Cognitive-Behavioral Group Therapy for Latino Youth with Type 1 Diabetes and Depression

May combine two claims.

Few culturally appropriate protocols have targeted Puerto Ricans with diabetes, and the available ones are mostly education programs for adults with type 2 diabetes.

“Few culturally appropriate protocols have focused on Puerto Ricans with diabetes and those available are mostly education programs directed to adults with Type 2 Diabetes Mellitus (T2DM”

• cites Osborn et al., 2010 sourcePartly supported

  The passage labeled Abstract says that few culturally appropriate diabetes education programs have focused on Puerto Rican Americans. The Methods (Participants) confirms that this study involved Puerto Rican adults with type 2 diabetes, but the paper does not establish that most available protocols for this population are education programs directed at those adults. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

This cognitive behavioral model emphasizes that people learn from and influence their environment, including relationships.

“This model also emphasizes how people learn from and influence their environment, including relationships”

• cites Aguilera, Garza, & Muñoz, 2010 sourceSupported

May combine two claims.

High levels of patient involvement in care are related to improved patient satisfaction, adherence, and health outcomes such as glycemic control and emotional distress.

“This premise is supported by the relation between high levels of patient involvement in care and improved patient satisfaction, adherence, and health outcomes, such as glycemic control and emotional distress (Miranda & Cooper, 2004).”

• cites Miranda & Cooper, 2004 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participation of ethnic minority patients in medical decision-making can improve health care and reduce health disparities.

“participation of ethnic minority patients in medical decision-making can improve health care and reduce health disparities.”

• cites Miranda and Cooper (2004) sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

José met criteria for other specified depressive disorder, reported low anxiety, showed some aggressiveness and low self-care in the previous month, and had the worst HbA1c among group members at 11.80.

“José met criteria for Other Specified Depressive Disorder. His last episode met criteria shortly before last month but significant symptoms remained. Unlike his mom, he reported low anxiety. Some aggressiveness and low self-care within the previous month were observed. His HbA1c (11.80) was the worst among GMs”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

David was upset with professionals who ignored the context of his type 1 diabetes but frequently nagged him about high glucose levels.

“David was upset about professionals who ignored the context of having T1DM but often nagged him for having high glucose levels”

May combine two claims.

In CBT-DM, group members collaborated in analyzing thoughts, gave feedback about activities and goals, shared T1DM management strategies, and supported each other.

“In CBT-DM, GMs collaborated in the analysis of thoughts, provided feedback about activities and goals, shared strategies for T1DM management, and were supportive to each other.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Therapy was delivered as planned and included only two individual sessions.

“Therapy was conducted as programmed and with only two individual sessions.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Type 1 diabetes-related hospitalizations numbered 1 for Luis, 2 for Rosa, 4 for Juana and David, and 18 for José.

“T1DM-related hospitalizations were 1 (Luis), 2 (Rosa), 4 (Juana and David), and 18 (José)”

May combine two claims.

Group members showed improved HbA1c, with gains observed at 6 months.

“and improved HbA1c. In the latter, gains were observed at 6M.”

May combine two claims.

Group members expected peer rejection for being different, and such rejection actually occurred.

“GMs expected peer rejection for being different and this actually occurred”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Despite using an insulin pump and having the highest self-care among group members, Rosa's HbA1c was high.

“Even with the insulin pump and the highest self-care among GMs, her HbA1c was high”

May combine two claims.

Rosa's self-care score decreased at post-treatment after she resumed insulin injections, but stabilized at 6 months.

“Rosa’s self-care score decreased at Post as she had recently resumed insulin injections. Yet, at 6M her score stabilized.”

The quote only partly states this claim.

Group members showed higher self-efficacy for T1DM from pre-treatment to post-treatment to 6-month follow-up.

“and for T1DM (MPre = 103.8, SDPre = 12.7; MPost = 117.0, SDPost = 12.6; M6M = 112.4, SD6M = 10.7)”

May combine two claims.

Luis met criteria for past-month major depressive disorder, scored high in social withdrawal and quite high in aggressiveness, and had the best HbA1c among group members at 6.80.

