6/19/2017. Welcome to the COPE Webinar Series for Health Professionals!

Transcription

1 Welcome to the COPE Webinar Series for Health Professionals! June 26, 2017 Can Acceptance and Commitment Therapy (ACT) Improve Adherence to Eating and Weight Loss Goals? Time: 12 noon 1 PM EDT Moderator: Lisa Diewald, MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention & Education Handouts of the slides are posted at: Sponsored by MacDonald Center for Obesity Prevention and Education (COPE) Goals Nursing/College Student Education Continuing Education Programming Research Can Acceptance and Commitment Therapy (ACT) Improve Adherence to Eating and Weight Loss Goals? Objectives: 1. Understand existing evidence supporting the efficacy of ACT strategies in facilitating behavioral adherence. 2. Identify the components of the ACT treatment model. 3. Practice ACT-based techniques that could be incorporated into obesity treatment. 1

2 CE Credits Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration The American College of Sports Medicine s Professional Education Committee certifies that Villanova University College of Nursing Continuing Education, Center for Obesity Prevention and Education (COPE) meets the criteria for official ACSM Approved Provider status (2015-December, 2018). Providership # CE Credits This webinar awards 1 contact hour for nurses and 1 CPEU for dietitians Suggested CDR Learning Need Codes: 5370, 6000, 6010 and 9020 Can Acceptance and Commitment Therapy (ACT) Improve Adherence to Eating and Weight Loss Goals? To Register: Villanova.edu/cope Jena Shaw Tronieri, Ph.D. Assistant Professor of Psychology Director of Clinical Services Center for Weight and Eating Disorders Department of Psychiatry Perelman School of Medicine at the University of Pennsylvania Sponsored by 2

3 DISCLOSURE Neither the planners or presenter have any conflicts of interest to disclose. Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice displayed in conjunction with an activity. Can Acceptance and Commitment Therapy (ACT) Improve Adherence to Eating and Weight Loss Goals? Jena Shaw Tronieri, Ph.D. Assistant Professor of Psychology Director of Clinical Services Center for Weight and Eating Disorders Perelman School of Medicine University of Pennsylvania Overview Overview of Acceptance and Commitment Therapy (ACT) treatment model ACT may enhance weight loss Brief interventions ACT-based behavioral weight loss programs Applying ACT to weight loss treatment: practical examples 3

4 ACT: TREATMENT MODEL Acceptance and Commitment Therapy Cognitive-behavioral therapy tradition Behavior therapies Cognitive therapies Acceptance-based therapies Basis in learning and cognitive theories Hayes & Strosahl, 1999, Guilford; Hayes et al., 2006, Behav Res Ther Acceptance and Commitment Therapy Psychopathology is a result of experiential avoidance Attempts to control unpleasant thoughts and feelings do not work Hayes & Strosahl, 1999, Guilford; Hayes et al., 2006, Behav Res Ther 4

5 Acceptance and Commitment Therapy Psychopathology is a result of experiential avoidance Attempts to control unpleasant thoughts and feelings do not work Unwillingness to have unpleasant thoughts/emotions Takes us out of the present moment Limits our ability to engage in valued activities Hayes & Strosahl, 1999, Guilford; Hayes et al., 2006, Behav Res Ther Hexaflex ACT Therapeutic Model Present Moment On-going, nonjudgmental contact with psychological & environmental events as they occur Acceptance Active embrace of thoughts, feelings, bodily sensations ` Values Clear, freely-chosen life directions Defusion Thoughts are not to be taken literally Thoughts do not determine behavior Self as Context Self as locus or perspective from which private events are experienced, not their content Committed Action Building patterns of effective action linked to chosen values Hayes et al., 1999, Behav Res Ther Hexaflex ACT Therapeutic Model Present Moment 6) At this time, in this situation? Acceptance 2) Are you willing to have that stuff fully and without defense Psychological ` Flexibility Values 5) Of your chosen values Defusion 3) As it is, and not as what it says it is, Self as Context 1) Given a distinction between you and the stuff you are struggling with and trying to change Committed Action 4) AND do what takes you in the direction 5

