Building Competency in Diabetes Education THE ESSENTIALS

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frequently leads to less optimal diabetes self-care, including missed meals, forgotten medication, missed testing, and decreased motivation for physical activity (147-149,150). Since stress is experienced differently with very individual responses, there is no single intervention that can be applied to all. Below is a list of interventions that may be incorporated into SME and SMS programs. They are to enhance successful adaptation and positive coping skills, in turn, helping to improve health outcomes. All the interventions share the following

pattern constructs (137): 1. Search for meaning.

2. Attempt to regain mastery. 3. Efforts to restore self-esteem.

Techniques to reduce stress response: • Psychological support/cognitive behavioural techniques (122,150,151): o Empowerment: There is strong consensus that an empowerment approach to care and education is more effective than a compliance model in enhancing psychological adjustment to diabetes and potentially preventing psychological distress (see Chapter 2: Foundations of Diabetes Self-Management Education and Support). Key ingredients to the empowerment approach are collaboration and patient participation in decision making (to the extent desired by the patient). Patient chosen goals are personally meaningful. Cultural values influence patient preferences to a large degree. o Assertiveness training, refuting irrational ideas. o Coping-skills training. o Brief CBT. o Counselling. • Stress reduction (152): o Biofeedback techniques. o Self-hypnosis, breathing techniques, progressive muscle relaxation. o Mindfulness training. o Imagery. o Meditation. o Exercise.