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Cognitive Behavioural Therapy for Severe Obesity

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Psychiatric Care in Severe Obesity

Abstract

In this chapter, we provide an overview of cognitive behavioural therapy (CBT), the rationale for integrating it into the management of severe obesity, and examples of CBT strategies that can be helpful in working with patients with severe obesity. We then review the empirical evidence supporting the effectiveness of CBT in patients with severe obesity (both surgical and non-surgical populations). Finally, we return to the case example to illustrate the application of CBT techniques in clinical practice.

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References

  1. Beck JS. Cognitive behaviour therapy: basics and beyond. 2nd ed. New York: Guilford; 2011.

    Google Scholar 

  2. Malik S, Mitchell JE, Engel S, Crosby R, Wonderlich S. Psychopathology in bariatric surgery candidates: a review of studies using structured diagnostic interviews. Compr Psychiatry. 2014;55(2):248–99.

    Article  PubMed  Google Scholar 

  3. Mitchell JE, Selzer F, Kalarchian MA, Devlin MJ, Strain GW, Elder KA, et al. Psychopathology before surgery in the longitudinal assessment of bariatric surgery-3 (LABS-3) psychosocial study. Surg Obes Relat Dis. 2012;8(5):533–41.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mühlhans B, Horbach T, de Zwaan M. Psychiatric disorders in bariatric surgery candidates: a review of the literature and results of a German prebariatric surgery sample. Gen Hosp Psychiatry. 2009;31:414–21.

    Article  PubMed  Google Scholar 

  5. Taylor VH, McIntyre RS, Remington G, Levitan RD, Stonehocker B, Sharma A. Beyond pharmacotherapy: understanding the links between obesity and chronic mental illness. Can J Psychiatry. 2012;57(1):5–12.

    PubMed  Google Scholar 

  6. Kalarchian MA, Wilson GT, Brolin RE, Bradley L. Binge eating in bariatric surgery patients. Int J Eat Disord. 1998;23(1):89–92.

    Article  CAS  PubMed  Google Scholar 

  7. Saunders R, Johnson L, Teschner J. Prevalence of eating disorders among bariatric surgery patients. Eat Disord. 1998;6(4):309–17.

    Article  Google Scholar 

  8. Gariepy G, Nitka D, Schmitz N. The association between obesity and anxiety disorders in the population. Int J Obes (Lond). 2010;34(3):407–19.

    Article  CAS  Google Scholar 

  9. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Pinninx BWJH, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–9.

    Article  PubMed  Google Scholar 

  10. Whiteside U, Chen E, Neighbors C, Hunter D, Lo T, Larimer M. Difficulties regulating emotions: do binge eaters have fewer strategies to modulate and tolerate negative affect? Eat Behav. 2007;8(2):162–9.

    Article  PubMed  Google Scholar 

  11. National Institute for Health and Care Excellence. Depression in adults: recognition and management. NICE clinical guideline 90. 2009. http://www.nice.org.uk/guidance/cg90

  12. National Institute for Health and Care Excellence. Eating disorders in over 8s: management. NICE clinical guideline 9. 2004. http://www.nice.org.uk/guidance/cg9

  13. Fairburn C. Overcoming binge eating. 2nd ed. New York: Guilford; 2013.

    Google Scholar 

  14. Apple RF, Lock J, Peebles R. Preparing for weight loss surgery: therapist guide. New York: Oxford University Press; 2006.

    Book  Google Scholar 

  15. Cooper Z, Fairburn CG, Hawker DM. Cognitive behavioural treatment of obesity. New York: Guilford; 2004.

    Google Scholar 

  16. Laliberte M, McCabe RE, Taylor V. The cognitive behavioural workbook for weight management. Oakland: New Harbinger; 2009.

    Google Scholar 

  17. National Institute for Health and Care Excellence. Obesity: identification, assessment, and management. NICE clinical guideline 189. 2014. http://www.nice.org.uk/guidance/cg189

  18. Cassin SE, Sockalingham S, Wnuk S, Strimas R, Royal S, Hawa R, et al. Cognitive behavioural therapy for bariatric surgery patients: preliminary evidence for feasibility, acceptability, and effectiveness. Cogn Behav Pract. 2013;20(4):529–43.

    Article  Google Scholar 

  19. McManus F, Waller G. A functional analysis of binge eating. Clin Psychol Rev. 1995;15(8):845–63.

    Article  Google Scholar 

  20. Schulte EM, Grilo CM, Gearhardt AN. Shared and unique mechanisms underlying binge eating disorder and addictive disorders. Clin Psychol Rev. 2016;44:125–39.

