Acceptance based behavioral intervention for weight loss: A randomized trial

描述（由申请人提供）：肥胖是一个主要的健康问题，影响着超过三分之一的美国成年人。行为体重控制计划是轻度和中度肥胖的治疗选择，但在体重减轻方面，患者之间存在明显的差异，通常在第6个月达到最大体重减轻，随后体重恢复。这两个问题都可以通过一种更专业的方法来改善，这种方法针对的是肥胖患者亚组，他们报告说，由于情绪和/或认知压力源，他们倾向于暴饮暴食，这被称为内部去抑制。最近的研究表明，大约50%的人进入行为减肥计划报告内部去抑制问题，这些人减掉的体重明显少于其他参与者，特别是在18个月的标准行为减肥计划。我们假设这些人可能会在行为减肥计划中获得更好的减肥结果，这种减肥计划侧重于基于接受的策略，而不是在标准的减肥计划中。基于接受的方法教导患者体验他们的想法和感受，而不是试图控制他们，并继续追求他们的行为目标，尽管经历了这些消极的想法和感受，而标准的行为项目教导患者通过认知重组和分散注意力等技术来控制他们的消极想法。基于接受的方法对各种心理和健康状况产生了积极的结果。在我们进行的一项初步研究中，我们使用基于接受的行为干预方法，对报告有处理负面内在暗示问题的肥胖患者取得了令人印象深刻的结果。我们建议进行一项随机对照试验，比较标准行为减肥治疗方案（SBT）与将标准行为减肥与基于接受的行为干预（ABBI）相结合的创新方法。我们将招募160名超重/肥胖患者，他们报告内部抑制解除程度高，因此可能从这种新的情绪调节方法中获益最多。这些参与者将被随机分配到18个月的SBT或ABBI，并在基线、6个月、12个月和18个月进行全面评估。主要假设是ABBI计划的参与者在6个月、12个月和18个月时比SBT减肥效果更好。第二种假设是，ABBI项目的参与者比SBT项目的参与者更能接受消极的想法和情绪，更能忍受痛苦，并且有更好的治疗依从性，并且对消极想法和情绪的接受程度的差异将调解两组之间体重减轻的差异。这个项目使用了一种创新的方法来治疗那些报告有内部去抑制问题的肥胖个体。开发一种改善减肥效果的方法将为肥胖领域带来巨大的好处。

DESCRIPTION (provided by applicant): Obesity is a major health problem, affecting over one-third of US adults. Behavioral weight control programs are the treatment of choice for mild and moderate obesity, but there is marked variability among patients in the weight losses achieved and the maximum weight losses are usually achieved by month 6, followed by weight regain. Both of these problems might be improved by a more specialized approach for the sub-group of obese patients who report a tendency to overeat in response to emotional and/or cognitive stressors, referred to as internal disinhibition. Recent studies show that approximately 50% of individuals entering behavioral weight loss programs report problems with internal disinhibition and that these individuals lose significantly less weight, particularly at 18 months, than other participants in standard behavioral weight loss programs. We hypothesize that these individuals might achieve better weight loss outcomes in a behavioral weight loss program that focuses on acceptance-based strategies rather than in a standard weight loss program. Acceptance based approaches teach patients to experience thoughts and feelings as they are, without attempting to control them and to continue to pursue their behavioral goals despite experiencing these negative thoughts and feelings, whereas standard behavioral programs teach patients to control their negative thoughts with techniques such as cognitive restructuring and distraction. Acceptance based approaches have yielded positive results for a variety of psychological and health conditions. In a pilot study we conducted, we obtained impressive results using an acceptance based behavioral intervention for obese patients who reported problems dealing with negative internal cues. We propose to conduct a randomized controlled trial comparing a standard behavioral weight loss treatment program (SBT) with an innovative approach that combines standard behavioral weight loss with an acceptance based behavioral intervention (ABBI). We will recruit 160 overweight/obese patients who report high internal disinhibition, and thus would be likely to benefit most from this novel approach to emotion regulation. These participants will be randomly assigned to 18 months of either SBT or ABBI with full assessments at baseline, 6, 12, and 18 months. The primary hypothesis is that participants in the ABBI program will achieve better weight losses than SBT at 6, 12, and 18 months. Secondary hypotheses are that participants in the ABBI program will report greater acceptance of negative thoughts and emotions and greater distress tolerance and will have better treatment adherence than participants in SBT, and that differences in acceptance of negative thoughts and emotions will mediate the differences in weight loss between the groups. This project uses an innovative approach to the treatment of obese individuals who report problems with internal disinhibition. Development of an approach that improves weight loss outcomes would provide a tremendous benefit to the field of obesity. PUBLIC HEALTH RELEVANCE: Obesity is a major health problem affecting over one third of US adults. Approximately half of the obese patients seeking help with weight control report problems dealing with negative thoughts and emotions and these individuals appear to do less well in standard treatment approaches. By incorporating strategies from a new treatment approach, in which patients are taught to accept these negative thoughts, rather than trying to change them, we may be able to improve the weight losses achieved by these obese patients.