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The effects of acceptance and commitment therapy-based exercises on eating behaviors in a laboratory setting

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The effects of acceptance and commitment therapy-based exercises on eating behaviors in a laboratory setting

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Content Running Head: ACT AND EATING BEHAVIORS 1
The Effects of Acceptance and Commitment Therapy-Based Exercises on Eating
Behaviors in a Laboratory Setting
Mia C. Brousseau
Master of Science (APPLIED BEHAVIOR ANALYSIS)
May 2019
University of Southern California
ACT AND EATING BEHAVIORS 2
Table of Contents
Abstract…….…………………………………………………………………………………….…………3
1.0 Introduction…………….………………...………...………………………………………………4
1.1 Acceptance and Commitment Therapy…………………………...……..……4
Mindfulness-based cognitive therapy and disordered eating……………………....5
Mindfulness attention induction and disordered eating……………………………...5
Mindful eating and food intake………………………………………………………................6
Mindfulness and reduced consumption of high calorie foods……………………....7
ACT, binge eating, and subclinical eating pathology…………………………………….7
Mindfulness and weight loss………………………………………………………………………8
2.0 Methods……….…………………………………………………………………………………….…9
2.1 Participants and Setting…………………………………………..………………….8
2.2 Response Measurement and Interobserver Agreement…………..….9
2.3 Procedures……....…………………...…………………………………………………..10
Design………………………………………………………………………………..…………………...10
Screening and Preference Assessments………………………………….…………………10
Informed Consent……………………………………………………………………..……………..11
Baseline…………………………………………………………………………………………………..11
Preliminary ACT Training……………………………………………………………….………..11
ACT Condition……………………………………………………………...………………………….13
Post-training……………………………………………………………………….…………………..15
Debriefing……………………………………………………………………………………………….16
3.0 Results…………………………………………………………………………….………………….16
4.0 Discussion………………………………………………………………..………………………...18
References…………………………………………………………………….………………………….25
ACT AND EATING BEHAVIORS 3
ABSTRACT:
Mindfulness-based strategies such as those used in Acceptance and Commitment
Therapy (ACT) are increasingly used for craving and weight management as well as
for behaviors related to disordered eating. A growing body of research in the clinical
psychology literature provides evidence that these approaches can be effective in
changing eating behaviors. However, few studies have examined the effects of these
strategies in controlled settings, while separating components of the strategies
accountable for success. Fewer still have attempted to identify the behavioral
mechanisms that may be responsible for behavior change in these interventions.
This study evaluates ACT-based strategies and their effects on the eating behaviors
of four participants in a laboratory setting. A multiple baseline design across
participants is used to assess the efficacy of an ACT-based intervention that involves
the application of ACT exercises during choices between healthy versus non-healthy
foods. Throughout this process the ACT exercises were gradually faded out and
indirect data were taken on generalization of healthy food consumption to the
participants’ natural environment.
ACT AND EATING BEHAVIORS 4
The Application of Acceptance and Commitment-Based Therapy Exercises to Improve
Healthy Eating Behaviors
1.0 Introduction
About three-fourths of the U.S. population has an eating pattern that is low in
vegetables, fruits, and oils and exceeds recommendations for added sugars, saturated fats,
and sodium (National Health and Nutrition Examination Survey, 2015). Food
consumption is linked to some of the leading causes of preventable death and diseases
such as: heart disease, diabetes, obesity, high blood pressure, stroke, osteoporosis, and
various cancers (Center for Science in the Public Interest (CSPI), 2016). Therefore, it is
important to eat a varied diet including plant-based foods to decrease the likelihood of
preventable death and disease. Current efforts to promote healthy eating are insufficient,
as obesity rates in the past 30 years have doubled in adults (CDC), tripled in children, and
quadrupled in adolescents (Ogden, 2015).
1.1 Acceptance and Commitment Therapy
Acceptance and commitment therapy (ACT), is an empirically based
psychological intervention that uses acceptance and mindfulness strategies with
commitment and behavior change strategies to increase psychological flexibility (Hayes,
Strosahl, & Wilson, 1999). ACT has been used on a variety of populations of individuals
such as those with; substance abuse, psychosis, anxiety, depression, chronic pain, and
eating disorders (Ruiz, 2010). Although numerous studies applying ACT-based
procedures have addressed disordered eating behaviors in the context of eating disorders,
few studies have used these procedures to promote healthy eating habits in those who do
not necessarily display disordered eating but wish to improve their eating habits.
ACT AND EATING BEHAVIORS 5
