Subscribe: American Psychologist - Vol 65, Iss 1
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American Psychologist - Vol 71, Iss 7

The American Psychologist is the official journal of the American Psychological Association. As such, the journal contains archival documents and articles covering current issues in psychology, the science and practice of psychology, and psychology's cont

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Copyright: Copyright 2016 American Psychological Association

Understanding diabetes and the role of psychology in its prevention and treatment.


Diabetes is a common, chronic, and costly condition that currently affects millions of individuals in the United States and worldwide with even greater numbers at high risk for developing the disease. Dramatic increases in diagnosed diabetes are projected for the decades to come meaning that most people will be affected by diabetes; either personally or through a family member. This article introduces the special issue of the American Psychologist focused on diabetes by providing an overview of the scope of diabetes and the importance of psychologists for improving disease management and quality of life. This includes an overview of the contributions of the behavioral and social sciences toward improved diabetes prevention and treatment. Finally, the article will point to opportunities for psychologists to close the gaps in the research, develop practice competencies, and increase training opportunities to meet the challenges of diabetes today and in the future. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

The social context of managing diabetes across the life span.


Diabetes self-management is crucial to maintaining quality of life and preventing long-term complications, and it occurs daily in the context of close interpersonal relationships. This article examines how social relationships are central to meeting the complex demands of managing Type I and Type 2 diabetes across the life span. The social context of diabetes management includes multiple resources, including family (parents, spouses), peers, romantic partners, and health care providers. We discuss how these social resources change across the life span, focusing on childhood and adolescence, emerging adulthood, and adulthood and aging. We review how diabetes both affects and is affected by key social relationships at each developmental period. Despite high variability in how the social context is conceptualized and measured across studies, findings converge on the characteristics of social relationships that facilitate or undermine diabetes management across the life span. These characteristics are consistent with both Interpersonal Theory and Self-Determination Theory, 2 organizing frameworks that we utilize to explore social behaviors that are related to diabetes management. Involvement and support from one’s social partners, particularly family members, is consistently associated with good diabetes outcomes when characterized by warmth, collaboration, and acceptance. Underinvolvement and interactions characterized by conflict and criticism are consistently associated with poor diabetes outcomes. Intrusive involvement that contains elements of social control may undermine diabetes management, particularly when it impinges on self-efficacy. Implications for future research directions and for interventions that promote the effective use of the social context to improve diabetes self-management are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice.


Diabetes is a chronic illness that places a significant self-management burden on affected individuals and families. Given the importance of health behaviors—such as medication adherence, diet, physical activity, blood glucose self-monitoring—in achieving optimal glycemic control in diabetes, interventions designed and delivered by psychologists hold promise in assisting children, adolescents, and adults with diabetes in improving their health status and lowering their risk of serious complications. This article first provides an overview of diabetes self-management and associated challenges and burdens. Socioeconomic status factors that may influence diabetes management and outcomes are briefly highlighted. We then review the evidence base for select psychosocial factors that may be implicated in diabetes self-management. Modifiable targets of psychological intervention are presented across 3 overarching domains: (a) knowledge, beliefs, and related cognitive constructs; (b) emotional distress and well-being; and (c) behavioral skills and coping. Important methodological issues facing future research are discussed, along with opportunities for psychologists in improving the care and treatment outcomes of individuals and families living with diabetes. In conclusion, we advocate for continued research emphasis on improving psychosocial aspects of living with diabetes, with greater attention to the situational context in which the self-regulatory processes underlying self-management occur. Psychologists have important roles to play in reducing emotional distress, improving patient knowledge, and providing training in behavioral skills to promote successful self-management and to support patient-centered diabetes care. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Psychological conditions in adults with diabetes.


Type 1 (T1D) and Type 2 diabetes (T2D) represent a demanding set of biopsychosocial challenges for patients and their families, whether the age of disease onset occurs in childhood, adolescence, or adulthood. Psychological conditions, defined as syndromes, disorders, and diabetes-specific psychological issues affect a larger proportion of individuals with T1D and T2D compared to the general population. In this review, we summarize the prevalence, impact and psychological treatments associated with the primary categories of psychological conditions that affect adults with T1D and T2D: depressive symptoms and syndromes, anxiety disorders, eating behaviors and disorders and serious mental illness. The implications of the literature for psychologists are discussed, and priorities for future research to advance the science of psychological conditions for adults with T1D and T2D are identified. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Neurocognitive consequences of diabetes.


Mild cognitive dysfunction is a well-established complication of diabetes and its management, although large numbers of psychologists and health professionals may be unaware of its existence, clinical implications, and etiology. Drawing on results from key studies, systematic reviews, and meta-analyses, this article delineates the neurocognitive phenotypes characteristic of Type 1 diabetes (T1D) and Type 2 diabetes (T2D), and identifies the most plausible risk factors, both those that may be modifiable, like degree of metabolic control, and those that cannot be changed, like the age when a child or adult is diagnosed. Most children and adults with T1D typically manifest lower scores on measures of intelligence and academic achievement, attention, psychomotor speed, and executive functions. These effects are especially pronounced in those who develop diabetes early in life, before the age of 6 or 7 years. Chronically elevated blood glucose values increase the risk of both cognitive dysfunction and microstructural changes in white matter tracts. Adults with T2D manifest cognitive dysfunction characterized by poorer performance on tasks requiring attention, psychomotor speed, planning and executive functions, and learning and memory. They are also at increased risk of developing dementia. Poorer metabolic control accelerates the rate of cognitive decline over time, and research suggests that improving metabolic control may slow the rate of decline. Psychologists and behavioral scientists can play a key role in preventing the onset of cognitive complications or in ameliorating their severity by implementing behavioral strategies known to increase adherence to medical regimens and improve metabolic control. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Psychology, technology, and diabetes management.


