Cognitive-Behavioral Therapy: Current Paths in the Management of Obesity

The treatment of obesity and its related chronic symptoms is one of the major issues that world healthcare systems are facing today. Cognitive-behavioral therapy (CBT) is one of the most effective therapies in the treatment of dysfunctional eating behaviors. In the first part of the chapter, the phenomenon of obesity will be introduced; subsequently, the role of CBT into obesity treatment will be underlined. CBT’s core strategies will be presented and analyzed: goal setting, self-monitoring, stimulus control, problem solving technique, and cognitive restructuring technique. The use of these strategies and related results is a major issue, emphasizing the need for further studies on the phenomenon of obesity, given the excellent results available in the short term, with significant weight loss, but the difficulties in keeping the results achieved in the long run. Since obesity is a chronic condition, CBT treatments must focus on different outcomes, considering weight loss as a consequence of a change in the individual’s eating style rather than as a major and only result to be pursued. Finally, we will take into account the topic of motivation in the psychological treatment of obesity since patient’s motivation assessment seems to be a major prerequisite for successful weight loss therapy

The ACTyourCHANGE study protocol: promoting a healthy lifestyle in patients with obesity with Acceptance and Commitment Therapy-a randomized controlled trial

BackgroundAs treatment of choice in promoting psychological flexibility, Acceptance and Commitment Therapy (ACT) was found to be effective in several conditions, and among different populations, including weight management in individuals with obesity. However, the mechanism of action of psychological flexibility is less known. The aim of the present study is, within the context of a brief ACT intervention for behavioral change and behavioral maintenance of a healthy lifestyle in a sample of inpatients with obesity, to explore the effect of each subcomponent of the psychological flexibility model on treatment processes and outcomes.MethodsA randomized controlled trial will be conducted. Ninety Italian adult inpatients with obesity attending a rehabilitation program for weight loss will be randomly allocated into three experimental conditions targeting respectively each subcomponent of the psychological flexibility model: group Engage focused on values-oriented behaviors, group Openness focused on acceptance and cognitive defusion, and group Awareness focused on being present and aware of thoughts, feelings, and behaviors at every moment. Weight, BMI (kg/m(2)), the Psychological General Well-Being Inventory (PGWBI), the Outcome Questionnaire-45.2 (OQ-45.2), the Depression Anxiety and Stress Scale (DASS-21), the Difficulties in Emotion Regulation Scale (DERS), the Dutch Eating Behaviors Questionnaire (DEBQ), the Brief Values Inventory (BVI), the Committed Action Questionnaire (CAQ), the Italian-Cognitive Fusion Questionnaire (I-CFQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Acceptance and Action Questionnaire (AAQ-II) will be assessed at the beginning (time 0), at the end of psychological intervention (time 1), and after 3 (time 2) and 6months (time 3) and 9months (time 4) from discharge. During the following month after discharge, outpatients will be monitored in their adherence to a healthy lifestyle, using a wearable device.To assess the effectiveness of the intervention, mixed between-within 3 (conditions) x4 (times) repeated measure ANOVAs will be conducted to examine changes from time 0 to time 1, 2, 3, and 4 in means of weight, BMI, and means of scores PGWBI, OQ-45.2, DASS, DERS, DEBQ, AAQ-II, BVI, CAQ, I-CFQ, and FFMQ, between three groups.DiscussionThis study will contribute to clarify the mechanism of action of each subcomponent of the psychological flexibility model and understand its impact on the promotion of a healthy lifestyle.Trial registrationClinicalTrials.govNCT04474509. Registered on July 4, 202

