Feasibility of acceptance and commitment therapy for post-bariatric surgery patients: the FAB study protocol

Authors

  • Lisa Cotter School of Health Sciences, Kate Granger Building, Guildford
  • Samantha Scholtz Research and Development, West London Mental Health Trust, Southall, London
  • Shikta Das UCL Institute of Cardiovascular Science, MRC Unit for Lifelong Health and Ageing at UCL, London
  • John Tayu Lee Imperial College London, Reynolds Building, Charing Cross Hospital, London
  • Dayna Lee-Baggley Behaviour Change Research Institute, Nova Scotia Health Authority, Halifax, Nova Scotia
  • Elizabeth A. Barley School of Health Sciences, Kate Granger Building, Guildford

DOI:

https://doi.org/10.18203/2349-3259.ijct20194655

Keywords:

Obesity, Acceptance and commitment therapy, Bariatric surgery, Third wave therapy, Psychological intervention, Weight management

Abstract

Background: Bariatric surgery is an effective treatment for obesity. However, around one in five people experience significant weight regain. In the months following surgery, loss of food as a hedonic reward, increased sensitivity to food-related cues, alcohol use and depression may translate into new obesogenic behaviours which can be targeted in therapy. Acceptance and Commitment Therapy (ACT) teaches acceptance of and defusion from thoughts and feelings which influence behaviour, and commitment to act in line with personal values. We will test whether people who have had bariatric surgery over one year ago find 10 weeks of ACT group therapy an acceptable treatment and whether a larger trial to test whether ACT can improve long-term post-operative outcomes would be feasible.

Methods: This will be a feasibility randomised controlled trial (RCT) with participants randomised to either ACT or a Usual Care Support Group control. Participants will be recruited at 15-18 months post-surgery and compared at baseline, 3, 6 and 12 months. The trial will provide information about recruitment and characteristics of the proposed outcome measures to inform a definitive RCT.

Conclusions: Trials big enough to determine whether a treatment approach works are costly, so this small study will help determine whether the methods used, such as how people are recruited, allocated to groups, and how data are collected, are likely to work on a bigger scale. This project is the first step in testing whether ACT can help people who have had bariatric surgery.

Trial Registration: Researchregistry.com, UIN: 3959 (date registered: 10 April 2018); ISRCTN registry ID: ISRCTN52074801.

References

World Health Organization. Obesity and Overweight, 2018. Available at: https://www.who. int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 14 June 2019.

NHS Digital. Statistics on obesity, physical activity and diet, 2018. Available at: https://digital.nhs. uk/data-and-information/publications/statistical/ statistics-on-obesity-physical-activity-and-diet/ statistics-on-obesity-physical-activity-and-diet-england-2018. Accessed 14 June 2019.

Courcoulas AP, King WC, Belle SH, Berk P, Flum DR, Garcia L, et al. Seven-year weight trajectories and health outcomes in the longitudinal assessment of bariatric surgery (LABS) study. JAMA Surg. 2018;153(5):427-34.

Cooper TC, Simmons EB, Webb K, Burns JL, Kushner RF. Trends in weight regain following roux-en-Y gastric bypass (RYGB) bariatric surgery. Obesity Surg. 2015;25(8):1474-81.

Ostlund MP, Backman O, Marsk R, Stockeld D, Lagergren J, Rasmussen F, et al. Increased admission for alcohol dependence after gastric bypass surgery compared with restrictive bariatric surgery. JAMA Surg. 2013;148(4):374-7.

Scholtz S, Goldstone AP, le Roux CW. Changes in reward after gastric bypass: The advantages and disadvantages. Curr Atherosclerosis Reports. 2015;17(10):61.

National Institute for Health and Care Excellence. Obesity: Identification, assessment and management, 2014. Available at: https://www.nice. org.uk/guidance/cg189. Accessed 14 June 2019.

Stewart F, Avenell A. Behavioural interventions for severe obesity before and/or after bariatric surgery: A systematic review and meta-analysis. Obesity Surg. 2016;26(6):1203-14.

Marek RJ, Ben-Porath YS, Dulmen MHMV, Ashton K, Heinberg LJ. Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients. Surg Obes Relat Dis. 2017;13(3):514-21.

O'Reilly GA, Cook L, Spruijt-Metz D, Black DS. Mindfulness-based interventions for obesity-related eating behaviours: A literature review. Obesity Reviews: An Official J Int Assoc Study Obes. 2014;15(6):453-61.

Forman E, Butryn ML, Hoffman KL, Herbert JD. An open trial of an acceptance-based behavioral intervention for weight loss. Cogn Behav Prac. 2009;16(2):223-35.

