Clinical Psychology and Personality

Clinical Psychology and Personality

Determining the effectiveness of systemic-behavioral family therapy on coping styles and cognitive flexibility in type 1 diabetic adolescents

Document Type : Original Article

Authors
Zohre Ghaderi 1
Mahboobe Taher 2
shahnaz nouhi 3
Javad Esmaili 4
1 PhD student in Psychology, Islamic Azad University, Shahrood Branch, Shahrood, Iran
2 Associate Professor, Department of Psychology, Shahrood Branch, Islamic Azad University, Shahrood, Iran
3 Assistant Professor, Department of Psychology, Shahrood Branch, Islamic Azad University, Shahrood, Iran.
4 Assistant Professor, Department of Mathematics, Shahrood Bransh, Islamic Azad University
10.22070/cpap.2025.19799.1638
Abstract
Introduction: Diabetes is a metabolic and chronic disease that has a significant impact on the psychological factors of adolescents. Therefore, the aim of this research was to determine the effectiveness of behavioral systemic family therapy on coping styles and cognitive flexibility in type 1 diabetic adolescents.
Method: This study was a semi-experimental type with a pre-test and post-test design with two experimental and control groups. The statistical population was typing 1 diabetic adolescents aged 14-18 years old in Tehran and their parents in 2019, from which 30 volunteers were randomly selected and placed in two experimental and control groups. Then the questionnaires of Freudenberg and Luise (1993) coping styles and Dennis and Vanderwaal (2010) cognitive flexibility were completed by both groups. Then, family therapy was performed on the experimental group. And again, the questionnaires were presented to both groups. Data were analyzed using SPSS version 24 software and covariance analysis method.
Results: The results showed that in the sub-scales of coping styles including referring to others (P=0.012) and problem-oriented (P<0.001) between the two experimental and control groups in the post-test There was a significant difference in cognitive flexibility subscales including alternatives (P=0.002), control (P>0.001) and alternatives for human behavior. (P>0.001) There was a significant difference between the two experimental and control groups in the post-test.
Discussion and conclusion: Therefore, behavioral systemic family therapy can be used to improve and correct the psychological factors of type 1 diabetic adolescents.
Keywords
behavioral systemic family therapy
coping styles
cognitive flexibility
adolescent
type 1 diabetes
1-    Hoseini Tavan, H., Nouhi Rajab, A. Comparing the effectiveness of positive psychology training and motivational interviewing on lifestyle and psychological capital in people with type 2 diabetes. Clinical psychology and personality. Clinical psychology and personality. 2023.
https://doi.org/10.22070/cpap.2023.16683.1271 [In Persian]
2-    Pop-Busui, R., Januzzi, J. L., Bruemmer, D., Butalia, S., Green, J, B., Horton, W. B., et al. Heart failure: an underappreciated complication of diabetes. A consensus report of the American Diabetes Association. Diabetes Care. 2022.
https://doi.org/10.2337/dci22-0014.
3-    Diabetes atlas [Internet]. 2014.
http://www.idf.org/diabetesatlas.
4-    Karam Ghadiri, N., Hasan Abadi, H., Mojtabai, R., Nikoo Sokhan, A. Expert patient: a new approach in self-management of type 2 diabetes based on diabetes knowledge education and somatogeny knowledge. Clinical psychology and personality. 2020; 17(2): 47-61.
https://doi.org/10.22070/cpap.2020.2907
[In Persian]
5-    Bahjati, F. The Effectiveness of The Intervention Based on Informational–Motivational and Behavioral Skills (IMB) Self-Care Model on Quality of Life in Students with Diabetes. Quarterly journal of research in psychological health. 2019; 13(2): 45-63.
http://dx.doi.org/10.52547/rph.13.2.45
[In Persian].
6-    Peltonen, E. J., Veijola, R., Ilonen, J., Knip, M., Niinikoski, H., Toppari, J., et al. What is the role of puberty in the development of islet autoimmunity and progression to type 1 diabetes? European Journal of Epidemiology. 2023; 38(6): 689-97.
https://doi.org/10.1007/s10654-023-01002-7.
