Third, we discuss challenges encountered while developing and implementing the treatment. Finally, we provide concluding remarks on the potential of this approach for improving treatment outcomes for individuals with BE, and discuss future research directions. Fortunately, with the right planning, we can use some of those situational factors to foster the changes we want to make. Many formal weight-loss programs require people to limit their eating to one place, using only certain dishes, to facilitate portion control.
- Notably, BWL interventions typically instruct participants to set low to moderate calorie goals (typically 1,200–1,500 calories per day) and to restrict intake of palatable, high-calorie foods (Brownell, 2000).
- Teasdale et al. suggest that preventive interventions such as cognitive therapy operate by changing the patterns of cognitive processing that become active in states of mild negative affect preceding a full relapse into major depression.
- The patient and therapist agreed on a longer-term goal of a 10% weight loss and discussed that treatment would involve getting her started with skills to work towards her weight loss goal in a healthy and gradual manner.
- She engaged in somewhat regular exercise (approximately 1–2 times per week), but had difficulty consistently maintaining the prescribed amount (3 times per week).
- If your desk is so cluttered you can’t find your bills, never mind creating a budget; spend some time getting organized so that the mess doesn’t become a barrier to managing your finances.
- As participants came up with new statements during the brainstorm session, a portable label printer was used to print new cards for the persons who regained weight.
There is a large literature on self-efficacy and its predictive relation to relapse or the maintenance of abstinence. Results from multilevel models of eating episode type (overeating (OE) vs. non-overeating (non-OE)) predicting affective response presented as estimate (SE). If you want to eat out less, you might need to consider attending some cooking classes to make home meal preparation less daunting. If you haven’t been in a gym in a while, it might help to schedule a session with a trainer.
III.D. Abstinence Violation Effect
She described having a good relationship with her immediate family and having several friends. However, she noted that one barrier was that eating what she perceived as unhealthy foods were a major component of her social interactions. At her baseline assessment in Phase I, she reported 30 binge episodes over the past month. At the conclusion of Phase I, Rachel’s BMI was 28.3 and she reported 1 binge episode over the past month.
Practitioners indicated change in daily structure, stress, maladaptive coping skills, habitual behavior, and lack of self-efficacy regarding weight loss maintenance as most important recurrent (mentioned in all groups) predictors. Persons who regained weight indicated lifestyle imbalance or experiencing a life event, lack of perseverance, negative emotional state, abstinence violation effect, decrease in motivation and indulgence as most important recurrent predictors. At the conclusion of treatment, Rachel was not experiencing binge episodes, and she lost 4 lbs (2.6% of initial body weight) from the start of treatment.
International Journal of Obesity
In addition, time was spent revisiting each participant’s values identified during Phase I (e.g., being a good parent, being an active and engaged member of the community). Treatment aimed to help participants clarify values that supported their commitment to their healthy eating and exercise behaviors (e.g., losing one pound per week in the service abstinence violation effect of working towards a value of living a long, healthy life). Several researchers have attempted to improve weight loss outcomes for BE by integrating CBT and BWL or using sequential treatment designs (e.g., CBT followed by BWL or vice versa; de Zwaan et al., 1992; Grilo et al., 2011; Masheb, Grilo, & Rolls, 2011; Nauta, Hospers, Kok, & Jansen, 2000).
We also gradually introduced physical activity goals, as physical activity has been shown to reduce binge episodes (Moulton, 1996; Pendleton, Goodrick, Poston, Reeves, & Foreyt, 2002) and encourage weight loss (Fossati et al., 2004; McIver, O’Halloran, & McGartland, 2009; Moulton, 1996; Pendleton et al., 2002). The novel treatment approach described in this paper was developed as an extension of a recent study of an ABBT for BED (Juarascio, Manasse, Schumacher, Espel, & Forman, 2016), in which participants completed a novel acceptance-based behavioral treatment for BED (i.e., Phase I; Juarascio et al., 2016). The treatment in Phase I was “weight neutral,” in that treatment was primarily focused on reducing binge eating symptoms and discouraged active weight loss attempts during treatment. Initial work in samples of primarily female adults enrolled in BWLIs has demonstrated that lapses have been followed by feelings of guilt and failure as well as decreasing self-efficacy to lose weight and resist future temptations (Carels et al., 2004; McKee et al., 2014).
