Psychosocial issues are increasingly recognized as being of primary importance in diabetes care. This is illustrated by the burgeoning number of publications on behavioural and social issues in both psychological and medical journals. In addition, an increasing number of international conferences and symposia on diabetes are beginning to address cognitive, emotional and behavioural issues surrounding diabetes, its complications and management. With this growing awareness of the importance of psychology in diabetes care, health care professionals experience an increasing need for easily accessible background information and practical guidelines on behavioural issues. However, only a handful of books are available for clinicians who wish to know what to do about the psychological aspects of diabetes care, from supporting patients and families coping with diagnosis and following the treatment regimen, through to complex psychological problems such as the diagnosis and management of depression and eating disorders. These are the issues this book hopes to begin to address. It seeks to bridge the gap between psychological research on the self-care and management of diabetes and the delivery of care and services provided by the diabetes care team. As such, this book is seen as an accompaniment to Clare Bradley's Handbook of Psychology and Diabetes (1994), which focuses on psychological assessment in diabetes. The content of this book is targeted at all individuals involved in the delivery of diabetes, including our fellow psychologists.

When considering who to ask to contribute to this book, we were acutely aware of two groups of psychologists. The largest, and most well-established group is the Council of Behavioural Medicine and Psychology of the American Diabetes Association (ADA). To date, these North American behavioural scientists have generated the overwhelming majority of psychological research and publications, and have compiled an excellent how-to-

do-it book under the editorship of Barbara Anderson and Richard Rubin (1996). Fortunately, we can see steadily increasing European work in this field, facilitated by the EASD Study Group, Psychosocial Aspects of Diabetes (PSAD). This group continues to develop and bring a distinctly European perspective to the psychology of diabetes care. Therefore, when seeking contributors for this compilation, we have endeavoured to reflect the work of both groups of researchers, thereby offering a true international perspective on psychology in diabetes care.

This book also seeks to provide a broad, evidence-based approach to behavioural intervention in diabetes care. Based on reviews of empirical and theoretical work, each chapter will make practical recommendations for diabetes care provision and future research. The authors of the nine chapters were asked to explore different approaches to intervention with children, adolescents and adults with diabetes. The first chapter is by Barbara Anderson and Julienne Brackett (USA), on Diabetes during childhood, addressing developmental and family issues. Chas Skinner, Sue Chanon, Lesley Howells and Adele McEvilly (UK) then discuss the abundance of psychological literature on adolescents with diabetes, with special reference to the beliefs and attitudes of adolescents with diabetes and how these affect their self-care behaviours. Research on the psychological impact of pregnancy in diabetes is reviewed in Chapter 3 by Frank Snoek (The Netherlands), with special focus on pre-conception counselling programmes. In Chapter 4, a truly international group of authors from the USA (Bob Anderson and Martha Funnell), Sweden (Anita Carlson and Nuha Saleh-Stattin) and the UK (Sue Cradock and Chas Skinner), discuss the background and implications of the empowerment approach to diabetes education and self-management, taking into account ethnic and cultural factors. The rich potential of motivational interviewing as a vehicle for behaviour change in diabetes patients is reviewed by Yvonne Doherty, Peter James and Sue Roberts (UK) in Chapter 5. This clearly sets the stage for Russell Glasgow and Elizabeth Eakins (USA) chapter on medical office-based interventions and how these can significantly contribute to the behaviour change process in diabetes. Chapters 7 and 8 expand on two different psychoeducational group programmes that were developed specifically for diabetes patients: Blood Glucose Awareness Training (BGAT), by Linda Gonder-Frederick, Daniel Cox, William Clarke and Diana Julian (USA), and Cognitive-Behavioural Group Training (CBGT), by Nicole van der Ven, Marlene Chatrou and Frank Snoek (The Netherlands). The last chapter, by Richard Rubin (USA), building on rich experience as a psychologist involved in diabetes care, reviews the indications and benefits of psychotherapy and counselling in diabetes, with reference to adaptional problems, depression, anxiety and eating disorders.

In conclusion, this book offers a comprehensive summary of current psychological knowledge and thought as it relates to the delivery of diabetes care and how to support professionals and individuals with diabetes to achieve their goals. We hope this book is a worthy start to this endeavour. Albeit incomplete, we sincerely hope you will find it informative, that it helps you reflect on your practice, whatever your professional role, and that it enables you to develop a more thoughtful approach to those individuals you are striving to care for.

We would like to thank the authors for their willingness to contribute to this volume and their considerable efforts to meet the editorial demands. We also thank Deborah Reece and Colleagues from John Wiley & Sons Ltd, Chichester, UK, for their initiative, efficiency and support.

Frank Snoek and Chas Skinner

Psychology in Diabetes Care, Edited by: Frank J. Snoek & T. Chas Skinner Copyright © 2000 John Wiley & Sons, Ltd ISBNs: 0-471-97703-9 (Hardback); 0-470-84656-9 (Electronic)

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