Preliminary Results from the ACTyourCHANGE in Teens Protocol: A Randomized Controlled Trial Evaluating Acceptance and Commitment Therapy for Adolescents with Obesity

Acceptance and Commitment Therapy for Obesity

PURPOSE OF REVIEW

To describe the recent literature on acceptance and commitment therapy (ACT) interventions for individuals with obesity. The review begins with a brief overview of the ACT model, describes seminal work in this area, and examines more recent literature on the use of ACT to improve outcomes among individuals with obesity.

RECENT FINDINGS

Early trials established ACT's efficacy for weight loss among adults with obesity. More recent research has focused on testing efficacy among adolescents, measuring effects in "real world" settings, refining interventions to optimize outcomes and enhance scalability, and examining outcomes beyond weight (e.g., internalized weight stigma, eating regulation). Current data indicate that ACT-based interventions produce comparable, or, in some cases, superior weight loss compared to standard behavioral interventions. ACT has also shown promise for improving other outcomes of interest. ACT may improve a variety of obesity-related outcomes, although additional research is needed.

Systematic Literature Review of the Impact of Islamic Psychotherapy on Adolescent Spiritual Well-Being

Islamic psychotherapy has been widely utilized in various fields, particularly in psychology, focusing on aspects of aqidah, worship, and morality, which can significantly contribute to individuals' spiritual well-being. Despite the abundance of studies on Islamic psychotherapy, systematic literature reviews on this topic remain scarce. This article aims to review the literature on the impact of Islamic psychotherapy on adolescent spiritual well-being. A qualitative research methodology was employed, involving the collection of documentary data from past studies and the inductive analysis of findings. This systematic literature review (SLR) was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles and related resources were identified through three primary databases: Scopus, Web of Science, and Google Scholar. The thematic analysis revealed three main themes: mental health, therapeutic approaches and interventions, and well-being. The findings indicate that mental health significantly influences both psychological and physical health issues, necessitating appropriate therapeutic interventions to enhance adolescents' spiritual well-being. This review emphasizes the importance of Islamic psychotherapy in addressing mental health challenges among Muslim  adolescents. Future researchers are encouraged to conduct more comprehensive SLRs with broader scopes, including more significant research questions and diverse databases.

Systematic review and meta-analysis of the effect of psychological interventions on anxiety in children and youth with chronic medical conditions

OBJECTIVES

Anxiety disorders affect 20%-50% of youth with chronic medical conditions (CMCs) and can interfere with medical care and treatment outcomes. Psychological therapies are typically designed for youth without CMCs; thus, this systematic review (Open Science Framework preregistration osf.io/a52nd/) assesses the effect of psychological therapies on anxiety, functional impairment and health-related quality of life (HRQOL) in this unique population.

METHODS

We included randomized controlled trials of psychological therapies vs. any comparator for youth (ages 24 and younger) with CMCs that assessed child anxiety. We excluded studies of adults and those not in English. Medline, Embase, PsycInfo, and CENTRAL databases were searched, studies were screened using COVIDENCE software, and meta-analysis was undertaken in R. Study quality was assessed using the Cochrane Risk of Bias tool, version 2. Quality of evidence was assessed using the GRADE system.

RESULTS

Thirty-three studies with 2676 participants (ages 5-21 years) were included in the meta-analysis. Nearly all had at least some risk of bias. Overall, psychological interventions resulted in lower anxiety (Hedges' g = -0.48 [-0.71; -0.25]), but did not have a significant effect on functional impairment or HRQOL. Based on the GRADE criteria, we have moderate confidence in these results. Treatments with higher risk of bias and those with live therapist components had greater effects on anxiety.

CONCLUSIONS

Psychological interventions may be effective for improving anxiety for children and youth with CMCs, particularly those with a live therapist. More high-quality studies are needed to understand what components produce the best outcomes for patients.