7-    Kim, A., Knudsen, J. G., Madara, J. C., Benrick, A., Hill, T., Abdul Kadir, L., et al. AVP-induced counter-regulatory glucagon is diminished in type 1 diabetes. bioRxiv. 2020:2020.01. 30.927426.
https://doi.org/10.1101/2020.01.30.927426.
8-    Rabbone, I., Schiaffini, R., Cherubini, V., Maffeis, C., Scaramuzza, A. Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children? Diabetes Care. 2020; 43(11): 2870-2.
https://doi.org/10.2337/dc20-1321.
9-    Leslie, R. D., Evans-Molina, C., Freund-Brown, J., Buzzetti, R., Dabelea, D., Gillespie, K. M., et al. Adult-onset type 1 diabetes: current understanding and challenges. Diabetes Care. 2021; 44(11): 2449-56.
https://doi.org/10.2337/dc21-0770.
10- Hamadzadeh, S., Ezati, ZH., Abedsaeidi, ZH., Nasiri, N. Coping Styles and Self-Care Behaviors among Diabetic Patients. . Iranian Nursing Journal(IJN). 2013; 25(80): 24-33.
https://sid.ir/paper/114283/en [In Persian]
11- Lee, J. K., Orsillo, S. M. Investigating cognitive flexibility as a potential mechanism of mindfulness in generalized anxiety disorder. Journal of behavior therapy and experimental psychiatry. 2014; 45(1): 208-16.
https://doi.org/10.1016/j.jbtep.2013.10.008.
12- Hayes, S. C. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior therapy. 2004; 35(4): 639-65.
https://doi.org/10.1016/S0005-7894(04)80013-3.
13- Hu, T., Zhang, D., Wang, J. A meta-analysis of the trait resilience and mental health. Personality and Individual differences. 2015; 76: 18-27.
https://doi.org/10.1016/j.paid.2014.11.039.
14- Feldman, M. A., Anderson, L. M., Shapiro, J. B., Jedraszko, A. M., Evans, M., Weil, L. E., et al. Family-based interventions targeting improvements in health and family outcomes of children and adolescents with type 1 diabetes: a systematic review. Current Diabetes Reports. 2018; 18: 1-12.
https://doi.org/10.1007/s11892-018-0981-9.
15- Hilliard, M.E., Holmes, C. S., Chen, R., Maher, K., Robinson, E., Streisand, R. Disentangling the roles of parental monitoring and family conflict in adolescents' management of type 1 diabetes. Health Psychology. 2013; 32(4): 388.
https://doi.org/10.1037/a0027811.
16- zamanifar, M., Keshavarzi Asadi, F., Hassani, F., Emamipour, S. Effectiveness of Systemic- Behavioral Couple Therapy on Sexual satisfaction and Self Differentiation in  Each Couple with Marital Conflict Health promotion management. 2022; 11(2): 45-58.
http://jhpm.ir/article-1-1337-fa.html [In Persian]
17- Reibstein, J., Singh, R. The Intercultural Exeter Couples Model: Making Connections for a Divided World Through Systemic-Behavioral Therapy: John Wiley & Sons; 2020. 186-7‌.
https://doi.org/10.1111/1467-6427.12368
18- Carr, A. Evidence for the efficacy and effectiveness of systemic family therapy. The handbook of systemic family therapy. 2020; 1:119-46. https://doi.org/10.1002/9781119438519.ch6.
19- Shakerian, S., Amini, H. The Effect of Education Based on the Family-oriented Empowerment Model on Self-care Behaviors of Patients with Type 2 Diabetes Referred to Rural Health Centers in Neka. Journal of Health Research in Society. 2019; 5(2): 11-8. http://jhc.mazums.ac.ir/article-1-403-fa.html [In Persian]
20- MohammadZadehFarhani, A.,  Naderi, F., Rajab, A., Ahadi, H., Kraskian, A. The effectiveness of cognitive-behavioral therapy on psychological problems and blood sugar control in children with type 1 diabetes mellitus. Journal of pediatric and infant nursing. 2018; 4(3): 56-63.
