Mindfulness and acceptance-based interventions for obesity: Using a factorial design to identify the most effective components

基于正念和接受的肥胖干预措施：使用因子设计来确定最有效的组成部分

• 批准号: 10429914
• 负责人: Evan M Forman
• 金额: $ 55.46万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10429914
• 关键词: Aftercare; Attention; Awareness; Behavior Therapy; Behavioral; Benchmarking; Body Weight decreased; Calories; Cause of Death; Characteristics; Cognitive; Cues; Data; Effectiveness; Elements; Evaluation; Food; Future; Goals; Gold; Health Benefit; Health Priorities; Individual; Intake; Knowledge; Obesity; Outcome; Overweight; Participant; Phase; Physical activity; Positioning Attribute; Predisposition; Quality of life; Science; Series; Testing; Training; Treatment Efficacy; Treatment outcome; Uncertainty; Weight maintenance regimen; Work; arm; base; clinically significant; cognitive testing; cost; design; follow up assessment; follow-up; improved; innovation; mindfulness; obesity treatment; psychologic; randomized trial; skills; therapy design; treatment comparison; treatment optimization; virtual; waist circumference; weight loss intervention

Project Summary/Abstract Behavioral weight loss treatment (BT), which teaches cognitive and behavioral skills, is the gold standard and first line of treatment for obesity. Outcomes, while clinically significant, are considered suboptimal in that many participants fail to reach and/or maintain the 5 and 10% benchmarks associated with key health benefits. Over the past 30 years, many trials have tested cognitive and behavioral innovations on standard BT skills, but thus far virtually none has produced significantly improved weight losses. Mindfulness and acceptance-based behavioral treatments (MABTs) for obesity is an exception in that rigorous trials have demonstrated considerably greater weight losses for this approach when directly compared to gold standard BT. Yet, MABTs’ outcomes have varied, as have their composition. The ability to continue improving and successfully disseminating behavioral treatments for obesity depends on the field increasing its understanding of which MABT components are most efficacious. Consistent with a Phase I of a Multiphasic Optimization Strategy (MOST) approach, we reviewed theoretical accounts of MABTs and identified three key MABT components: (1) Mindful Awareness, (2) Mindful Acceptance, and (3) Values Clarity. Consistent with the second phase of a MOST, this study will utilize a full 2x2x2 factorial design in which 288 overweight/obese participants are assigned to one of eight behavioral weight loss treatments, i.e., representing each permutation of MABT components being included or excluded from the treatment. Due to the ability of a factorial design to pool conditions to examine each main effect, analyses have the same power as a two-arm design. The primary aim of the current study is to evaluate the independent efficacy of mindful awareness, mindful acceptance and values clarity components of MABT on weight loss (at post-treatment and at 6, 12 and 24 months follow-up) over and above standard BT. Secondary aims are to: (1) To evaluate the independent efficacy of mindful awareness, mindful acceptance and values clarity components of MABT on waist circumference, calorie intake, physical activity and quality of life; (2) To confirm that each treatment component impacts the variable which it targets; (3) To test the hypotheses that the efficacy of the treatment components is moderated by susceptibility to internal and external food cues. The exploratory aim is to quantify the component interaction effects, which may be synergistic, fully additive, or partially additive. This study investigates an innovative and especially promising behavioral approach, and will be one of the first to utilize a full factorial design for obesity intervention optimization. Furthermore, it will be the first-ever study to conduct a component analysis to discern independent efficacies of MABT components, and the first to examine interactions of behavioral weight loss components with each other and with baseline characteristics of participants. Results will position the field for future work, i.e., the evaluation of an optimized treatment that can be expected to have superior efficacy and disseminability.

项目摘要/摘要 教授认知和行为技能的行为减肥治疗（BT）是黄金标准， 肥胖症的第一道治疗。结果虽然具有临床意义，但被认为是次优的 参与者未能达到与关键健康益处相关的5％和10％基准。超过 在过去的30年中，许多试验测试了标准BT技能的认知和行为创新，但 几乎没有什么都没有产生显着改善体重减轻。正念和基于接受 肥胖的行为治疗（MABT）是一个例外，因为严格的试验已经证明 与黄金标准BT相比，这种方法的体重减轻要大大增加。但是，Mabts 结果和成分有所不同。能够继续改善并成功的能力 传播肥胖行为治疗的行为治疗取决于该领域，增加了对哪个领域的理解 MABT组件是最有效的。与多相优化策略的第一阶段一致 （大多数）我们回顾了MABT的理论叙述，并确定了三个关键的MABT组件： （1）正念意识，（2）正念接受和（3）价值观清晰。与第二阶段一致 大多数，这项研究将利用完整的2x2x2阶乘设计，其中288个超重/肥胖参与者是 分配给八种行为减肥治疗之一，即表示MABT的每个排列 组件包括或排除在处理之外。由于阶乘设计的能力 检查每个主要效果的条件，分析具有与两臂设计相同的功率。主要目的 当前的研究是评估正念意识，正念接受和 值MABT对体重减轻的清晰度成分（在治疗后和6、12和24个月的随访中） 超过标准BT。次要目的是：（1）评估正念的独立效率 Mabt的意识，正念接受和价值观的清晰度组成部分，腰围，卡路里 摄入量，体育锻炼和生活质量； （2）确认每个治疗成分都会影响变量 它的目标； （3）检验假设，即治疗成分的效率由 对内部和外部食物提示的敏感性。探索目的是量化组件相互作用 效果，可能是协同作用，完全加性或部分添加剂的效果。这项研究调查了创新和 特别有前途的行为方法，并将成为第一个利用整个阶乘设计进行对象的人之一 干预优化。此外，这将是有史以来第一个进行组件分析的研究 MABT组件的独立效率，也是第一个检查行为减肥相互作用的效率 彼此组成部分，并具有参与者的基线特征。结果将定位 未来的工作，即对优化治疗的评估，可以期望具有较高的效率和 分散性。