“he met criteria for a past-month MDD. He obtained a high score in social withdrawal and a quite high score on aggressiveness, but his HbA1c (6.80) was the best among GMs”

Probably not a substantial claim: may not pass S3 (load-bearing).

Rosa did not meet criteria for any anxiety disorder at post-treatment.

“and Rosa did not met criteria for any anxiety disorder.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Apathy reduced Luis's involvement in pleasant activities with others.

“Apathy reduced Luis’ involvement in pleasant activities with others”

May combine two claims.

Juana, David, and José rated treatment satisfaction as 4 (very satisfied), Rosa as 3 (mostly satisfied), and Luis as 2 (50% satisfied).

“Juana, David, and José rated their treatment satisfaction with the highest score (4 = very satisfied) and Rosa rated hers as 3 (mostly satisfied). Luis provided a rating of 2 (50% satisfied).”

May combine two claims.

Rosa met criteria for severe major depressive disorder, specific phobia, and lifetime agoraphobia.

“Rosa met criteria for severe MDD, Specific Phobia, and lifetime Agoraphobia”

Probably not a substantial claim: may not pass S3 (load-bearing).

Mothers reported that all but one youth followed meal plan recommendations only half the time.

“Mothers reported that all but one youth were following meal plan recommendations only 50% of the time”

May combine two claims.

As a group, improvements were observed in depression-related interpersonal problems, hopelessness (mostly at 6 months), social withdrawal, helplessness, self-esteem/guilt problems, self-care behaviors, aggressiveness, and anxiety.

“As a group, improvements were also observed in depression-related interpersonal problems, hopelessness (mostly at 6M), social withdrawal, helplessness, self-esteem/guilt problems, self-care behaviors, aggressiveness, and anxiety.”

May combine two claims.

Similar improvements were observed in suicide ideation, with dramatic reductions for Juana and Luis.

“Similar results were observed in suicide ideation, an area in which Juana and Luis’ reductions were dramatic.”

May combine two claims.

Mothers' satisfaction ratings were similar to the youths', and the mean combined rating for youths and mothers was 3.4.

“Mothers gave similar ratings. Mean GMs’ and mothers’ ratings were of 3.4.”

May combine two claims.

Juana presented with severe depressive symptoms, suicidal ideation, and moderate anxiety.

“Juana presented severe depressive symptoms, suicidal ideation, and moderate anxiety”

Probably not a substantial claim: may not pass S3 (load-bearing).

Rosa did not improve her HbA1c.

“Rosa did not improve her HbA1c.”

May combine two claims.

The most salient features of CBT-DM identified by participants were sharing with and listening to others with similar problems, acceptance by group members, therapist support, and tools for dealing with difficulties.

“The chance to share with and listen to others with similar problems, GMs’ acceptance, therapists support, and tools learned for dealing with their difficulties, were identified as the most salient features of CBT-DM.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Two group members had high suicidal ideation.

“Two group members (GMs) had high suicidal ideation”

Probably not a substantial claim: may not pass S3 (load-bearing).

Mothers complained about the group members' self-care.

“Moms complained about GMs’ self-care”

May combine two claims.

At post-treatment, all group members showed considerable reductions in evaluator-rated depressive symptoms, and most showed decreases in CDI scores, with José as the exception.

“At post-treatment (Post), all GMs showed considerable reductions in evaluators-rated depressive symptoms, and most showed decreases in CDI scores (Table 1). The exception was José.”

May combine two claims.

The clients had scores of at least 13 on the Children's Depression Inventory or at least 44 on the Children's Depression Rating Scale-Revised.

“Clients had scores ≥ 13 on the Children’s Depression Inventory (CDI) or scores ≥ 44 on the Children’s Depression Rating Scale-Revised (CDRS-R)”

Probably not a substantial claim: may not pass S3 (load-bearing).

Four of the mothers reported a mid-low socioeconomic status.

“Four of their moms reported a mid-low socioeconomic status”

Probably not a substantial claim: may not pass S3 (load-bearing).

The time since type 1 diabetes diagnosis ranged from 2 to 12 years.

“Time since their T1DM diagnosis ranged between 2 and 12 years”

Probably not a substantial claim: may not pass S3 (load-bearing).

