Telehealth acceptance and commitment therapy for weight loss: Protocol of the WeLNES full scale randomized controlled trial.

Behavioral interventions delivered via one-on-one telephone coaching (hereafter referred to as telehealth) for weight loss have had great population-level reach but to date limited efficacy. Acceptance and Commitment Therapy (ACT) has promise to improve behavioral weight loss treatment efficacy by addressing the fundamental challenges of weight loss and maintenance: overeating in response to internal (e.g., stress) and external (e.g., high calorie foods) cues. Here we describe the Weight Loss, Nutrition, and Exercise Study (WeLNES) randomized controlled trial that is testing the efficacy of an ACT-based telehealth coaching intervention for weight loss in comparison to a Standard Behavioral Therapy (SBT)-based telehealth coaching intervention. A total of 398 adults with overweight or obesity are being recruited and randomized to either ACT or SBT telehealth coaching. Participants in both arms are offered twenty-five telehealth coaching sessions in year one and nine booster sessions in year two. All participants receive a Bluetooth-enabled scale to self-monitor weight and a Fitbit Inspire + Fitbit app for tracking diet and physical activity. The primary aim is to determine whether a greater proportion of ACT participants will achieve a clinically significant weight loss of ≥10% compared with SBT participants at 12-months. Secondary outcomes include change in weight from baseline to 6, 12, and 24-months. Whether the effect of ACT on weight loss is mediated by ACT processes and is moderated by baseline factors will also be examined. If ACT proves efficacious, ACT telehealth coaching will offer an effective, broadly scalable weight loss treatment-thereby making a high public health impact.

Physical activity changes during an automated online weight loss program.

Evidence-based online behavioral weight loss (BWL) treatment targets a combination of diet, physical activity, and behavioral skills training. While weight loss outcomes are well documented, little is known about changes in physical activity. This study examined changes in objectively measured physical activity across the energy expenditure spectrum during a fully automated, online BWL program. Adults with overweight or obesity (n = 63) completed a 12-week, online BWL program. Participants wore an accelerometer for 7 days and body weight was measured in-clinic at pre- and post-treatment. At post-treatment, mean daily moderate-to-vigorous physical activity increased by about 4 min (SE = 1.59, p = 0.01). There were no statistically significant changes in light physical activity or time spent sedentary (p's > 0.05). Despite only minimal changes in moderate-to-vigorous physical activity overall, larger increases correlated with greater weight loss (r = - 0.28, p = 0.02), which averaged 6.1% of baseline weight at post-treatment. Though achieving important weight loss outcomes, online programs may fail to produce clinically relevant improvements in physical activity, which can put weight loss maintenance at risk.

Association of Weight-Related Stigmas With Daily Pain Symptoms Among Individuals With Obesity.

BACKGROUND: Individuals with obesity are disproportionately impacted by pain-related symptoms. PURPOSE: This study evaluated experienced weight stigma and internalized weight bias (IWB) as predictors of pain symptoms in daily life among individuals with obesity. METHODS: Adults with obesity (n = 39; 51% female, 67% White, 43.8 ± 11.6 years old, BMI = 36.8 ± 6.7 kg/m2) completed a baseline assessment (demographics, experienced weight stigma, IWB) and a 14-day Ecological Momentary Assessment (EMA) period involving five daily prompts of pain/aches/joint pain, muscle soreness, experienced weight stigma, and IWB. Generalized linear models were used to assess experienced weight stigma and IWB at baseline as prospective predictors of EMA pain/soreness symptoms. Multi-level models were used to test the association of momentary weight stigma experiences and IWB with pain/soreness at the same and subsequent EMA prompts. RESULTS: IWB at baseline, but not experienced weight stigma, was associated with more frequent pain symptoms (p < .05) and muscle soreness (p < .01) during EMA. Momentary IWB (but not experienced stigma) was associated with more pain/aches/joint pain and muscle soreness at the same and subsequent prompt. CONCLUSIONS: Internalized (but not experienced) weight bias was prospectively associated with pain symptoms in daily life among individuals with obesity. Results are consistent with growing evidence that weight-related stigmas represent psychosocial factors that contribute to weight-related morbidity typically attributed to body size.

Examining the role of experiential avoidance and valued action in the negative effects of weight self-stigma.

