Stephanie G. Kerrigan

Mindfulness and its relationship with eating disorders symptomatology in women receiving residential treatment

OBJECTIVE Mindfulness and its related constructs (e.g., awareness and acceptance) are increasingly being recognized as relevant to understanding eating disorders and improving treatment. The purpose of this study was to (1) examine the relationship between mindfulness and ED symptomatology at baseline and (2) examine how changes in mindfulness relate to change in ED symptomatology. METHOD Measures of mindfulness and ED symptomatology were administered to 88 patients upon admission to residential ED treatment and at discharge. RESULTS Baseline ED symptomatology was associated with lower awareness, acceptance, and cognitive defusion, and higher emotional avoidance. Improvements in these variables were related to improvement in ED symptomatology. DISCUSSION Interventions targeting mindfulness could be beneficial for patients with EDs.

Could training executive function improve treatment outcomes for eating disorders

Current gold standard treatments for eating disorders (EDs) lack satisfactory efficacy, and traditional psychological treatments do not directly address executive functioning deficits underpinning ED pathology. The goal of this paper is to explore the potential for enhancing ED treatment outcomes by improving executive functioning deficits that have been demonstrated to underlie eating pathology. To achieve our objective, we (1) review existing evidence for executive functioning deficits that underpin EDs and consider the extent to which these deficits could be targeted in neurocognitive training programs, (2) present the evidence for the one ED neurocognitive training program well-studied to date (Cognitive Remediation Therapy), (3) discuss the utility of neurocognitive training programs that have been developed for other psychiatric disorders with similar deficits, and (4) provide suggestions for the future development and research of neurocognitive training programs for EDs. Despite the fact that the body of empirical work on neurocognitive training programs for eating disorders is very small, we conclude that their potential is high given the combined evidence for the role of deficits in executive functioning in EDs, the initial promise of Cognitive Remediation Training, and the success in treating related conditions with neurocognitive training. Based on the evidence to date, it appears that the development and empirical evaluation of neurocognitive training programs for EDs is warranted.

Measuring the Ability to Tolerate Activity-Related Discomfort: Initial Validation of the Physical Activity Acceptance Questionnaire (PAAQ).

BACKGROUND Physical activity (PA) is essential for health, but many adults find PA adherence challenging. Acceptance of discomfort related to PA may influence an individuals ability to begin and sustain a program of exercise. The aim of this study was to evaluate the psychometric properties of the Physical Activity Acceptance Questionnaire (PAAQ). METHODS The PAAQ was administered to 3 distinct samples (N = 418). Each sample completed additional self-report measures; 1 sample also wore accelerometers for 7 days (at baseline and 6 months later). RESULTS The PAAQ demonstrated high internal validity for its total score (α = .89) and 2 subscales (Cognitive Acceptance α = .86, Behavioral Commitment α = .85). The PAAQ also showed convergent validity with measures of mindfulness, self-reported physical activity levels, and accelerometer-verified levels of moderate-to-vigorous PA (MVPA; P-values < .05). The Cognitive Acceptance subscale showed predictive validity for objectively-verified PA levels among individuals attempting to increase PA over 6 months (P = .05). Test-retest reliability for a subset of participants (n = 46) demonstrated high consistency over 1 week (P < .0001). CONCLUSIONS The PAAQ demonstrates sound psychometric properties, and shows promise for improving the current understanding of PA facilitators and barriers among adults.

A Survey of Bariatric Surgery Patients’ Interest in Postoperative Interventions

BackgroundA substantial minority of bariatric surgery patients display clinically significant weight regain and recurrence of obesity-related comorbidities. Although postoperative follow-up and behavioral interventions are associated with better weight loss outcomes, many patients fail to attend or receive these services. More information is needed to better target and increase the probability of sustained treatment in those patients experiencing postoperative weight regain. The purpose of this study was to understand the challenges that patients perceive themselves to be facing and assess their receptivity and preferences for postoperative interventions.MethodsA survey developed by the authors was sent to patients who received bariatric surgery from a program based in an academic medical center between September 2008 and December 2010 (n = 751).ResultsData from 154 responders indicate that the vast majority of individuals who have undergone bariatric surgery are satisfied with surgery and their weight losses; however, most reported being on a trajectory of weight regain. Patients endorsed concerns about both current eating behavior and, additional, future weight regain. In addition, these patients expressed strong interest in participating in postoperative programs aimed at stopping and reversing regain.ConclusionsThe results provide novel information about bariatric surgery patients’ receptivity to and preferences for interventions after bariatric surgery.

From last supper to self-initiated weight loss: Pretreatment weight change may be more important than previously thought.

Evaluate the association between pretreatment and during‐treatment weight change, as well as differences in self‐regulation between those who gain weight, remain weight stable, and lose weight pretreatment.