THE MULTIDIMENSIONAL STRUCTURE OF SUBJECTIVE AGING: TOWARDS A NEW MEASUREMENT TOOL

La percezione soggettiva dell’invecchiamento, o invecchiamento soggettivo, intesa come il modo in cui le persone anziane interpretano e costruiscono aspettative nei confronti del processo di invecchiamento stesso, rappresenta un argomento di enorme interesse clinico. L’ invecchiamento soggettivo è ad oggi considerato un fattore chiave in grado di influire direttamente sulle nostre aspettative di vita. Numerose ricerche hanno studiato la relazione esistente tra invecchiamento soggettivo, o altre concettualizzazioni teoriche comunemente usate, e la salute individuale. Gli individui con una visione negativa dell'invecchiamento corrono maggiori rischi di sviluppare malattie croniche, presentano tassi di ospedalizzazione più elevati, funzionamento cognitivo e fisico compromesso, maggiore incidenza di malattie neurodegenerative e una sostanziale diminuzione della longevità. L'invecchiamento soggettivo appare anche connesso alla salute psicologica e alla qualità della vita degli individui over 65. Inoltre, questo costrutto psicologico appare potenzialmente mutevole e come tale di estrema importanza per tutti quegli interventi che mirano a migliorare la salute psicofisica di una popolazione sempre più longeva. Nonostante il forte legame evidenziato in letteratura tra diversi indicatori di salute e l'invecchiamento soggettivo, il numero di strumenti psicometrici statisticamente validi e teoricamente affidabili è ancora modesto. Questa tesi si concentra sul processo di sviluppo di un nuovo questionario psicologico per la valutazione dell'invecchiamento soggettivo; uno strumento psicometrico che potrebbe essere utilizzato per aumentare la nostra conoscenza sulle diverse componenti specifiche dell'invecchiamento soggettivo in grado di influenzare la salute e il benessere individuale in età avanzata. Il lavoro di tesi trae fondamento da basi teoriche ampiamente consolidate in letteratura nello studio dell'invecchiamento soggettivo, con un focus principale alla teoria dello stereotipo internalizzato sviluppata dalla Dottoressa Becca Levy. Nei diversi capitoli costituenti il lavoro di tesi verranno affrontate diverse domande di ricerca riguardanti la valutazione e le implicazioni sulla salute dell'invecchiamento soggettivo, ampliando potenzialmente la nostra conoscenza psicologica e psicometrica su questo costrutto.Great emphasis has been given by clinicians to the way older adults experience and view the aging process itself, a research field broadly known as “subjective aging.” Subjective aging or perception of aging in the on-topic literature is now considered a key factor directly affecting the aging trajectory. Several studies have explored the existing relationship between subjective aging, or other commonly used theoretical conceptualizations of it, and health-related outcomes. Individuals holding negative views of aging have been empirically linked to higher risks of developing chronic conditions, higher hospitalization rates, lower cognitive and physical functioning, neurodegenerative diseases, and decreased longevity. Subjective aging has also been connected with psychological outcomes, like depression, anxiety, or older adults’ quality of life. Moreover, this psychological construct seems susceptible to change, and as such of extreme importance for interventions enhancing the psychological and physical health of an aging population. Despite the strong longitudinal relationships highlighted between different health outcomes and subjective aging, the amount of statistically valid and theoretically reliable self-report measures of it is still modest. This dissertation will focus on the development of a new questionnaire assessing subjective aging, a psychometric tool that could be used to increase our knowledge about different specific dimensions of subjective age influencing health and well-being in later life. The current dissertation manuscript will build upon widely established theoretical foundations for the construct of subjective aging, with the main focus being on Becca Levy’s stereotype embodiment theory. In the different chapters comprising this manuscript, different research questions regarding the assessment and health implications of subjective aging will be answered, potentially expanding our psychological and psychometrical knowledge about this fundamental construct

ACTonFood. Acceptance and Commitment Therapy-Based Group Treatment Compared to Cognitive Behavioral Therapy-Based Group Treatment for Weight Loss Maintenance: An Individually Randomized Group Treatment Trial

The purpose of this Individually Randomized Group Treatment Trial was to compare an Acceptance and Commitment Therapy-based (ACT) group intervention and a Cognitive Behavioral Therapy-based (CBT) group intervention for weight loss maintenance in a sample of adult patients with obesity seeking treatment for weight loss. One hundred and fifty-five adults (BMI: Kg/m2 = 43.8 [6.8]) attending a multidisciplinary rehabilitation program for weight loss were randomized into two conditions: ACT and CBT. Demographical, physical, and clinical data were assessed at the beginning of the program (t0), at discharge (t1), and at 6-month follow-up (t2). The following measures were administered: The Acceptance and Action Questionnaire-II (AAQ-II) and the Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM). Generalized linear mixed models were performed to assess differences between groups. Moderation effects for gender and Eating Disorders (ED) have been considered. From baseline to discharge, no significant differences between interventions were found, with the only exception of an improvement in the CORE-OM total score and in the CORE-OM subjective wellbeing subscale for those in the CBT condition. From discharge to follow-up, ACT group participants showed significant results in terms of weight loss maintenance, CORE-OM total score, and CORE-OM and AAQ-II wellbeing, symptoms, and psychological problems subscales. Gender moderated the effects of time and intervention on the CORE-OM subscale reporting the risk for self-harm or harm of others. The presence of an eating disorder moderated the effect of time and intervention on the CORE-OM total score, on the CORE-OM symptoms and psychological problems subscales, and on the AAQ-II. Patients who received the ACT intervention were more likely to achieve a ≥5% weight loss from baseline to follow-up and to maintain the weight loss after discharge. The ACT intervention was thus effective in maintaining weight loss over time

ACTonHEALTH study protocol: Promoting psychological flexibility with activity tracker and mHealth tools to foster healthful lifestyle for obesity and other chronic health conditions