Harmful effects of weight self-stigma on quality of life and health behaviors have been well-established. However, the processes that lead to these negative outcomes are less understood. Psychological inflexibility is defined as a pattern of rigid psychological reactions dominating over values and meaningful actions. A lack in valued action is characterized by the absence of activities that are connected to what is personally meaningful. In this secondary analysis, we aim to extend research by examining two subprocesses of psychological inflexibility, experiential avoidance and lack of valued action, as statistical mediators of the relations between weight self-stigma and quality of life/health behavior outcomes. Baseline data from a clinical trial comparing weight loss maintenance interventions in a sample of 194 adults living with overweight or obesity and seeking treatment is analyzed. Results show that greater experiential avoidance and lower valued action were significantly related to lower quality of life and satisfaction with social roles, as well as greater depression, anxiety, and binge eating. Further, results from a parallel mediation analysis indicated that weight self-stigma is indirectly related to anxiety, disinhibited eating, and hunger through the relationship with experiential avoidance and lack of valued action.

Internalized weight stigma in women with class III obesity: A randomized controlled trial of a virtual lifestyle modification intervention followed by a mindful self-compassion intervention.

Background: Internalized weight stigma (Internalized-WS) is prevalent among individuals with severe obesity, particularly women, and is associated with shame, disordered eating, and weight gain. Effective, accessible interventions that address both severe (Class-III) obesity and Internalized-WS are needed. This randomized pilot trial evaluated the feasibility, acceptability, and preliminary efficacy of a fully-remote lifestyle modification intervention (LM) followed by mindful self-compassion training (MSC) or control. Methods: Twenty-eight women with Class-III obesity (46.6 ± 3.7 kg/m2) and elevated Internalized-WS were randomized to a virtually-delivered 4-month LM followed by a 2-month MSC or cooking/dietary education (CON). Psychosocial measures/weight were assessed at baseline, 4-(post-LM), 6-(post-MSC/CON), and 9-month (follow-up). Results: Improvements in Internalized-WS, shame, and self-compassion were observed with LM. Mean 4-month weight loss was 6.3 ± 3.7%. MSC had lower attendance and usefulness ratings versus CON. Post-MSC/CON, MSC yielded significant and/or meaningful improvements in Internalized-WS, self-compassion, and intuitive eating relative to CON. Weight loss did not differ by group at 6-month, and at 9-month trended lower in MSC versus CON. Conclusion: Virtual LM is feasible, acceptable, and leads to significant weight loss among women with severe obesity; MSC led to further improved Internalized-WS, self-compassion, and intuitive eating. Continued work is needed to elucidate effects of self-compassion training on Internalized-WS, its mechanisms, and linkages to cardiometabolic health and long-term weight loss.

HIV Status, Obesity, and Risk for Weight Stigma: Comparing Weight Stigma Experiences and Internalization Among Adults with Obesity with and Without HIV.

Little is known about weight stigma among people living with HIV (PLWH). This study examined whether levels of perceived weight stigma experiences and internalization, assessed retrospectively and naturalistically, differed among adults with obesity based on HIV status. 50 PLWH (BMI = 35 kg/m2) and 51 adults without HIV (BMI = 36 kg/m2) completed retrospective assessments of lifetime perceived weight stigma experiences/internalization. Next, participants were invited to complete an optional 2-week Ecological Momentary Assessment study. 28 PLWH and 39 adults without HIV completed five momentary assessments of perceived weight stigma experiences/internalization daily. In covariate-adjusted models, PLWH reported 1.2-2.8 times lower frequency of lifetime and momentary perceived weight stigma experiences than adults without HIV, but levels of retrospectively- and naturalistically-assessed internalized weight stigma did not differ between groups. Findings suggest that HIV status may buffer against perceptions of weight stigma events, but not internalized weight stigma, highlighting weight stigma as an important area for future research in PLWH.

Tracking Valued and Avoidant Functions with Health Behaviors: A Randomized Controlled Trial of the Acceptance and Commitment Therapy Matrix Mobile App.

This randomized controlled trial evaluated the acceptability and additive effects of self-monitoring avoidant and valued functions of behavior, in the context of self-monitoring physical activity and dietary behavior in a mobile app. The self-monitoring approach was based on the Acceptance and Commitment Therapy (ACT) Matrix. A sample of 102 adults interested in improving their diet and physical activity were randomized to a Health Behavior Tracking app (HBT), HBT plus ACT matrix app (HBT+ACT), or waitlist condition. Online self-report assessments were completed at baseline, mid (2 weeks), and post-intervention (4 weeks). Participants reported high usability, but mixed satisfaction with both apps. About half of the prompted app check-ins were completed on average, with 14% never using the ACT app. Participants in the HBT+ACT app condition reported greater self-reported physical activity over time relative to HBT and waitlist, potentially due to protecting against a decrease over time in physical activity observed in the other two conditions. HBT and HBT+ACT conditions both improved self-reported sedentary behavior relative to waitlist. HBT+ACT improved cognitive restraint with eating more than HBT. Neither the HBT or HBT+ACT app improved other health behavior outcome measures or values processes relative to the waitlist. Overall, findings suggest some benefits of the ACT Matrix app for addressing physical activity by tracking valued/avoidant functions, but mixed findings on acceptability, outcomes, and processes of change suggests impact may be relatively limited.