In the previous three months, all youth displayed anger, disappointment, or resentfulness about having type 1 diabetes.

“Mothers said in the past 3 months all showed anger, disappointment, or resentfulness, for having T1DM”

Probably not a substantial claim: may not pass S3 (load-bearing).

Only Luis and Rosa carried daily supplies to treat hypoglycemia.

“Only Luis and Rosa carried daily supplies with them to treat hypoglycemia”

Probably not a substantial claim: may not pass S3 (load-bearing).

All group members had a history of mental illness.

“All GMs had history of mental illness”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All caregivers had a history of major depressive disorder or current depressive symptoms, and most also had a history of anxiety disorders or current symptoms.

“All caregivers had a history of MDD or current depressive symptoms and most had also a history of anxiety disorders or current symptoms”

Probably not a substantial claim: may not pass S3 (load-bearing).

José said he quit marijuana.

“José said he quit marijuana.”

Probably not a substantial claim: may not pass S3 (load-bearing).

David's anxiety at post-treatment coincided with complaints of being judged at home.

“David’s anxiety at Post concurred with complaints of being judged at home.”

May combine two claims.

Treatment gains on depression were sustained in all youth, with mean scores at post-treatment and 6-month follow-up below cut-off points or within normal range.

“Treatment gains on depression were sustained in all youth, with mean scores at Post and at 6M below the cut-off points or within normal range.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some group members arrived late more than once even though schedules were set according to their preferences.

“Schedules were set by GMs’ preferences but some arrived late more than once.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Juana had the lowest baseline self-care score and the second worst HbA1c value, 9.90.

“She seemed very angry about having T1DM and showed the lowest baseline self-care score and the second worst HbA1c value (9.90)”

Probably not a substantial claim: may not pass S3 (load-bearing).

José complained that peers pitied him because they thought he could not eat certain foods.

“José complained that peers felt pity for him thinking he could not eat some foods”

May combine two claims.

Among collective factors observed in this case were family conflict (all cases), low social support (most), parent-child communication problems (most), parental psychopathology (most), low T1DM knowledge (two mothers and one youth), and punctuality (some).

“Among collective factors we observed in our case were family conflict (all cases), low social support (most), parent-child communication problems (most), parental psychopathology (most), low T1DM knowledge (two moms and one youth), and punctuality (some).”

May combine two claims.

Most group members had recurrent or chronic depression, and many had been resistant, non-compliant, or dissatisfied with previous depression treatments.

“most of our GMs had recurrent or chronic depression, and many had been resistant, non-compliant, and/or dissatisfied with previous depression treatments.”

May combine two claims.

The mothers of José and Rosa suspected and confirmed that the youths falsified glucose test results.

“The mothers of José and Rosa suspected, and confirmed, that the youths falsified results of glucose tests.”

Probably not a substantial claim: may not pass S3 (load-bearing).

José was found using marijuana.

“José was also found using marijuana.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

Latinos are more likely to seek mental health services in primary care settings.

“Evidence suggests that Latinos are more likely to seek mental health services in primary care settings”

• cites Vega, Kolody, Aguilar-Gaxiola, & Catalano, 1999 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Diabetes is among the most prevalent chronic physical illnesses globally, harms quality of life, and frequently co-occurs with depression.

“Diabetes is one of the most prevalent chronic physical illnesses around the world with deleterious impact to the quality of life of those affected and is often comorbid with depression”

• cites Lloyd et al., 2010 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Depressive symptoms among youth with type 1 diabetes in Puerto Rico occurred at rates between 36.7% and 45.5%.

“rates for depressive symptoms among them were between 36.7 and 45.5%”

• cites Rivera, González-Nieves, Vélez, & Colón de Martí, 2007; Rosselló & Jiménez, 2007Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Latino youth, with the exception of Native Americans, face a higher risk of depression than youth of other ethnic or racial groups and have less access to mental health services than non-Latinos.

“Except for Native Americans, Latino youth are at greater risk for depression than youth from other ethnic/racial groups and have less access to mental health services than non-Latinos”

• cites Saluja et al., 2004; Sen, 2004Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The core elements and goals of CBT for adolescent depression were kept, while adaptations for type 1 diabetes culture were made and new goals were added: feeling more in control of diabetes and improving self-care and glycemic control.

