SHORT-TERM IMPACT OF A STRESS MANAGEMENT AND HEALTH PROMOTION PROGRAM ON PERCEIVED STRESS,PARENTAL STRESS,HEALTH LOCUS OF CONTROL, AND CORTISOL LEVELS IN PARENTS OF CHILDREN AND ADOLESCENTS WITH DIABETES TYPE 1: A PILOT RANDOMIZED CONTROLLED TRIAL Eleni Tsiouli, MSc, 1 Vassilis Pavlopoulos, PhD, 2 Evangelos C. Alexopoulos, MD, DSc, MSc, PhD, 1 George Chrousos, MD, DSc, 1,3,n and Christina Darviri, Pr 1#,n Background: Parents of children and adolescents with dia- betes type 1 (DT1) usually experience high stress levels, as they have to cope with multiple demands in their everyday life. Different complex interventions have been implemented, which sometimes have led to opposite results. Objective: The purpose of this study was to assess stress levels in parents of children and adolescents with DT1 and to evaluate the effectiveness of a stress management program (progressive muscle relaxation combined with diaphragmatic breathing) in reducing perceived and parenting stress, increasing internal locus of control, promoting healthy lifestyle, and normalizing cortisol levels. Study Design: Randomized controlled trial. Methods: A total of 44 parents were randomly assigned to the intervention group (performing relaxation for eight weeks, n ¼ 19) and control group (n ¼ 25). Pre–post measurements included cortisol levels, lifestyle characteristics, perceived stress, perception of health, and parenting stress. Results: A statistically significant decrease in perceived stress (from 27.21 to 19.00, P ¼ .001), as well as in parenting stress (from 85.79 to 73.68, P ¼ .003), was observed in the intervention group. A statistically significant difference was found in perceived stress between the two groups after the intervention (D mean ¼ 6.64, P ¼ .010). No significant difference was revealed between or within the groups in cortisol levels. Significant improvement was reported by the subjects of the intervention group in various lifestyle parameters. Conclusions: Relaxation techniques seem to have a positive impact on stress and on various lifestyle factors in parents of children and adolescents with DT1. Future research on long- term benefits of an intervention program comprising of various relaxation schemes is warranted. Key words: Diabetes type 1, cortisol, parenting stress, perceived stress, stress management (Explore 2014; 10:88-98 & 2014 Elsevier Inc. All rights reserved.) BACKGROUND Diabetes type 1 (DT1) is a chronic and progressive disease that has been on the increase during the last decades. 1 It requires dramatic lifestyle changes for both patients and their parents. DT1 is associated with several short- and long-term complica- tions. Given the aforementioned, in the case of impaired glucose control, DT1 sets the perfect ground for increased stress levels within family members, causing disruptions in diabetes manage- ment and leading to early onset of several complications. 2 Such lifestyle imposes restrictions on activities; causes discomfort and fear of the future; and may result in a continuous stimulation due to economic problems associated with the therapy. Parents usually feel guilt as they seek the causes of the disease and hold high expectations for scientific progress that may lead to more effective medical treatment. 3–7 In addition, parental caregiving quality increases as children grow and face different challenges. The authors declare that no financial support was received, there was a submission for approval to the Ethics Committee Department of the Pediatric Hospital, “Agia Sofia,” and there are no conflicts of interest. Registration number: UoAMedPR-4716-180211-25. e-mail: cdarviri@yahoo.com 1 Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Athens, Greece 2 Department of Psychology, School of Philosophy, University of Athens, Athens, Greece 3 First Department of Pediatrics, Children’s Hospital Aghia Sofia, School of Medicine, University of Athens, Athens, Greece # Corresponding author n These authors contributed equally and share last authorship. 88 & 2014 Elsevier Inc. All rights reserved. EXPLORE March/April 2014, Vol. 10, No. 2 ISSN 1550-8307/$36.00 http://dx.doi.org/10.1016/j.explore.2013.12.004 ORIGINAL RESEARCH