Table 2.

Example of a brief exchange to reduce diabetes distress: The Finger Trap Metaphor

Provider: It sounds like you have really been struggling with your diabetes. It must be difficult. Youth: Yeah, I’m really sick of it. Provider: When there is something difficult or uncomfortable in your life, it’s pretty natural to try to avoid it or even pretend like it is not there. Youth: Yeah. Provider: That reminds me of something. Do you know what a finger trap is? Maybe you got one as a party favor or a prize when you were younger. Youth: Yeah, I know what those are. Provider: Let us think about how a finger trap works. You put your fingers in and start to pull out, then what happens? Youth: It grabs you. Provider: Right! It grabs you. In fact, the harder you pull, the harder it grabs you and more it restricts your movements. The more you try to escape it, the more it controls you. Isn’t that kind of how your diabetes works? Youth: Hmmm Provider: You did not choose to have diabetes, and if you could you would probably wish it away, but you cannot. It makes sense that you want to pull away from it, but when you do it with diabetes, it starts to take over your life; you do not feel as well, your parents are on your case, or maybe you end up in the hospital for DKA. It’s a fight you cannot win. Youth: I guess so. Provider: Let me ask you this, how do you loosen up a finger trap? Youth: Stop pulling? Provider: Yeah, right. You would have to stop fighting with it. You might even need to push your fingers in. You need to go into the trap to loosen its grip on you! Notice when you push in that you are still in the trap. It did not go anywhere and neither will diabetes, but now at least it’s not so restricting. You have space to move around. Maybe diabetes works the same way. If you can find a way to accept it — not like it, but be willing to work with it — maybe it will not feel like it’s so restricting, and you can get back to what’s important to you.

We tend to keep a stash of finger traps handy for just such an occasion, but the physical object is not essential to effectively deploying the technique. This technique was originally described by Hayes, Strosahl, and Wilson [72]