Testing judgments about attribution-emotion-action linkages: A life-span approach
Rachel began experiencing a “heightened awareness” of food in her late 20s, which occurred in association with an increase in her weight. She became motivated to lose weight, which led to an increased preoccupation with food (e.g., finishing a meal and already thinking about what she was going to eat next) to an extent that Rachel found excessive. She reported moderate fluctuations in her weight over the past 20 years, with her highest weight being 165 lbs (at age 38) and her lowest weight being 120 lbs (at age 21). She attempted to lose weight approximately 5 years prior to beginning the current treatment in a commercial loss program. She reported successfully losing “some” weight following the program, but regained the weight shortly after she ended the program. The neurotransmitter serotonin has been the focus of considerable research in patients with anorexia nervosa and bulimia nervosa.
Such a framework should not only include predictors that are known from prior models, such as Marlatt’s Relapse Prevention Model, but also predictors that have been newly identified in this study and other recent studies (Kwasnicka, Dombrowski, White, & Sniehotta, 2019; Roordink et al., 2021). For example, in this study self-value and resilience received high importance ratings, but these are not reflected in current models. We believe a theoretical framework based on the latest insights would be of added value to the field of relapse prevention and can inform future weight loss maintenance interventions. Apart from theories, insight into predictors of relapse can be obtained from previous studies; such as the recent literature review by Roordink and colleagues (Roordink et al., 2021) on the predictors of lapse and relapse in physical activity and dietary behavior, based on 37 prospective studies.
In addition, the influence of the social or physical environment is often felt in combination with individual factors (e.g. not being able to cope with the social pressure at a party), which might make environmental factors more distal and therefore harder to recall. This remoteness of environmental factors is also reflected in the so-called fundamental attribution error, which is defined as ‘the tendency for attributors to underestimate the impact of situational factors and to overestimate the role of dispositional factors in controlling behavior’ (Ross, 1977). Participants’ greater focus on individual factors could furthermore be stimulated by the current stigma surrounding overweight and obese individuals and the notion that they are to blame for their weight (Puhl & Heuer, 2010).
- “This is important because getting stuck in self-defeating thoughts (i.e. what I did ‘wrong’) gets in the way of progress and growth,” Grupski says.
- To evaluate preliminary effectiveness of the treatment to produce initial weight loss, therapists assessed body weight and height at the intake session using a research-grade Seca calibrated scale with measuring rod to calculate BMI.
- The abstinence violation effect (AVE) highlights the distinction between a lapse and relapse.
- 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.
However, if one lacks skills, then the model predicts a decrease in self-efficacy and an increase in positive outcome expectancies for the effects of using the substance. This is a likely predecessor of giving into temptation in the initial use of a substance. Julie reported that her BE episodes occurred in social settings as well as when she was alone. She described experiencing significant distress before and after the binges and that the binges were often triggered by “bottled-up” stress, access to food, or hunger due to long periods of time between eating. (a) When restrained eaters’ diets were broken by consumption of a high-calorie milkshake preload, they subsequently show disinhibited eating (e.g. increased grams of ice-cream consumed) compared to control subjects and restrained eaters who did not drink the milkshake (figure based on data from ). (b) Restrained eaters whose diets were broken by a milkshake preload showed increased activity in the nucleus accumbens (NAcc) compared to restrained eaters who did not consume the preload and satiated non-dieters .
Abstinence violation effect: Validation of an attributional construct with smoking cessation
A verbal or written contract will increase the chance that gamblers will recontact at an appropriate stage and therefore minimise the likelihood of a full blown relapse. To understand relapse in this disorder, we highlight cognitive processes underlying the binge/purge cycle. Links are drawn between cognitions, causal perceptions, and the binge/purge cycle in a reformulation of the abstinence violation effect with a special focus on attributions. This reformulation is then applied to the lapse-relapse transition in bulimia nervosa.
Since this weight gain, Anna reported one successful weight loss attempt through a commercial weight-loss program, during which time she lost approximately 35 lbs. Anna reported that since that time, she gradually regained back to her current weight (approximately 144 lbs), and that she had remained relatively stable at this weight for several years. Anna had also attempted weight loss through calorie and fitness tracking on her phone, though these attempts had not lasted long. Recent studies have also explored whether abnormalities in metabolic signals related to energy metabolism contribute to symptoms in the eating disorders. Several studies have suggested that patients with bulimia nervosa may have a lower rate of energy utilization (measured as resting metabolic rate) than healthy individuals.