Study protocol for a randomized controlled trial comparing two low-intensity weight loss maintenance interventions based on acceptance and commitment therapy or self-regulation.

BACKGROUND: Weight regain is common following behavioral obesity treatment and attenuates many of the benefits of initial weight loss. This paper describes a randomized controlled trial that will evaluate the efficacy of two low-contact weight loss maintenance interventions based on Acceptance and Commitment Therapy (ACT) and self-regulation (SR). Potential mechanisms of action and moderators of treatment effects will also be evaluated. METHODS: Adults (anticipated N = 480) with overweight or obesity will complete an initial 3-month online weight loss program (Phase 1). Participants who achieve ≥4 kg weight loss (anticipated N = 288) will then be randomized to an ACT or SR weight loss maintenance intervention. Both interventions will entail four 2.5 h, face-to-face, group-based workshop sessions and 6 months of email contact. Assessments will be conducted at phase 1 baseline, phase 1 completion/pre-randomization, and 6, 12, 18, 24, and 30 months post-randomization. The primary outcome will be weight change for the period from randomization to 30 months. Potential process measures including ACT-based constructs (e.g., psychological acceptance, values-consistent behavior), self-weighing frequency, and motivation will be also be assessed, as will potential moderators (e.g., initial weight loss). CONCLUSIONS: This study will compare the efficacy of two intervention approaches (ACT and SR) delivered in a scalable workshop format for long-term weight loss maintenance. Future research could examine efficacy and cost-effectiveness of these approaches in real world settings.

Preliminary Evaluation of a 1-Day Acceptance and Commitment Therapy Workshop for Increasing Moderate-to-Vigorous Physical Activity in Adults with Overweight or Obesity.

BACKGROUND: Novel strategies to help adults with overweight/obesity increase motivation for becoming active are needed. This single-arm trial aimed to test the feasibility, acceptability, and preliminary efficacy of a 4-h acceptance and commitment therapy (ACT)-based workshop intervention for increasing moderate-to-vigorous physical activity (MVPA) among insufficiently active adults with overweight/obesity. METHODS: Participants (N = 41) received a 1-day 4-h ACT workshop followed by weekly e-mails and monthly phone calls for 3 months. The primary outcome was change in accelerometer-measured MVPA minutes/day at 3 and 6 months. Process variables (i.e., autonomous motivation, PA acceptance) through which the ACT intervention was hypothesized to increase MVPA were assessed via questionnaires. RESULTS: Participants completed 91% of phone calls and 75% of e-mail surveys. Acceptability ratings were > 4.5 out of 5 for "understandable," "useful," and "intent-to-use" on all intervention components. Participants on average achieved significant increases in bouted and total MVPA at 3 months that were maintained at 6 months. Participants also reported significant increases in physical activity acceptance and autonomous motivation, the latter of which related to MVPA changes. CONCLUSION: Results support the feasibility and acceptability of the ACT workshop intervention for promoting MVPA changes among insufficiently active adults with overweight/obesity. Rigorous testing of this approach as a low-intensity standalone or add-on intervention to increase MVPA is warranted.

Evaluation of intervention components to maximize outcomes of behavioral obesity treatment delivered online: A factorial experiment following the multiphase optimization strategy framework.

