An acceptance-based behavioral intervention for weight loss: a pilot study

On average, participants in behavioral weight-loss interventions lose 8 kilograms (kg) at 6 months, but there is marked variability in outcomes with some participants losing little or no weight. Individuals with difficulties with internal disinhibition (i.e., eating in response to emotions or thoughts) typically lose less weight in such programs and may require an innovative, specialized approach. This pilot study examined the preliminary acceptability and efficacy of a 24-week acceptance-based behavioral intervention for weight loss among overweight and obese adults reporting difficulty with eating in response to emotions and thoughts. Participants were 21 overweight or obese men and women (mean age=52.2±7.6 years; baseline mean body mass index=32.8±3.4). Eighty-six percent completed the 6-month program and a 3-month follow-up assessment. Ratings of program satisfaction averaged 4.9 on a five-point scale. Multilevel modeling analyses indicated participants lost an average of 12.0 kg (SE=1.4) after 6 months of treatment and 12.1 kg (SE=1.9) at 3-month follow-up, thus exceeding the weight losses typically seen in behavioral treatment programs. Decreases in internal disinhibition and weight-related experiential avoidance were found at 6- and 3-months follow-up. Greater decreases in weight-related experiential avoidance were associated with greater weight loss at the end of the program (r=.64, p=.002), suggesting a potential mechanism of action. Although there have been a few preliminary studies using acceptance-based approaches for obesity, this is the first study to specifically target emotional overeaters, a subgroup that might be particularly responsive to this new approach. Our findings provide initial support for the feasibility, efficacy, and acceptability of this approach for this subgroup of participants. Further study with longer follow-up, a more diverse sample, and comparison to a standard behavioral program is clearly warranted.     

Correspondence programs for smoking cessation and weight control: a comparison of two strategies in the Minnesota Heart Health Program

Mailed invitations to participate in weight loss and/or smoking cessation correspondence programs to 31,400 households in a suburban community. Two programs were offered to randomized subsets of households, a 6-month correspondence program costing +5 and the same program for free but requiring a +60 deposit to be refunded based on success in weight loss or smoking cessation. Overall, sign-up included 1,304 people for weight loss and 142 for smoking cessation. The +5 program was about 5 times as popular as the incentive program. Validated weight change after 6 months averaged about 4 lb for the +5 program and 8 lb for the incentive program. Corresponding rates of smoking cessation were about 9% and 20%, respectively. We conclude that correspondence programs for the promotion of weight control and smoking cessation are potentially cost-effective methods for reaching individuals in the community at large, many of whom would not be interested in clinic-based programs. Issues meriting further research include recruitment, especially of smokers, and evaluation of the relative trade-offs in recruitment success versus efficacy of differing treatment approaches.     

A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventions that work

This meta-analytic review summarizes obesity prevention programs and their effects and investigates participant, intervention, delivery, and design features associated with larger effects. A literature search identified 64 prevention programs seeking to produce weight gain prevention effects, of which 21% produced significant prevention effects that were typically pre- to post effects. Larger effects emerged for programs that targeted children and adolescents (vs. preadolescents) and females, programs that were relatively brief, programs that solely targeted weight control versus other health behaviors (e.g., smoking), programs evaluated in pilot trials, and programs wherein participants must have self-selected into the intervention. Other factors, including mandated improvements in diet and exercise, sedentary behavior reduction, delivery by trained interventionists, and parental involvement, were not associated with significantly larger effects.     

Primary Prevention Mental Health Programs for Children and Adolescents: A Meta-Analytic Review

Used meta-analysis to review 177 primary prevention programs designed to prevent behavioral and social problems in children and adolescents. Findings provide empirical support for further research and practice in primary prevention. Most categories of programs produced outcomes similar to or higher in magnitude than those obtained by many other established preventive and treatment interventions in the social sciences and medicine. Programs modifying the school environment, individually focused mental health promotion efforts, and attempts to help children negotiate stressful transitions yield significant mean effects ranging from 0.24 to 0.93. In practical terms, the average participant in a primary prevention program surpasses the performance of between 59% to 82% of those in a control group, and outcomes reflect an 8% to 46% difference in success rates favoring prevention groups. Most categories of programs had the dual benefit of significantly reducing problems and significantly increasing competencies. Priorities for future research include clearer specification of intervention procedures and program goals, assessment of program implementation, more follow-up studies, and determining how characteristics of the intervention and participants relate to different outcomes.     

