Acceptance based behavioral intervention for weight loss: A randomized trial

描述(申请人提供)：肥胖是一个主要的健康问题，影响超过三分之一的美国成年人。行为体重控制计划是治疗轻度和中度肥胖症的首选方案，但不同患者的体重减轻程度存在显著差异，最大限度的体重减轻通常在6个月前实现，随后体重恢复。这两个问题都可能通过针对肥胖患者亚组的更专门的方法来改善，这些患者报告有因情绪和/或认知压力而暴饮暴食的倾向，这种压力被称为内部去抑制。最近的研究表明，大约50%参加行为减肥计划的人报告了内部去抑制问题，这些人的体重减轻明显少于标准行为减肥计划的其他参与者，特别是在18个月时。我们假设，这些人在注重基于接受的策略的行为减肥计划中可能取得更好的减肥结果，而不是在标准减肥计划中。基于接受的方法教会患者体验他们的想法和感觉，而不是试图控制他们，并在经历这些负面想法和感受的情况下继续追求他们的行为目标，而标准的行为程序教会患者通过认知重组和分心等技术来控制他们的负面想法。以接受为基础的方法对各种心理和健康状况产生了积极的结果。在我们进行的一项试点研究中，我们对肥胖患者进行了基于接受的行为干预，获得了令人印象深刻的结果，这些患者报告了处理负面内在暗示的问题。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)和结合标准行为减肥和基于接受的行为干预(ABBI)的创新方法。我们将招募160名超重/肥胖患者，他们报告说内部去抑制作用很强，因此很可能从这种情绪调节的新方法中受益最大。这些参与者将被随机分配到SBT或ABBI的18个月，并在基线、6个月、12个月和18个月时进行全面评估。主要的假设是，ABBI计划的参与者在6个月、12个月和18个月时的体重减轻效果比SBT更好。第二个假设是，ABBI计划的参与者将报告更多地接受负面想法和情绪，以及更强的对痛苦的耐受性，并且将比SBT参与者有更好的治疗依从性，并且在接受负面想法和情绪方面的差异将调节两组之间的体重减轻差异。这个项目使用一种创新的方法来治疗那些报告内部去抑制问题的肥胖者。开发一种改善减肥效果的方法将为肥胖症领域提供巨大的好处。 与公共健康相关：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。在寻求体重控制帮助的肥胖患者中，大约有一半的人报告了处理负面想法和情绪的问题，这些人在标准治疗方法中似乎表现不佳。通过采用一种新的治疗方法的策略，即教育患者接受这些负面想法，而不是试图改变它们，我们或许能够改善这些肥胖患者实现的体重减轻。

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.