Abstract
Introduction: Reliance on linear biomedical models in the treatment of type 2 diabetes without deep intervention in the cognitive, emotional, and behavioral layers of the patient’s experience has reached a plateau of treatment efficacy in practice. This study was conducted with the aim of developing and validating an integrated technology-enhanced cognitive-behavioral-emotion-focused therapeutic package for type 2 diabetes.
Methods: A sequential exploratory design was employed in this study. In the first phase, a systematic review of sources from 2010–2025 and directed qualitative analysis (NVivo) led to the extraction of clusters around axes of emotion regulation, cognitive and meaning reconstruction, stress coping and management, technology-enhanced self-care, social support, and relapse prevention. In the second phase, these clusters were operationalized into an eight-session protocol and submitted to 10 specialists for examination of content validity.
Results: The Content Validity Ratio (CVR) with a threshold of 0.62 and Content Validity Index (CVI) with a threshold of 0.79 were calculated, and results for all items exceeded the threshold. Several borderline cases were revised after feedback (terminology correction, consolidation, or clarification of technology-enhanced procedures) and were retained without structural deletion in the final version. Integrative analysis showed that the integration of the application (daily logging of mood, thoughts, and behaviors; adaptive feedback; intelligent reminders) with sequences of emotional–cognitive skills can create the capacity for “closed-loop learning” to reduce the gap between sessions and daily life and generate secondary data for future personalization.
Conclusion: Given the confirmation of formal and content validity of the technology-enhanced cognitive-behavioral-emotion-focused therapeutic package based on specialist assessment, this protocol can be applied to individuals with type 2 diabetes. With a comprehensive view and attention to all three domains of cognition, behavior, and emotion, this study addressed bridging the gap between existing protocols and their fragmentation. The integration of technology aims at making this disease management more practical and facilitating it in everyday life.