Diabetes Research Group, Weston Education Centre, King's College London, London, UK.
Department of Psychology and Human Development, University College London, London, UK.
Diabet Med. 2021 Jul;38(7):e14578. doi: 10.1111/dme.14578. Epub 2021 May 6.
This qualitative study aimed to develop the first cognitive behavioural therapy model outlining the development and maintenance of disordered eating in type 1 diabetes and report on recovery strategies and resilience factors to improve previous theoretical models of type 1 diabetes and disordered eating.
Twenty-three women (n = 9 with type 1 diabetes and disordered eating, n = 5 with type 1 diabetes recovering from disordered eating, and n = 9 with type 1 diabetes without disordered eating) participated in semi-structured interviews. Data were analysed using grounded theory and individual cognitive-behavioural formulations were developed for each participant to inform the development/maintenance and resilience models.
The development/maintenance model summarises commonly experienced vicious cycles of thoughts, feelings and behaviours in type 1 diabetes and disordered eating. The resilience model summarises strategies and knowledge acquired by those with type 1 diabetes in recovery from disordered eating and individuals with type 1 diabetes who did not develop disordered eating. Early adverse life events, past psychiatric history, perfectionist personality traits, difficult experiences around type 1 diabetes diagnosis and its relentless daily management sensitise individuals to eating, weight and shape cues. Alongside physical symptoms/complications, unhelpful interpersonal reactions and inadequate healthcare, vicious cycles of thoughts, feelings and behaviours develop. 'Good enough' psychological adaptation to type 1 diabetes, integrating type 1 diabetes into one's identity, self care and compassion around eating, weight and shape were key protective/post-traumatic resilience factors.
This first cognitive behavioural therapy model of type 1 diabetes and disordered eating informed by personal experience will inform an intervention for type 1 diabetes and disordered eating.
本定性研究旨在制定首个概述 1 型糖尿病中饮食失调发展和维持的认知行为治疗模型，并报告恢复策略和韧性因素，以改进以前关于 1 型糖尿病和饮食失调的理论模型。
23 名女性（n=9 名患有 1 型糖尿病和饮食失调，n=5 名患有 1 型糖尿病并从饮食失调中恢复，n=9 名患有 1 型糖尿病但无饮食失调）参加了半结构化访谈。使用扎根理论进行数据分析，并为每位参与者制定个体认知行为公式，以提供发展/维持和韧性模型的信息。
发展/维持模型总结了 1 型糖尿病和饮食失调中常见的思想、感觉和行为的恶性循环。韧性模型总结了从饮食失调中恢复的 1 型糖尿病患者以及没有发展饮食失调的 1 型糖尿病患者所获得的策略和知识。早期不良生活事件、既往精神病史、完美主义人格特质、1 型糖尿病诊断及其无情的日常管理带来的困难经历，使个体对饮食、体重和体型线索敏感。除了身体症状/并发症、无益的人际反应和医疗保健不足外，思想、感觉和行为的恶性循环也会发展。“足够好”的心理适应 1 型糖尿病、将 1 型糖尿病融入个人身份、自我护理以及对饮食、体重和体型的同情，是关键的保护/创伤后韧性因素。
本研究通过个人经验为基础的首个认知行为疗法 1 型糖尿病和饮食失调模型，将为 1 型糖尿病和饮食失调的干预提供信息。
