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A pilot randomized controlled trial of telephone-based cognitive behavioural therapy for preoperative bariatric surgery patients

https://doi.org/10.1016/j.brat.2016.03.001Get rights and content

Highlights

  • We compare telephone-based CBT (Tele-CBT) to standard pre-operative care.

  • We examine changes in eating psychopathology following Tele-CBT.

  • We examine changes in psychosocial functioning following Tele-CBT.

  • Tele-CBT improves eating psychopathology and depression more than standard care.

  • Tele-CBT improves treatment accessibility for obese bariatric surgery patients.

Abstract

Background

Psychosocial interventions can improve eating behaviours and psychosocial functioning in bariatric surgery candidates. However, those that involve face-to-face sessions are problematic for individuals with severe obesity due to mobility issues and practical barriers.

Objective

To examine the efficacy of a pre-operative telephone-based cognitive behavioural therapy (Tele-CBT) intervention versus standard pre-operative care for improving eating psychopathology and psychosocial functioning.

Methods

Preoperative bariatric surgery patients (N = 47) were randomly assigned to receive standard preoperative care (n = 24) or 6 sessions of Tele-CBT (n = 23).

Results

Retention was 74.5% at post-intervention. Intent-to-treat analyses indicated that the Tele-CBT group reported significant improvements on the Binge Eating Scale (BES), t (22) = 2.81, p = .01, Emotional Eating Scale (EES), t (22) = 3.44, p = .002, and Patient Health Questionnaire-9 (PHQ-9), t (22) = 2.71, p = .01, whereas the standard care control group actually reported significant increases on the EES, t (23) = 4.86, p < .001, PHQ-9, t (23) = 2.75, p = .01, and General Anxiety Disorder-7 (GAD-7), t (23) = 2.93, p = .008 over the same time period.

Conclusions

Tele-CBT holds promise as a brief intervention for improving eating psychopathology and depression in bariatric surgery candidates.

Section snippets

Participants

Participants (N = 72) were adult bariatric surgery candidates recruited from a Canadian Bariatric Surgery Program. Exclusion criteria included current ineligibility for bariatric surgery, lack of computer access, or having significant language barriers, poorly controlled psychiatric illness or severe medical illness that would render Tele-CBT very difficult. Given the absence of clear pre-operative psychological predictors of bariatric surgery outcome (Livhits et al., 2012), participation was

Statistical analysis

All analyses were performed using SPSS Statistics for Windows (Version 18.0; SPSS, IBM Corp, Armonk, NY). Descriptive statistics including means, standard deviations, and frequency counts were calculated to describe participant characteristics. Independent t tests and chi-square were used to compare completers with dropouts, and to compare the Tele-CBT group with the Control group, on demographic variables and baseline clinical variables.

A 2 (Group: Tele-CBT vs. Control) x 2 (Time: baseline,

Results

Recruitment and Participant Flow. The CONSORT diagram is depicted in Fig. 1. Recruitment for the study occurred over a period of 9 months. Of 72 individuals screened for eligibility, 15 did not meet the study inclusion/exclusion criteria, and 10 chose to not participate. Of the remaining 47 participants who were randomly assigned to the Tele-CBT group (n = 23) or Control group (n = 24), 35 (74.5%) completed the post-treatment measures: 16 (70.0%) from the Tele-CBT Group and 19 (79.1%) from the

Discussion

The current pilot RCT found Tele-CBT to be a feasible intervention and efficacious in improving eating psychopathology and psychosocial functioning in pre-operative bariatric surgery patients. These findings are in line with previous research that has found CBT to be effective in improving disordered eating and affective symptoms in pre-operative bariatric surgery patients (Ashton et al., 2009, Gade et al., 2015). The RCT design of the current study permitted comparison with a standard

Conclusions

In summary, the current pilot RCT provided preliminary support that a 6-session pre-operative Tele-CBT intervention is feasible, and appears efficacious in improving eating psychopathology and depression immediately following the intervention. These pilot findings lend support to the growing body of literature demonstrating that CBT can be a helpful tool for bariatric surgery patients and provide an impetus to investigate other novel methods of treatment delivery to increase accessibility to

Author note

This research was supported by funding from the Canadian Institutes of Health Research (Grant #317877) and the Ontario Ministry of Health and Long Term Care. Dr. Stephanie Cassin and Dr. Sanjeev Sockalingam are both primary authors. Correspondence concerning this article should be addressed to Dr. Stephanie Cassin, Department of Psychology, Ryerson University, 350 Victoria St., Toronto, Ontario, Canada, M5B 2K3.

Acknowledgements

The authors would like to thank Dr. Sarah Royal for conducting Tele-CBT with a subset of the participants and Vincent Santiago for assisting with the manuscript.

References (33)

  • S. Tutty et al.

    Evaluating the effectiveness of cognitive behavioural teletherapy in depressed adults

    Behavior Therapy

    (2010)
  • V. Abiles et al.

    Effectiveness of cognitive behavioural therapy on weight loss after two years of bariatric surgery in morbidly obese patients

    Nutricion Hospitalaria

    (2013)
  • B. Arnow et al.

    The emotional eating scale: the development of a measure to assess coping with negative affect by eating

    International Journal of Eating Disorders

    (1995)
  • N.N. Beck et al.

    Do post-operative psychotherapeutic interventions and support groups influence weight loss following bariatric surgery? A systematic review and meta-analysis of randomized and nonrandomized trials

    Obesity Surgery

    (2012)
  • A.P. Courcoulas et al.

    Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity

    Journal of the American Medical Association

    (2013)
  • H. Gade et al.

    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

    Obesity Surgery

    (2015)
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