6 ACT FOR WEIGHT LOSS Lifestyle Modification Programs Reduce calorie intake Reduce consumption of high-calorie foods Increase consumption of low-calorie foods Increase physical activity Reduce sedentary behaviors Behavioral strategies Self-monitoring (food, exercise, weight) Goal-setting, problem-solving Stimulus control e.g., Ryan, Espeland, Foster, et al., 2003, Control Clin Trials. Weight Loss Barriers Tendency to consume high calorie foods when available (neurobiological, learned) 1 The current food/exercise environment 2 Limited awareness of food decisions 3 Healthy choices predicted/perceived to be less pleasurable 4 1 Finlayson et al., 2008, Appetite; 2 Wansink, 2004, Annu Rev Nutr; 3 Wansink & Sobal, 2007, Environ Behav; 4 Forman & Butryn, 2015, Eat Behav 6

7 How Might ACT Target Barriers? Mindfulness Improve awareness of reactions to food cues Improve awareness of internal states Hunger/satiety Emotions Thoughts about food or physical activity How Might ACT Target Barriers? Acceptance/Defusion Unpair eating from cravings, urges to eat, thoughts about food, and negative emotional states Increase willingness to forgo a choice that is perceived as more pleasurable Values Enhance intrinsic motivation ACT FOR WEIGHT LOSS: CURRENT EVIDENCE 7

8 Current Evidence Mindfulness-based treatments Analogue studies ACT workshops Uncontrolled trials/ brief interventions Randomized controlled trials Mindfulness-Based Treatments Mindfulness-based Weight Loss Programs Mixed efficacy of mindfulness for behavioral weight loss 1 Differential benefit of general vs. eatingspecific awareness Awareness alone may not confer additional benefit 1 Olson and Emery, 2015, Psychosom Med 8

9 Workshops ACT Workshops Additional weight loss after previous completion of a weight loss program (6- hour ACT workshop) 1 Greater weight loss and increases in physical activity in women attempting to lose weight (four 2-hour ACT workshops) 2 1 Lillis et al., 2009, Ann Behav Med; 2 Tapper et al., 2009, Appetite ACT for Physical Activity Two, 2-hour workshops (week 2 & 4) ACT Psychoeducation N = 54 undergraduates Outcome: Athletic center visits Week 1 (baseline) Week 5 (post) Week 8 (follow-up) Butryn, Forman, Hoffman, Shaw, & Juarascio, 2011, J Phys Act Health 9

10 ACT for Physical Activity Larger increase in the ACT group at post (F(1,42) = 7.33, p <.01, η 2 =.15) Partially maintained at follow-up (F(1,42) = 2.91, p =.09, η 2 =.07). Butryn, Forman, Hoffman, Shaw, & Juarascio, 2011, J Phys Act Health ACT-Based Treatments Preliminary Trials Open trials 7.9 kg loss after 12 weeks, additional weight loss (1.7kg) by month six kg loss in disinhibited eaters after 24 weeks, maintained at month three 2 Brief (8 sessions) controlled trial for weight gain prevention 2.2 kg loss at 1-year follow up, compared to 1.1 kg gain in control 3 1Forman et al., 2009, Cogn Behav Prac; 2 Niemier et al., 2007, Obesity; 3 Katterman et al., 2013, J Contextual Behav Sci 10

11 First Randomized Controlled Trial Compared group standard behavioral treatment (SBT) to acceptance-based behavioral treatment (ABT) 40-weeks (30 sessions) ABT included standard behavioral protocol plus segments focusing on ACT-based skills Forman, Butryn, Juarascio, Bradley, Lowe, Herbert, & Shaw, 2013, Obesity Participants N = 128 (N Post = 117, N Follow up = 82) BMI: 34.1 ± 3.6 kg/m 2 Age: 45.7 ± 12.8 years Race: 62.3% Caucasian 24.6% African American 3.8% Hispanic 1.6% Asian Forman, Butryn, Juarascio, Bradley, Lowe, Herbert, & Shaw, 2013, Obesity ABT vs. SBT for Weight Loss: Results 0 Percent Weight Loss SBT ACT Baseline Post Follow-Up Difference not significant at post (p =.24) or follow-up (p =.37) Forman et al., 2013, Obesity 11

