Abstract
To explore what thoughts, feelings, and learning processes were involved in obese participants' lifestyle change during an acceptance and commitment therapy (ACT) lifestyle intervention delivered in primary health care. Previous studies have revealed that lifestyle interventions are effective at promoting initial weight loss, but reduced weight is often difficult to sustain because of the failure to maintain healthy lifestyle changes. Achieving and maintaining lifestyle changes requires to learn self-regulation skills. ACT-based lifestyle interventions combine many self-regulatory skill factors, and the results from previous studies are promising. Research on the individual learning processes of lifestyle change is still needed. This study investigated a subset of data from a larger web-based lifestyle intervention. This subset consisted of online logbooks written by 17 obese participants (n = 17, body mass index mean 41.26 kg/m2) during the six-week online module. The logbooks were analyzed via data-driven content analysis. Four groups were identified based on the participants being at different phases in their lifestyle changes: stuck with barriers, slowly forward, reflective and hardworking, and convincingly forward with the help of concrete goals. Differences between the groups were manifested in personal barriers, goal setting, training of mindfulness and acceptance, and achieving healthy actions. The ACT-based lifestyle intervention offered participants an opportunity to reflect on how their thoughts and feelings may hinder healthy lifestyle changes and provided tools for learning psychological flexibility.
Highlights
Obesity is a universal risk factor for many noncommunicable diseases, such as cardiovascular diseases and diabetes (WHO, 2011)
The lifestyle intervention was implemented as a part of normal work in primary health care, so it is directly applicable to practice
The findings revealed four distinct groups in different phases of lifestyle changes, and three main advantages of the ACT-based intervention: (1) it provides tools for dealing with problematic thoughts and feelings that are often a barrier to lifestyle changes; (2) it provides assistance in identifying personal values and in setting concrete goals when planning lifestyle changes; and (3) it encourages taking value-based actions
Summary
Obesity is a universal risk factor for many noncommunicable diseases, such as cardiovascular diseases and diabetes (WHO, 2011). Previous studies have found that many self-factors, such as positive body image, self-efficacy, and autonomous motivation, and self-regulatory skills and techniques, such as goal setting, action planning, and self-monitoring, are associated with successful lifestyle changes, weight outcomes, and weight management (Greaves et al, 2011; 2017; Gupta et al, 2014; Teixeira et al, 2015; Burgess et al, 2017b). Over the past few years, acceptance and commitment therapy (ACT), a third-generation cognitive behavioral therapy, has been applied within the context of lifestyle intervention by combining many self-factors and self-regulatory skills and processes (Hooper and Larsson, 2015; Hayes, 2016; Rogers et al, 2017). ACT is designed to increase psychological flexibility (Hayes, 2016), which is defined as the ability to identify and deal with barriers to change, and as the ability to take responsibility for one’s well-being (Hayes et al, 2006)
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