Mindfulness-based cognitive therapy and disordered eating. Alberts and Raes
(2012) conducted a study in which 26 women who reported having disordered eating
were split into two groups. One group was the mindfulness-based cognitive therapy
(MBCT) intervention group and the other group of individuals was placed on a waiting
list for the intervention. Although described as a cognitive therapy and not ACT, per se,
MBCT contains multiple components that overlap highly with the ACT model of
psychological flexibility. The MBCT-intervention included components such as: mindful
eating, awareness of physical sensations, awareness of relevant thoughts and feelings,
acceptance, and awareness of daily habits. Outcomes were measured via weight check-
ins and multiple questionnaires related to body shape, mindfulness, eating behavior,
dichotomous thinking, and general food craving. Twelve participants were assigned to
the treatment group, while fourteen were assigned to a waiting-list control group. The
waiting-list period lasted for the duration of the treatment period, which was 8 weeks.
The intervention consisted of 8 weekly sessions lasting 2.5 hours and participants were
invited to practice all exercises learned in the sessions during time at home for
approximately 45-60 minutes a day. They found that lower levels of food cravings,
dichotomous thinking, body dissatisfaction, emotional eating and external eating were
reported after the intervention period, compared to a waiting list control group. No direct
measures of behavior were included as dependent variables.
Mindfulness attention induction and disordered eating. Fisher et al. (2016)
conducted a group design study with forty participants in a university setting in which
they included a mindfulness attention induction script in the experimental condition
compared to an attention control condition. They assessed cravings and food intake using
ACT AND EATING BEHAVIORS 6
multiple mindfulness and craving questionnaires and measured food intake in a
laboratory setting. The forty participants were split evenly between the control and
intervention groups. The study of pretest measures on appetite, state mindfulness, and
mood followed by 10 minutes of either mindfulness induction or a control task. Then 10
minutes of a food-cue exposure task was conducted in which participants were exposed
to two food items and were instructed to hold, smell, and touch the foods to their lips.
They were instructed not to consume or taste the foods during this task. After the food
exposure task post-test measures were taken on appetite, state mindfulness, mood, and
state craving. An additional 10 minutes of either mindful self-practice or sitting was
conducted in the presence of cued foods. At the end of delay, measures on appetite, state
mindfulness, mood, state craving, and desire for cued foods was taken followed by a food
intake measurement and exit questions. The results showed that attention with a mindful
attitude may promote better eating behaviors in the short-term, and adds to the evidence
base justifying the examination of components of mindfulness-based interventions within
the context of obesity prevention and management. A strength of this study is the
inclusion of a direct measure of food intake as a dependent variable.
Mindful eating and food intake. Seguias and Tapper (2017) conducted a group
design study with 51 participants recruited at a university in which they examined the
effects of applying a mindful eating strategy during lunch times and measuring the effects
of memory of food intake later in the day. The two conditions of this study consisted of a
control group in which participants ate lunch with no audio recording and an
experimental group consisting of a mindful eating strategy. The mindful eating strategy
consisted of an audiotape that played during mealtime focusing on bringing the
ACT AND EATING BEHAVIORS 7
participants attention to the properties of food. The measurements taken throughout this
study included: (a) heartbeat through an electrocardiogram (ECG); (b) questionnaires on
appetite, memory, and reinforcement; (c) a sensitivity theory personality questionnaire;
(d) demographics; and (e) snacking, and dieting status. They found that results of mindful
eating were not moderated by interoceptive awareness and no significant differences
were found in memory. They also found reductions in afternoon snack consumption
when mindfully eating in the lunch condition.
Mindfulness and reduced consumption of high calorie foods. Several studies
have evaluated the effects of mindfulness using group designs to reduce consumption of
high calorie foods such as chocolate (Forman, Hoffman, Juarascio, Butryn, & Herbert,
2013, Hooper, Sandoz, Ashton, Clarke, & McHugh, 2012, Jenkins and Tapper 2014,
Moffitt, Brinkworth, Noakes, & Mohr, 2012). Two of these studies found no significant
differences among groups when comparing ACT-based interventions to control groups
and the third study found a reduction in high calorie food consumption in the defusion
condition, but not the acceptance and control conditions. The last study found lower
