Mindfulness and acceptance-based interventions for obesity: Using a factorial design to identify the most effective components

项目摘要/摘要 教授认知和行为技能的行为减肥治疗(BT)是黄金标准和 肥胖症的一线治疗。结果虽然在临床上意义重大，但在许多情况下被认为是次优的。 参与者未能达到和/或维持与关键健康福利相关的5%和10%的基准。完毕 在过去的30年里，许多试验测试了标准BT技能的认知和行为创新，但因此 几乎没有一种方法能显著改善减肥效果。以正念和接受为基础 行为疗法(MABT)是一个例外，因为严格的试验已经证明 与黄金标准BT相比，这种方法的体重损失要大得多。然而，MABTS的 结果各不相同，其构成也各不相同。持续改进并取得成功的能力 推广肥胖的行为疗法有赖于该领域增加对哪种行为疗法的理解 MABT成分是最有效的。与多阶段优化策略的第一阶段保持一致 (MOST)方法，我们回顾了MABT的理论描述，并确定了MABT的三个关键组成部分： (1)正念意识，(2)正念接受，(3)重视清晰度。与第二阶段的 大多数情况下，这项研究将利用完整的2x2x2析因设计，其中288名超重/肥胖参与者 被分配到八种行为减肥治疗中的一种，即代表MABT的每个排列 被纳入或排除在治疗之外的成分。由于阶乘设计的集合能力 在考察每个主要影响的条件下，分析具有与双臂设计相同的威力。主要目标是 目前这项研究的目的是评估正念意识、正念接受和正念认知的独立功效。 评估MABT的清晰度成分对减肥的影响(在治疗后以及6、12和24个月的随访中) 超过标准的英国电信。次要目标是：(1)评估正念的独立效能 意识、认真接受和重视MABT对腰围、卡路里的透明度成分 摄入量、体力活动和生活质量；(2)确认每个治疗成分影响变量 它的目标是什么；(3)测试治疗成分的疗效受到以下因素影响的假设 对内部和外部食物暗示的敏感性。探索性的目标是量化组件的交互作用 效果，可以是协同作用、完全相加或部分相加。本研究调查了一种创新的和 尤其是很有希望的行为方法，并将是第一批利用全因素方差设计来治疗肥胖的方法之一 干预优化。此外，这将是有史以来第一次进行成分分析来识别 MABT成分的独立有效性，并首次研究了行为减肥的相互作用 各组成部分之间相互关联，并具有参与者的基线特征。结果会将该字段定位为 今后的工作，即评估一种可预期具有更好疗效和 传播性。

Project Summary/Abstract Behavioral weight loss treatment (BT), which teaches cognitive and behavioral skills, is the gold standard and first line of treatment for obesity. Outcomes, while clinically significant, are considered suboptimal in that many participants fail to reach and/or maintain the 5 and 10% benchmarks associated with key health benefits. Over the past 30 years, many trials have tested cognitive and behavioral innovations on standard BT skills, but thus far virtually none has produced significantly improved weight losses. Mindfulness and acceptance-based behavioral treatments (MABTs) for obesity is an exception in that rigorous trials have demonstrated considerably greater weight losses for this approach when directly compared to gold standard BT. Yet, MABTs’ outcomes have varied, as have their composition. The ability to continue improving and successfully disseminating behavioral treatments for obesity depends on the field increasing its understanding of which MABT components are most efficacious. Consistent with a Phase I of a Multiphasic Optimization Strategy (MOST) approach, we reviewed theoretical accounts of MABTs and identified three key MABT components: (1) Mindful Awareness, (2) Mindful Acceptance, and (3) Values Clarity. Consistent with the second phase of a MOST, this study will utilize a full 2x2x2 factorial design in which 288 overweight/obese participants are assigned to one of eight behavioral weight loss treatments, i.e., representing each permutation of MABT components being included or excluded from the treatment. Due to the ability of a factorial design to pool conditions to examine each main effect, analyses have the same power as a two-arm design. The primary aim of the current study is to evaluate the independent efficacy of mindful awareness, mindful acceptance and values clarity components of MABT on weight loss (at post-treatment and at 6, 12 and 24 months follow-up) over and above standard BT. Secondary aims are to: (1) To evaluate the independent efficacy of mindful awareness, mindful acceptance and values clarity components of MABT on waist circumference, calorie intake, physical activity and quality of life; (2) To confirm that each treatment component impacts the variable which it targets; (3) To test the hypotheses that the efficacy of the treatment components is moderated by susceptibility to internal and external food cues. The exploratory aim is to quantify the component interaction effects, which may be synergistic, fully additive, or partially additive. This study investigates an innovative and especially promising behavioral approach, and will be one of the first to utilize a full factorial design for obesity intervention optimization. Furthermore, it will be the first-ever study to conduct a component analysis to discern independent efficacies of MABT components, and the first to examine interactions of behavioral weight loss components with each other and with baseline characteristics of participants. Results will position the field for future work, i.e., the evaluation of an optimized treatment that can be expected to have superior efficacy and disseminability.