An Open Trial Examining Dialectical Behavior Therapy Skills and Behavioral Weight Loss for Adults With Emotional Eating and Overweight/Obesity

Third-wave cognitive behavioral interventions for weight loss have shown promise. However, sparse data exists on the use of dialectical behavior therapy for weight loss. Adapted dialectical behavior therapy skills programs may be especially well suited for adults who engage in emotional eating and are seeking weight loss. Dialectical behavior therapy is skills-based, shares theoretical links to emotional eating, and is effective in treating binge eating. The current study examined the feasibility, acceptability, and preliminary efficacy of Live FREE: FReedom from Emotional Eating, a 16-session group-based intervention. A total of 87 individuals expressed interest in the program, and 39 adults with overweight/obesity (BMI ≥25) and elevated self-reported emotional eating were enrolled. Live FREE targeted emotional eating in the initial sessions 1–9, and sessions 10–16 focused primarily on behavioral weight loss skills while continuing to reinforce emotion regulation training. Assessments were administered at baseline, posttreatment, and 6-month follow up. Enrolled participants were primarily female (97.4%) and Caucasian (91.7%). Treatment retention was strong with participants attending an average of 14.3 sessions and 89.7% of participants completing the intervention. On average, participants lost 3.00 kg at posttreatment, which was maintained at follow-up. Intent-to-treat analyses showed improvements in key outcome variables (self-reported emotional eating, BMI, emotion regulation) over the course of the intervention. Combining dialectical behavior therapy skills with conventional behavioral weight loss techniques may be an effective intervention for adults with overweight/obesity who report elevated emotional eating.     

Effects of a short-term exercise program on caloric consumption

The present study investigated the effects of a short-term exercise program on caloric intake. Thirty-three women were randomly assigned to either a high-intensity exercise group (80% maximum heart rate), low-intensity exercise group (55% maximum heart rate), or waiting list control group. Exercisers were required to ride ergometer bicycles three times per week for 7 weeks, expending 200 kilocalories of energy per exercise session. All participants recorded food intake during specified weeks before, during, and following the exercise program. Results showed no significant caloric intake differences among the three groups, but a trend toward reduction in food intake with increased exercise intensity was found. Interestingly, comparisons between caloric intake on exercise and nonexercise days revealed that both exercise groups consumed significantly less on exercise days. Additionally, the control group evidenced a larger caloric intake level than did the two exercise groups on exercise days. These results suggest that exercisers do not compensate for energy expenditure by increasing caloric intake and that choosing between low- and high-intensity exercise does not differentially alter caloric intake. Nevertheless, maximization of negative energy balance or weight loss may be best achieved by exercise programs of high frequency and intensity.     

Consumer Preference Programs for Individuals Who Are Homeless and Have Psychiatric Disabilities: A Drop-In Center and a Supported Housing Program

We illustrate Fairweather's approach to Experimental Social Innovation and Dissemination with two experimental studies of programs to reduce homelessness for 168 and 225 people with mental illness and often substance abuse. Literally homeless participants were randomly assigned to programs that emphasized consumer choice or to the usual continuum of care, in which housing and services are contingent on sobriety and progress in treatment. A drop-in center that eliminated barriers to access to services was more successful than control programs in reducing homelessness, but after 24 months only 38% of participants had moved to community housing. A subsequent apartment program, in which individuals in the experimental condition moved to subsidized apartments directly from the street, with services under their control, had 79% in stable housing (compared to 27% in the control group) at the end of 6 months. Groups in this study did not differ on substance abuse or psychosocial outcomes.     

Memory improvement tapes: How effective for elderly adults?

