نوع مقاله : مقاله پژوهشی
عنوان مقاله English
نویسندگان English
Introduction: Obesity and overweight are major health problems. The present study aimed to compare the effectiveness of cognitive behavioral therapy and acceptance and commitment on emotional distress and lifestyle related to obesity in overweight individuals with disordered eating.
Materials and Methods: This is a a quasi-experimental study with a pre-test, post-test design, and with a control group and a two-month follow-up. The statistical population consisted of all overweight individuals with disordered eating behaviors who referred to two obesity treatment clinics in Tehran between January 2023 and June 2024 (200 individuals). 45 people were selected using convenient and purposive sampling and randomly assigned to three cognitive behavioral therapy commitment and acceptance, and control groups (15 people in each group). Cognitive-behavioral, commitment, and acceptance therapies were done for 8 sessions in the experimental groups, with no treatment for the control group. Emotional distress questionnaires (Simmons and Gaher) and obesity-related lifestyle questionnaires (Clark et al) were used. Data were analyzed using two-way repeated measures analysis of variance (ANOVA).
Results: The mean lifestyle-related obesity score of the cognitive behavioral group decreased from pre-test (103.61 ± 6.39) to post-test (75.07 ± 5.65); in the commitment and acceptance group, this score decreased from 103.58 ± 5.24 in the pre-test () to 88.27 ± 5.16 in the post-test (). The improvement rate in emotional distress scores in the commitment and acceptance treatment group was significantly greater than the cognitive behavioral therapy group. (P=0.032).
Conclusion: Commitment and acceptance therapy is a more effective intervention in reducing emotional distress in overweight individuals. Its use, alongside other treatment methods, is recommended by therapists and nutritionists.
کلیدواژهها English
1. Oh J, Mun WL, Lee YE, Roh SY, Kim G. Interrelation Between BMI, Dietary Habits, Self-Rated Health, and Body Image Perception Among Korean Adolescents: The Korea Youth Risk Behavior Web-Based Survey 2022. Nutrients. 2025; 17(2): 253.
3. World Health Organization. WHO European Childhood Obesity Surveillance Initiative (COSI): Report on the sixth round of data collection, 2022–2024. World Health Organization. Regional Office for Europe; 2025 Oct 27.
4. Khalid R, Lister NB, Paxton SJ, Maguire S, Libesman S, Seidler AL, et al. Potential pathways to the onset and development of eating disorders in people with overweight and obesity: A scoping review. Obesity Reviews. 2025; 6(1): e13840.
5. Wąsacz M, Sarzyńska I, Ochojska D, Błajda J, Bartkowska O, Brydak K, et al. Psychosocial Consequences of Excess Weight and the Importance of Physical Activity in Combating Obesity in Children and Adolescents: A Pilot Study. Nutrients. 2025; 17(10): 1690.
6. Gravina D, Violi M, Bordacchini A, Diadema E, Fantasia S, Simoncini M, et al. Emotional Eating, Impulsivity, and Affective Temperaments in a Sample of Obese Candidates for Bariatric Surgery: Which Linkage? Brain Sciences. 2025; 15(4): 372-381.
7. Calugi S, Dalle Grave R. Psychological features in obesity: A network analysis. International Journal of Eating Disorder. 2020; 53(2): 248-255.
8. Brown RJ, Burton AL, Abbott MJ. The relationship between distress tolerance and symptoms of depression: Validation of the Distress Tolerance Scale (DTS) and short‐form (DTS‐SF). Journal of Clinical Psycholog. 2022; 78(12): 2609-2630.
9. Kozak AT, Davis J, Brown R, Grabowski M. Are overeating and food addiction related to distress tolerance? An examination of residents with obesity from a US metropolitan area. Obesity research & clinical practice. 2017; 11(3): 287-298.
10. Steptoe A, Frank P. Obesity and psychological distress. Philosophical Transactions of the Royal Society B 2023; 378(1888): 20220225.
11. Huang TY, Jiang DX, Zhang DX, Yuan W, Cao WN, Bai QY, et al. Personality traits and the response to lifestyle interventions for adult obesity: A systematic review and meta-analysis. Personality and Individual Differences 2024; 219: 112497.
12. Simone M, Telke S, Anderson LM, Eisenberg M, Neumark-Sztainer D. Ethnic/racial and gender differences in disordered eating behavior prevalence trajectories among women and men from adolescence into adulthood. Social Science & Medicine 2022; 294: 114720.
13. Nisar A, Watkins RC, Gillard D, Grindle CF, Thompson PA, Pegram J, et al. Adding implementation support to a universal Acceptance and Commitment Therapy-based school well-being intervention: A cluster-randomised controlled trial. Journal of Contextual Behavioral Science 2025; 36: 100886.
14. Wergeland GJ, Ghaderi A, Fjermestad K, Enebrink P, Halsaa L, Njardvik U, et al. Family therapy and cognitive behavior therapy for eating disorders in children and adolescents in routine clinical care: a systematic review and meta-analysis. European Child & Adolescent Psychiatry 2025; 34(3): 883-902.