“The essential elements and goals of CBT for AD were preserved, but adaptations to the T1DM culture were done, and new therapy goals were added: to feel more in control of diabetes, and to improve self-care and glycemic control”

Classified as probably not a substantial claim. May combine two claims.

Cognitive behavioral therapy holds that changing thoughts is essential for changing responses to events, and that behavioral activation can reduce depressed mood and anhedonia by increasing positive reinforcement.

“CBT assumes that changing what people think is essential to modify how they respond to events, and that behavioral activation techniques could be used to overcome depressed mood and anhedonia by providing increasing positive reinforcement in their lives”

• cites González-Prendes, Hindo, & Pardo, 2011 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In 2013, at least 1.8% of Puerto Ricans under age 20 received treatment for diabetes, mostly type 1, a rate notably higher than the 0.25% found in the U.S. pediatric population.

“In 2013, at least 1.8% of people under 20 years old in PR received treatment for diabetes, mostly T1DM”

• cites Puerto Rico Department of Health, 2015Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Centers for Disease Control and Prevention, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In the open trial, diabetes management and control issues were integrated into the manual, as were strategies for common worries and difficulties, based on published studies with the type 1 diabetes population.

“issues related to diabetes management and control were integrated into the manual, as well as strategies for dealing with common worries and difficulties presented by adolescents”

• cites Rosselló & Jiménez-Chafey, 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

CBT-DM targets depressive symptoms in Latino youth with type 1 diabetes and is grounded in a well-validated theoretical model.

“In contrast, CBT-DM targets depressive symptoms in Latino youth with T1DM, and was grounded in a well-validated theoretical model”

• AssumptionRests on an assumption: Theoretically driven interventions are significantly more effective than interventions that are not theoretically driven.

Probably not a substantial claim: may not pass S3 (load-bearing).

Group cognitive behavioral therapy has been recommended for Latinos because it is short-term, directive, and problem-solving in nature.

“Group CBT has been recommended for treating Latinos because of its short-term, directive, and problem-solving nature”

• cites Organista, 2000 sourceNot checked — no full text of the source

May combine two claims.

Youth with type 1 diabetes who have depressive symptoms face a higher risk of poor glycemic control, medical complications, and hospitalizations.

“T1DM youth with depressive symptoms are at higher risk for poor glycemic control, medical complications, and hospitalizations”

• cites Stewart, Rao, Emslie, Klein, & White, 2005 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Puerto Rico, about 4.42% of youth aged 11 to 17 meet criteria for major depressive disorder and 5.25% have sub-threshold depression.

“About 4.42% of youth 11 to 17 years old from Puerto Rico (PR) meet criteria for Major Depressive Disorder (MDD) and 5.25% present with sub-threshold depression”

• cites González-Tejera et al., 2005 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Until the previous decade, 29 of every 30 youth with diabetes in Puerto Rico had type 1 diabetes.

“until the past decade, 29 of every 30 youth with diabetes in PR had T1DM”

• cites Pérez-Perdomo, Pérez-Cardona, Allende-Vigo, Rivera-Rodríguez, & Rodríguez-Lugo, 2005Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In a second study, cognitive behavioral therapy for adolescent depression was adapted to a group format, and when CBT and interpersonal psychotherapy were compared in individual and group formats, CBT produced significantly greater decreases in depression than IPT.

“In a second study, CBT for AD was adapted to a group format, and CBT and IPT in individual and group formats were compared. Again, CBT proved to be efficacious in reducing depression, producing significantly greater decreases than IPT”

• cites Rosselló, Bernal, & Rivera-Medina, 2008 sourceNot checked — no full text of the source

May combine two claims.

Youth with type 1 diabetes have a higher risk of depressive symptoms than controls, and their earlier symptoms predict later ones up to five years afterward.

“Youth with Type 1 Diabetes Mellitus (T1DM) are at a higher risk for depressive symptoms than controls, with their past symptoms predicting future ones up to 5 years later”

• cites Hood et al., 2006; Johnson, Eiser, Young, Brierley, & Heller, 2013Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Depression increased when the youth's best efforts at glycemic control appeared ineffective, leading to hopelessness, helplessness, guilt, and low self-esteem, as in Rosa's case.

