Third‐wave cognitive behaviour therapies for weight management: A systematic review and network meta‐analysis

Abstract

This systematic review and network meta-analysis synthesized evidence on the effects of third-wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity.Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre-intervention and ≥ 3 months postbaseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science).Thirty-seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta-analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random-effects pairwise meta-analysis found moderate-to high-quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post-intervention (standardized mean difference [SMD]: −0.09, 95% confidence interval [CI]: −0.22, 0.04; N = 19; I 2 = 32%), 12 months (SMD: −0.17, 95% CI: −0.36, 0.02; N = 5; I 2 = 33%), and 24 months (SMD: −0.21, 95% CI: −0.42, 0.00; N = 2; I 2 = 0%). Network meta-analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head-to-head trials up to 18 months. Acceptance and commitment therapy (ACT)-based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta-regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long-term follow-up are needed to identify who these interventions work for, their most effective components, and the most cost-effective method of delivery. network meta-analysis, obesity, third-wave behavioural therapy, weight loss 1 | BACKGROUND Although behavioural interventions are effective at helping people to lose weight, many people struggle to sustain effective weight management behaviours over extended periods due to a combination of biological, psychological, social, and environmental factors that drive weight gain. 1,2 Standard behavioural programmes can be effective in the short term, but less so in the longer term. 3-6 These usually combine diet and physical activity advice with core behavioural change techniques including goal setting, self-monitoring, problem solving, and planned social support. 7 It has been proposed that third-wave cognitive behaviour therapies (3wCBT), including acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness-based cognitive behavioural ther- Nazrul Islamhttps://orcid.org/0000-0003-3982-4325

A randomized controlled trial of online acceptance and commitment therapy to improve diet and physical activity among adults who are overweight/obese

“…This is problematic given theorizing that ACT would support long-term behavior change, and this study only used a short term follow up assessment of 8 weeks. Prior studies have found long-term improvements when ACT is delivered in an in-person format [8,10], but long-term effects have not been studied with selfguided ACT. Similarly, psychological inflexibility failed to mediate the effects of ACT on the primary healthy eating outcome due to a non-significant relation between psychological inflexibility and this measure.…”

“…A growing body of research indicates the potential benefits of Acceptance and Commitment Therapy (ACT) [7] for diet, physical activity, and weight loss [8][9][10][11][12]. ACT is a modern cognitive behavior therapy (CBT) that aims to reduce maladaptive behavior regulatory effects of cognition, affect, and other internal experiences (i.e., psychological inflexibility) through acceptance and mindfulness-based methods, while increasing adaptive motivators for behavior through values-based methods [7].…”

“…A key difference between ACT and traditional CBT is its emphasis on changing how individuals respond to internal experiences (i.e., reducing the impact of thoughts and feelings on behavior through acceptance and mindfulness), rather than seeking to directly alter internal experience (i.e., change strategies like cognitive restructuring and emotion regulation). When delivered in-person by a therapist, ACT has been found effective for improving diet, physical activity, weight loss, and quality of life among adults who are overweight/obese in several randomized controlled trials [8][9][10][11][12]. Furthermore, studies indicate that ACT improves these outcomes through reductions in psychological inflexibility [10][11][12].…”

Psychedelics and Health Behavior Change - Journal of Psychopharmacology (in press)

“…Looking forward, the therapeutic container for such work could be the ACE model (Accept, Connect, Embody) which was used to support patients undergoing psilocybin treatment for depression (Watts and Luoma, 2020) and is based on Acceptance and Commitment Therapy or ACT (A-Tjak et al, 2015). In fact, Walsh and Thiessen (2018) have also proposed that psychedelic therapy should incorporate Acceptance and Commitment Therapy, a framework which has also been used for different mental and physical health problems, including obesity (Lawlor et al, 2020) and depression (Bai et al, 2020). Alternatively, as highlighted above,…”

Comparison of the Effects of Cognitive Behavioral Therapy and Behavioral Treatment on Obesity Treatment by Patient Subtypes: A Systematic Review and Meta-analysis

“…We excluded the developed CBT studies such as thirdwave CBT from our CBT criteria. Third-wave CBTs such as mindfulness-based cognitive therapy and dialectical behavioral therapy have recently been used for treating obesity 25,26) ; however, these focus on the processes of acceptance, mindfulness, attention, or value 27) that exceeds the traditional CBT criteria. We excluded studies comparing CBT with no treatment, pharmacological intervention treatment, or surgical treatment.…”