levels of food consumption in the mindfulness-related condition compared to the
cognitive restructuring and control conditions.
ACT, binge-eating, and subclinical eating pathology. Several other studies
have assessed the use of ACT-based interventions for treating binge eating symptoms and
subclinical eating pathology (Baer, Fischer, & Huss, 2006, Dalen, Smith, Shelley, Sloan,
Leahigh, & Begay, 2010, Hill, Masuda, Moore, & Twohig, 2015, Juarascio, Forman, &
Herbert, 2010, Kearney, Milton, Malte, McDermott, Martinez, & Simpson, 2012,
Kristeller and Hallet 1999, and Strandskov, Ghaderi, Ansdersson, Parmskog, Hjort,
ACT AND EATING BEHAVIORS 8
Warn, & Andersson, 2017). All seven of these studies using ACT-based interventions
resulted in substantial improvements in symptoms such as: frequency of binges and
binge-related concerns, depression, perceived stress, physical symptoms, emotional
eating, and uncontrolled eating.
Mindfulness and weight loss. Several studies have also evaluated the use of
mindfulness-based strategies on weight loss for individuals with motivation to lose
weight (Mantzios & Wilson 2015, Miller et al. 2012). The study conducted by Mantzios
& Wilson (2015) included 62 military employees across three groups. The two
mindfulness intervention groups consisted of mindfulness meditation alone and
mindfulness meditation combined with self-compassion, while the control group
consisted of dieting only. The 5-week study assessed outcomes on weight and BMI. The
results showed that both experimental groups improved significantly compared to the
control group and that mindfulness with self-compassion was more effective than
mindfulness alone.
In summary, a variety of research supports the potential utility of mindfulness-
based approaches to improving eating, but little previous research has assessed the effects
of these strategies on direct measures of behavior. In addition, very little research on
mindfulness based approaches to improving eating have used single case designs, which
can be effective in identifying the effects of interventions on the behavior of individual
participants. The purpose of the current study was to evaluate the effects of ACT-based
strategies on the eating behaviors of individuals in a laboratory setting using a single-case
design. The eating behaviors measured in this study included both healthy and non-
healthy choice making, and complete consumption of each choice made.
ACT AND EATING BEHAVIORS 9
2.0 Method
2.1 Participants and Setting
The participants included four undergraduate college students, with no prior
diagnoses of eating related disorders, at least 18 years of age, had access to an electronic
device with the application “myfitnesspal”, and spoke fluent English. The study took
place in a 6 m x 6 m lab meeting room, equipped with tables and chairs. Participants were
compensated in the form of $5 for every 30 minutes of time spent in the laboratory.
Compensation was not contingent on any specific outcomes and instead contingent on the
duration of time spent participating in the study.
2.2 Response Measurement and Interoberver Agreement
The dependent variables that were measured throughout this study were choice
and complete consumption of healthy and unhealthy foods on each trial. IOA was
collected for 73% of sessions and observers obtained 100% agreement. Social validity
was assessed through a written assessment at the conclusion of the study for each
participant. Examples of social validity assessment questions covered areas such as
validity of outcomes, procedures, goals, and external validity. Participants used an
application on their mobile phones to record their food consumption for one day before
and one day after participation. Data from the food logs were scored according to four
categories of foods. “Specified foods other than fruits and vegetables” were defined as
any food item listed as preferred on the initial preference assessment. “Specified fruits
and vegetables” were defined as any food item listed as non-preferred on the assessment.
“Unspecified foods other than fruits and vegetables” were defined as food items not listed
on the assessment and not vegetables of fruits. “Unspecified fruits and vegetables” were
ACT AND EATING BEHAVIORS 10
defined as food items not listed on the assessment including only vegetables and fruits.
These four categories were used because all participants expressed a desire to increase
their consumption of fruits and vegetables.
2.3 Procedures
Design. A multiple baseline design across participants was used, consisting of the
following phases; baseline, ACT training, and post-training.
Screening and Preference Assessment. Participants were screened for any
potential food allergies prior to participation. For a food to be included in the study, the
participant must have stated that they have consumed it at least once in the past with no
evidence of a reaction to the foods. A brief preference assessment was conducted at the
beginning of the study in which each participant was asked to list ten highly preferred
