As treatment continued, additional strategies for coping with negative affect and cravings for food were reviewed, and Anna found these to be helpful in moderating her intake as well. Binge eating (BE; i.e., the consumption of a large amount of food in a discrete time period, accompanied by a sense of loss of control) is highly comorbid with overweight or obesity and is the primary symptom of binge eating disorder (BED). Current gold-standard treatment for BED (i.e., CBT) does not produce meaningful weight loss, thus failing to address a critical treatment target. This article describes the development of a novel acceptance-based behavioral treatment (ABBT) for individuals with clinically significant BE desiring to reduce BE symptoms and achieve concurrent weight loss. We discuss the development and structure of the novel treatment approach, and describe the test of a proof of concept version of the treatment in a clinical case series of four individuals. In the context of each clinical case description, we present initial acceptability of the treatment and challenges faced in treatment development and delivery.
- By weighing yourself regularly (WW encourages weekly weigh-ins instead of daily) you’ll become more in tune with your body and normalize day-to-day ups and downs.
- “Friction is anything that makes a behavior less likely to happen (you’re tired, you are surrounded by tempting foods, the behavior requires a lot of complicated steps),” Grupski says.
- At the end of each session, the therapist assigned homework to promote practice of the skills outside of session.
- This weight gain is often exacerbated by continued, or reemergent, binge eating (Grilo et al., 2011).
- One is to assume they should punish themselves for failure rather than rewarding success.
It sounds serious, but if you’re trying to lose weight, there’s a good chance you’re familiar with this concept — which is the name for feeling like you’ve failed when you don’t follow your plan perfectly, and then just giving up entirely. And don’t forget to cheer on your friends who are reaching their goals (like you can do via the WW Connect app) as well. “When we see people who we can relate to succeed, it increases our belief that we can, too,” Grupski says. “WW leverages the power of community and member-to-member connections, providing members with opportunities to learn from and be inspired by one another’s successes along the way.”
The abstinence violation effect in bulimia nervosa
For example, the patient integrated social components into her exercise routine, such as exercising with a friend, to increase both accountability and enjoyment. At the beginning of Phase I of treatment, Julie had a BMI of 42.60 kg/m2 and reported an objective binge episode frequency of 12. At the end of Phase I, Julie had a BMI of 41.49 kg/m2 and reported 0 objective binge episodes over the past month. Sessions 1–2 involved beginning to learn to monitor calories without abstinence violation effect making dietary changes, and in Session 3, a calorie goal of 1,300 calories was set, which was 100 calories fewer than Rachel’s daily average consumption. By Session 5, Rachel had improved her calorie monitoring skills and realized that she was consuming more calories than she initially believed. It was thus collectively decided that a 1,300 calorie/day goal was too low compared to her current consumption, and her goal was adjusted upwards to 1,400 calories/day.
Therefore, to avoid delivering conflicting components of the treatments, we chose to exclude cognitive restructuring components in this treatment. Instead, we incorporated an acceptance-based approach to cognitive symptoms, while integrating only the behavioral components of CBT and BWL treatments. As we developed the treatment approach, conflicting strategies from the BE, behavioral weight loss, and acceptance-based treatments had to be integrated into one coherent framework.
4. Affective responses predicting weight loss
Given that Rachel’s BMI was in the overweight but not obese range (28.4 kg/m2), it was decided that a BMI of less than 25 could be an appropriate long-term goal to work towards, and the program was framed as a way to progress towards her weight loss goal in a healthy and gradual manner. Rachel reported that her primary reason for participating in Phase II was to work on sustaining healthy behavior and to develop specific behaviors and tools that would allow her to maintain healthy eating patterns and lose weight. Rachel reported depressive symptoms including sleeping approximately 2–3 hours more than normal, de- creased interest in activities she typically enjoyed, and feeling less energetic than usual. She also reported the presence of family stressors in the past month, which had caused her to feel more sad and anxious than normal. She described herself as a generally anxious person and often feeling concerned about her performance (e.g., at work) and not doing enough to help others.
We assessed BMI because it is a useful and easily obtained measure of obesity, a good estimate of body fat and gauge of medical risk, and can be used in all adults regardless of sex (NHLBI, 1998). Although several effective treatments exist for reducing BE (described in further detail below), facilitating clinically significant weight loss in individuals with BE pathology remains a challenge (Wilson, Wilfley, Agras, & Bryson, 2010). Overall, weight loss in individuals with BE is particularly challenging, and effective weight loss treatment options are lacking for these individuals.
Behavioral, psychological, and environmental predictors of obesity and success at weight reduction
As a result, further exposures included more specific parameters and sessions also focused on problem-solving barriers to completing exposures. Julie expressed a desire to lose weight but also to become more consistent in “healthy eating.” Specifically, she hoped to reduce her BE and improve her ability to return to a regular diet after an episode of loss-of-control eating or a period of weight gain. Given her history of repeated weight-loss attempts, Julie identified a more generalized goal of overall change in diet and caloric intake.
- Although several effective treatments exist for reducing BE (described in further detail below), facilitating clinically significant weight loss in individuals with BE pathology remains a challenge (Wilson, Wilfley, Agras, & Bryson, 2010).
- First, we describe the central elements of the ABBT treatment, which integrated treatment components from an ABBT weight control intervention incorporating both standard BWL and acceptance-based treatments components (Forman et al., 2013) and was tailored to meet the unique treatment needs of individuals susceptible to BE.
- She reflected that the program had helped her develop more flexibility in her attitude towards food (e.g., not feeling distressed about going over her calorie goal one day as long as her weekly average was on target).
- The frequency and size of her self-reported binge episodes indicated that she met criteria for BED.
- Finally, we provide concluding remarks on the potential of this approach for improving treatment outcomes for individuals with BE, and discuss future research directions.
She denied engaging in any compensatory behavior (i.e., vomiting, laxative use, compulsive exercise). Upon initiating treatment, Rachel ate regular meals, and did not often skip meals or engage in strict dietary restriction. Rachel did not engage in regular structured exercise, but she walked to and from work each weekday (approximately 30 minutes of walking in total). During Session 1, Anna’s current symptoms, history, and background information were collected, and Anna identified initial goals for treatment (see Table 1 for a description of session-by-session treatment content).