Positive Psychological Characteristics in Diabetes: A Review
Harvard Medical School, Boston, MA, USA, .Current Diabetes Reports (Impact Factor: 3.08). 09/2013; 13(6). DOI: 10.1007/s11892-013-0430-8
Positive psychological characteristics, such as optimism, self-efficacy, and resilience, have been increasingly associated with improved outcomes in medically ill individuals. However, there has been minimal systematic review of these characteristics and their associations with outcomes in people with diabetes. We aim to review these associations, their potential mediating mechanisms, and the evidence supporting interventions targeting these qualities. In people with diabetes, positive psychological characteristics are significantly associated with improved glycemic control, fewer complications, and reduced rates of mortality. Potential mechanisms mediating these associations include behavioral factors (e.g., improved treatment adherence), reduced inflammation, and improved neuroendocrine and autonomic functioning. Most psychosocial treatments in this population have focused on improving self-efficacy and resilience; such interventions may improve quality of life, well-being, and diabetes self-care. While untested in diabetes, interventions to boost other positive characteristics have been effective in other medically ill patients and may warrant further study in this cohort.
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- "Brain injury rehabilitation is another area that may benefit from modified PPT (Bertisch, Rath, Long, Ashman, & Rashid, 2014; Evans, 2011). PPT has also been adapted for suicidal inpatients (Huffman et al., 2014) and for physical health conditions (Celano, Beale, Moore, Wexler, & Huffman, 2013; DuBois et al., 2012; Huffman et al., 2011). More generally, positive interventions are being adapted for various populations, for example, people with developmental disabilities (Feldman, Condillac, Tough, Hunt, & Griffiths, 2002). "
ABSTRACT: Positive psychotherapy (PPT) is an established psychological intervention initially validated with people experiencing symptoms of depression. PPT is a positive psychology intervention, an academic discipline that has developed somewhat separately from psychotherapy and focuses on amplifying well-being rather than ameliorating deficit. The processes targeted in PPT (e.g., strengths, forgiveness, gratitude, savoring) are not emphasized in traditional psychotherapy approaches to psychosis. The goal in modifying PPT is to develop a new clinical approach to helping people experiencing psychosis. An evidence-based theoretical framework was therefore used to modify 14-session standard PPT into a manualized intervention, called WELLFOCUS PPT, which aims to improve well-being for people with psychosis. Informed by a systematic review and qualitative research, modification was undertaken in 4 stages: qualitative study, expert consultation, manualization, and stake-holder review. The resulting WELLFOCUS PPT is a theory-based 11-session manualized group therapy. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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ABSTRACT: Psychological insulin resistance (PIR) affects patients' self-care behaviors and quality of life due to the delay of insulin treatment for optimal glycemic control. Although effective patient-provider communication and relationships have been shown to improve patients' overall treatment adherence and attitude toward treatment, little is known about the potential mechanisms by which effective patient-provider communication and relationships decrease PIR and whether these relationships are mediated by diabetes self-efficacy. The purpose of this study is to examine whether diabetes self-efficacy among patients with type 2 diabetes (T2D) mediates the relationships between PIR and perceived patient-provider relationships. A total of 178 patients with T2D participated in a cross-sectional study. Data were obtained by patient interview using validated measures of diabetes attitude, diabetes knowledge, self-efficacy, and patient-provider communication. PIR was measured by using a validated measure, Barriers to Insulin Treatment. A structural equation model was developed to estimate direct and indirect effects of patient-provider relationship on PIR when self-efficacy was controlled as a mediator. Diabetes knowledge and attitude were not significantly associated with PIR. Better patient-provider relationship was directly associated with lower PIR (β = -.40, p = 0.008). When diabetes self-efficacy was included as a mediator, the direct effect between patient-provider relationship and PIR changed (β = -.27, p = 0.034), indicating that better patient-provider relationship that reduces PIR is due to greater diabetes self-efficacy. The findings suggest that development of intervention programs aimed at improving diabetes self-efficacy-which may be positively correlated with better patient-provider relationship-is needed to reduce PIR.
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ABSTRACT: Most patients with type 2 diabetes (T2D) have suboptimal adherence to recommended diet, physical activity, and/or medication. Current approaches to improve health behaviors in T2D have been variably effective, and successful interventions are often complex and intensive. It is therefore vital to develop interventions that are simple, well-accepted, and applicable to a wide range of patients who suffer from T2D. One approach may be to boost positive psychological states, such as positive affect or optimism, as these constructs have been prospectively and independently linked to improvements in health behaviors. Positive psychology (PP) interventions, which utilize systematic exercises to increase optimism, well-being, and positive affect, consistently increase positive states and are easily delivered to patients with chronic illnesses. However, to our knowledge, PP interventions have not been formally tested in T2D. In this paper, we review a theoretical model for the use of PP interventions to target health behaviors in T2D, describe the structure and content of a PP intervention for T2D patients, and describe baseline data from a single-arm proof-of-concept ( N = 15 ) intervention study in T2D patients with or without depression. We also discuss how PP interventions could be combined with motivational interviewing (MI) interventions to provide a blended psychological-behavioral approach.
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