Psychological flexibility mediates change in intuitive eating regulation in acceptance and commitment therapy interventions
Open accessAbstract
Objective: Despite the promising results related to intuitive eating, few studies have attempted to explain the processes encouraging this adaptive eating behaviour. The focus of the present study was on exploring mechanisms of change in intuitive eating and weight in acceptance and commitment therapy (ACT) interventions. Mediation provides important information regarding the treatment processes and theoretical models related to specific treatment approaches. The study investigates whether psychological flexibility, mindfulness skills and sense of coherence mediated the interventions’ effect on intuitive eating and weight. Design: Secondary analysis of a randomized control trial. Mediation analysis compared two ACT interventions – face-to-face (in a group) and mobile (individually) – with a control group using a latent difference score model. Settings: Data were collected in three Finnish towns. Subjects: The participants were overweight or obese (n 219), reporting symptoms of perceived stress. Results: The effect of the interventions on participants’ (i) BMI, (ii) intuitive eating and its subscales, (iii) eating for physical rather than emotional reasons and (iv) reliance on internal hunger and satiety cues was mediated by changes in weight-related psychological flexibility in both ACT groups. Conclusions: These findings suggest that ACT interventions aiming for lifestyle changes mediate the intervention effects through the enhanced ability to continue with valued activities even when confronted with negative emotions and thoughts related to weight.
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Targeted measures of experiential avoidance are more accurate in predicting psychological and behavioral outcomes than general measures.
“Targeted measures of EA have found to be more accurate in predicting psychological and behavioral outcomes [23, 25, 40].”
From Psychological inflexibility explains distress in parents whose children have chronic conditions (2018) · cites this paper as [25]
The Discussion reports that the weight-specific measure mediated changes in weight and intuitive eating, while the general measure did not. It suggests that targeted measures may better assess change processes in this setting, but does not establish greater predictive accuracy across psychological and behavioral outcomes generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredChanges in important outcomes in acceptance-based interventions are mediated by experiential avoidance, mindfulness, and defusion.
“several studies have demonstrated that changes in important outcomes in acceptance-based interventions are mediated by EA (e.g., [23–25]), mindfulness [26] and defusion [27]”
From Psychological inflexibility explains distress in parents whose children have chronic conditions (2018) · cites this paper as [25]
Evidence on remotely delivered ACT-based weight management interventions is scarce; a recent systematic review identified only three studies, which were not designed to detect effects on weight.
“Evidence on remotely delivered ACT-based weight management interventions is currently scarce; a recent systematic review identified only three studies [2], and these were not designed to detect effects on weight [3–5].”
From Supporting Weight Management during COVID-19 (SWiM-C): twelve-month follow-up of a randomised controlled trial of a web-based, ACT-based, guided self-help intervention (2023) · cites this paper as [3]
The cited paper studied a mobile ACT intervention and measured weight (Measurements), but its stated aims focused on intuitive eating and mediation of changes in eating and weight (Abstract). The Intervention effects section reports no significant effect on weight; none of these passages establishes whether the study was designed or powered to detect a weight effect. I searched for its design, sample-size rationale and statistical power. (LLM, conf=0.70)
Experimental — accuracy not yet measuredFor the comparison between 3wCBT and no/minimal intervention at post-intervention, the quality of evidence was high (three studies).
“For the comparison between 3wCBT and no/minimal intervention at post‐intervention, the quality of evidence was 'high' (three studies);40, 44, 67”
From Third‐wave cognitive behaviour therapies for weight management: A systematic review and network meta‐analysis (2020) · cites this paper as [44]
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- Authors
- Sairanen, E., Tolvanen, A., Karhunen, L., Kolehmainen, M., Järvelä-Reijonen, E., Lindroos, S., Peuhkuri, K., Korpela, R., Ermes, M., Mattila, E., & Lappalainen, R.
- Affiliations
- Karlstad University (SE)
- University of Jyväskylä (FI)
- University of Eastern Finland (FI)
- University of Helsinki (FI)
- Corresponding author
- Sairanen, Essi
- ORCID
- Venue
- Public Health Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017-04-17
- Volume
- 20
- Issue
- 9
- Pages
- 1681-1691
- ISSN
- 1368-9800 (ISSN-L)
- 1475-2727
- PMC
- PMC10261668
- OpenAlex
- W2605720743
- Cited by
- 44
- References
- 64
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 5 · 2023: 4 · 2022: 8 · 2021: 6 · 2020: 7 · 2019: 5 · 2018: 3
- FWCI
- 5.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Public Health Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UEF eRepo (University of Eastern Finland) (submittedVersion)
- Työväentutkimus Vuosikirja (submittedVersion)
- Funders
- Tekes (1104/10)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- intuitive eating, acceptance and commitment therapy, psychological flexibility, mindfulness, sense of coherence, weight loss, obesity, overweight, food intake regulation, hunger and satiety cues, emotional eating, perceived stress, mobile health intervention, group intervention, mechanisms of change
- MeSH terms
- Adult, Appetite Regulation, Body Weight, Cues, Eating, Emotions, Female, Follow-Up Studies, Health Education, Humans, Hunger, Life Style, Male, Middle Aged, Obesity, Surveys and Questionnaires, Satiation, Health Behavior, Body Mass Index, Overweight, Acceptance and Commitment Therapy
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