unhealthy foods that they wish they would eat less of and ten healthy low-preferred foods
that they do not currently eat but wish that they did. They were asked to rank order these
food items according to how problematic the unhealthy foods were and which healthy
foods they would prefer to work on. Participants were also asked questions pertaining to
their motivation for healthy eating and what current supports they have in their life for
eating related goals. Participants were made aware at the beginning of the study that our
goal is to help them make healthier choices and increase their healthy food consumption.
Questions pertaining to response effort and food availability were also asked during the
screening process such as common stores they shop at to purchase foods, how often they
eat out and where, and other general eating habits.
ACT AND EATING BEHAVIORS 11
Informed Consent. During the first study visit, each participant received and
signed a document with a brief description of the study as well as their rights as a
research participant in this study.
Baseline. Prior to the start of food choice trials participants were asked about
whether they had eaten within the last 2 hours. Food choice trials commenced if the
participant had reported they did not eat within the last two hours. During each trial in
baseline the participants were presented with two food options, one healthy food option
and one unhealthy food option, based on individual preference assessments. One bite of
each food item was presented as a trial and participants were instructed to “pick one”.
After a choice was made the remaining item was removed from the table. Trials rotated
randomly through several different healthy and several different unhealthy foods.
Generalization probes for food consumption outside of the laboratory setting were
included in the baseline phase. Participants were asked to download a free application on
their phone or other electronic device that provided them with the tools for tracking their
food intake and sharing it with the researcher. The participants were asked to record their
consumption of food for one full day prior to the start of the baseline phase of
intervention in the natural environment, as well as after intervention. They were asked to
track the full day of food consumption for one of the three days leading up to the
beginning of baseline and for no longer than three days after the last post-training trial.
Preliminary ACT-training. This training period consisted of practicing a general
mindfulness-based exercise such as “five senses” or “mindful meditation”. Food choices
were not presented during this training period and no measurements were in place. This
ACT AND EATING BEHAVIORS 12
condition was solely for the purpose of allowing the participants to gain practice in being
mindful during guided exercises.
Five senses (Stoddard & Afari 2014). The participant was asked to look around
and notice five things that they haven’t noticed before, whether it is a pattern on the wall,
reflection of light on a surface, or an object placed in a corner of the room. The
participant was then asked to notice four things that they feel. This could be the feel of
their clothing, the feel of a breeze, or the feel of the pressure of their hands on a surface.
They then were asked to notice three things that they can hear, such as background
sounds, air conditioning noise, or cars in the distance. Next, the participant was asked to
notice two things that they can smell such as flowers, coffee, or air freshener. Lastly, the
participant was asked to notice one thing that they can taste, such as a piece of gum or
just how their mouth tastes.
Mindful Meditation (Stoddard & Afari, 2014). The participant was asked to find a
comfortable position to sit for a few minutes. They were asked to start by noticing their
breath by paying attention to how it enters and then leaves their body. They were told to
notice as their mind begins to wander and pull them out of the present moment. The
participants were then asked to notice their thoughts and feelings as if they were an
outside observer watching what happens inside their brain while taking note of this they
were asked to return back to noticing their breathing. If their mind begins to wander, they
were asked to notice where the thoughts were going and to accept them as they were
happening. They were told to try and return to their breathing and continue this process
for a few more moments.
ACT AND EATING BEHAVIORS 13
ACT Condition. After the initial ACT training, food choice trials were continued
as in baseline. This condition was identical to baseline with the addition of the ACT-
based exercises that were guided intermittently between trials, depending on the
participants’ response to the intervention. All participants started the ACT condition by
engaging in the exercises pertaining to mindfulness and based off of visual inspection and
feedback from the participants, decisions were made on which of the other ACT-based