http://jpen.ir/article-1-272-fa.html [In Persian]
21- Mousaviyan, N., Kraskian-Mujembari, A.‌, Aghayousfi, A. The Effectiveness of Cognitive Therapy on the Reduction of Glycated Hemoglobin in Patients with Diabetic Type 2. Journal of Behavioral Science Research. 2017; 15(3): 285-90. http://rbs.mui.ac.ir/article-1-543-fa.html [In Persian]
22- Martyn-Nemeth, P., Duffecy, J., Quinn, L., Park, C., Mihailescu, D., Penckofer, S. A cognitive behavioral therapy intervention to reduce fear of hypoglycemia in young adults with type 1 diabetes (FREE): study protocol for a randomized controlled trial. Trials. 2019; 20:1-9.
https://doi.org/10.1186/s13063-019-3876-4.
23- Shariatmadar, A., Naimi, M. Predicting the motivation of academic progress through the coping styles of teenagers Research in educational systems. 2016;9(31): 191-210.
https://www.jiera.ir/article_49450_721db4e78e64539d62e9f712ebcb78e9.pdf [In Persian]
24- Dennis, J. P., Vander Wal, J. S. The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research. 2010; 34: 241-53.
https://doi.org/10.1007/s10608-009-9276-4.
25- Share, H., Robati, Z. The effectiveness of group therapy based on acceptance and commitment on cognitive flexibility, suicidal thoughts, depression and hopelessness in soldiers. Iranian Journal of Psychiatry and Clinical Psychology. 2021; 27(4): 412-27. http://ijpcp.iums.ac.ir/article-1-3095-fa.html [In Persian]
26- Carr, A. Family therapy and systemic interventions for child‐focused problems: The current evidence base. Journal of Family Therapy. 2019; 41(2): 153-213.
https://doi.org/10.1111/1467-6427.12226.
27- Sargazishad, T., Kerman saravi, F., Navidiyan., A. The effect of the family-centered empowerment model on the quality of life and self-efficacy of adolescents with type 1 diabetes. Iranian Journal of Endocrine and Metabolism, bimonthly research journal of Endocrine and Metabolism Research Center. 2016; 19(5): 330-9U.  http://ijem.sbmu.ac.ir/article-1-2276-fa.html [In Persian]
28- Knowles, S. R., Apputhurai, P., O’Brien, CL., Ski, CF., Thompson, D. R., Castle, D. J. Exploring the relationships between illness perceptions, self-efficacy, coping strategies, psychological distress and quality of life in a cohort of adults with diabetes mellitus. Psychology, health & medicine. 2020; 25(2): 214-28. https://doi.org/10.1080/13548506.2019.1695865.
29- Christiansen, A. T., Thomas, V., Kafescioglu, N., Karakurt, G., Lowe, W., Smith, W., et al. Multicultural supervision: Lessons learned about an ongoing struggle. Journal of Marital and Family Therapy. 2011; 37(1): 109-19.
https://doi.org/10.1111/j.1752-0606.2009.00138.x.
30- Yeh, SCJ., Huang, CH., Chou, HC. Relationships among coping, comorbidity and stress in patients having haemodialysis. Journal of Advanced Nursing. 2008; 63(2): 166-74.
https://doi.org/10.1111/j.1365-2648.2008.04659.x.
31- Santos, F. R., Sigulem, D., Areco, K. C., Gabbay, M. A., Dib, S. A., Bernardo, V. Hope matters to the glycemic control of adolescents and young adults with type 1 diabetes. Journal of Health Psychology. 2015; 20(5): 681-9.
https://doi.org/10.1177/1359105315573429.
32- Wysocki, T., Harris, M. A., Buckloh, L. M., Mertlich, D., Lochrie, A. S., Taylor, A., et al. Effects of behavioral family systems therapy for diabetes on adolescents’ family relationships, treatment adherence, and metabolic control. Journal of pediatric psychology. 2006; 31(9): 928-38. https://doi.org/10.1093/jpepsy/jsj098.