Most people with diabetes know the drill. Upon diagnosis, they get plenty of pamphlets, doctor recommendations, and an onslaught of websites letting them know that diet and exercise should be their top priority. But being informed is really only part of the solution, says Jillian Inouye, associate dean for research at the schools of Nursing and Allied Health. She is also a Tony & Renee Marlon Angel Professorship recipient.
Inouye's research looks at helping people with diabetes through cognitive behavior intervention (a set of counseling techniques and therapies). With training in nursing and psychology, Inouye is most curious about the mental, social, and emotional barriers to achieving health goals.
"Most of the time people with diabetes are told to eat healthy and exercise, but they're not given the detailed skills on how to do that when they're on the go and fast food is closer than a home cooked meal," she said.
Inouye's recently published research involves a study with more than 200 people of Pacific Islander or Asian descent. One group was given standard diabetes education while another group was exposed to a six-week cognitive intervention model that looked at patients' values, priorities, and opinions about food and lifestyle. Both groups were then followed and results measured over a period of time.
In the end, Inouye's research shows that there's a lot more to a dietary choices than willpower alone.
Why did you enter this field?
I was always focused on why people behave in certain ways. I found when I was a nurse, having knowledge is great, but it's only a first step. You need to know what else is going on and why certain things interfere with completing goals. Patients may know (what to do), but for some reason they can't do it. There are a lot of behavioral and psychological things that interfere with people taking control of their life situations.
The Mood Factor
Previous research has found that mood disorders and depression can interfere with taking care of yourself, and it's not uncommon to find diabetics with these problems too. Cognitive behavior intervention is used in a lot of mood disorders. But it hasn't been used much with chronic disease conditions like diabetes.
Culture and Food
I worked with Asians and Asian Pacific Islanders. Particularly, the latter felt food was such a social thing. There's a lot of reciprocity involved. Whenever people eat, they have to make enough food for others to show their appreciation. They give the gift of food and make huge amounts to send home with people. I've also heard in African American culture you may see this too. Most people will talk about how they know they shouldn't be doing this, but say "I have to show appreciation."
Changing the Discussion
We like to use what's called a values clarification. We ask, You want to live to how old? Do you want to see your children graduate school? These are things that might be more important than being polite and nice (and eating too much just to show appreciation). We weren't especially focused on telling them to change their behavior in terms of eating and diet, but more on changing the value system.
Cognitive behavioral therapy helps them to think differently about their problems or their solutions and how they perceive things in their lives. You can talk about examples like when someone cuts you off in traffic. They may not have been trying to aggravate you. Maybe there was an emergency. It's the same thing with a buffet full of food. Your culture says you should eat it for appreciation. Well, what are some other ways to show appreciation? How can we make decisions based on logic instead of emotion? It was like a first step in changing their attitudes about their ability to control their behaviors.
We also found that biofeedback and relaxation techniques, while we were doing cognitive restructuring, were very helpful. A relaxed heart rate and less stress brought empowerment, a physiologic change, and the feeling they could manage themselves and their behavior.
How do people respond when you talk about using psychology to treat diabetes?
They are very positive. For one thing, diabetes is a behavioral lifestyle disease -- it's not only medical. You have to manage the care of so many different things on a day-to-day level that are really behavioral as well as medical problems. I think people with diabetes appreciate and are eager to learn anything that can help them lead a regular life.