New Style of Talk Therapy May Help You Manage Your Diabetes
If you have a broken bone, if you're recovering from an operation or if you have an illness that's probably going to go away, taking care of yourself might get tedious sometimes, but you know it's temporary, so you're likely to stick with your treatment plan. When you have diabetes, the knowledge that you'll be managing your condition for the rest of your life can be enough to make you lose your motivation.
Some professionals in the field of diabetes have become interested in a new way of talking to patients about managing diabetes. It's called "motivational interviewing," or MI, and it focuses on behavior change in a way that encourages patients to identify for themselves solutions and behaviors that might work for them, rather than having their healthcare providers make suggestions.
MI is used not just for diabetes. It can also be used to help people identify ways to eat healthier food, to help people with eating disorders change their behaviors and to help people who have problems with addiction, among other uses.
During a typical MI session, the patient talks more than the practitioner. The practitioner encourages the patient to talk about the reasons why change is so hard, and why the patient finds it difficult to make changes even when he or she understands that different behavior can offer significant benefits. Instead of offering advice and talking about how important it is to eat right, test blood sugar frequently, get exercise, etc., the practitioner spends much more time simply listening to the patient. This, in turn, can give patients a deeper understanding of their own inner conflict
One of the hallmarks of MI is that it promotes empowerment of the patient. Research has shown that wanting to change is not always enough to make people do what it takes. They also need to believe that change is possible for them. They need to have the confidence in themselves that they'll be able to continue with the behavior change even when things are more difficult than usual. MI practitioners have a goal of helping patients come to the conclusion that they themselves really do want to and are able to make changes. The practitioners encourage patients to come up with their own solutions and methods for replacing current behavior with behavior that will improve their health.
MI is considered a "patient-centered" approach to care because it focuses more on collaboration with the clinician and places importance on the concerns of the patient. More and more clinicians are being trained in MI techniques.
In a recent study of a group of 66 teenagers who had type 1 diabetes, half had four motivational interviewing sessions over the course of a year, while the other half had six traditional "support visits" in a year. At the end of the year, the teenagers in the MI group had lower hemoglobin A1C levels, higher satisfaction with their lives, greater sense of well being and less anxiety.
More and more clinicians are learning motivational interviewing techniques. If you think you're interested in this type of therapy, ask your doctor or other member of your diabetes team where you might find someone who uses this kind of approach.
Diabetes Care, June 2007; G. Welch, G. Rose, D. Ernst, "Motivational Interviewing and Diabetes: What Is It, How Is It Used, and Does it Work?" Diabetes Spectrum, Volume 19, Number 1, 2006;