BACKGROUND: Behavioral lifestyle intervention (BLI) is recommended as a first-line treatment for obesity. While BLI has been adapted for online delivery to improve potential for dissemination while reducing costs and barriers to access, weight losses are typically inferior to gold standard treatment delivered in-person. It is therefore important to refine and optimize online BLI in order to improve the proportion of individuals who achieve a minimum clinically significant weight loss and mean weight loss. STUDY DESIGN: Five experimental intervention components will be tested as adjuncts to an established 12-month online BLI: virtual reality for BLI skills training, interactive video feedback, tailored intervention to promote physical activity, skills for dysregulated eating, and social support combined with friendly competition. Following the Multiphase Optimization Strategy (MOST) framework, the components will first be refined and finalized during Preparation Phase pilot testing and then evaluated in a factorial experiment with 384 adults with overweight or obesity. A priori optimization criteria that balance efficacy and efficiency will be used to create a finalized treatment package that produces the best weight loss outcomes with the fewest intervention components. Mediation analysis will be conducted to test hypothesized mechanisms of action and a moderator analysis will be conducted to understand for whom and under what circumstances the interventions are effective. CONCLUSION: This study will provide important information about intervention strategies that are useful for improving outcomes of online BLI. The finalized treatment package will be suitable for testing in a future randomized trial in the MOST Evaluation Phase.

Food reward sensitivity, impulsivity, and weight change during and after a 3-month weight loss program.

BACKGROUND: Greater sensitivity to food rewards and higher levels of impulsivity (and an interaction between these variables, termed "reinforcement pathology") have been associated with obesity in cross-sectional studies. Less is known regarding how these constructs may impact attempts at weight loss or longer-term weight loss maintenance. METHODS: We provided 75 adults (69%Female, 84%White, age = 50.8y, BMI = 31.2kg/m2) with a 3-month Internet-based weight loss program and assessed weight, food reward sensitivity (via the Power of Food Scale [PFS]), and impulsivity (via Go No-Go [GNG] and Delay Discounting [DD] computer tasks) at baseline and at Months 3, 6, 9, and 12. No additional intervention was provided Months 3-12. Multi-level mixed-effect models were used to examine changes in PFS, GNG, and DD over time and associations between these measures and weight loss/regain. RESULTS: Participants lost 6.0±1.1kg Months 0-3 and regained 2.4±1.1kg Months 3-12. Across time points, higher PFS scores were associated with higher weight, p = .007; however, there were no significant associations between GNG or DD and weight nor between the interactions of PFS and GNG or DD and weight, ps>.05. There were significant decreases from Months 0-3 in PFS, GNG, and DD, ps < .05; however, neither baseline values nor changes were significantly associated with weight change and there were no significant associations between the interactions of PFS and GNG or DD and weight change, ps>.05. CONCLUSION: Results demonstrated an association between food reward sensitivity and weight. Further, decreases in both food reward sensitivity and impulsivity were observed during an initial weight loss program, but neither baseline levels nor improvements were associated with weight change. Taken together, results suggest that the constructs of food reward sensitivity, impulsivity, and reinforcement pathology may have limited clinical utility within behavioral weight management interventions. Future intervention studies should examine whether food-related impulsivity tasks lead to a similar pattern of results.

Body shape concerns across racial and ethnic groups among adults in the United States: More similarities than differences.

This study evaluated the relationship between race/ethnicity and body shape concerns among adults in the U.S. and evaluated if this relationship varied by Body Mass Index (BMI) and gender. Data were collected from U.S. adults (N = 2,212) using a national online survey panel designed to approximate the US census data. Gender, age, race/ethnicity, BMI and body shape concerns (Body Shape Questionnaire) were assessed. Analysis of variance was utilized to evaluate the race/ethnicity and BSQ association and if the relationship varied by gender and BMI category. The sample (65 % White, 13 % Black/African American, 16 % Latino/Hispanic/Mexican American and 6 % Asian/Pacific Islander) was 50 % female; mean age of 44.2 years (SD = 16.8); BMI of 27.4 (SD = 6.7). A gender by BMI category interaction (p < .01) revealed no difference in BSQ scores by gender when BMI < 18, but higher BSQ scores among women for all other BMI groups. A main effect of race/ethnicity revealed BSQ scores were equally high across racial/ethnic groups, except individuals who identified as White (M = 42.0, SD = 19.7) reported higher BSQ than those identified as Asian/Pacific Islander (M = 37.4, SD = 17.4). Body shape concerns are common among US adults. Individuals of racial/ethnic minority status may experience similar gender- and BMI-related differences in body shape concerns as White individuals.

Characterizing Lifetime and Daily Experiences of Weight Stigma among Sexual Minority Women with Overweight and Obesity: A Descriptive Study.

