Diabetes Education Certification Behavioral & Psychosocial Support 2 — Questions and Answers
Question 1: A patient with type 2 diabetes consistently misses follow-up appointments and reports feeling 'fine without medication.' This behavior BEST reflects which psychosocial barrier?
- Health literacy deficit
- Illness denial (Correct answer)
- Financial toxicity
- Social isolation
Correct answer: Illness denial
Minimizing or dismissing illness severity is a classic manifestation of denial, a common coping mechanism that interferes with self-management.
Question 2: Which motivational interviewing technique involves reflecting the patient's own statements about change back to them to amplify discrepancy?
- Affirmation
- Double-sided reflection (Correct answer)
- Open-ended questioning
- Decisional balance
Correct answer: Double-sided reflection
A double-sided reflection acknowledges both the patient's resistance and their stated reasons for change, surfacing internal discrepancy without confrontation.
Question 3: When screening for depression in a person with diabetes using the PHQ-2, a score of 3 or higher indicates the need to:
- Prescribe an SSRI immediately
- Administer the PHQ-9 for further evaluation (Correct answer)
- Refer directly to a psychiatrist
- Repeat the screen in 4 weeks
Correct answer: Administer the PHQ-9 for further evaluation
A PHQ-2 score ≥3 is a positive screen that warrants full assessment with the PHQ-9 before determining the appropriate intervention.
Question 4: A diabetes educator notices a patient avoids all social eating events due to fear of making mistakes with food choices. This pattern is MOST consistent with:
- Diabulimia
- Diabetes distress (Correct answer)
- Food neophobia
- Avoidant/restrictive food intake disorder
Correct answer: Diabetes distress
Diabetes distress includes emotional burden around social situations and fear of judgment, which can lead to avoidance behaviors that impair quality of life.
Question 5: The Social Cognitive Theory concept most directly targeted when a diabetes educator uses group skill demonstrations is:
- Reciprocal determinism
- Observational learning (modeling) (Correct answer)
- Locus of control
- Stimulus control
Correct answer: Observational learning (modeling)
Observational learning (modeling) occurs when patients acquire self-management skills by watching others perform them successfully in a group setting.
Question 6: Which of the following BEST describes 'diabetes burnout' as distinct from clinical depression?
- Persistent sad mood lasting more than 2 weeks
- Exhaustion and disengagement specifically from diabetes tasks without generalized hopelessness (Correct answer)
- Suicidal ideation related to medication burden
- Elevated HbA1c as the primary diagnostic criterion
Correct answer: Exhaustion and disengagement specifically from diabetes tasks without generalized hopelessness
Diabetes burnout is characterized by fatigue and disengagement from self-care tasks but does not include the pervasive hopelessness or neurovegetative symptoms of clinical depression.
Question 7: A certified diabetes care and education specialist (CDCES) uses the '5 A's' framework in a brief counseling session. Which 'A' involves collaboratively setting a specific, achievable goal with the patient?
- Ask
- Advise
- Agree (Correct answer)
- Arrange
Correct answer: Agree
The 'Agree' step in the 5 A's framework involves jointly establishing a specific, patient-centered goal that reflects shared decision-making.
Diabetes Education Certification Behavioral & Psychosocial Support 2
A patient with type 2 diabetes consistently misses follow-up appointments and reports feeling 'fine without medication.' This behavior BEST reflects which psychosocial barrier?