    Article  PubMed  Google Scholar 

  21. Burns DD. The feeling good handbook: revised edition. New York: Penguin; 1999.

    Google Scholar 

  22. Greenberger D, Padesky CA. Mind over mood. New York: Guilford; 1995.

    Google Scholar 

  23. Marchesini G, Natale S, Chierici S, Manini R, Besteghi L, Di Domizio S, et al. Effects of cognitive-behavioural therapy on health-related quality of life in obese subjects with and without binge eating disorder. Int J Obes Relat Metab Disord. 2002;26(9):1261–7.

    Article  CAS  PubMed  Google Scholar 

  24. Stahre L, Hällström T. A short-term cognitive group treatment program gives substantial weight reduction up to 18 months from the end of treatment: a randomized controlled trial. Eat Weight Disord. 2005;10(1):51–8.

    Article  CAS  PubMed  Google Scholar 

  25. Munsch S, Biedert E, Keller U. Evaluation of a lifestyle change programme for the treatment of obesity in general practice. Swiss Med Wkly. 2003;133(9-10):148–54.

    PubMed  Google Scholar 

  26. Sbrocco T, Nedegaard R, Stone J, Lewis E. Behavioural choice treatment promotes continuing weight loss: preliminary results of a cognitive-behavioural decision-based treatment for obesity. J Consult Clin Psychol. 1999;67:260–6.

    Article  CAS  PubMed  Google Scholar 

  27. Nauta H, Hospers H, Kok G, Jansen A. A comparison between a cognitive and a behavioural treatment for obese binge eaters and obese non-binge eaters. Behav Ther. 2000;31(3):441–61.

    Article  Google Scholar 

  28. Nauta G, Hospers H, Jansen A. One-year follow-up effects of two obesity treatment on psychological well-being and weight. Br J Health Psychol. 2001;6(3):271–84.

    Article  CAS  PubMed  Google Scholar 

  29. Painot D, Jotterand S, Kammer A, Fossati M, Golay A. Simultaneous nutritional cognitive—behavioural therapy in obese patients. Patient Educ Couns. 2001;42(1):47–52.

    Article  CAS  PubMed  Google Scholar 

  30. Dennis K, Pane K, Adams B, Qi BB. The impact of a shipboard weight control program. Obes Res. 1999;7(1):60–7.

    Article  CAS  PubMed  Google Scholar 

  31. Werrij MQ, Jansen A, Mulkens S, Elgersma HJ, Ament AJHA, Hospers HJ. Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity. J Psychosom Res. 2009;67(4):315–24.

    Article  PubMed  Google Scholar 

  32. de Zwaan M. Binge eating disorder and obesity. Int J Obes Relat Metab Disord. 2001;25(1):51–5.

    Article  Google Scholar 

  33. Spitzer RL, Devlin M, Walsh BT, Hasin D, Wing R, Marcus M, et al. Binge eating disorder: a multisite field trial of the diagnostic criteria. Int J Eat Disord. 1992;11(3):191–203.

    Article  Google Scholar 

  34. Spitzer RL, Yanovski S, Wadden T, Wing R, Marcus M, Stunkard AJ, et al. Binge eating disorder: its further validation in a multisite study. Int J Eat Disord. 1993;13(2):137–53.

    Article  CAS  PubMed  Google Scholar 

  35. Telch CF, Stice E. Psychiatric comorbidity in women with binge eating disorder: prevalence rates from a non-treatment seeking sample. J Consult Clin Psychol. 1998;66(5):768–76.

    Article  CAS  PubMed  Google Scholar 

  36. Marchesini G, Solaroli E, Baraldi L, Natale S, Migliorini S, Visani E, et al. Health-related quality of life in obesity: the role of eating behaviour. Diabetes Nutr Metab. 2000;13(3):156–64.

    CAS  PubMed  Google Scholar 

  37. Brownley KA, Berkman ND, Sedway JA, Lohr KN, Bulik CM. Binge eating disorder treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007;40:337–48.

    Article  PubMed  Google Scholar 

  38. Duchesne M, Appolinario JC, Range BP, Freitas S, Papelbaum M, Coutinho W. Evidence of cognitive-behavioural therapy in the treatment of obese patients with binge eating disorder. Rev Psiquiatr Rio Gd Sul. 2007;29(1):80–92.

    Article  Google Scholar 

  39. Iacovino JM, Gredysa DM, Altman M, Wilfley DE. Psychological treatment for binge eating disorder. Curr Psychiatry Rep. 2012;14(4):432–46.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Agras WS, Telch CF, Arnow B, Eldredge K, Detzer MJ, Henderson J, et al. Does interpersonal therapy help patients with binge eating disorder who fail to respond to cognitive-behavioural therapy? J Consult Clin Psychol. 1995;63(3):356–60.

