act and obesity
DESCRIPTION
Sandra Weinelands talk at the Nordic ACBS Forum 2012.TRANSCRIPT
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ACT and obesity S.Weineland
Obesity (BMI <30) is resistant to psychological methods of treatment, if anything other than a short-‐term perspecGve is taken (Fairburn, 2010).
Success is short-‐termed and followed by weight regain for the majority of individuals.
Focus on….
• PrevenGon • Environment (toxic food environment)
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Need for a broader focus in psychological treatment?
Living With the SGgma of Obesity
• Obesity is associated with characterisGcs such as being lazy, less competent, lacking self-‐discipline, and being emoGonally unstable (Wang, Brownell, & Wadden, 2004).
• SGgmaGzing experiences correlate with social isolaGon, depression, and binge eaGng (Annis, Cash, & Hrabosky, 2004; Puhl & Brownell, 2001).
Body dissaGsfacGon
• Internalized, weight-‐related self-‐sGgma is recognized by self-‐devaluaGon and fear of other judgments based on weight (Lillis, Luoma, Levin, & Hayes, 2010).
• Body dissaGsfacGon is characterized by behaviors such as pre-‐occupaGon with weight, self-‐devaluaGon, avoidance of body exposure and avoiding for example inGmate relaGonships (Puhl & Heuer, 2009).
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EmoGonal eaGng
• One strategy for handling negaGve emoGons is eaGng for emoGonal relief (Spoor et al., 2006; Valdo Ricca et al., 2009).
• Shame and body dissaGsfacGon correlate significantly with over eaGng among obese paGents (Annis, Cash, & Hrabosky, 2004; Hrabosky et al., 2007; Puhl & Brownell, 2001).
• In a prospecGve study, body dissaGsfacGon was shown to predict binge eaGng a`er five years among overweight individuals (Neumark-‐Sztainer, Paxton, Hannan, Haines, & Story, 2006).
EmoGonal eaGng and experiental aviodance
• ExperienGal avoidance is predicGve of binge eaGng (Kingston, Clarke, & Remington, 2010).
• ExperienGal avoidance seems to mediate the relaGon between negaGve emoGons and binge eaGng (Kingston, et al., 2010).
Rebound of emoGonal suppression
• Suppression of thoughts related to food predicts food cravings, binge eaGng (Barnes & Tantleff-‐Dunn, 2010; Geliebter & Aversa, 2003).
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AssumpGons
• Behavior paeerns such as experiental avoidance -‐ established and maintained
• IdenGfying with weight and body shape creates suffering
• Pufng life on hold while waiGng to lose weight reduces life quality
ACT for obesity
• Aim at directly target the underlying factor of experienGal avoidance involved in inflexible behavioral paeerns.
• Rather than focusing on weight and eaGng itself, the focus is on observing, in a non-‐judgmental fashion, inner experiences as separate events and pufng energy into valued acGons.
Experiments -‐ acceptance and defusion strategies
Acceptance and defusion reduce cravings and the consumpGon of chocolate compared to control or supression strategies (Forman et al., 2007; Hooper, Sandoz, Ashton, Clarke, & McHugh, 2012).
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ACT obesity intervenGon studies 1. Forman EM, Butryn ML, Hoffman KL, Herbert JD. An Open Trial of an Acceptance-‐Based
Behavioral IntervenGon for Weight Loss. Cog Behav Pract. 2009;16(2):223-‐35.
2. Lillis J, Hayes S, BunGng K, Masuda A. Teaching Acceptance and Mindfulness to Improve the Lives of the Obese: A Preliminary Test of a TheoreGcal Model. Ann Behav Med. 2009;37(1):58-‐69.
3. Lillis J, Levin ME, Hayes SC. Exploring the relaGonship between body mass index and health-‐related quality of life: A pilot study of the impact of weight self-‐sGgma and experienGal avoidance. J Health Psychol. 2011 July 1, 2011;16(5):722-‐7.
4. Tapper K, et al. Exploratory randomised controlled trial of a mindfulness-‐based weight loss intervenGon for women. AppeGte. 2009;52(2):396-‐404.
5. Weineland S, Arvidsson D, Kakoulidis TP, Dahl J. Acceptance and commitment therapy for bariatric surgery paGents, a pilot RCT. Obe Res Clin Pract. 2012;6(1):21-‐30.
6. Weineland S, Hayes S, Dahl, J. Psychological flexibility and the gains of acceptance-‐based treatment for post bariatric surgery: Six month follow-‐up and a test of the underlying model, Clin Obes. In press
Bariatric surgery – evidence based for long term weight loss
However, there are sGll…
• Fear of weight gain (Kinzl, Traweger, Trefalt, & Biebl, 2003)
• Body de-‐evaluaGon (Adami, Meneghelli, Bressani, & Scopinaro, 1999; Kinzl et al., 2003)
• SubjecGve binge eaGng and loss of control over food (de Zwaan et al., 2003; Niego et al., 2007)
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Method
• Recruiment in a clinical obesity surgery sefng • N=39 (ACT=19 TAU= 20) • Drop out: 4 in ACT and 2 in TAU.
Partcipants
• 23 years duraGon of obesity • 20 years of failed weight loss aeempts prior to surgery
• PresenGng concerns with body dissaGsfacGon and eaGng
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ACT -‐ IntervenGon
• InGal session: Life-‐line • 6 weeks Internet treatment and phone contact
The Internet program included psycho-‐educaGonal texts, wriGng exercises, movies and audio files.
• Session at the clinic
TAU intervenGon
• Standard follow-‐up procedures, dietary advice provided by the bariatric surgery team.
6 month follow-‐up Mixed Model Repeated Measures (MMRM)
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MediaGon
• Do post-‐treatment changes in psychological flexibility mediate outcomes (eaGng disorder aftudes and behaviors, body dissaGsfacGon, and quality of life) at six month follow up?
MediaGon analysis
Bootstrapped cross product test, entering baseline levels of the AAQ-‐W, BMI, specific outcome as covariates
AAQ-‐W mediated Quality of life (point esGmate = 3.32, SE = 2.32, 95% CI: 0.05, 10.61)
Body dissaGsfacGon (point esG-‐ mate = -‐8.16, SE = 4.00, 95% CI: -‐22.75, -‐2.67),
Disordered eaGng (point esGmate = -‐0.35, SE = 0.22, 95% CI: -‐0.84, -‐0.003).
RelaGonship between treatment to outcome a`er accounGng/controlling for the mediator
• Quality of life non-‐significant, t (29) = 0.97, p = 0.34
• Body dissaGsfacGon non-‐significant, t (29) = -‐0.75, p = 0.46,
• Disordered eaGng non-‐significant, t (29) = -‐0.78, p = 0.45
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Conclusions
ACT is promising and should be evaluated further for obesity (to evaluate the effects on long term weight loss) and a`er bariatric surgery.
Thank you! [email protected]