PROJECT SUMMARY
Successful management of type 2 diabetes requires adhering to physician-recommended medication,
dietary, and exercise regimens. Most of these adherence-related behaviors provide little to no short-term
benefit and rather may be aversive (e.g., caloric restriction and physical exertion). However, treatment
adherence provides critical health benefits in the future, allowing patients to halt or reverse disease
progression and avoid diabetes-related complications (e.g., renal disease or diabetic retinopathy). Thus,
successful management of type 2 diabetes requires one's present behavior to be guided by future outcomes.
Unfortunately, accumulating evidence indicates that individuals with type 2 diabetes and those at risk for this
disorder rapidly devalue the future (a phenomenon known as delay discounting), which past and present data
suggest contributes to treatment nonadherence. Thus, interventions shown to increase valuation of the future
are likely to improve adherence. One such intervention is episodic future thinking (EFT), a form of prospection
in which participants vividly imagine events that might occur in their future. Recent and ongoing work indicate
that EFT, which activates neural systems associated with both planning and prospection, improves valuation of
the future and reduces a wide range of maladaptive health behaviors (e.g., dietary intake in overweight/obese
populations and cigarette smoking in smokers). The overall goal of this project is to use a remotely delivered
EFT intervention to improve treatment adherence and adherence-related outcomes in type 2 diabetes. In
Specific Aim 1, participants with poorly controlled type 2 diabetes (defined as hemoglobin A1C =8%) will
engage in either EFT or a control thinking condition in the natural environment during a four-week trial.
Outcome measures will be assessed at baseline, as well as 4-week and 6-month follow-up laboratory visits,
and will include medication adherence, dietary intake, body mass index, glycemic control, blood pressure, and
delay discounting. During the trial, we will also remotely assess physical activity, medication adherence, dietary
intake, and delay discounting. In Specific Aim 2, we will examine acceptability of the remotely delivered EFT
intervention. For an intervention to be effective in clinical settings, it should be easy to use and its helpfulness
should be clear to patients. Thus, participants will rate the EFT or control conditions along several dimensions
of acceptability, including ease of use, usefulness, and helpfulness. Ratings will be obtained separately for
components of both the intervention and measurement to isolate acceptability of the intervention itself. High
intervention ratings would suggest that EFT may be implemented with high treatment fidelity in clinical settings
and is more likely to be disseminated among treatment providers and adopted by patients.