    Article  CAS  PubMed  Google Scholar 

  41. Munsch S, Biedert E, Meyer A, Michael T, Schlup B, Tuch A, et al. A randomized comparison of cognitive behavioural therapy and behavioural weight loss treatment for overweight individuals with binge eating disorder. Int J Eat Disord. 2007;40(2):102–13.

    Article  PubMed  Google Scholar 

  42. Grilo CM, Masheb RM. A randomized controlled comparison of guided self-help cognitive behavioural therapy and behavioural weight loss for binge eating disorder. Behav Res Ther. 2005;43:1509–25.

    Article  PubMed  Google Scholar 

  43. Grilo CM, Masheb RM, Gueorguieva R, Wilson GT, White MA. Cognitive-behavioural therapy, behavioural weight loss, and sequential treatment for obese patients with binge eating disorder. J Consult Clin Psychol. 2011;79(5):675–85.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Wilson GT, Wilfley DE, Agras WS, Bryson SW. Psychological treatments of binge eating disorder. Arch Gen Psychiatry. 2010;67(1):94–101.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Wilson GT, Grilo CM, Vitousek KM. Psychological treatments of eating disorders. Am Psychol. 2007;62(3):199–216.

    Article  PubMed  Google Scholar 

  46. Hilbert A, Bishop ME, Stein RI, Tanofsky-Kraff M, Swenson AK, Welch RR, Wilfley DE. Long-term efficacy of psychological treatment for binge eating disorder. Br J Psychiatry. 2012;200(3):232–7.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ricca V, Mannucci E, Mezzani B, Moretti S, Di Bernardo M, Bertelli M, et al. Fluoxetine and fluvoxamine combined with individual cognitive-behaviour therapy in binge eating disorder: a one-year follow-up study. Psychother Psychosom. 2001;70(6):298–306.

    Article  CAS  PubMed  Google Scholar 

  48. Eldredge KL, Steward Agras W, Arnow B, Telch CF, Bell S, Castonguay L, et al. The effects of extending cognitive-behavioural therapy for binge eating disorder among initial treatment nonresponders. Int J Eat Disord. 1997;21(4):347–52.

    Article  CAS  PubMed  Google Scholar 

  49. Agras WS, Telch CF, Arnow B, Eldredge K, Wilfley DE, Raeburn SD, et al. Weight loss, cognitive-behavioural and desipramine treatments in binge eating disorder: an addictive design. Behav Ther. 1994;25(2):209–38.

    Article  Google Scholar 

  50. Wilfley DE, Welch RR, Stein RI, Spurrell EB, Cohen LR, Saelens BE, et al. A randomized comparison of group cognitive-behavioural therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Arch Gen Psychiatry. 2002;59(8):713–21.

    Article  PubMed  Google Scholar 

  51. Grilo CM, Masheb RM, Wilson GT. Efficacy of cognitive behavioural therapy and fluoxetine for the treatment of binge eating disorder: a randomized double-blind placebo-controlled comparison. Biol Psychiatry. 2005;57(1):301–9.

    Article  CAS  PubMed  Google Scholar 

  52. Agras WS, Telch CF, Arnow B, Eldredge K, Marnell M. One-year follow-up of cognitive-behavioural therapy for obese individuals with binge eating disorder. J Consult Clin Psychol. 1997;65(2):343–7.

    Article  CAS  PubMed  Google Scholar 

  53. Devlin MJ, Goldfein JA, Petkova E, Jiang H, Raizman PS, Wolk S, et al. Cognitive behavioural therapy and fluoxetine as adjuncts to group behavioural therapy for binge eating disorder. Obes Res. 2005;13(6):1077–88.

    Article  PubMed  Google Scholar 

  54. Fossati M, Amati F, Painot D, Reiner M, Haenni C, Golay A. Cognitive-behavioural therapy with simultaneous nutritional and physical activity education in obese patients with binge eating disorder. Eat Weight Disord. 2004;9(2):134–8.

    Article  CAS  PubMed  Google Scholar 

  55. Coucoulas AP, Christian NJ, Belle SH, Berk PD, Flum DR, Garcia L, et al. Weight change and health outcomes at 3 years after surgery among individuals with severe obesity. JAMA. 2013;310:2416–25.

    Google Scholar 

  56. Shah M, Simha V, Garg A. Review: long term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91:4223–31.

    Article  CAS  PubMed  Google Scholar 

  57. Wolnerhanssen BK, Peters T, Kern B, Schotzau A, Ackermann C, von Flue M, Peterli R. Predictors of outcome in treatment of morbid obesity by laparoscopic adjustable gastric banding: results of a prospective study of 380 patients. Surg Obes Relat Dis. 2008;4(4):500–6.

