emotional support approach, the BATHE (background, affect, trouble, handling, empathy) Model, is estimated to take 15 min (4).

Feasibility must also be assessed in terms of what it costs to ignore psychosocial problems or to employ an ineffective approach to behavior change. Patients who have psychological problems use health services more intensively, and if patients do not change their behavior, the clinician must spend time dealing with the problem at subsequent visits. Finally, research suggests that dealing with patients' concerns does not require additional time if done correctly (5). Thus, effective clinical procedure may also be efficient.

OVERVIEW OF INTERVENTIONS—

The review we present is not . . . [Full Text of this Article]

THEORIES/MODELS OF BEHAVIOR AND BEHAVIOR CHANGE—

BEHAVIOR CHANGE INTERVENTIONS—

Constructing a problem
Start with the patient's problem.
Specify the problem.
Collaborative goal setting
Collaborative problem solving
Identify barriers to goal attainment.
Formulate strategies to achieve the goal.
Contracting for change
Track outcomes.
Rewarding success.
Continuing support
EMOTIONAL SUPPORT INTERVENTIONS—

Identifying patients who suffer from diabetes distress
Primary interventions to alleviate diabetes-related distress
Enhancing diabetes-specific self-efficacy.
Encouraging realistic expectations.
Enhancing motivation.
Identifying psychiatric disorders
Treating depression
MULTIPLIER EFFECTS—

RESEARCH IMPLICATIONS—

CONCLUSIONS—

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