Acceptance-based behavioral treatment for obesity: Maintenance and Mechanisms.

描述(申请人提供)：肥胖症已经变得如此普遍，现在被认为是一种全国性和全球性的流行病。药理学、外科手术和环境干预的局限性表明了对行为程序的迫切需要。然而，从长远来看，标准的行为治疗效果微乎其微，大多数参与者最终都会恢复他们失去的体重。体重恢复可以追溯到参与者在遵循推荐的饮食和体力活动处方方面的困难，这似乎与一成不变的生物驱动和内部(例如，悲伤、焦虑、渴望)和外部(例如，存在美味的食物和节省劳动力的设备)暗示有关。在我们的实验室中，我们发现，通过提高对痛苦的耐受性(例如，对负面影响的容忍、对食物的渴望)、对内部状态的当下意识以及这些因素如何影响行为(即元认知意识)以及对个人价值观的清晰度的干预，可以增强抵抗这些暗示的能力。特别是，我们已经证明了基于接受的行为干预，结合了这些策略，对控制体重有希望。我们由美国国立卫生研究院资助的初步研究表明，对于那些报告抑郁水平更高、对食物的心理反应以及内部和外部暗示饮食的参与者来说，基于接受的策略在减肥方面具有特别强的效果。拟议项目的主要目标是评估ABT相对于黄金标准的较长期疗效。 肥胖症的行为治疗。第二个目标是测试两种治疗方法在积极干预和治疗后减肥维持阶段的假想作用机制。在我们最近使用基于实验室的行为测量和重复实施的生态瞬时评估(EMA)来更好地理解采用和保持健康行为选择的挑战的基础上，我们将使用这两种测量策略来最准确地捕捉瞬间进食和体力活动失误的因果路径。与回溯性自我报告相比，EMA提供了相当大的优势，后者容易受到不准确和偏见的影响。我们还旨在评估适度假设，这些假设表明，ABT的优越性对于那些情绪障碍较大、对食物环境敏感、内外不限制进食的人尤其明显。我们的目标是实现更长期的目标，即利用证据最大限度地发挥干预措施的最有效成分，将患者与治疗类型相匹配，并开发实时干预措施，旨在纠正自然界出现的有问题的饮食和体力活动决定。因此，我们将随机分配200名超重参与者参加24次ABT或SBT，为期一年。所有参与者都将接受跟踪，直到基线后36个月。EMA和基于实验室的行为评估将允许对缓和和调节途径进行更有效的测量，包括内部状态与其对行为的影响之间的关系，以及这些联系如何受到治疗的影响。

DESCRIPTION (provided by applicant): Obesity has become so prevalent it is now considered a national and global epidemic. The limitations of pharmacologic, surgical and environmental interventions point to the critical need for behavioral programs. However, standard behavioral treatments are only minimally effective in the long term, with most participants eventually gaining back their lost weight. Weight regain can be traced to participants' difficulty following recommended diet and physical activity prescriptions, which appears tied to immutable biological drives and internal (e.g., sadness, anxiety, cravings) and external (e.g., presence of delicious foods and labor- saving devices) cues. In our lab we have found that the ability to resist these cues is bolstered by interventions that increase distress tolerance (e.g., tolerance of negative effect, food cravings), present-moment awareness of internal states and how these may be affecting behavior (i.e., metacognitive awareness), and clarity about one's personal values. In particular, we have shown that acceptance-based behavioral interventions, which incorporate these strategies, have promise for weight control. Our NIH-funded pilot study demonstrated an especially strong effect of acceptance-based strategies on weight loss for participants who reported higher levels of depression, psychological responsivity to food, and internally and externally-cued eating. The primary goal of the proposed project is to evaluate the longer-term efficacy of ABT in relation to gold standard behavioral treatment for obesity. A secondary goal is to test hypothesized mechanisms of action of the two treatments, both during active intervention and during the post-treatment weight loss maintenance phase. Building on our recent work using lab-based behavioral measures and repeatedly-administered, ecological momentary assessment (EMA) to better understand the challenges of adopting and maintaining healthful behavior choices, we will use both these measurement strategies to most accurately capture causal pathways to in-the-moment eating and physical activity lapses. EMA offers considerable advantages over retrospective self-reports which are subject to inaccuracies and biases. We also aim to evaluate moderation hypotheses stating that the superiority of ABT will be especially pronounced for those with greater mood disturbance, sensitivity to the food environment, and internal and external disinhibited eating. Our aims work towards longer-range goals of using evidence to maximize the most effective components of interventions, matching patients to treatment type, and developing real-time interventions aimed at correcting problematic eating and physical activity decisions as they occur naturalistically. Accordingly, we will randomly assign 200 overweight participants to 24 sessions of ABT or SBT, delivered over one year. All participants will be followed until 36 months post-baseline. EMA and lab-based behavioral assessments will allow more valid measurement of moderating and mediating pathways including the relationship between internal states and their impact on behavior, and how these associations are affected by treatment.