This study explored the incorporation of type 1 diabetes mellitus (T1DM) into self-identity among adolescents. Guided interviews explored 40 adolescents' views of T1DM in relation to their sense of self and relationships with others. Responses were analyzed using thematic analysis. Results revealed that the entire sample described T1DM as a significant burden; many described how T1DM made them feel less "normal." Adolescents described both positive and negative aspects of self-management in social relationships, though most reported benefits in sharing T1DM with friends. Females were more likely to share information about T1DM and to describe positive changes in self-perception as a result of T1DM. The psychosocial processes related to integration of T1DM into self-identity described in these qualitative data provide hypothesis-generating findings that can guide future quantitative research examining incorporation of T1DM into adolescent self-identity in relation to measures of self-esteem, peer orientation, self-management, and glycemic control.

Aims To explore diabetes distress in a sample of adults with type 2 diabetes, treated and not treated with insulin. Methods Six focus groups were conducted with 32 adults with type 2 diabetes, divided by treatment regimen (insulin-treated N=15; 67% female; 60% black; 46% Hispanic; M age 54; M HbA1c 73 mmol/mol (8.8%); non-insulin-treated N=17; 53% female; 65% black; 13% Hispanic; M age 58; M HbA1c 55 mmol/mol (7.2%)). A coding team transcribed and analyzed interviews to describe themes. Themes were then compared between groups and with existing diabetes distress measures. Results Participants in both groups described a range of sources of diabetes distress, including lack of support/understanding from others, difficulties communicating with providers, and distress from the burden of lifestyle changes. Insulin-treated participants described significant emotional distress related to the burden of their insulin regimen. They were more likely to report physical burden related to diabetes; to describe feeling depressed as a result of diabetes; and to express distress related to challenges with glycemic control. Non-insulin-treated participants were more likely to discuss the burden of comorbid medical illnesses. Conclusions Our data generate hypotheses for further study into the emotional burdens of diabetes for insulin-treated adults with type 2 diabetes, and are in line with quantitative research documenting increased diabetes-related distress among insulin-treated individuals. Data describe needs, currently unmet by most models of care, for comprehensive assessment and tailored management of diabetes-related distress.

Objectives Erectile rehabilitation (ER) following radical prostatectomy (RP) is considered an essential component to help men regain erectile functioning; however many men have difficulty adhering to this type of a program. This qualitative study explored men's experience with ER, erectile dysfunction (ED), and ED treatments to inform a psychological intervention designed to help men adhere to ER post-RP. Methods Thirty men, one to three years post-RP, who took part in an ER program, participated in one of four focus groups. Thematic analysis was used to identify the primary themes. Results Average age was 59 (SD=7); mean time since surgery was 26 months (SD=6). Six primary themes emerged: 1) frustration with the lack of information about post-surgery ED; 2) negative emotional impact of ED and avoidance of sexual situations; 3) negative emotional experience with penile injections and barriers leading to avoidance; 4) the benefit of focusing on the long-term advantage of ER versus short-term anxiety; 5) using humor to help cope; and 6) the benefit of support from partners and peers. Conclusions Men's frustration surrounding ED can lead to avoidance of sexual situations and ED treatments, which negatively impact men's adherence to an ER program. The theoretical construct of Acceptance and Commitment Therapy (ACT) was used to place the themes into a framework to conceptualize the mechanisms underlying both avoidance and adherence in this population. As such, ACT has the potential to serve as a conceptual underpinning of a psychological intervention to help men reduce avoidance to penile injections and adhere to an ER program.