“Depression also rose if their best efforts for glycemic control did not seem to work, leading to hopelessness, helplessness, guilt, and low self-esteem, as with Rosa”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The study used a multistage assessment procedure: phone contact, in-person screening with the CDI, CDRS, SIQ-Jr, and a clinical interview, and a second session with the MINI and self-report forms.

“We used a multistage procedure. Upon phone contact, caregivers provided data on youth depression in the past two weeks. If criteria were met (at least a minor depressive episode), both came to an in-person screening, in which youth completed the CDI, CDRS, Suicide Ideation Questionnaire-Junior (SIQ-Jr) and a clinical interview for depressive disorders criteria”

Probably not a substantial claim: may not pass S3 (load-bearing).

The adaptation of cognitive behavioral therapy for adolescent depression into CBT-DM was described in Rosselló and Jiménez-Chafey (2006).

“The adaptation of CBT for AD into CBT-DM was described in Rosselló and Jiménez-Chafey (2006)”

• cites Rosselló and Jiménez-Chafey (2006)Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The study also considered the CBT-DM open trial's results when identifying areas for revision.

“We also pondered CBT-DM open trial’s results when identifying areas in need for revision”

Probably not a substantial claim: may not pass S3 (load-bearing).

José's exception was believed to be because he underreported his symptoms at baseline.

“We believe this was because he underreported his symptoms at baseline (Pre).”

Probably not a substantial claim: may not pass S3 (load-bearing).

An expert team including clinical psychologists, a nutritionist, and a pediatric endocrinologist reviewed the first CBT-DM manual.

“Our expert team, including clinical psychologists, a nutritionist, and a pediatric endocrinologist, reviewed the first CBT-DM manual”

Classified as probably not a substantial claim.

CBT-DM was delivered in groups to encourage peer support, acceptance, and understanding because the youth shared a chronic illness, depressive symptoms, and similar stressors.

“we delivered CBT-DM in groups to encourage peer support, acceptance, and understanding since youth shared not only a chronic illness but also depressive symptoms and similar stressors”

• AssumptionRests on an assumption: Delivering CBT-DM in groups encourages peer support, acceptance, and understanding because the youth share a chronic illness, depressive symptoms, and similar stressors.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

David's higher anxiety and increased family conflict may explain his increased HbA1c at post-treatment (11.20).

“David’s higher anxiety and increased family conflict may explain his increased HbA1c at Post (11.20).”

May combine two claims.

In the open trial, self-care and glycemic control did not change.

“Yet, self-care and glycemic control remained unchanged”

• cites Rosselló & Jiménez-Chafey, 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The authors think Luis's ADHD continued, but no post-treatment data were collected because he denied ADHD at pre-treatment.

“We think Luis’s ADHD continued but collected no Post data as he denied ADHD at Pre.”

May combine two claims.

These negative beliefs were destructive, judgmental, or rigid and altered the youth's perceptions of internal and external events, producing negative emotional, behavioral, interpersonal, and physical consequences.

“These beliefs were destructive, judgmental or rigid, and altered youth perceptions of internal and external events, leading to negative emotional (e.g., depressed mood, loneliness, guilt), behavioral (e.g., inactivity, apathy, poor self-care), interpersonal (e.g., withdrawal, rejecting help, aggressiveness), and physical consequences (e.g., high glucose level, stress)”

Classified as probably not a substantial claim. May combine two claims.

In the People module, content on family conflict, communication, and cohesion was added, including practice of conflict-resolution skills for diabetes-related situations involving parents.

“As family conflict, communication, and cohesion are related to depression and glycemic control in T1DM youth, we added content on these areas including the practice of conflict-resolution skills with diabetes-related situations that involved parents”

• AssumptionRests on an assumption: Family conflict, communication, and cohesion are related to depression and glycemic control in youth with type 1 diabetes.

Probably not a substantial claim: may not pass S3 (load-bearing).

Six health care professionals from diabetes clinics or community groups completed in-depth interviews and provided feedback after studying the manual.