Use of technology in diabetes management is rapidly advancing and has the potential to help individuals with diabetes achieve optimal glycemic control. Over the past 40 years, several devices have been developed and refined, including the blood glucose meter, insulin pump, and continuous glucose monitor. When used in tandem, the insulin pump and continuous glucose monitor have prompted the Artificial Pancreas initiative, aimed at developing control system for fully automating glucose monitoring and insulin delivery. In addition to devices, modern technology, such as the Internet and mobile phone applications, have been used to promote patient education, support, and intervention to address the behavioral and emotional challenges of diabetes management. These state-of-the-art technologies not only have the potential to improve clinical outcomes, but there are possible psychological benefits, such as improved quality of life, as well. However, practical and psychosocial limitations related to advanced technology exist and, in the context of several technology-related theoretical frameworks, can influence patient adoption and continued use. It is essential for future diabetes technology research to address these barriers given that the clinical benefits appear to largely depend on patient engagement and consistence of technology use. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Evidence-based behavioral interventions to promote diabetes management in children, adolescents, and families.


As members of multidisciplinary diabetes care teams, psychologists are well-suited to support self-management among youth with Type 1 diabetes (T1D) and Type 2 diabetes (T2D) and their families. Psychological and behavioral interventions can promote adherence to the complex and demanding diabetes care regimen, with the goals of promoting high quality of life, achieving optimal glycemic control, and ultimately preventing disease-related complications. This article reviews well-researched contemporary behavioral interventions to promote optimal diabetes family- and self-management and health outcomes in youth with T1D, in the context of key behavioral theories. The article summarizes the evidence base for established diabetes skills training programs, family interventions, and multisystemic interventions, and introduces emerging evidence for technology and mobile health interventions and health care delivery system interventions. Next steps in behavioral T1D intervention research include tailoring interventions to meet individuals’ and families’ unique needs and strengths, and systematically evaluating cost-effectiveness to advocate for dissemination of well-developed interventions. Although in its infancy, this article reviews observational and intervention research for youth with T2D and their families and discusses lessons for future research with this population. Interventions for youth with T2D will need to incorporate family members, consider cultural and family issues related to health behaviors, and take into account competing priorities for resources. As psychologists and behavioral scientists, we must advocate for the integration of behavioral health into routine pediatric diabetes care in order to effectively promote meaningful change in the behavioral and medical well-being of youth and families living with T1D and T2D. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Behavior change to prevent or delay Type 2 diabetes: Psychology in action.


Self-management is critical for the prevention and control of chronic health conditions. Research shows that dietary and physical activity behaviors related to obesity are inextricably linked to the development, course, and outcomes of Type 2 diabetes and its comorbidities. Therefore, a compelling case has been made for behavioral lifestyle intervention as the first-line approach. Academic psychologists and other behavioral scientists have contributed to all stages of obesity and diabetes prevention research and practice. They have made seminal contributions to the evidence-based science of health behavior change with the National Institutes of Health funded Diabetes Prevention Program randomized clinical trial and subsequent translation and dissemination efforts as exemplars. Beginning with social–cognitive learning theory and behavior modification for obesity, research psychologists have elucidated the critical elements associated with treatment efficacy and have demonstrated the benefits of identifying individuals at elevated risk and providing early intervention. Most often, the psychologist’s role has been to design and evaluate programs based on behavioral principles, or supervise, train, and facilitate adherence to interventions, rather than function as the primary provider. Lifestyle interventions have made a strong public health impact, but pressing challenges remain. Issues include difficulties with long-term weight loss maintenance, heterogeneity of treatment response, pragmatic translation and dissemination concerns such as optimal training and delivery formats, scalability of lifestyle intervention programs, reimbursement, and a need for environmental and policy approaches that promote healthy lifestyle norms and behaviors for all communities. Health psychology should be at the forefront in addressing all of these concerns. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Evidence-based lifestyle interventions for obesity and Type 2 diabetes: The Look AHEAD intensive lifestyle intervention as exemplar.


The majority of individuals with Type 2 diabetes (T2D) are overweight or obese, and this excess adiposity negatively impacts cardiovascular risk and contributes to challenges in disease management. Treatment of obesity by behavioral lifestyle intervention, within the context of diabetes, produces broad and clinically meaningful health improvements, and recent studies demonstrate long-term sustained weight management success with behavioral lifestyle interventions. Details of the Look AHEAD intensive lifestyle intervention are provided as an exemplar approach to the secondary prevention of T2D and obesity. The presence of behavior change expertise in the development and delivery of evidence-based behavioral weight control is discussed, and issues of adaptation and dissemination are raised, with a model to guide these important steps provided. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Innovations in healthcare delivery and policy: Implications for the role of the psychologist in preventing and treating diabetes.


Although the biomedical model has dominated U.S. health care for more than a century, it has failed to adequately address current U.S. health care challenges, including the treatment and prevention of chronic disease; the epidemic rise in diabetes is one important example. In response, newer models of health care have been developed that address patients’ mental and physical health concerns by multidisciplinary care teams that place the patient and family in the center of shared decision making. These new models of care offer many important opportunities for psychologists to play a larger role in the prevention and treatment of diabetes. However, for psychology’s role to be fully realized, both external and internal challenges must be addressed. This will require psychologists to become more interdisciplinary, more familiar with the larger health care culture, more willing to expand their skill sets, and more collaborative with other health disciplines both from a patient-care and a larger advocacy perspective. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)