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A Contextual Behavioral Approach for Obesity Surgery Patients
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis investigates a contextual behavioral approach for obesity surgery patients. In a contextual approach a behavior is interpreted as inseparable from its current and historical context. Candidates for bariatric surgery often have a history of self-stigma, body dissatisfaction and eating for emotional relief. Despite losing a large amount of weight post surgery, psychological problems may still be present for some patients. One possible common underlying process observed in body concerns and eating patterns is experiential avoidance. Experiential avoidance is defined as; any attempt to avoid, change, or control unwanted thoughts and feelings when so doing causes harm.

Though a multidisciplinary team is recommended for post-surgical care, there are few studies evaluating the psychological treatment of patients undergoing bariatric surgery. In this thesis a protocol based on Acceptance and Commitment Therapy (ACT), was developed and implemented, partly via the Internet, in a clinical setting. In an acceptance-based approach to obesity, psychological well-being is the main outcome. ACT was significantly more effective than ‘treatment as usual’ in terms of body dissatisfaction and quality of life after surgery. Both groups improved in eating disordered attitudes and behaviors. Predictions based on the underlying treatment model were also investigated. Positive treatment outcomes were found to be associated with increased psychological flexibility.  Despite some methodological limitations, the results are promising and future studies should further evaluate ACT in the context of bariatric surgery.

This thesis also acknowledges the need for clinical assessment tools appropriate for the bariatric surgery context. The Acceptance and Action Questionnaire for Weight (AAQ-W) is a measure of experiential avoidance, and was evaluated in the present thesis. The AAQ-W was found to be a reliable and valid measure for people undergoing bariatric surgery. Another measure, Disordered Eating in Bariatric Surgery (DEBS) was developed and evaluated. The DEBS was found to posses satisfactory psychometric properties in terms of reliability and validity.  The AAQ-W and the DEBS may facilitate both systematic clinical evaluation and future research within the area of bariatric surgery.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , 103 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 84
Keyword [en]
obesity, bariatric surgery, stigma, emotional eating, body dissatisfaction, Acceptance and Commitment therapy, Internet
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:uu:diva-183622ISBN: 978-91-554-8524-5 (print)OAI: oai:DiVA.org:uu-183622DiVA: diva2:563626
Public defence
2012-12-14, Universitetshuset sal IV, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-11-23 Created: 2012-10-30 Last updated: 2013-02-11Bibliographically approved
List of papers
1. Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT
Open this publication in new window or tab >>Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT
2012 (English)In: Obesity Research and Clinical Practice, ISSN 1871-403X, Vol. 6, no 1, e21-e30 p.Article in journal (Refereed) Published
Abstract [en]

Bariatric surgery (BS) is rated as the best evidence based treatment for obesity with regard to weight loss and maintenance of weight loss evaluated to date. Although BS interventions are effective, 20-30% of BS patients start to regain weight within 24 months. Emotional eating is a behavior pattern which has been found to predict poor outcome. The aim of this study is to evaluate the effects of acceptance and commitment therapy (ACT) for patients who underwent BS, with regard to emotional eating, body dissatisfaction and quality of life. This study is a randomized controlled trial (n = 39) with two conditions (1) ACT including two face-to-face sessions and support via an Internet application and (2) treatment as usual (TAU) comprising the standard follow-up used by the BS team. Results show that participants in the ACT condition significantly improve on eating disordered behaviors, body dissatisfaction, quality of life and acceptance for weight related thoughts and feelings, as compared to those in the TAU group. This study shows that it is possible to improve effects of BS by specifically targeting emotional eating behavior.

Keyword
Obesity, Bariatric surgery, Acceptance and commitment therapy, Internet application, Eating behavior
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-141358 (URN)10.1016/j.orcp.2011.04.004 (DOI)000306956900003 ()
Available from: 2011-01-11 Created: 2011-01-11 Last updated: 2012-12-03Bibliographically approved
2. Psychological flexibility and the gains of acceptance-based treatment for post-bariatric surgery: six-month follow-up and a test of the underlying model
Open this publication in new window or tab >>Psychological flexibility and the gains of acceptance-based treatment for post-bariatric surgery: six-month follow-up and a test of the underlying model
2012 (English)In: Clinical Obesity, ISSN 1758-8103, E-ISSN 1758-8111, Vol. 2, no 1-2, 15-24 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Blackwell Publishing Ltd, 2012
Keyword
Acceptance and commitment therapy, bariatric surgery, body dissatisfaction, eating behaviour
National Category
Social Sciences
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-183022 (URN)10.1111/j.1758-8111.2012.00041.x (DOI)
Available from: 2012-10-21 Created: 2012-10-21 Last updated: 2017-12-07Bibliographically approved
3. Measuring experiential avoidance in a bariatric surgery population: Psychometric properties of AAQ-W
Open this publication in new window or tab >>Measuring experiential avoidance in a bariatric surgery population: Psychometric properties of AAQ-W
2013 (English)In: Obesity Research and Clinical Practice, ISSN 1871-403X, E-ISSN 1878-0318, Vol. 7, no 6, E464-E475 p.Article in journal (Refereed) Published
Abstract [en]

Background: Valid measures capturing underlying psychological processes post surgery for obesity are needed to help identify important clinical targets and develop psychosocial interventions in conjunction with surgery. The Acceptance and Action Questionnaire for Weight (AAQ-W) measures experiential avoidance and has never been evaluated in a bariatric surgery population. Method: Participants were recruited at a bariatric surgery clinic during follow-up care. The evaluation of psychometric properties of AAQ-W was done by repeated measurements of reliability (n = 62), convergent validity (n = 75 and n = 178), predictive validity (n = 61), factor analysis and calculation of internal consistency (n = 178). Results: The AAQ-W was found to have satisfactory psychometric properties. Internal consistency was high (alpha = .86). Results showed good stability over time (r = .77) and validity coefficients ranging from r = .36 to .71. AAQ-W scores measured six months post surgery predicted satisfaction with life, negative emotional states, emotional eating and general eating pathology measured one year post surgery. However AAQ-W measured at six months did not predict percent excess BMI Loss at one year. Factor analysis showed that a five factor solution (Food as Control, Body Acceptance, Self-Stigma, Self-Efficacy and Emotional Avoidance) might be a good fit (n = 178). Conclusion: This study shows that the AAQ-W appears to be a psychometrically sound measure that can be used by researchers and clinicians in the context of bariatric surgery.

Keyword
Bariatric surgery, Experiential avoidance, Acceptance and Action Questionnaire for Weight (AAQ-W), Validity, Reliability, Factor analysis
National Category
Social Sciences
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-183023 (URN)10.1016/j.orcp.2012.06.002 (DOI)000328081200007 ()
Available from: 2012-10-21 Created: 2012-10-21 Last updated: 2017-12-07Bibliographically approved
4. Screening for Disordered Eating following Obesity Surgery: Psychometric properties of the Disordered Eating in Bariatric Surgery (DEBS)
Open this publication in new window or tab >>Screening for Disordered Eating following Obesity Surgery: Psychometric properties of the Disordered Eating in Bariatric Surgery (DEBS)
2012 (English)Article in journal (Refereed) Submitted
National Category
Social Sciences
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-183025 (URN)
Available from: 2012-10-21 Created: 2012-10-21 Last updated: 2013-09-09Bibliographically approved

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