Abstract

The effectiveness of two commercially available audiocassette memory improvement programs was evaluated in a sample of 32 healthy, community-living elderly adults. Participants were given a set of either Syber Vision's Neuropsychology of Memory Power tapes (Bornstein, 1989) or Nightingale-Conant's Mega Memory tapes (Trudeau, 1992), and a portable cassette player, and instructed to complete the programs within 10 weeks. All participants received a comprehensive battery of memory tests prior to and immediately following the memory improvement programs. Participants completing the memory improvement programs showed no greater gains in memory test performance than no-treatment control participants, but did report greater confidence in their memory abilities. Participants completing the Mega Memory program thought they were less likely to develop Alzheimer's disease after having completed it compared with participants in the other two conditions. Participants reported finding both tape programs acceptable and potentially useful for improving memory; those who completed the Memory Power program reported somewhat greater satisfaction than those completing the Mega Memory program. the claims about rapid, dramatic memory improvement with use of these products were not substantiated in this group of elderly adults and appear to be grossly exaggerated.     

Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach.

OBJECTIVE: This investigation was designed to improve behavioral weight loss program (BWLP) treatment outcomes by providing stepped care (SC) to individuals experiencing difficulties with weight loss during treatment. SC entails transition to more intensive treatments when less intensive treatments fail to meet treatment goals. In a BWLP, motivational interviewing (MI) may increase participants' motivation toward behavioral change and thus complement the acquisition of behavioral change skills. It was hypothesized that BWLP+SC (MI) participants (i.e., participants who failed to meet weight loss goals and received MI) would demonstrate superior treatment outcomes when compared with BWLP (SC matched) participants (i.e., participants who failed to meet weight loss goals but did not receive MI). DESIGN: Fifty-five obese, sedentary adults were randomly assigned to a BWLP+SC or a BWLP. MAIN OUTCOME MEASURES: Changes in weight, cardiorespiratory fitness, self-reported physical activity, and diet (i.e., calories, percentage daily intake of fat, protein, and carbohydrates) in response to treatment were assessed. RESULTS: Participants significantly decreased their weight, increased physical activity/fitness, and improved dietary intake (ps<.05). BWLP+SC (MI) participants lost more weight and engaged in greater weekly exercise than BWLP (SC matched) participants who did not receive MI (ps<.05). CONCLUSION: For individuals experiencing weight loss difficulties during a BWLP, MI may have considerable promise.     

Self-help and long-term behavior therapy for obesity

The Trevose Behavior Modification Program, a self-help group offering continuing care for obesity, has recently been shown to produce large long-term weight losses. The present study aimed to replicate this finding across different settings and participants, assessing the weight losses and attrition rates of 128 participants in three Trevose program satellite groups that used the same treatment procedures and manual as the central Trevose group. The satellite groups' results closely paralleled those of the Central Group. Mean intent-to-treat weight loss, or final losses recorded for all participants regardless of their treatment termination date, was 13.7 +/- 0.7% of initial body weight (1.8 +/- 0.7 kg). At two years, 43.8% of participants remained in treatment, having lost a mean of 19.0 +/- 0.8% of their body weight (16.2 +/- 1.0 kg); at five years, 23.4% remained, having lost 18.4 +/- 1.1% of body weight (15.6 +/- 1.5 kg). These results demonstrate that the Trevose model of weight control, combining self-help and continuing care, can be extended and disseminated to other settings, with potentially significant public health consequences.     

Evidence That a Very Brief Psychological Intervention Boosts Weight Loss in a Weight Loss Program

Reducing morbidity and mortality associated with being overweight is a crucial public health goal. The aim of the present research was to test the efficacy of a very brief psychological intervention (a volitional help sheet) that could be used as an adjunct to standard weight loss programs to support increased weight loss in an overweight sample. Seventy-two overweight participants currently participating in a weight loss program were randomly allocated to either an intervention (volitional help sheet) condition or a control (distracter task) condition. The main outcome measure was weight at 1-month follow-up. Participants in both conditions lost significant amounts of weight, but those in the intervention condition lost significantly more than those in the control condition (d = 0.66). The findings support the efficacy of the volitional help sheet to promote additional weight loss in an overweight sample engaged in a weight loss program. The volitional help sheet therefore represents a very brief, low-cost intervention that could be used to supplement ongoing weight-loss programs.     