Depression and emotional eating in children and adolescents: A systematic review and meta-analysis

Major Depressive Disorder in youth is associated with obesity and adult cardiovascular disease (CVD) risk. Eating in response to emotions (emotional eating) is a potential contributing factor to this association. Although emotional eating is associated with Major Depressive Disorder in adults, findings in children and adolescents are mixed. This systematic review and meta-analysis aims to determine the association between depression and emotional eating in children and adolescents. Systematic searches were conducted in seven databases. Studies were included if the study population had a mean age of ≤18 years and assessed both depression and emotional eating using validated measures. The search generated 12,241 unique studies, of which 37 met inclusion criteria. Random-effects meta-analyses of study outcomes were performed. Thirty-seven studies (26,026 participants; mean age = 12.4 years, SD = 3.1) were included. The mean effect size was significant for both cross-sectional and longitudinal data (Hedges' g = 0.48, p < 0.0001; g = 0.37, p = 0.002, respectively), revealing a positive moderately strong association between depressive symptoms and emotional eating in youth. Among longitudinal studies, the association was stronger when depressive symptoms and emotional eating were assessed using child and adolescent self-report versus parent-report. No studies examined youth with a clinical diagnosis of depression. Meta-analyses revealed that depressive symptoms and emotional eating are positively associated in children and adolescents. However, further research in clinical samples is needed. Results raise the possibility for the importance of emotional eating in the link between depression and early CVD risk, though further examination is required to determine whether emotional eating is a potential treatment target to decrease CVD risk among adolescents with increased depression symptoms.

Acceptance and commitment coaching for music performance anxiety in adolescent singers

Introduction

Most of the anxiety disorders, particularly social anxiety, seem to develop either during childhood or adolescence. Adolescent singers who experience physical, mental and emotional changes along with voice change are particularly prone to the development of MPA. However, adolescence also seems to be an opportune time to instil healthy behaviours in singing students as they are more likely to remember these coping strategies, owing to the release of dopamine and the 'reminiscence bump'. As this period of a singer's life is wrought with inevitable anxiety development, the additional aim of the study was to develop a coaching framework which can be used by singing teachers in their practice. Mindset training for adolescents seems crucial to help them continue singing through puberty so they do not drop out of singing lessons or choir during voice change and identity development.

Methods

The study aimed to determine if Acceptance and Commitment coaching could be used with adolescent singers with MPA and to record and analyse rich qualitative data in the form of semi-structured participant interviews and questionnaires.

Results

When their perception of MPA symptoms and physiological and psychological arousal before a performance changed, their behaviour and reactions changed accordingly. The change took place over a period of time, which was characterised by discoveries about themselves, confusion in understanding new concepts and letting go of old habits. Interestingly, by the end of the coaching sessions, their preoccupation with pleasing the audience and appearing perfect on stage was replaced by a new-found delight in pursuing values and goals related to their singing. Along with this came the acceptance of themselves and others as individuals with the potential for growth and change and the capacity to learn from mistakes.

Discussion

This study marks the first investigation into the effectiveness of using of ACC as an intervention for MPA in adolescent singers undergoing puberty by a singing teacher. The results are promising and suggest that ACC is an effective MPA intervention for adolescent singers to cope with inevitable development-related anxieties and keep them engaged in the activity of singing during their pubertal years.

Indicated Stress Prevention Addressing Adolescents with High Stress Levels Based on Principles of Acceptance and Commitment Therapy: A Randomized Controlled Trial

INTRODUCTION

Stress affects many adolescents and is associated with physical and mental health symptoms that can have a negative impact on normative development. However, there are very few evidence-based, specific treatment approaches. The aim of the study was to investigate an eight-session group intervention using components of Acceptance and Commitment Therapy (ACT) enriched with elements of CBT (psychoeducation, problem solving) and art therapy, compared to a waitlist control (WLC) group, regarding its efficacy in reducing stress and associated symptoms.

METHODS

We conducted a randomized controlled trial in eight cohorts. Eligible participants were 13-18 years old with elevated stress levels. Via block-randomization (n = 70), participants were allocated to receive ACT (n = 38) or WLC (n = 32) and subsequent ACT. We used a multimodal assessment (self-reports, interviews, ecological momentary assessment, physiological markers) before treatment (T1), after the training of the ACT group (T2) and after subsequent training in the WLC group (T3). Primary outcome was perceived stress at T2 assessed with the Perceived Stress Scale. The trial was preregistered at the German Clinical Trials Register (ID: DRKS00012778).