Introduction The sexual dysfunction following prostate cancer treatments often leads to a reduction in intimate contact for couples. A number of psychosocial interventions have been developed to enhance intimacy in these couples. This paper reviews three of these interventions and is a summary of a presentation given as part of a symposium at the 2011 Cancer Survivorship and Sexual Health Meeting. Aim The goal of this presentation was to: (i) review three types of psychosocial interventions; and (ii) describe the methodological issues highlighted by these interventions. Main Outcome Measures Validated measures of relationship intimacy and communication. Methods To be selected, the interventions had to be: a randomized control trial, focus on a couples approach to therapy, and report at least one relationship outcome. Results The results were not consistent within or across studies, and suggest that some specific aspects of the interventions may be helpful for the patient, while other aspects of the studies may be helpful for the partner. The Northouse et al. study suggests that partners may benefit from a focus on couple work, as compared to the patient. The Canada et al. study indicates that when focusing on sexual functioning, working with a couple did not show significant benefit compared to working with a man alone. The study did show, however, that a sexual-based intervention can improve the use of erectile dysfunction treatments and suggests patients may benefit from specific focus on side effects of treatment. The Manne et al. study highlights the importance of targeting these interventions to couples who report distress, and for distressed couples, an intervention can show positive results. Conclusions Intimacy enhancing interventions can be effective for couples, while the partners may benefit more from couples work; the patients may benefit more from focus on specific side effects.

Aims To explore the relationships between diabetes-specific self-esteem, self-care and glycaemic control among diverse adolescents with Type 1 diabetes.Methods Adolescents (aged 13-21 years) diagnosed with Type 1 diabetes for at least one year, receiving care at an urban medical centre, completed a self-report battery including demographic information, the Diabetes-Specific Self-Esteem Scale and Self-Care Inventory. Glycaemic control (HbA 1c ) was obtained from medical records at recruitment and one year later. Bivariate correlation and multiple linear regression assessed relationships between the Diabetes-Specific Self-Esteem scale, Self-Care Inventory and HbA 1c at baseline and one year.Results Participants included 85 adolescents (15.9 AE 2.1 years; 53% women; 47% Hispanic/Latino). Diabetes-specific self-esteem scores did not differ based on patient characteristics but were significantly correlated with baseline self-care (r = 0.59, P < 0.001) and HbA 1c at baseline (r = -0.51, P < 0.001) and one year later (r = -0.48, P < 0.001). Diabetes-specific self-esteem remained a significant correlate of baseline (b = -0.41, P < 0.001) and follow-up HbA 1c (b = -0.37, P = 0.008) when adjusting for covariates and self-care. Diabetes-specific self-esteem was not significantly associated with change in HbA 1c .Conclusions Results suggest that diabetes-specific self-esteem is significantly associated with self-care and glycaemic control among diverse adolescents with Type 1 diabetes. Diabetes-specific self-esteem may be more closely related to HbA 1c than reports of the frequency of self-care behaviours, and could represent a useful tool for clinical and research applications.

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Background: There remains a need for interventions addressing psychopathology in individuals with cognitive and intellectual disability (ID). This case examines the application of Dialectical Behavior Therapy (DBT) in an adolescent with Neurofibromatosis 1 (NF1) and multiple psychiatric diagnoses. Treatment targeted suicidal ideation (SI), non-suicidal self-injury (NSSI) and impulsivity, while addressing cognitive limitations. Case background:The patient met criteria for Major Depressive Disorder, Borderline Personality Disorder, and Attention-Deficit Hyperactivity Disorder. She had a two-year history of NSSI behavior and two prior psychiatric inpatient hospitalizations. At baseline, she presented with deficits in interpersonal relationships, emotional reactivity and maternal conflict. Course of treatment:The treatment plan followed the DBT-A protocol, with modifications made to address the patient's cognitive limitations. Adaptions included greater reliance on behavioral and visual learning strategies, increased maternal involvement, regular collaboration with the multidisciplinary care team, and shortened sessions to fit the patient's attentional capability. Treatment outcomes:The patient showed a reduction in NSSI, SI, and did not require further psychiatric hospitalization. Patient and mother evidenced increased skill use. Additional outcomes are discussed.Conclusions: These adaptations offer a preliminary account of DBT-A for an adolescent with cognitive impairments. Important factors for successful modification included a multidisciplinary treatment approach, adapted and targeted teaching methods, and significant reliance on behavioral principles. This case study suggests that DBT is a promising treatment for individuals with ID and cognitive impairments and should be further tested within this population.