Weight loss intervention for individuals with high internal disinhibition: design of the Acceptance Based Behavioral Intervention (ABBI) randomized controlled trial

Jason Lillis, Heather M Niemeier, Kathryn M Ross, J Graham Thomas, Tricia Leahey, Jessica Unick, Kathleen E Kendra, Rena R Wing, Jason Lillis, Heather M Niemeier, Kathryn M Ross, J Graham Thomas, Tricia Leahey, Jessica Unick, Kathleen E Kendra, Rena R Wing

Abstract

Background: Obesity is public health problem associated with significant health risks and healthcare costs. Behavioral weight control programs produce clinically meaningful weight losses, however outcomes have high variability and maintenance continues to be a problem. The current study is an NIH-funded randomized clinical trial testing a novel approach, Acceptance-Based Behavioral Intervention (ABBI), that combines techniques from standard behavioral treatment (SBT) and Acceptance and Commitment Therapy (ACT). We test this approach among individuals reporting high internal disinhibition who typically respond poorly to standard interventions and appear to benefit from ACT components.

Methods/design: The ABBI study targets recruitment of 160 overweight or obese adults (BMI of 25-50) who report that they overeat in response to negative emotional states. These individuals are randomly assigned to either (1) ABBI or (2) SBT. Both interventions involve weekly meetings for 22 sessions, bi-weekly for 6 sessions, and then monthly for 3 sessions and both receive the same calorie intake target (1200-1800, depending on starting weight), exercise goal (work up to 250 min per week), and self-monitoring skills training. SBT incorporates current best practice interventions for addressing problematic thoughts and emotions, sometimes called "change" or "control" strategies. ABBI uses acceptance-based techniques based on ACT. Full assessments occur at baseline, 6, 12, and 18 months. Weight loss from baseline to 18 months is the primary outcome.

Discussion: The ABBI study is unique in its focus on integrating acceptance-based techniques into a SBT intervention and targeting a group of individuals with problems with emotional overeating who might experience particular benefit from this novel approach.

Trial registration: ClinicalTrials.gov, NCT01461421 (registered October 25, 2011).

Keywords: Acceptance; Acceptance and commitment therapy; Disinhibition; Emotional eating; Mindfulness; Obesity; Weight loss.

