Commentary: revising behavioral family systems therapy to enhance treatment adherence and metabolic control in adolescents with type 1 diabetes.

摘要

The quality of family relationships, which can influence critical outcomes such as adherence to medical treatment and medical management for pediatric chronic illness, is an important target of psychological interventions (Drotar, 2005; Fiese, 2005). In a series of studies, Wysocki and colleagues found that Behavioral Family Systems Therapy (BFST; Robin & Foster, 1989) can enhance family communication for adolescents with type 1 diabetes (Wysocki et al, 1997, 1999, 2000; Wysocki, Greco, Harris, Bubb, & White, 2001). On the other hand, BFST did not enhance treatment adherence or glycemic control, which is a critical health outcome that affects the rate of onset of diabetes-related complications (DCCT Research Group, 1994). The previous failure of BFST to demonstrate a significant impact on diabetes-related treatment adherence in the context of a randomized controlled trial (RCT) stimulated Wysocki and colleagues' most recent intervention research that is reported in this issue. This research fills an important need. Adherence to medical treatment has proven to be a very difficult outcome to change, not only in type 1 diabetes (Hampson et al., 2001), but in pediatric chronic illness in general (Rapoff, 1999). For this reason, new interventions and refinement of available models are very much needed.