Background: Obesity and the state of being overweight are increasing steadily and becoming a global epidemic. Recent research reports 64% of the adult population as overweight in Europe and the USA. The social and economic impacts are increasing, and most of the rehabilitation programs, while effective in the short term, do not produce long-lasting results. An explanatory model from a behavioral perspective can describe the phenomena with the lack of sources of reinforcement related to healthful habits in a daily life context. Methods/design: A randomized clinical trial combining single-subject studies and a four-arm group design will be conducted to compare the effect of the current standard in obesity treatment to Acceptance and Commitment Therapy (ACT) and wearable technology at different times, before starting intervention, at the end, and at follow-up visits of 3, 6, and 12 months measuring changes over time of physical activity and psychological well-being. Discussion: The goal of this project, combining ACT and wearable technology, is to develop an effective intervention, efficient and sustainable, which even after discharge can provide adequate contingencies of reinforcement in the natural environment, integrating systematic measurements, continuous feedback, and individualized, values-based objectives. The intervention is aimed to provide a contingent reinforcement for healthful behaviors instead of reinforcing only the achievement of a significant weight loss. The aim of the project, combining Acceptance and Commitment Therapy and Wearable Technology, is to develop an effective, efficient and sustainable intervention able to provide a contingent reinforcement for healthy behaviors. The intervention is aimed to promote adequate healthy behaviors in the natural environment, integrating systematic measurements, continuous feedback and individualized values-based objectives, instead of reinforcing only the achievement of a significant weight loss. Trial registration: ClinicalTrials.gov, NCT03351712. Registered on 24 November 2017

The ACTyourCHANGE study protocol: promoting a healthy lifestyle in patients with obesity with Acceptance and Commitment Therapy-a randomized controlled trial

BACKGROUND: As treatment of choice in promoting psychological flexibility, Acceptance and Commitment Therapy (ACT) was found to be effective in several conditions, and among different populations, including weight management in individuals with obesity. However, the mechanism of action of psychological flexibility is less known. The aim of the present study is, within the context of a brief ACT intervention for behavioral change and behavioral maintenance of a healthy lifestyle in a sample of inpatients with obesity, to explore the effect of each subcomponent of the psychological flexibility model on treatment processes and outcomes.METHODS: A randomized controlled trial will be conducted. Ninety Italian adult inpatients with obesity attending a rehabilitation program for weight loss will be randomly allocated into three experimental conditions targeting respectively each subcomponent of the psychological flexibility model: group Engage focused on values-oriented behaviors, group Openness focused on acceptance and cognitive defusion, and group Awareness focused on being present and aware of thoughts, feelings, and behaviors at every moment. Weight, BMI (kg/m2), the Psychological General Well-Being Inventory (PGWBI), the Outcome Questionnaire-45.2 (OQ-45.2), the Depression Anxiety and Stress Scale (DASS-21), the Difficulties in Emotion Regulation Scale (DERS), the Dutch Eating Behaviors Questionnaire (DEBQ), the Brief Values Inventory (BVI), the Committed Action Questionnaire (CAQ), the Italian-Cognitive Fusion Questionnaire (I-CFQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Acceptance and Action Questionnaire (AAQ-II) will be assessed at the beginning (time 0), at the end of psychological intervention (time 1), and after 3 (time 2) and 6months (time 3) and 9months (time 4) from discharge. During the following month after discharge, outpatients will be monitored in their adherence to a healthy lifestyle, using a wearable device. To assess the effectiveness of the intervention, mixed between-within 3 (conditions) *4 (times) repeated measure ANOVAs will be conducted to examine changes from time 0 to time 1, 2, 3, and 4 in means of weight, BMI, and means of scores PGWBI, OQ-45.2, DASS, DERS, DEBQ, AAQ-II, BVI, CAQ, I-CFQ, and FFMQ, between three groups.DISCUSSION: This study will contribute to clarify the mechanism of action of each subcomponent of the psychological flexibility model and understand its impact on the promotion of a healthy lifestyle.TRIAL REGISTRATION: ClinicalTrials.gov NCT04474509 . Registered on July 4, 2020

Placebo and Nocebo Effects as Bayesian-Brain Phenomena: The Overlooked Role of Likelihood and Attention

The Bayesian-brain framework applied to placebo responses and other mind-body interactions suggests that the effects on the body result from the interaction between priors, such as expectations and learning, and likelihood, such as somatosensorial information. Significant research in this area focuses on the role of the priors, but the relevance of the likelihood has been surprisingly overlooked. One way of manipulating the relevance of the likelihood is by paying attention to sensorial information. We suggest that attention can influence both precision and position (i.e., the relative distance from the priors) of the likelihood by focusing on specific components of the somatosensorial information. Two forms of attention seem particularly relevant in this framework: mindful attention and selective attention. Attention has the potential to be considered a "major player" in placebo/nocebo research, together with expectations and learning. In terms of application, relying on attentional strategies as "amplifiers" or "silencers" of sensorial information could lead to an active involvement of individuals in shaping their care process and health. In this contribution, we discuss the theoretical implications of these intuitions with the aim to provide a comprehensive framework that includes Bayesian brain, placebo/nocebo effects, and the role of attention in mind-body interactions