Blaming the victim: When disease-prevention programs misfire

This study sought to determine whether or not a disease prevention program might have anegative impact on attitudes towards disease victims. Knowledge of, and attitudes towards AIDS and several other serious diseases were assessed before and after college students viewed a filmed educational program on AIDS. Results showed that, compared to a control group, participants who had seen the AIDS film reported significantlygreater fear and dislike of a hypothetical AIDS patient. The film also significantly enhanced participants’ perceptions that AIDS is a preventable disease. Results are discussed in terms of the possibility that health-education programs emphasizing preventability may inadvertently increase peoples’ tendency to blame the victim. Portions of this paper were presented at the Annual Meeting of the American Psychological Society, Dallas, Texas, June 1990.     

Does internet-based prevention reduce the risk of relapse for anorexia nervosa?

Technological advancements allow new approaches to psychotherapy via electronic media. The eating disorder literature currently contains no studies on internet intervention in anorexia nervosa (AN). This study presents a RCT on an internet-based relapse prevention program (RP) over nine months after inpatient treatment for AN. The sample comprised 258 women, randomized to the RP or treatment as usual (TAU). Expert- and self-ratings were evaluated by intent-to-treat analyses. Concerning age, age at onset and comorbidity, both groups were comparable at randomization. During the RP, the intervention group gained weight while the TAU group had minimal weight loss. RP completers gained significantly more body weight than patients in the TAU condition. Group-by-time comparisons for eating-related cognitions and behaviors and general psychopathology showed a significantly more favorable course in the RP program for "sexual anxieties" and "bulimic symptoms" (interview), and "maturity fears" and "social insecurity" (EDI-2). General psychopathology showed no significant group-by-time interaction. Important factors for successful relapse prevention were adherence to the intervention protocol and increased spontaneity. Considering the unfavorable course and chronicity of anorexia nervosa (AN), internet-based relapse prevention in AN following inpatient treatment appears a promising approach. Future internet-based programs may be further improved and enhanced.     

Benchmarking the “Question,Persuade, Refer” Program Against Evaluations of Established Suicide Prevention Gatekeeper Trainings

Gatekeeper training is a common approach for aiding suicidal youth. This study utilizes comparative effectiveness “benchmarks” from established programs to evaluate the Question, Persuade, Refer (QPR) program. The QPR program was implemented with adults (N = 2,389) working in youth‐serving community agencies. Questionnaires assessed suicide prevention knowledge, attitudes, subjective norms, perceived behavioral control, and behaviors. Consistent with benchmarked studies, participants in QPR demonstrated knowledge and suicide prevention behavior gains compared with control groups. Future research should utilize benchmarking methods as a measure of effectiveness, and more thoroughly assess mechanisms that promote behavior change.     

Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial

Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxiety disorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxiety disorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxiety disorder (GAD), panic disorder, and/or social phobia were randomly assigned to a treatment group, or to a waitlist control group. Treatment consisted of CBT based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses. Seventy-five percent of treatment group participants completed all 6 lessons within the 8 week program. Post-treatment data was collected from 38/40 treatment group and 38/38 control group participants, and 3-month follow-up data was collected from 32/40 treatment group participants. Relative to controls, treatment group participants reported significantly reduced symptoms of anxiety as measured by the Generalized Anxiety Disorder - 7 Item, Social Phobia Screening Questionnaire, and the Panic Disorder Severity Rating Scale - Self Report Scale, but not on the Penn State Worry Questionnaire, with corresponding between-groups effect sizes (Cohen’s d) at post-treatment of 0.78, 0.43, 0.43, and 0.20, respectively. The clinician spent a total mean time of 46 min per person over the program, participants rated the procedure as moderately acceptable, and gains were sustained at follow-up. Modifications to the Anxiety program, based on post-treatment feedback from treatment group participants, were associated with improved outcomes in the control group. These results indicate that transdiagnostic programs for anxiety disorders may be successfully administered via the Internet.     