Figures

Fig. 1
Fig. 1
Study design

References

    1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–814. doi: 10.1001/jama.2014.732.
    1. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Aff. 2009;28(5):W822–W831. doi: 10.1377/hlthaff.28.5.w822.
    1. Finkelstein EA, Fiebelkorn IC, Corso PS, Binder SC. Medical expenditures attributable to injuries - United States, 2000 (Reprinted from MMWR, vol 53, pg 1–4, 2004) JAMA. 2004;291(7):817–818. doi: 10.1001/jama.291.7.817.
    1. MacLean PS, Wing RR, Davidson T, Epstein L, Goodpaster B, Hall KD, et al. NIH working group report: innovative research to improve maintenance of weight loss. Obesity. 2015;23(1):7–15. doi: 10.1002/oby.20967.
    1. Loveman E, Frampton GK, Shepherd J, Picot J, Cooper K, Bryant J, et al. The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review. Health Technol Assess. 2011;15(2):1.
    1. Wing RR. Behavioral approaches to the treatment of obesity. In: Bray G, Bouchard C, editors. Handbook of obesity: Clinical applications. 2. New York: Marcel Dekker, Inc.; 2004.
    1. Wadden TA, Stunkard AJ, Liebschutz J. Three year follow-up of the treatment of obesity by very-low-calorie diet, behavior therapy, and their combination. J Consult Clin Psychol. 1988;56(6):925–928. doi: 10.1037/0022-006X.56.6.925.
    1. Jakicic J, Wing R, Winters C. Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women. JAMA. 1999;282(16):1554–1560. doi: 10.1001/jama.282.16.1554.
    1. Murphy JK, Williamson DA, Buxton AE, Moody SC, Absher N, Warner M. The long-term effects of spouse involvement upon weight loss and maintenance. Behav Ther Behavior Therapy. 1982;13:681–693. doi: 10.1016/S0005-7894(82)80024-5.
    1. Diabetes Prevention Program Research Group The diabetes prevention program: description of the lifestyle intervention. Diabetes Care. 2002;25:2165–2171. doi: 10.2337/diacare.25.12.2165.
    1. Forman EM, Hoffman KL, McGrath KB, Herbert JD, Brandsma LL, Lowe MR. A comparison of acceptance- and control-based strategies for coping with food cravings: an analog study. Behav Res Ther. 2007;45(10):2372–2386. doi: 10.1016/j.brat.2007.04.004.
    1. Hoffman KL, Forman EM, Herbert JD, Butryn ML, Juarascio AS, Ryan NM, et al. Comparison of acceptance-based and standard cognitive-based coping strategies for craving sweets in overweight and obese women. In: Herbert J, et al., editors. Cognitive reappraisal vs. experiential acceptance. New York: 43rd Annual Convention of the Association for Behavioral and Cognitive Therapies; 2009.
    1. Forman EM, Hoffman KL, McGrath KB, Herbert JD, Brandsma LL, Lowe MR. A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study. Behav Res Ther. 2007;45(10):2372–2386. doi: 10.1016/j.brat.2007.04.004.
    1. Hayes SC, Strosahl K, Wilson KG. Acceptance and commitment therapy: An experiential approach to behavior change. New York: The Guilford Press; 1999.
    1. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25. doi: 10.1016/j.brat.2005.06.006.
    1. Ost LG. Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis. Behav Res Ther. 2008;46(3):296–321. doi: 10.1016/j.brat.2007.12.005.
    1. Telch CF, Agras WS, Linehan MM. Dialectical behavior therapy for binge eating disorder. J Consult Clin Psychol. 2001;69:1061–1065. doi: 10.1037/0022-006X.69.6.1061.
    1. Brown RA, Evans DM, Miller IW, Burgess ES, Mueller TI. Cognitive-behavioral treatment for depression in alcoholism. J Consult Clin Psychol. 1997;65(5):715–726. doi: 10.1037/0022-006X.65.5.715.
    1. Brown RA, Lejuez CW, Kahler CW, Strong DR. Distress tolerance and duration of past smoking cessation attempts. J Abnorm Psychol. 2002;111(1):180–185. doi: 10.1037/0021-843X.111.1.180.
    1. Lillis J, Hayes SC, Bunting K, Masuda A. Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model. Ann Behav Med. 2009;37:58–69. doi: 10.1007/s12160-009-9083-x.
    1. Gifford EV, Lillis J. Avoidance and inflexibility as a common clinical pathway in obesity and smoking treatment. J Health Psychol. 2009;14(7):992–996. doi: 10.1177/1359105309342304.
    1. Forman EM, Butryn ML, Hoffman KL, Herbert JD. An open trial of an acceptance-based behavioral intervention for weight loss. Cogn Behav Pract . 2009;16:223–235. doi: 10.1016/j.cbpra.2008.09.005.
    1. Forman EM, Butryn ML, Juarascio AS, Bradley LE, Lowe MR, Herbert JD, et al. The mind your health project: a randomized controlled trial of an innovative behavioral treatment for obesity (vol 21, pg 1119, 2013) Obesity. 2014;22(3):971. doi: 10.1002/oby.20656.
    1. Stunkard AJ, Messick S. The 3-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985;29(1):71–83. doi: 10.1016/0022-3999(85)90010-8.
    1. Niemeier HM, Phelan S, Fava JL, Wing RR. Internal disinhibition predicts weight regain following weight loss and weight loss maintenance. Obesity. 2007;15:2485–2494. doi: 10.1038/oby.2007.295.
    1. Butryn ML, Thomas JG, Lowe MR. Reductions in internal disinhibition during weight loss predict better weight loss maintenance. Obesity. 2009;17(5):1101–1103. doi: 10.1038/oby.2008.646.
    1. Niemeier HM, Leahey T, Reed KP, Brown RA, Wing RR. An acceptance-based behavioral intervention for weight loss: a pilot study. Behav Ther. 2012;43(2):427–435. doi: 10.1016/j.beth.2011.10.005.