“Six health care professionals (i.e., two pediatric endocrinologists, a pharmacist/diabetes educator, an exercise physiologist, a nurse, and a nutritionist/diabetes educator) from diabetes clinics or community groups completed in-depth interviews providing feedback after studying the manual”

May combine two claims.

The open trial found that youth depressive symptoms significantly decreased, while self-esteem, diabetes self-efficacy, quality of life, and functionality increased.

“Results of this study showed that youth depressive symptoms significantly decreased, while self-esteem, diabetes self-efficacy, quality of life, and functionality increased”

• cites Rosselló & Jiménez-Chafey, 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

During sessions, group members received healthy snacks and beverages and were told to use the bathroom as needed; these factors promoted treatment satisfaction.

“During sessions, GMs were provided with healthy snacks and beverages to consume at any time and were told to use the bathroom as needed. These factors promoted treatment satisfaction”

• AssumptionRests on an assumption: Providing healthy snacks and beverages and allowing bathroom use promotes treatment satisfaction.

May combine two claims.

Luis's social withdrawal was linked to negative thoughts about his mother's repeated attempts to get help for him, which contributed to his shyness and mutism.

“Luis’ social withdrawal was related to negative cognitions about his mother’s repeated attempts to seek help for him, contributing to his shyness and mutism”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Type 1 diabetes-related examples were inserted in the Negative and Positive Thought Worksheets, and both were shortened because youth with type 1 diabetes and depression could be more prone to fatigue.

“we inserted T1DM-related examples in the Negative and Positive Thought Worksheets and shortened both as T1DM youth with depression could be more prone to fatigue”

• AssumptionRests on an assumption: Youth with type 1 diabetes and depression may be more prone to fatigue.

Classified as probably not a substantial claim.

The authors believe that increased commonality among group members boosted simpatía's therapeutic power in this burdened, underserved, low-income population.

“We believe that increased commonality among GMs boosted simpatía’s therapeutic power in this burdened, underserved, and low-income population.”

May combine two claims.

The behavioral consequences of negative thoughts increased interpersonal and physical problems, and these problems in turn increased negative thoughts.

“Behavioral results of negative thoughts resulted in increases in interpersonal and physical problems, and vice versa”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Getting in touch with his feelings may have increased José's reported anxiety at 6 months.

“Getting in touch with his feelings may have increased José’s report of anxiety at 6M.”

Classified as probably not a substantial claim.

In the revised version, a man and a woman were required as therapists to facilitate young men's engagement, emotional expression, and participation in activities.

“In this revised version, we required a man and a woman as therapists (TRs). By including a man therapist (MT) we wanted to facilitate young men’s engagement, emotional expression, and participation in activities”

• AssumptionRests on an assumption: Including a man therapist facilitates young men's engagement, emotional expression, and participation in activities.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Recruiting group members with specific physical and mental health comorbidities is a challenge, but the environment created by commonalities among group members outweighed the challenges.

“To recruit GMs with specific physical and mental health comorbidities is a challenge but the environment created by commonalities among GMs outscored challenges.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Poor self-care led to poor glycemic control.

“Poor self-care led to poor glycemic control”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Some HbA1c improvements could be more related to insulin pump use than to CBT-DM.

“Some HbA1c improvements could be more related to the use of an insulin pump than to CBT-DM.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Mental health factors such as ADHD, ODD, Conduct Disorder, anxiety symptoms, and social withdrawal or Social Phobia could affect outcomes in a therapy with similar goals and format as CBT-DM.

“Mental health factors, such as ADHD (limiting attention span or ability to remain seated), ODD and Conduct Disorder (hindering disposition to follow directions, like group rules and self-care guidelines), anxiety symptoms (elevating glucose levels), and social withdrawal or Social Phobia (if small groups are the feared situation), could affect outcomes in a therapy with similar goals and format as”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Latino men's beliefs linked to machismo may manifest as reluctance to seek mental health services and express sadness, and self-medication with substances, which may be barriers to care.

“Latino men’s beliefs linked to machismo may manifest as reluctance to seek mental health services and express sadness, and self-medication with substances; these may also be barriers to care.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The authors' experience suggests that managing ADHD in CBT-DM could require special planning and strategies.