RESULTS

Results showed significantly lower levels of perceived stress in the ACT group at T2, illustrating superiority of ACT compared to WLC with a medium to large effect size (d = 0.77). Furthermore, the training was effective in the reduction of symptoms of school burnout and physical symptoms associated with stress.

CONCLUSION

Indicated prevention, especially when based on the principles of ACT and CBT, seems efficient in significantly decreasing stress in adolescents with increased stress.

Integrating COM-B and the person-based approach to develop an ACT based therapy programme to raise self-determination in adolescents with obesity

BACKGROUND

This paper details the development of the Adolescent Intrinsic Motivation 'AIM2Change' intervention to support weight-management in young people previously unable to make changes whilst attending a tier 3 weight management service for children and young people. AIM2Change is an acceptance and commitment therapy based intervention that will be delivered one-to-one online over a seven-week period.

METHODS

To develop this intervention, we have triangulated results from a qualitative research study, patient and public involvement groups (PPI) and a COM-B (capability, opportunity, motivation, behaviour) analysis, in a method informed by the person-based approach.

RESULTS

The integrated development approach yielded a broad range of perspectives and facilitated the creation of a tailored intervention to meet the needs of the patient group whist remaining pragmatic and deliverable.

CONCLUSIONS

The next steps for this intervention will be in-depth co-development of the therapy sessions with service users, before implementing a proof of concept trial.

The impact of psychological distress on weight regain in post-bariatric patients during the COVID-19 pandemic: A latent profile analysis

OBJECTIVE

The COVID-19 pandemic has caused a global health crisis disrupting healthcare delivery for people with severe obesity who have undergone bariatric surgery. This study examined the role of psychological distress during the first Italian COVID-19 lockdown in predicting post-operative outcomes in post-bariatric patients reaching the end of the 12-18 months follow-up during the lockdown. By using a person-centered approach, groups of patients with different psychological distress profiles were identified. We hypothesized that compared to post-bariatric patients with low psychological distress, post-bariatric patients with high psychological distress will be more at risk of weight regain.

METHODS

A total of 67 patients (71.6% female, M_age = 45.9) participated in this observational retrospective cohort study. Patients' anthropometric data were gathered from medical records while the weight at the end of the lockdown through phone interviews. Psychological distress, operationalized with anxiety symptoms, depressive symptoms, and sleep disturbances, was assessed by an online self-report questionnaire.

RESULTS

Significant differences were highlighted in the high and low psychological distressed group in weight changes, F(1,58) = 5.2, p < 0.001, η² = 0.3. Specifically, compared to post-bariatric patients in the low psychological distress group, those in the high psychological distressed group reported weight regained (95% CI = 1.0, 2.6).

CONCLUSION

Results highlight the need to target post-bariatric patients with high psychological distress who are at risk for weight regain during the COVID-19 pandemic. Interventions mitigating psychological distress and obesogenic behaviors during future pandemics or in post-COVID times are needed in vulnerable post-bariatric patients reporting high psychological distress.

Cognitive Fusion and Emotional Eating among Adolescents with Obesity: A Preliminary Cross-Sectional Study

Cognitive fusion and avoidance are supposed to exert a key role in the development and maintenance of disordered eating behaviors related to obesity, such as emotional eating. A large portion of the research has focused on adult populations, while few data are available on adolescents so far. The current cross-sectional study is intended to explore the association between cognitive fusion, avoidance, and emotional eating in a sample of fifty-six Italian adolescents (13-17 years) with obesity (body mass index > 97th centile). For this purpose, participants attending a 3-week body weight reduction program were assessed using demographical, physical, and clinical data. A multivariate linear regression model was performed in order to preliminarily investigate the predictive role of cognitive fusion on emotional eating, controlling for possible confounding factors. Results showed a significant association between cognitive fusion and emotional eating. Regression revealed that cognitive fusion was a significant contributor for explaining emotional eating (controlling for sex) [R² = 0.551; Adjusted R² = 0.534; F(2,53) = 32.5; p < 0.001]. Even if preliminary, our findings suggest a predictive role of cognitive fusion on emotional eating, and also suggest that cognitive fusion can be considered a key component in understanding and addressing of disordered eating behaviors related to obesity. Future replications are required to expand the sample and collect longitudinal data. Intervention programs for childhood obesity could benefit from this line of research.