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The current article presents and evaluates an Acceptance and Commitment Therapy (ACT) approach for obesity-related psychological struggles post-bariatric surgery. Some patients who have undergone bariatric surgery report loss of control over eating and distress concerning body figure and shape, which can affect other outcomes such as weight loss and quality of life post surgery. A recent randomized trial (n = 39) evaluating a 6-week treatment package of ACT following bariatric surgery found large and significant effects as compared with treatment as usual (TAU) on eating disordered behaviours, body dissatisfaction, psychological flexibility and quality of life. Though effects were found, questions remain regarding maintenance of outcomes and the process changes related to outcomes. The present study examines both the maintenance of behavioural change at a 6-month follow-up for the original study and the processes that may be involved in the outcomes. ACT led to gains in quality of life (es = 0.88) and body dissatisfaction (es = 0.77), as compared with TAU at follow-up. Both groups improved in eating disordered behaviours (ACT; es = 0.86 and TAU; es = 0.55). A series of multiple mediator tests supported the role of enhanced psychological flexibility in the changes seen in body dissatisfaction, eating disordered behaviour and quality of life. This study provides preliminary support for the ACT treatment model in terms of optimizing bariatric surgery outcomes.

This is the first trial to investigate the outcome of tailored and ACT-influenced, cognitive behavioral Internet treatment for eating disorder psychopathology, and the relation between knowledge acquisition and outcome. This study utilized a randomized controlled design, with computer-based allocation to treatment or waiting list control group. Participants were recruited via advertisements in social media and newspapers in Sweden. Participants fulfilling the criteria for bulimia nervosa (BN), or Eating Disorder Not Otherwise Specified (EDNOS), with a BMI above 17.5, were enrolled in the study (N = 92). The treatment group received an Internet-based, ACT-influenced CBT intervention, developed by the authors, for eating disorders. The treatment lasted 8 weeks, and was adapted to the participant's individual needs. A clinician provided support. The main outcome measures were eating disorder symptoms and body shape dissatisfaction. Intent-to-treat analysis showed that the treatment group (n = 46) improved significantly on eating disorder symptoms and body dissatisfaction, compared with the waiting list control group (n = 46), with small to moderate effect sizes (between group effects, d = 0.35-0.64). More than a third of the participants in the treatment group (36.6%), compared to 7.1% in the waiting list control condition, made clinically significant improvements. Results showed a significant increase in knowledge in the treatment group compared to the waiting list control group (between group effect, d = 1.12), but we found no significant correlations between knowledge acquisition and outcome (r= -0.27 to -r = 0.23). The results provide preliminary support for Internet-based, tailored, and ACT-influenced treatment, based on CBT for participants with eating disorder psychopathology.

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