12 20 ABT vs. SBT for weight loss: Moderation Weight Loss (kg) at Posttreatment ABT SBT 0 High Depression** High Emotional Eating* High Food Responsivity High Disinhibition p <.10, p <.05*, or p <.01** ABT vs. SBT for Weight Loss: Conclusions Advantage of ACT was small and did not reach statistical significance Considerations Attrition/sample size Length of follow up period Was a sufficient dosage of ACT delivered? Forman et al., 201, Obesity Second Randomized Controlled Trial Compared group SBT to ABT 52-weeks (25 sessions) ABT protocol modified to increase dosage and integration of ACT-based skills Forman, Butryn, Manasse, et al., 2016, Obesity 12

13 Participants N = 190 (N Post = 149) BMI: 36.9 ± 5.8 kg/m 2 Age: 51.6± 10.1 years Race: 70.5% Caucasian 24.7% African American 3.7% Hispanic 1.1% Asian Forman et al., 2016, Obesity Second RCT Comparing ABT to SBT Percent Weight Loss Baseline Mid-treatment Post-treatment SBT ABT Significant effect of condition (p =.01) Forman et al., 2016, Obesity ABT vs. SBT for Weight Loss: Conclusions ABT produced significantly greater weight loss at the end of a 1-year program Revised ABT program included greater focus on ACT skills, especially willingness and acceptance of loss of pleasure Considerations Replication with follow-up Dissemination Forman et al., 201, Obesity 13

14 APPLYING ACT TO WEIGHT LOSS TREATMENT: SAMPLE EXERCISES Control What You Can, Accept What You Can t Minimizing contact with problem cues and experiential avoidance are not the same DO still use behavioral strategies like stimulus control BUT it s impossible to avoid problem cues all of the time Acceptance Have you been waiting for change to be easy? Willingness To move towards my value of, I have to be willing to have. If you re not willing to have it, you will. 14

15 Mindfulness Paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment (Jon Kabat-Zinn). Mindfulness Paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment (Jon Kabat-Zinn). Pay attention to your eating experience Pay attention to your eating decisions Mindful Eating 1. Turn off/tune out from the outside world 2. Focus your attention on the food Notice sight and smell Notice taste and texture 3. Eat slowly 4. Notice what you do while you eat (habits) 5. Tune in to the inside world (thoughts, feelings, internal sensations) 15

16 Mindful Decision-Making Increase awareness that an eating/exercise decision is being made Notice the external (e.g., food cues) and internal experiences (e.g., thoughts, emotions, physical sensations) that may influence your decision-making Bring to mind your short- and long-term goals and values Values Clarity Values as freely-chosen life directions Clarity: a good parent vs. a parent who listens openly and respects their child s opinions How are your values related to your weight loss goals? Why is weight loss important to you right now? What are you hoping will be different in your life if you lose this weight/make healthier eating choices/exercise more? Commitment to Valued Action Picture yourself 5 years from now living a life more consistent with your most important values. What can you start doing now to make that outcome more likely? Does doing X move me towards or away from my most important values? 16

17 Defusion Separate your actions from your thoughts about those actions I can t pick up the pen Reason-giving I can t (or I have to) because can interfere with weight loss Practice exercises: But vs. and Carrot vs. chocolate Urge Surfing Mindfulness, acceptance, and defusion Surf the urge of your craving When you experience a strong craving, tune into it and notice your experience (without reacting to it) Strength of craving Thoughts, emotions, sensations Cravings typically rise and fall, like a wave. What Does ACT Bring to Weight Loss? ACT strategies may not make weight loss easier, but could help patients adhere to their goals when it is difficult. Tools for responding differently to thoughts, emotions, and sensations that might otherwise interfere with behavior change Clearer connection between healthy behaviors and values may increase motivation to maintain those behaviors 17