    Article  PubMed  Google Scholar 

  58. Kalarchian MA, Wilson GT, Brolin RE, Bradley E. Effects of bariatric surgery on binge eating and related psychopathology. Eat Weight Disord. 1999;4(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  59. Sallet PC, Sallet JA, Dixon JB, Collis E, Pisani CE, Levy A, et al. Eating behaviour as a prognostic factor for weight loss after gastric bypass. Obes Surg. 2007;17(4):445–51.

    Article  PubMed  Google Scholar 

  60. Abiles V, Rodriguez-Ruis S, Abiles J, Obispo A, Gandara N, Luna V, et al. Effectiveness of cognitive-behavioural therapy in morbidity obese candidates for bariatric surgery with and without binge eating disorder. Nutr Hosp. 2013;28(5):1523–9.

    CAS  PubMed  Google Scholar 

  61. Ashton K, Drerup M, Windover A, Heinberg L. Brief, four-session group CBT reduces binge eating behaviours among bariatric surgery candidates. Surg Obes Relat Dis. 2009;5(2):257–62.

    Article  PubMed  Google Scholar 

  62. Ashton K, Heinberg L, Windover A, Merrell J. Positive response to binge eating intervention enhances postoperative weight loss. Surg Obes Relat Dis. 2011;7(3):315–20.

    Article  PubMed  Google Scholar 

  63. Cassin SE, Sockalingam S, Du C, Wnuk S, Hawa R, Parikh S. A pilot randomized controlled trial of telephone-based cognitive behavioural therapy for preoperative bariatric surgery patients. Behav Res Ther. 2016;80:17–22.

    Article  PubMed  Google Scholar 

  64. Gade H, Hjelmesæth J, Rosenvinge JH, Friborg O. Effectiveness of a cognitive behavioural therapy for dysfunctional eating among patients admitted for bariatric surgery: a randomized controlled trial. J Obes. 2014;21:127936.

    Google Scholar 

  65. Gade H, Friborg O, Rosenvinge JH, Smastuen MC, Hjelmesæth J. The impact of a preoperative cognitive behavioural therapy (CBT) on dysfunctional eating behaviours, affective symptoms and body weight 1 year after bariatric surgery: a randomized controlled trial. Obes Surg. 2015;25(11):2112–9.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Leahey TM, Crowther JH, Irwin SR. A cognitive-behavioural mindfulness group therapy intervention for the treatment of binge eating in bariatric surgery patients. Cogn Behav Pract. 2008;15(4):364–75.

    Article  Google Scholar 

  67. Kalarchian MA, Marcus MD, Courcoulas AP, Cheng Y, Levine MD. Preoperative lifestyle intervention in bariatric surgery: a randomized clinical trial. Surg Obes Relat Dis. 2016;12(1):180–7. doi:10.1016/j.soard.2015.05.004.

    Article  PubMed  Google Scholar 

  68. Lier HO, Biringer E, Stubhaug B, Tangen T. The impact of preoperative counseling on postoperative adherence in bariatric surgery patients: a randomized controlled trial. Patient Educ Couns. 2012;87(3):336–42.

    Article  PubMed  Google Scholar 

  69. Kalarchian MA, Marcus MD, Courcoulas AP, Cheng Y, Levine MD, Josbeno D. Optimizing long-term weight control after bariatric surgery: a pilot study. Surg Obes Relat Dis. 2012;8(6):710–6.

    Article  PubMed  Google Scholar 

  70. Kalarchian MA, Marcus MD. Psychosocial interventions pre and post bariatric surgery. Eur Eat Disord Rev. 2015;23(6):457–62.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Psychology, Ryerson University, Toronto, ON, Canada

    Stephanie E. Cassin Ph.D., C.Psych. & Molly Atwood

  2. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Stephanie E. Cassin Ph.D., C.Psych.

  3. Centre for Mental Health, University Health Network, Toronto, ON, Canada

    Stephanie E. Cassin Ph.D., C.Psych.

Authors
  1. Stephanie E. Cassin Ph.D., C.Psych.
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  2. Molly Atwood
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Corresponding author

Correspondence to Stephanie E. Cassin Ph.D., C.Psych. .

Editor information

Editors and Affiliations

  1. Toronto Western Hospital Bariatric Surgery Program, Centre for Mental Health, University Health Network, Toronto, Ontario, Canada

    Sanjeev Sockalingam

  2. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

    Raed Hawa

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Cassin, S.E., Atwood, M. (2017). Cognitive Behavioural Therapy for Severe Obesity. In: Sockalingam, S., Hawa, R. (eds) Psychiatric Care in Severe Obesity. Springer, Cham. https://doi.org/10.1007/978-3-319-42536-8_18

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  • DOI: https://doi.org/10.1007/978-3-319-42536-8_18

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