Weineland S, Arvidsson D, Kakoulidis TP, Dahl J. Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT. Obesity Res Clin Prac. 2012;6(1):e1-e90.

Ogden J, Hollywood A, Pring C. The impact of psychological support on weight loss post weight loss surgery: A randomised control trial. Obesity Surg. 2015;25(3):500-5.

Odom J, Zalesin KC, Washington TL, Miller WW, Hakmeh B, Zaremba DL, et al. Behavioral predictors of weight regain after bariatric surgery. Obesity Surg. 2010;20(3):349-56.

Ferchak CV, Meneghini LF. Obesity, bariatric surgery and type 2 diabetes – a systematic review. Diabetes/Metab Res Rev. 2004;20(6):438-45.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13.

R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing 2018. Vienna, Austria. Available at: https://www.R-project.org/. Accessed 14 June 2019.

Lancaster GA, Dodd S, Williamson PR. Design and analysis of pilot studies: Recommendations for good practice. J Eva Clin Prac. 2004;10(2):307-12.

Moher D, Schulz KF, Altman DG. The CONSORT statement: Revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet (London, England) 2001;357(9263):1191-4.

Bradley LE, Forman EM, Kerrigan SG, Butryn ML, Herbert JD, Sarwer DB. A pilot study of an acceptance-based behavioral intervention for weight regain after bariatric surgery. Obesity Surg. 2016;26(10):2433-41.

Lundgren T, Louma J, Dahl, J, Strohsal K, Melin L. The bull's-eye values survey: A psychometric evaluation. Cogn Behav Prac. 2012;19(4):518-26.

Francis AW, Dawson DL, Golijani-Moghaddam N. The development and validation of the Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT). J Contextual Behav Sci. 2016;5(3):134-45.

Gifford EV, Kohlenberg BS, Hayes SC, Antonuccio DO, Piasecki MM, Rasmussen-Hall ML, et al. Acceptance-based treatment for smoking cessation. BehavTherap 2004;35:689-705.

Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes. 2009;33:289-95.

Hallal P, Victora C. Reliability and validity of the international physical activity questionnaire (IPAQ). Med Sci Sports Exercise. 2004;36(3):556.

Martinez-Gonzalez MA, Garcia-Arellano A, Toledo E, Salas-Salvado J, Buil-Cosiales P, et al. A 14-Item Mediterranean Diet Assessment Tool and Obesity Indexes among High-Risk Subjects: The PREDIMED Trial. PLoS ONE. 2012;7(8):e43134.

Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): w collaborative project on early detection of persons with harmful alcohol consumption. II. Addiction. 1993;8:791-804.

Van Strien T, Frijters J, Bergers G, Defares PB. The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behaviour. Int J Eating Disord. 1986;5(2):295-315.

Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361-70.

Beecham J, Knapp M. Costing psychiatric interventions. In: Thornicroft G (ed). Measuring Mental Health Needs. 2nd edition. Gaskell, London, UK; 2001: 200-224.

The EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199-208.

Al-Janabi H, Flynn T, Coast J. Development of a self-report measure of capability wellbeing for adults: the ICECAP-A. Quality Life Res. 2012;21:167-76.

Simons JS, Gaher RM. The distress tolerance scale: Development and validation of a self-report measure. Motivat Emot. 2005;29:83-102.

Cardaciotto L, Herbert JD, Forman EM, Moitra E, Farrow V. The assessment of present-moment awareness and acceptance: The Philadelphia mindfulness scale. Assessment. 2008;15:204-23.

Forman EM, Herbert JD, Juarascio AS, Yeomans PD, Zebell JA, Goetter EM, et al. The Drexel defusion scale: A new measure of experiential distancing. J Context Behav Sci. 2012;1:55-65.

Butryn ML, Arigo DR, Raggio GA, Kaufman AI, Kerrigan SG, Forman EM. Measuring the Ability to Tolerate Activity-Related Discomfort: Initial Validation of the Physical Activity Acceptance Questionnaire (PAAQ). J Phys Act Health. 2015;12(5):717-6.

Juarascio A, Forman E, Timko CA, Butryn M, Goodwin C. The development and validation of the food craving acceptance questionnaire. Eating Behaviors. 2011;12:182-7.

Curtis L, Burns A. Unit Costs of Health and Social Care 2018. Personal Social Services Research Unit, University of Kent, Canterbury. 2018.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.

Bradley LE, Forman EM, Kerrigan SG, Goldstein SP, Butryn ML, Thomas JG, et al. Project HELP: A remotely delivered behavioral intervention for weight regain after bariatric surgery. Obesity Surg. 2017;27(3):586-98.

Downloads

Published

2019-10-19