exercises were subsequently implemented (i.e. values, defusion, etc.). Contingent on two
out of three consecutive trials in which unhealthy food was chosen, participants were
guided through an additional ACT exercise and then instructed to apply the exercise to
the next food choice trial. The additional exercises are described below.
Mindful Eating (Stoddard & Afari, 2014). This present-moment awareness
exercise consisted of first noticing how the food looked on the table, then picking up the
food and noticing the weight of it and how it felt against your skin. Then the participant
was asked to notice its texture and any other properties of the food. The participant was
asked to notice the smell of the food. Next the participant was asked to put the food in
their mouth on top of their tongue without eating it and to observe how it felt there and
any taste it has. They were asked to roll the food around their mouth and pay attention to
the feeling. Lastly, the participant was asked to slowly chew the food and notice how the
texture changes and how it tasted as it spread across their tongue. They were asked to
notice if their mouth began to fill with saliva and the temperature it left on their tongue.
The participant was told to notice all of these sensations until they had finished eating the
food. None of the target healthy or unhealthy foods were used during the mindful eating
exercise (i.e., other healthy foods were included).
ACT AND EATING BEHAVIORS 14
Mindful Bodyscan (Stoddard & Afari, 2014). The participant was asked to pay
close attention to physical sensations throughout their body without trying to change or
relax their body but instead to just notice how they become more aware of it. The
participant was told to begin by paying attention to their feet first by noticing the warmth,
coolness, pressure, pain, or even a breeze over the skin. They were asked to slowly move
the noticing of sensations up their body to their calves, thighs, pelvis, stomach, chest,
back, shoulders, arms, fingers, neck, and then their head. After they have traveled all the
way up their body they were asked to begin to move back down through each body part
until they reach their feet again.
Responding to Triggers (Stoddard & Afari 2014). This defusion exercise involved
bringing out a highly desired food, presumably unhealthful, and allowing the participant
to see and smell it and then describe some thoughts, feelings, and cravings they
experience in the presence of the food item. The participant was provided with a paper
and pen during this exercise and asked to write down these thoughts, feelings, and
cravings. As the participant shared what they wrote down the individual running the
exercise began to label each of these as thoughts, emotions, or cravings so the participant
could experience the distinctions. They were then asked to explore different ways of
relating to the cravings using the metaphor of a wave to help them consider the
possibility of just experiencing cravings as they rise and fall without acting on them.
Values Bull’s Eye (Lundgren et al. 2012). This exercise included a worksheet with
an outline of concentric circles that are split along the lines of a compass. Each quarter of
the bull’s eye represents a part of the individual’s life. These parts included;
work/education, leisure, personal growth/health, and relationships. First the participants
ACT AND EATING BEHAVIORS 15
were asked to list their values for each of the parts in their bull’s eye model. The values
that are listed were here and now rather than goals for the future, they did not need to be
justified but did need to be prioritized, held tightly, and freely chosen. The participant
was asked to write each value beside each of the areas they relate to. The participant was
asked to prioritize their top three values by either marking them with a symbol or
highlighting them. Once all the values were identified and written in the areas, they were
asked to mark where they stand with their values today. The participant was asked to
revisit the bull’s eye worksheet at a later time to mark their progress or regression
towards their values.
Drop the Anchor (Harris, 2011). This exercise consisted of having the participant
stand up and plant their feet into the ground while noticing the muscle tension in their
legs. They were asked to bring their awareness to the sensations of gravity moving down
their spine and into their feet and to notice their surroundings and any internal private
events. The participant is asked to count cycles of five deep breathes while noticing the
way their chest expands and compresses.
After a consistent effect was demonstrated, guided ACT exercises were faded
gradually and systematically, based on visual inspection of the data. The frequency of
ACT exercises was faded over the course of stable healthy choices until only vocal
reminders to make choices mindfully were given. Vocal reminders were faded out
gradually until healthy choice making maintained in the absence of reminders. Choice
making was considered to be stable after 2 consecutive choices of a healthy food item.