    1. Thomas S, Reading J, Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q) Can J Sport Sci. 1992;17:338–345.
    1. Pronk NP, Wing RR. Physical activity and long-term maintenance of weight loss. Obes Res. 1994;2(6):587–599. doi: 10.1002/j.1550-8528.1994.tb00110.x.
    1. Jakicic JM, Marcus BH, Lang W, Janney C. Effect of exercise on 24-month weight loss maintenance in overweight women. Arch Intern Med. 2008;168(14):1550–1559. doi: 10.1001/archinte.168.14.1550.
    1. Block G, Woods M, Potosky A, Clifford C. Validation of a self-administered diet history questionnaire using multiple diet records. J Clin Epidemiol. 1990;43:1327–1335. doi: 10.1016/0895-4356(90)90099-B.
    1. Jeffery RW, Wing RR, Thornson C, Burton LR, Raether C, Harvey J, et al. Strengthening behavioral interventions for weight loss: A randomized trial of food provision and monetary incentives. J Consult Clin Psychol. 1993;61(6):1038–1045. doi: 10.1037/0022-006X.61.6.1038.
    1. McGuire MT, Wing RR, Klem ML, Hill JO. Behavioral strategies of individuals who have maintained long-term weight losses. Obes Res. 1999;7(4):334–341. doi: 10.1002/j.1550-8528.1999.tb00416.x.
    1. Wing RR, Phelan S. Behavioral treatment of obesity: Strategies to improve outcome and predictors of success. In: Eckel RH, editor. Obesity: An academic basis for clinical evaluation and treatment. Lippincott: Williams & Wilkens; 2002. pp. 415–435.
    1. Wing RR, Papandonatos G, Fava JL, Gorin AA, Phelan S, McCaffery J, et al. Maintaining large weight losses: the role of behavioral and psychological factors. J Consult Clin Psychol. 2008;76(6):1015–1021. doi: 10.1037/a0014159.
    1. Pinto AM, Fava JL, Raynor HA, LaRose JG, Wing RR. Development and validation of the weight control strategies scale. Obesity. 2013;21(12):2429–2436. doi: 10.1002/oby.20368.
    1. DeWalt D, Rothrock N, Yount S, Stone AA. Evaluation of item candidates: The PROMIS qualitative item review. Med Care. 2007;45:S12–S21. doi: 10.1097/01.mlr.0000254567.79743.e2.
    1. Lundgren T, Luoma JB, Dahl J, Strosahl K, Melin L. The bull's-eye values survey: a psychometric evaluation. Cogn Behav Pract. 2012;19(4):518–526. doi: 10.1016/j.cbpra.2012.01.004.
    1. Lillis J, Hayes SC. Measuring avoidance and inflexibility in weight related problems. Intl J Behav Consultation Ther. 2008;4:30–40. doi: 10.1037/h0100829.
    1. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the acceptance and action questionnaire-ii: a revised measure of psychological inflexibility and experiential avoidance. Behav Ther. 2011;42(4):676–688. doi: 10.1016/j.beth.2011.03.007.
    1. Gifford EV, Kohlenberg BS, Hayes SC, Antonuccio DO, Piasecki MM, Rasmussen-Hall ML, et al. Acceptance-based treatment for smoking cessation. Behav Ther. 2004;35:689–705. doi: 10.1016/S0005-7894(04)80015-7.
    1. Brown RA, Lejuez CW, Strong DR, Kahler CW, Zvolensky MJ, Carpenter LL, et al. A prospective examination of distress tolerance and early smoking lapse in adult self-quitters. Nicotine Tob Res. 2009;11(5):493–502. doi: 10.1093/ntr/ntp041.
    1. Hajek P, Belcher M, Stapleton J. Breath-holding endurance as a predictor of success in smoking cessation. Addict Behav. 1987;12(3):285–288. doi: 10.1016/0306-4603(87)90041-4.
    1. Look AHEAD Research Group The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring) 2006;14(5):737–752. doi: 10.1038/oby.2006.84.
    1. Baker RC, Kirschenbaum DS. Self-monitoring may be necessary for successful weight control. Behav Ther. 1993;24(3):377–394. doi: 10.1016/S0005-7894(05)80212-6.
    1. Boutelle KN, Kirschenbaum DS. Further support for consistent self-monitoring as a vital component of successful weight control. Obes Res. 1998;6(3):219–224. doi: 10.1002/j.1550-8528.1998.tb00340.x.
    1. Perri MG, McKelvey WF, Renjilian DA, Nezu AM, Shermer RL, Viegener BJ. Relapse prevention training and problem-solving therapy in the long-term management of obesity. J Consult Clin Psychol. 2001;69(4):722–726. doi: 10.1037/0022-006X.69.4.722.
    1. Wing R, Jeffery R. Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance. J Consult Clin Psychol. 1999;67(1):132–138. doi: 10.1037/0022-006X.67.1.132.
    1. Bandura A, Simon KM. The role of proximal intentions in self-regulation of refractory behavior. Cogn Ther Res. 1977;1:177–193. doi: 10.1007/BF01186792.
    1. Marlatt GA, Gordon JR. Relapse prevention: Maintenance strategies in addictive behavior change. New York: Guilford; 1985.
    1. Hayes SC, Acceptance LJ, Therapy C. Theories of psychotherapy. Washington, DC: American Psychological Association; 2012.
    1. Lillis J, Dahl J, Weineland SM. The diet trap: Feed your psychological needs & end the weight loss struggle using acceptance and commitment therapy. Oakland, CA: New Harbinger Publications; 2014.
    1. Jeffery RW, Drewnowski A, Epstein LH, Stunkard AJ, Wilson GT, Wing RR, et al. Long-term maintenance of weight loss: Current status. Health Psychol. 2000;19(1):5–16. doi: 10.1037/0278-6133.19.Suppl1.5.
    1. Wadden TA, Volger S, Tsai AG, Sarwer DB, Berkowitz RI, Diewald LK, et al. Managing obesity in primary care practice: an overview with perspective from the POWER-UP study. Int J Obes. 2013;37:S3–S11. doi: 10.1038/ijo.2013.90.
    1. Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley and Sons; 1987.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel