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: 9762330
• 负责人: Evan M Forman
• 金额: $ 65.3万
• 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/9762330
• 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; Intervention; 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 optimization; virtual; waist circumference

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.

项目概要/摘要 行为减肥治疗 (BT) 教授认知和行为技能，是黄金标准， 肥胖症的一线治疗结果虽然具有临床意义，但在许多方面被认为不是最理想的。 参与者未能达到和/或维持与关键健康益处相关的 5% 和 10% 基准。 过去 30 年，许多试验测试了标准 BT 技能的认知和行为创新，但因此 迄今为止，几乎没有一种方法能够显着改善基于正念和接受的减肥效果。 肥胖的行为治疗（MABT）是一个例外，因为严格的试验已经证明 然而，与黄金标准 BT 直接相比，这种方法的重量损失要大得多。 结果各不相同，其持续改进和成功的能力也各不相同。 肥胖行为疗法的传播取决于该领域对哪些行为的理解的加深 MABT 组件最有效，符合多阶段优化策略的第一阶段。 (MOST) 方法中，我们回顾了 MABT 的理论解释并确定了三个关键的 MABT 组成部分： (1) 正念意识，(2) 正念接受，以及 (3) 价值观清晰度，与第二阶段一致。 最重要的是，本研究将采用完整的 2x2x2 因子设计，其中 288 名超重/肥胖参与者 分配给八种行为减肥治疗之一，即代表 MABT 的每种排列 由于因子设计能够合并，因此可以将成分包含在处理中或排除在处理之外。 检查每个主效应的条件，分析具有与双臂设计相同的功效。 当前研究的目的是评估正念意识、正念接受和正念的独立功效 评估 MABT 的清晰度成分对减肥的影响（治疗后以及 6、12 和 24 个月的随访时） 超越标准 BT 的次要目标是：（1）评估正念的独立功效。 意识、正念接受和价值观 MABT 腰围、卡路里的清晰度组成部分 (2) 确认每个治疗成分对变量的影响 (3) 检验治疗成分的功效受以下因素调节的假设： 对内部和外部食物线索的易感性探索的目的是量化成分相互作用。 效应，可能是协同的、完全相加的或部分相加的。本研究研究了一种创新的和相加的效应。 特别有前途的行为方法，并将成为第一个利用全因子设计治疗肥胖的方法 此外，这将是有史以来第一项进行成分分析以辨别的研究。 MABT 成分的独立功效，并且第一个检查行为减肥的相互作用 各个组成部分之间以及参与者的基线特征的结果将为该领域定位。 未来的工作，即评估预计具有优异疗效的优化治疗方法 传播性。