Post-training. Post-training trials were identical to baseline.
ACT AND EATING BEHAVIORS 16
Debriefing. At the conclusion of all data collection the participants were
debriefed on the overall purpose and processes used throughout the study as well as the
outcomes attained. Participants were given the opportunity to ask any questions about the
study and its conclusions.
3.0 Results
Figure 1 depicts the complete consumption of both healthy and unhealthy food
options on a cumulative graph. All participants completely consumed bites of the
unhealthy food option during the baseline phase with the exception of participant 4 who
intermittently chose the healthy choice. Initially, participants 1, 2, and 3 did not consume
the healthy food choice option in the ACT condition, but for participants 2 and 3 they
began to choose and consume the healthy food item option over the unhealthy food item.
Participant 1 did not reliably choose the healthy option during the mindfulness portion of
the ACT training but began to choose the healthy option after the values portion of the
ACT training was introduced. Participant 4 immediately chose the healthy option after
starting the ACT condition and reliably chose the healthy option for the remainder of the
phase. During the post-training phase participants 1, 2, and 3 consistently consumed the
healthy food item over the unhealthy food item for the entire post-training phase.
Participant 4 consumed the healthy option for the majority of the post-training phase with
the exception of one unhealthy food item choice before returning back to consuming the
healthy food item.
Figure 2 depicts the food log data for participant 1 in the baseline and post-
training phases. In the baseline phase participant 1 had eaten 0% of servings that were
categorized as fruits or vegetables and in the post-training phase 60% of the foods eaten
ACT AND EATING BEHAVIORS 17
were categorized as fruits or vegetables. Figure 3 shows the food log data for participant
2 in the baseline and post-training phases. In the baseline phase participant 2 consumed
21% of servings that were categorized as fruits or vegetables. In the post-training phase,
they consumed 41% of servings that were categorized as fruits or vegetables. Figure 4
depicts food log data for participant 3 during the baseline phase. During baseline
participant 3 consumed 9% of servings categorized as fruits or vegetables. Post-training
food log data was not provided by participant 3. Figure 5 represents the food log data for
participant 4 during baseline and post-training phases. Participant 4 consumed 50% of
servings categorized as fruits or vegetables in the baseline phase and 40% of servings
categorized as fruits or vegetables in the post training phase. Figure 6 displays the
specific ACT exercises that were used for all four participants in the sequential order that
they were delivered in.
Figure 7 shows the social validity data based off of an assessment provided to all
four participants. On a scale of 1 (strongly disagree) to 5 (strongly agree), on average,
participants rated a 4 for the agreement of the procedures of this study helping them make
healthier choices in the lab. All participants rated a 5, in agreement to the mindfulness
procedures being easy to follow. All participants strongly agreed that they valued the goal
of eating healthier. On average, participants agreed that the mindfulness exercises used
were helpful in their daily life. All participants strongly agreed that the mindfulness
procedures were enjoyable overall. Figure 8 displays a table of foods included in the
study based on each individual preference assessment. All participants were provided
three choices in each category with the exception of participant 4 who expressed that one
ACT AND EATING BEHAVIORS 18
of the healthy food items included was no longer a valuable food to begin consuming and
was therefore, excluded from the study.
4.0 Discussion
These results suggest that ACT-based interventions are effective in directly
influencing healthy eating behaviors by improving healthy choices and increasing amount
of consumption of healthy options while decreasing consumption of unhealthy food
options in the laboratory. The ACT-based interventions were successful in showing
immediate behavior change as well as success in fading out the guided practices
demonstrating generalization of the practices, at least across foods within the laboratory.
Due to the increasing rates of preventable disease and death caused by eating
related personal health decisions these findings have implications towards the
effectiveness of ACT-based interventions for improving healthy eating in populations
who may be at risk or may wish to improve their current eating habits. Results of this
study suggest that mindfulness-based and value’s exercises may help to increase
immediate healthy food choice making.
One limitation of this study is that it was conducted in a lab setting in which some
reactivity could have occurred due to the unnatural setting of eating behavior. Because