18 THANK YOU! Questions? Books on ACT for Weight Loss Bailey, A., Ciarrochi, J., & Harris, R. (2014). The Weight Escape: How to Stop Dieting and Start Living. Shambhala Publications. Haynos, A. F., Forman, E. M., Butryn, M. L., & Lillis, J. (Eds.). (2016). Mindfulness and Acceptance for Treating Eating Disorders and Weight Concerns: Evidence-Based Interventions. New Harbinger Publications. Forman, E. M., & Butryn, M. L. (2016). Effective Weight Loss: An Acceptance-based Behavioral Approach, Clinician Guide. Oxford University Press. Forman, E. M., & Butryn, M. L. (2016). Effective Weight Loss: An Acceptance-Based Behavioral Approach, Workbook. Oxford University Press. Lillis, J., Dahl, J., & Weineland, S. M. (2014). The diet trap: feed your psychological needs and end the weight loss struggle using acceptance and commitment therapy. New Harbinger Publications. References Butryn, M. L., Forman, E., Hoffman, K., Shaw, J., & Juarascio, A. (2011). A pilot study of acceptance and commitment therapy for promotion of physical activity. Journal of Physical Activity & Health, 8(4), 516. Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), doi: /s (04) Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), doi: /j.brat Hayes, S. & Smith, S.. (2005;2009). Get out of your mind and into your life : The new acceptance and commitment therapy. Oakland, Calif: New Harbinger Publications. Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press. Finlayson, G., King, N., & Blundell, J. (2008). The role of implicit wanting in relation to explicit liking and wanting for food: Implications for appetite control. Appetite, 50(1), doi: /j.appet Forman, E.M., Butryn, M.L., Juarascio, A.S., Bradley, L.E., Lowe, M.R., Herbert, J.D. & Shaw, J.A. (2013) The Mind Your Health Project: A randomized controlled trial of an innovative behavioral treatment for obesity. Obesity. 21(6), DOI: /oby Forman, E. M., Butryn, M. L., Manasse, S. M., Crosby, R. D., Goldstein, S. P., Wyckoff, E. P., & Thomas, J. G. (2016). Acceptance based versus standard behavioral treatment for obesity: Results from the mind your health randomized controlled trial. Obesity, 24(10), doi: /oby

19 References Forman, E. M., Butryn, M. L., Hoffman, K. L., & Herbert, J. D. (2009). An open trial of an acceptance-based behavioral intervention for weight loss. Cognitive and Behavioral Practice, 16(2), doi: /j.cbpra Forman, E., & Butryn, M. (2015). A new look at the science of weight control: How acceptance and commitment strategies can address the challenge of self-regulation. Appetite, 84, doi: /j.appet Katterman, S. N., Goldstein, S. P., Butryn, M. L., Forman, E. M., & Lowe, M. R. (2014). Efficacy of an acceptance-based behavioral intervention for weight gain prevention in young adult women. Journal of Contextual Behavioral Science, 3(1), Lillis, J., Niemeier, H. M., Thomas, J. G., Unick, J., Ross, K. M., Leahey, T. M.,... Wing, R. R. (2016). A randomized trial of an acceptance based behavioral intervention for weight loss in people with high internal disinhibition. Obesity, 24(12), doi: /oby Lillis, J., & Kendra, K. E. (2014). Acceptance and commitment therapy for weight control: Model, evidence, and future directions. Journal of Contextual Behavioral Science, 3(1), 1-7. doi: /j.jcbs Lillis, J., Hayes, S. C., Bunting, K., & Masuda, A. (2009). Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model. Annals of Behavioral Medicine, 37(1), doi: /s x Niemeier, H. M., Leahey, T., Palm Reed, K., Brown, R. A., & Wing, R. R. (2012;2011;). An acceptancebased behavioral intervention for weight loss: A pilot study. Behavior Therapy, 43(2), doi: /j.beth Olson, K. L., & Emery, C. F. (2015). Mindfulness and weight loss: A systematic review. Psychosomatic Medicine, 77(1), 59. References Tapper, K., Shaw, C., Ilsley, J., Hill, A. J., Bond, F. W., & Moore, L. (2009). Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women. Appetite, 52(2), doi: /j.appet Wansink, B. (2004). Environmental factors that increase the food intake and consumption volume of unknowing consumers. Annual Review of Nutrition, 24(1), doi: /annurev.nutr Wansink, B., & Sobal, J. (2007). Mindless eating: The 200 daily food decisions we overlook. Environment and Behavior, 39(1), doi: / Evaluations and CE Certificates Those completing the webinar will be ed a link to the evaluation. The will be sent to the address that you used to register for the webinar. Complete the evaluation soon after you receive the . The evaluation does expire after 3 weeks. Once expired, you cannot obtain a certificate. Once the evaluation is completed, the certificate will be ed separately within 2 or 3 business days. 19

20 Questions and Answers Moderator: Lisa K. Diewald MS, RD, LDN Web site: To receive monthly s on upcoming COPE events, please join COPE s Contacts on our website. Thank you for your time and interest. 20