Alho, I., Lappalainen, P., Muotka, J., & Lappalainen, R. (2022). Acceptance and commitment therapy group intervention for adolescents with type 1 diabetes: A randomized controlled trial. Journal of Contextual Behavioral Science, 25, 153-161. https://doi.org/10.1016/j.jcbs.2022.08.002
Type 1 diabetes can be a challenging disorder to manage, and it needs a significant amount of self-care and daily management. Management tends to deteriorate during adolescence due to both physiological and psychological factors. This study aimed to investigate the use of methods based on acceptance and commitment therapy (ACT) for the purpose of increasing well-being, psychological flexibility, and motivation regarding treatment among adolescents whose glycosylated hemoglobin was above the recommended value. This study is one of the first to examine the impact of an ACT-intervention on glycemic control.
In this pilot study, we developed an ACT-based group intervention and invited 12–16-year-old adolescents at a pediatric diabetes outpatient clinic to join the study. Participants demonstrating difficulty managing their diabetes were randomized into either the ACT+Treatment-as-usual group (ACT+TAU, n = 36) or the TAU only group (n = 36). The intervention participants were offered a five-session ACT-based group intervention. The program consisted of structured group sessions held every two weeks and voluntary homework. Glycosylated hemoglobin (HbA1c) levels were monitored for both groups as well as diabetes-related psychological flexibility, acceptance and mindfulness skills, symptoms of depression and anxiety, and quality of life. The questionnaires were completed at the start and end of the program, and the HbA1c values were collected from the medical records.
Compared to the TAU group, the ACT+TAU group showed significantly larger changes in glycemic control (between-group Cohen's d = 0.59), diabetes-related psychological flexibility (d = 0.29), and symptoms of anxiety (d = 0.48). There was no significant effect on depression, mindfulness and acceptance skills, or quality of life. All the adolescents reported being satisfied with the group, and 97% were willing to recommend it to others.
Based on these initial findings, the acceptance-, mindfulness-, and value-based model seems to be suitable for adolescents with type 1 diabetes who have difficulty controlling their chronic illness. Adding a psychological group-based intervention to standard (TAU) diabetes care for adolescents could increase treatment compliance.
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