Sexual minority women are disproportionately impacted by obesity yet are underrepresented in weight stigma research. This Ecological Momentary Assessment (EMA) study is a secondary analysis that aimed to elucidate the frequency and contextual characteristics of perceived experiences of lifetime and momentary weight stigma among sexual minority women with overweight/obesity. Participants were 55 sexual minority women ages 18-60 with a body mass index ≥25 kg/m2. Perceived lifetime weight stigma events were assessed at baseline. For the subsequent five days, participants used a smartphone to complete five daily, random EMA prompts assessing the frequency/characteristics of perceived weight stigma events in daily life. All participants reported at least one lifetime weight stigma event. During the EMA period, participants reported 44 momentary weight stigma events (M = 0.80), with 24% of participants reporting at least one event. During most instances of weight stigma, women perceived the stigma's cause to be their weight and another minority identity (e.g., sexual orientation). Findings showing high rates of perceived lifetime weight stigma in this sample and frequent co-occurrence of perceived weight stigma with stigma due to other marginalized identities in daily life underscore the need for future, larger studies investigating weight stigma through an intersectional lens in sexual minority women with overweight/obesity.

Confirmatory Factor Analysis of the Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States Sample of Adults with Overweight and Obesity.

OBJECTIVE: To examine the psychometric properties of the English language version of the 10-item Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States (U.S.) sample of women and men with overweight/obesity (OW/OB). METHOD: Adults with OW/OB seeking weight loss (N = 283; 59% women) completed the AAQW-R and other weight-related and psychosocial measures. Confirmatory factor analysis was used to examine single-factor, three-factor, and second-order factor structures of the AAQW-R, which were previously examined in a sample of Portuguese women. A chi-square difference test was used to compare the fit of a single-factor structure with three-factor and second-order factor structures. Internal reliability and convergent validity were examined for the total and three-factor subscale scores. RESULTS: The single-factor structure evidenced poor fit to the data whereas the three-factor structure evidenced acceptable fit. The second-order structure was assessed qualitatively due to limitations to statistical model specification. The internal reliability of the AAQW-R total score and each of the three subscales were in the good and acceptable ranges, respectively. Total and subscale scores demonstrated good convergent validity. DISCUSSION: Findings suggest that the English language version of the AAQW-R can be used to assess weight-related experiential avoidance in U.S. adult samples with OW/OB as a three-factor construct (food as control, weight as a barrier to living, weight stigma), with or without a total score. Additional research should confirm measurement invariance among various sociodemographic groups.

Self-stigma and weight loss: The impact of fear of being stigmatized.

This study sought to examine whether two facets of weight self-stigma (fear of enacted stigma and self-devaluation) were associated with weight change and treatment engagement for 188 individuals participating in a 3-month online weight loss program. Fear of enacted stigma predicted less weight loss 3 months later after controlling for demographics, eating problems, and psychological symptoms. Self-devaluation did not predict weight loss. Neither weight self-stigma variable predicted engagement in the online program. These results add to the literature indicating the negative effects of weight self-stigma while highlighting the central role of fear of being stigmatized by others in this process.

Assessing the valuing process in Acceptance and Commitment Therapy: Experts' review of the current status and recommendations for future measure development.

Within Acceptance and Commitment Therapy (ACT), personal values provide the foundational framework of the therapeutic process and are considered necessary to facilitate targeted behavioral movement and a more vital, meaningful life. Considering the proposed nature of values as a core mechanism of change in this way, a thorough understanding of the therapeutic valuing process through which targeted changes occur is essential to evaluate the true efficacy of the ACT model empirically and implement it most effectively. However, to date, development of measurement tools for this purpose is limited and those that do exist are often inconsistent in their targeted constructs. The current study collected in-depth, descriptive data from ACT experts to critically examine how the valuing process in ACT is currently defined and measured and make recommendations for future measure development. 11 experts participated in semi-structured interviews and responded to topic guided questions. Thematic analyses of experts' responses were then conducted, and eight core themes were identified. Findings denoted that experts' definitions of the valuing process and its core components are largely consistent with theoretical conceptualization of ACT but that no measurement tool to date provides a complete and adequate assessment of this process. Experts expressed the need for measures capable of assessing essential contextual aspects of the valuing process and gaining a more proximal evaluation of values-consistent behaviors and experiential momentary awareness. The current study provides insight into critical areas for improvement and provides recommendations for future measure development for the empirical assessment of the valuing process in ACT which is crucial for evaluating the role of values work as a therapeutic mechanism of action.

Effects of Cognitive Strategies on Neural Food Cue Reactivity in Adults with Overweight/Obesity.