15. Rosner R, Rau J, Kersting A, Rief W, Steil R, Rummel AM, et al. Grief-Specific Cognitive Behavioral Therapy Vs Present-Centered Therapy: A Randomized Clinical Trial. JAMA psychiatry 2025; 82(2): 109-117.
16. Cha JY, Kim SY, Lim YW, Choi KH, Shin IS. Comparative effectiveness of cognitive behavioral therapy and behavioral therapy in obesity: a systematic review and network meta-analysis. Journal of Clinical Psychology in Medical Settings 2025; 32(1): 96-110.
17. Colombo PE, Wickramarachchi M, Lakshmi A, Kudlek L, Ahern A, Tait S, et al. The impact of behavioral weight management interventions on eating behavior traits in children with overweight or obesity: Systematic review and meta‐analysis. Obesity Reviews.2025; 26(1): e13839.
18. Miri SF, Javadi M, Lin CY, Griffiths MD, Björk M, Pakpour AH. Effectiveness of cognitive-behavioral therapy on nutrition improvement and weight of overweight and obese adolescents: A randomized controlled trial. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2019; 13(3): 2190-2197.
19. Schumacher LM, Miller N, Jennings EL, Chabria R, Butryn ML. Acceptance and Commitment Therapy for Obesity. Current obesity reports 2025; 14(1): 41.
20. Guerrini Usubini A, Cattivelli R, Giusti EM, Riboni FV, Varallo G, Pietrabissa G, et al. The ACTyourCHANGE study protocol: promoting a healthy lifestyle in patients with obesity with Acceptance and Commitment Therapy—a randomized controlled trial. Trials. 2021; 22(1): 290.
21. Arch JJ, Fishbein JN, Finkelstein LB, Luoma JB. Acceptance and commitment therapy processes and mediation: Challenges and how to address them. Behavior therapy 2023; 54(6): 971-988.
22. Petäjä M, Lappalainen R, Kettunen T, Lappalainen P, Kaipainen K, Muotka J, et al. Changes in self-rated health, quality of life, and psychological flexibility among adults with overweight over a 24-month acceptance and commitment therapy–based lifestyle intervention. Health Psychology Open. 2024; 11: 20551029241302977.
23. Power D, Jones A, Keyworth C, Dhir P, Griffiths A, Shepherd K, et al. Emotional eating interventions for adults living with overweight and obesity: a systematic review and meta‐analysis of behaviour change techniques. Journal of Human Nutrition and Dietetics 2025; 38(1): e13410.
24. Najjar Kakhki I, Kalhornia Golkar M, Nezhadmohammad Nameghi A, Mohammadi Shirmahaleh F, Valizadeh M. Comparison of the Effectiveness of Group Therapies based on Acceptance and Commitment and Schema on Coping Style Avoidance and Body Mass Index in Obese and Overweight People with Emotional Eating. Journal of Applied Psychological Research 2024; 15(2): 17-32. [Persian]
25. Gobadi Kahnamoue N, Azmoudeh M, Esmaielpour KH, SakenAzari R. Comparison of the effectiveness of cognitive-behavioral couple therapy and emotionally focused couple therapy on interpersonal emotion regulation of couples with emotional divorce. Community Health Journal 2024; 18(1): 11-21. [Persian]
26. Simons JS, Gaher RM. The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and emotion 2005; 29(2): 83-102.
27. Mahmoudpour A, Shariatmadar A, Borjali A, Shafiabad A. Psychometric Properties of the Distress Tolerance Scale (DTS) in the Elderly. Quarterly of Educational Measurement 2021; 12(46): 49-64. [Persian]
28. Clark MM, Abrams DB, Niaura RS, Eaton CA, Rossi JS. Self-efficacy in weight management. Journal of Consulting and Clinical of Psychology 1991; 59: 739-44.
29. Fathi Z, Latifi Z. Comparing the Effectiveness of Body Appreciation Training and Self-Healing Training for Food Cravings and Weight Control Self-Efficacy among Overweight Women. Positive Psychology Research 2023; 8(4): 75-94. [Persian]
30. Lecerf JM, Apfeldorfer G, Hincker P, Julien-Sweerts S, Bonte AD, Deplanque D, et al. Eating behavior changes with an online cognitive behavioral therapy program for weight loss in individuals with overweight or obesity: A pilot study. Cahiers de Nutrition et de Diététiqu 2025.
31. Tavallaei M, Sharq MH, Seyhoon M, Tahvilian N, Hosseinzadeh M. The Effectiveness of Treatment Based on Acceptance and Commitment Therapy on Psychological Capital, Weight and Fat Mass in Obese Women. Tolooebehdasht 2024; 23(4): 15-30. [Persian]
32. Mohseni M, Kuckuck S, Meeusen RE, Jiskoot G, Lengton R, Savas M, et al. Improved physical and mental health after a combined lifestyle intervention with cognitive behavioural therapy for obesity. International journal of endocrinology and metabolism 2022; 21(1): e129906.