Reduced substance use as a secondary benefit of an indicated cognitive-behavioral adolescent depression prevention program

Our first aim was to test whether a group cognitive-behavioral (CB) depression prevention program reduces substance use escalation over 2-year follow-up relative to two active comparison interventions and a brochure assessment control. Our second aim examined whether reductions in depressive symptoms mediate intervention effects, as posited by the affect-regulation model of substance use. In this indicated prevention trial, 341 high school adolescents at risk for depression because of the presence of elevated depressive symptoms were randomized to a Group CB intervention, group supportive-expressive group intervention, CB bibliotherapy, or educational brochure control condition. Participants in Group CB had significantly lower rates of substance use compared with brochure control participants at both 1- and 2-year follow-up and lower substance use at 2-year follow-up relative to bibliotherapy participants; no other condition differences were significant. Mediational analyses suggested that reductions in depressive symptoms from baseline to posttest accounted for changes in substance use over 2 years for participants in Group CB relative to brochure control participants but did not mediate effects relative to those receiving bibliotherapy. Results suggest that a secondary benefit of this CB group indicated depression prevention program is lower rates of long-term substance use. Findings supported the hypothesis that, relative to a nonactive comparison condition, reductions in depressive symptoms mediated the effects of Group CB prevention on substance use escalation. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

A group behavior modification approach to adolescent obesity

This article describes a group weight control project with severely obese adolescent girls in a medical setting. Behavior modification and nutritional principles were utilized with peer group interaction. Significant others were included through separate group meetings. This approach produced small amounts of net weight loss for the girls. The drop-outs continued to have a net gain. As a treatment method, this program was more effective for these girls than previous individual clinic contacts had been. When losing weight, the girls tended to use behavior modification techniques more often, and their diets became more adequate nutritionally. Development of group cohesion was tenuous and temporary. Girls who were functioning more independently appeared to do better in weight loss. Disinterested significant others were preferable to nonsupportive ones. A predictive factor was identified, the girls' perception of control. This was measured by the I-E test. Those with a more internalized perception of control were more likely to continue with the program and more likely to lose weight. Because the patient group was small, findings are tentative. However, this program helped to define particular areas that deserve further exploration.     

Buffering against weight gain following dieting setbacks: An implicit theory intervention

Research on implicit theories suggests that incremental beliefs—that attributes are malleable—can help buffer people against the adverse effects of setbacks on goal achievement. We conducted a longitudinal experiment to examine whether an incremental beliefs intervention could help dieters manage their body weight in the face of severe dieting setbacks. To explore the efficacy of our incremental beliefs intervention, we randomly assigned individuals to a control, a knowledge, or an incremental beliefs condition. In addition to examining the main effect of intervention condition on weight-loss across a 12-week period, we also tested the hypothesis that although participants assigned to the control or knowledge intervention condition would gain more weight as dieting setbacks became more severe, participants assigned to the incremental beliefs condition would not. Results supported this hypothesis: Incremental beliefs protected against setback-related weight-gain. Implications for integrating implicit beliefs interventions with obesity relapse prevention programs are discussed.     

What Works Best for Reducing Symptoms and Improving Quality of Life? A 6-Months Follow-up Study on the Effectiveness of Group Cognitive Behaviour Therapy and Group Information and Support for Adults Suffering from Depression

A non-randomized effectiveness trial was conducted in an urban secondary care public mental health service in Ireland. The effectiveness of an 8 session group cognitive behavior therapy program (gCBT-8), where the focus was on behavioral activation and cognitive restructuring, was compared with that of an enhanced 12 session group cognitive behavior therapy program (gCBT-12), which contained additional sessions on schema work, and a 12 session information and support control group program (gIS-12) in which there was no CBT skills training. One hundred and eighty-one adults with unipolar mood disorders were allocated to gCBT-8 (N?=?67), gCBT-12 (N?=?62), or gIS-12 (N?=?52). Before and after treatment, and at 6 months follow-up participants completed the Beck Depression Inventory II (BDI-II), the Beck Anxiety Inventory, the Clinical Outcome and Routine Evaluation, the Dysfunctional Attitudes Scale, and the brief World Health Organization Quality of Life Scale. An intention-to-treat analysis of mean scores showed that the three programs had similar outcomes. There were significant improvements on all dependent variables with post-treatment gains maintained at follow-up. The three programs also led to similar remission and combined reliable improvement and remission rates on the BDI-II. It was concluded that all three programs had similar levels of effectiveness.