this was an initial study, no attempt was made to produce generalization of the effects of
the intervention outside of the lab and therefore no formal data were collected to test any
such generalization. An objective evaluation of how ACT-based interventions can affect
healthy eating behaviors outside of the lab context and in the individuals’ daily lives
should be an area of future research.
ACT AND EATING BEHAVIORS 19
Another limitation of this study is that the function of each individual’s unhealthy
eating behaviors was not identified prior to the start of the study. It is highly recognized
in the field of applied behavior analysis that interventions take a function-based
approach. It is possible that unhealthy food choices involve negative automatic
reinforcement in the form of escape from non-preferred foods and positive automatic
reinforcement in the form of access to preferred foods. If this is the case, it is possible
that mindful eating exercises work because they decrease or disrupt the aversive stimulus
functions of healthy foods and/or add new verbally mediated functions through relational
framing and transformation of stimulus functions. However, this study made no attempt
to assess the function of unhealthy choice making during baseline and no systematic
attempt to identify whether mindful eating was effective due to these functional variables.
Therefore, another area of future research would be to assess the function of the
individual’s own eating behaviors and attempt to identify the behavioral mechanisms
responsible for the effectiveness of mindful eating interventions.
Future studies should examine how these procedures could be adapted for use in
schools to establish mindful eating repertoires early on in life or during periods of life
change such as starting college. Future research should also look to adapt and evaluate
the effectiveness of these procedures for populations struggling with obesity, diabetes, or
other ailments related to food consumption. Future studies should also investigate the
effects of specific ACT processes on eating behavior by conducting a component analysis
so as to identify the effective variables in altering an individual’s eating behavior. Lastly,
an area for future research studies could be to improve the efficiency and reduce response
ACT AND EATING BEHAVIORS 20
effort of establishing mindfulness repertoires by creating an app or building group
instruction mindfulness programs for healthy eating.
ACT AND EATING BEHAVIORS 21
Figure 1. Number of cumulative choices completely consumed for healthy and unhealthy
options.
ACT AND EATING BEHAVIORS 22
Figure 2. Food log results for participant 1 during baseline and post training phases.
Figure 3. Food log results for participant 2 during baseline and post training phases.
ACT AND EATING BEHAVIORS 23
Figure 4. Food log results for participant 3 during baseline phase.
Figure 5. Food log results for participant 4 during baseline and post-training phases.
ACT AND EATING BEHAVIORS 24
Participant 1 Participant 2 Participant 3 Participant 4
Five Senses Five Senses Five Senses Five Senses
Mindful Eating Mindful Eating Mindful Eating Mindful Eating
Body Scan Body Scan Body Scan Body Scan
Mindful Eating Mindful Eating Drop the Anchor Drop the Anchor
Drop the Anchor Mindful Eating Mindful Eating -
Mindful Eating Responding to Triggers Mindful Eating -
Mindful Eating - Notice 5 Things -
Value’s Bullseye - - -
Value’s Bullseye - - -
Figure 6. ACT exercises for each participant in sequential order.
Figure 7. Social validity results for all four participants.
ACT AND EATING BEHAVIORS 25
Figure 8. Food included in the study based off of a list of preferred unhealthy foods and
nonpreferred healthy foods rank ordered by each participant.
ACT AND EATING BEHAVIORS 26
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Asset Metadata

Creator Brousseau, Mia Claire (author)

Core Title The effects of acceptance and commitment therapy-based exercises on eating behaviors in a laboratory setting

School College of Letters, Arts and Sciences

Degree Master of Science

Degree Program Applied Behavior Analysis

Publication Date 04/25/2019

Defense Date 03/19/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Aba,acceptance,acceptance and commitment therapy,ACT,behavior analysis,eating behaviors,healthy eating,mindfulness,OAI-PMH Harvest,single-subject,Values

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Tarbox, Jonathan (committee chair), Cameron, Michael (committee member), Harris, Jennifer (committee member), Manis, Franklin (committee member)

Creator Email broussea@usc.edu,miabrousseau@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-146878

Unique identifier UC11660323

Identifier etd-BrousseauM-7266.pdf (filename),usctheses-c89-146878 (legacy record id)

Legacy Identifier etd-BrousseauM-7266.pdf

Dmrecord 146878

Document Type Thesis

Format application/pdf (imt)

Rights Brousseau, Mia Claire

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

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