OBJECTIVE: Functional magnetic resonance imaging (fMRI) studies of obesity have revealed key roles for reward-related and inhibitory control-related activity in response to food cues. This study examines how cognitive strategies impact neural food cue reactivity. METHODS: In a within-participants, block-design, fMRI paradigm, 30 participants (24 women; mean BMI = 31.8) used four mind-sets while viewing food: "distract" (cognitive behavioral therapy based), "allow" (acceptance and commitment therapy based), "later" (focusing on long-term negative consequences), and "now" (control; focusing on immediate rewards). Participants rated cravings by noting urges to eat on four-point Likert scales after each block. RESULTS: Self-reported cravings significantly differed among all conditions (pairwise comparisons P < 0.05). Cravings were lowest when participants considered long-term consequences (LATER mind-set: 1.7 [SD 0.7]), were significantly higher when participants used the DISTRACT (1.9 [SD 0.7]) and ALLOW (2.3 [SD 0.9]) mind-sets, and were highest when participants used the NOW mind-set (3.2 [SD 0.7]). These behavioral differences were accompanied by differences in neural food cue reactivity. The LATER mind-set (long-term consequences) led to greater inhibitory-control activity in the dorsolateral prefrontal cortex. The cognitive behavioral therapy-based DISTRACT mind-set was associated with greater activity in executive function and reward-processing areas, whereas the ALLOW mind-set (acceptance and commitment therapy) elicited widespread activity in frontal, reward-processing, and default-mode regions. CONCLUSIONS: Because focusing on negative long-term consequences led to the greatest decrease in cravings and increased inhibitory control, this may be a promising treatment strategy for obesity.

Values-based and acceptance-based intervention to promote adoption and maintenance of habitual physical activity among inactive adults with overweight/obesity: a study protocol for an open trial.

INTRODUCTION: Despite the importance of regular moderate-intensity to vigorous-intensity physical activity (MVPA) for health benefits and long-term weight management, current comprehensive lifestyle interventions have focused on providing MVPA prescriptions and goals but with only minimal and intermittent focus on psychosocial theoretical constructs and novel strategies, perhaps explaining the often modest impact on adoption and maintenance of higher levels of MVPA. An intervention based on acceptance and commitment therapy (ACT) targeting the increase of values-based autonomous motivation could improve the adoption and maintenance of habitual MVPA among insufficiently active overweight or obese adults in a brief intervention format. METHODS AND ANALYSIS: The overall aim of this study is to develop and test the feasibility, acceptability and preliminary efficacy of an ACT-based brief workshop intervention for increasing bouted MVPA for inactive adults with overweight/obesity using a single-arm design. A total of 48 inactive adults with overweight/obesity will be recruited and attend a 4-hour, ACT-based workshop followed by weekly emails and monthly phone calls for 3 months. The workshop will teach values clarification and acceptance-based skills to increase values-based autonomous motivation and bouted MVPA. Participants will self-monitor minutes of MVPA and personal values and report on progress via weekly emails and monthly phone calls. Assessments will be conducted at baseline and at 3 and 6 months. ETHICS AND DISSEMINATION: Study procedures have been approved by the Institutional Review Board. Consent is given in writing and in person. Data collection and storage separates study data from personally identifying information. Two safety officers who are not connected to the study monitor study progress and participant safety. TRIAL REGISTRATION NUMBER: NCT03565731; Pre-results.

The Association of Changes in Pain Acceptance and Headache-Related Disability.

BACKGROUND: Migraine accounts for substantial suffering and disability. Previous studies show cross-sectional associations between higher pain acceptance and lower headache-related disability in individuals with migraine, but none has evaluated this association longitudinally during migraine treatment. PURPOSE: This study evaluated whether changes in pain acceptance were associated with changes in headache-related disability and migraine characteristics in a randomized controlled trial (Women's Health and Migraine) that compared effects of behavioral weight loss (BWL) treatment and migraine education (ME) on headache frequency in women with migraine and overweight/obesity. METHODS: This was a post hoc analysis of 110 adult women with comorbid migraine and overweight/obesity who received 16 weeks of either BWL or ME. Linear and nonlinear mixed effects modeling methods were used to test for between-group differences in change in pain acceptance, and also to examine the association between change in pain acceptance and change in headache disability. RESULTS: BWL and ME did not differ on improvement in pain acceptance from baseline across post-treatment and follow-up. Improvement in pain acceptance was associated with reduced headache disability, even when controlling for intervention-related improvements in migraine frequency, headache duration, and pain intensity. CONCLUSIONS: This study is the first to show that improvements in pain acceptance following two different treatments are associated with greater reductions in headache-related disability, suggesting a potential new target for intervention development. CLINICAL TRIALS INFORMATION: NCT01197196.