“Our experience suggests that managing ADHD in CBT-DM could require special planning and strategies.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

As with Rosa, group members may have problems with the insulin pump and may need an adjustment period to regain previous self-care levels after resuming insulin injections.

“As Rosa, GMs may have problems with the insulin pump and they may need an adjustment period to regain previous self-care levels after resuming insulin injections.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Trust issues among T1DM youth and their parents will probably arise.

“Trust issues among T1DM youth and their parents will probably arise.”

Probably not a substantial claim: may not pass S2 (checkable).

Assessing parental psychopathology and youth comorbidities is an essential step if therapy is to be sensitive to clients' context.

“assessing parental psychopathology and youth comorbidities is an essential step if therapy is to be sensitive to the clients’ context.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

These patients should benefit from activities requiring physical movement and from specific tasks that prevent distraction during discussions.

“These patients should benefit from participating in activities that require physical movement (such as role playing) and from the assignment of specific tasks that prevent them from distraction during discussions”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The impact of the group experience is optimal if sessions are facilitated by a man and a woman.

“The impact of this experience is optimal if sessions are facilitated by a man and a woman.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Glycemic control in those youth could be hindered, leading to more emotional problems and initiating a vicious cycle.

“Glycemic control in those youth could be hindered, leading to more emotional problems, initiating a vicious cycle.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Group psychotherapy could serve as a social instrument to move people from an individualistic and sectarian worldview to one that promotes community values and interdependence, congruent with Latino culture.

“it could serve as a social instrument to move people from an individualistic and sectarian worldview to one that promotes community values and interdependence, which indeed are congruent with the Latino culture.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). The quote only partly states this claim.

Specific strategies may be needed to prolong attention span in ADHD patients.

“specific strategies may be needed to prolong attention span.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

By ignoring these areas, clinicians working with T1DM youth risk wasting time and 'throwing punches blindly' because important dynamics affecting depressive and health symptoms could remain unknown.

“By ignoring these areas, clinicians that work with T1DM youth are at risk of wasting time and of “throwing punches blindly”, as important dynamics affecting the client’s depressive and health symptoms could remain unknown”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Thanks to therapists and group members, José shared his feelings with the group and learned to trust others and be trustworthy.

“thanks to therapists and GMs, José shared his feelings with the group and learned to trust others and be trustworthy.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

CBT-DM may be a useful treatment if delivered in primary care settings and a feasible alternative to antidepressants.

“CBT-DM may be a useful treatment if delivered in primary care settings, and a feasible alternative to antidepressants.”

The quote only partly states this claim.

Because stress sources were very similar, many recommendations from therapists or group members had general applicability and usefulness for the whole group.

“many recommendations provided by therapists or GMs found general applicability and usefulness for the whole group.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Adolescence itself could be a complicating factor for glycemic control and, to a lesser extent, emotional problems.

“Adolescence itself could be a complicating factor for glycemic control and, to a lesser extent, emotional problems.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

CBT-DM provides an oasis for a population avid for social support and acceptance and restructures self-care as a constructive activity promoting emotional and physical well-being, with the ultimate goal of improving quality of life.

“CBT-DM provides an oasis for a population avid for social support and acceptance and restructures self-care as a constructive activity that promotes emotional and physical well-being, with the ultimate goal of improving quality of life.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Therapists' non-judgmental and empathic stance and role modeling may be powerful, novel, motivating, and healing experiences for youth that could help them develop hope in creating collaborative relationships with other professionals and parent-youth teamwork in T1DM self-care.

“Therapists’ non-judgmental and emphatic stance, and role modeling, may be powerful, novel, motivating, and healing experiences to youth that could help them develop a sense of hope in creating collaborative relationships with other professionals, and even true parent-youth teamwork in T1DM self-care.”

May combine two claims.

Adapting CBT for AD to Latino youth with chronic physical illness and emotional problems and translating the protocol into primary care settings seems promising for reducing health disparities among Latino youth.

“Adapting CBT for AD to Latino youth populations with a chronic physical illness and emotional problems and translating the protocol into primary care settings, seems like a promising approach to reducing health disparities among Latino youth.”