Pilot Test of an Acceptance-Based Behavioral Intervention to Promote Physical Activity During Weight Loss Maintenance

ABSTRACT Behavioral interventions for obesity reliably facilitate short-term weight loss, but weight regain is normative. A high level of aerobic exercise may promote weight loss maintenance. However, adopting and maintaining a high level of exercise is challenging, and experiential acceptance may be important. The aim of this study was to pilot test the feasibility and efficacy of an acceptance-based behavioral treatment to promote moderate-to-vigorous physical activity (MVPA) among individuals who had recently lost weight. Adults (n = 16) who had recently lost ≥ 5% of weight were provided with a 12-week, group-based treatment. At 12 weeks, complete analyses indicated that participants had increased activity 69% (completing an average of 198.27 minutes/week of bouted MVPA, i.e., episodes of at least 10 minutes in duration). Medium-to-large effect sizes were observed for changes in process measures, including experiential acceptance. Future research to test this approach using an experimental design, a larger sample, and a longer period of observation is warranted.

A pilot study of an acceptance-based behavioral treatment for binge eating disorder

While existing treatments produce remission in a relatively large percentage of individuals with binge eating disorder (BED), room for improvement remains. Interventions designed to increase emotion regulation skills and clarify ones chosen values may be well-suited to address factors known to maintain BED. The current study examined the preliminary efficacy of a group-based treatment, Acceptance-based Behavioral Therapy (ABBT), in a small open trial (n=19), as well as the relationship between changes in hypothesized mechanisms of action and outcomes. ABBT includes the behavioral components of cognitive behavioral treatment for BED and emotion-focused strategies from acceptance and commitment therapy and dialectical behavioral therapy. Results from generalized linear multilevel modeling revealed significant fixed linear effects of time on depression, quality of life, global eating pathology, and binge frequency (all ps < .05). Global eating disorder symptoms appeared to improve rapidly from pre- to mid-treatment, and continued to improve toward post-treatment and follow-up, but at a slower rate. Binge frequency decreased rapidly from pre- to mid-treatment, followed by a slight increase at post-treatment and a reduction again by follow-up. Improvements in experiential acceptance were strongly and consistently related to decreases in overall eating pathology across several measures (rs = .35-.54). Additionally, greater access to emotion regulation strategies was strongly related to decreases in overall eating pathology (r= .67). Preliminary results support the efficacy of this novel treatment approach and indicate that additional research on ABBT for BED is warranted.

Associations between change in sedentary behavior and outcome in standard behavioral weight loss treatment

Sedentary behavior, particularly in prolonged periods, is an important determinant of health. Little research exploring changes in sedentary behavior during behavioral weight loss programs exists. This study evaluated the magnitude of changes in total and prolonged sedentary behavior and how these changes related to changes in weight and cardiovascular outcomes during a behavioral weight loss program. Participants (n = 450) in two lifestyle modification programs underwent assessments of sedentary behavior (by accelerometry), weight, waist circumference, blood pressure, and resting heart rate at baseline and after 6 months of treatment. Sedentary behavior was defined as both total and prolonged (≥30 continuous minutes) sedentary minutes/day. Reductions in total and prolonged sedentary time were significant and were accounted for by increases in moderate-to-vigorous physical activity (MVPA). Only changes in MVPA significantly predicted change in weight when entered into a model simultaneously with changes in sedentary behavior. Changes in total and prolonged sedentary time were not associated with changes in waist circumference, heart rate, or blood pressure. Change in sedentary time was not independently associated with change in health outcomes during a behavioral weight loss treatment. High variability in changes in sedentary time indicate that individual differences may be important to examine. Reducing sedentary time may not be powerful enough to impact these health outcomes above the effects of other changes made during these programs; alternatively, it may be that increasing focus in treatment on reducing sedentary time may engender greater decreases in sedentariness, which could lead to better health outcomes.

Time to Peak Weight Loss During Extended Behavioral Treatment: Peak Weight Loss

This study was designed to examine the variability in timing of peak weight loss in behavioral treatment (BT), that is, when treatment participants reach their greatest amount of cumulative weight loss.

The association between previous success with weight loss through dietary change and success in a lifestyle modification program

Prior work has yielded mixed results regarding the association between previous weight loss and success in a current weight loss attempt. The present study evaluated differences in baseline psychosocial processes, changes in these over time, and weight loss during a yearlong behavioral weight loss program between individuals who have and have not previously been successful losing weight through self-regulating dietary intake. Individuals with prior success had greater weight losses over time than those without. Differences in baseline and change over time in some facets of motivation and self-efficacy were observed, but only differences in attendance accounted for differential weight loss. Prior success with dietary self-regulation may predict better adherence to and success in behavioral weight control programs. Evaluating the type of weight control efforts that have previously helped induce weight losses may help to better match individuals to treatments likely to yield success.