Examining the description of the concept "treatment as usual" for patients with depression, anxiety and stress-related mental disorders in primary health care research - A systematic review.

BACKGROUND: In randomized controlled trials (RCTs) within medical research, applied interventions are compared to treatment-as-usual (TAU) as the control condition. The aim of the current study was to examine how the concept of TAU is described when used as control condition in RCTs evaluating treatments for depression, anxiety syndromes, and stress-related mental disorders in primary care. METHOD: A systematic review of RCTs utilizing TAU as control group in the RCT in accordance with PRISMA standards was conducted. We used one multidisciplinary database (Scopus), one database focused on nursing (Cinahl), and one medical database (PubMed). The searches were conducted in November 2021 and May 2022. RESULTS: The included 32 studies comprised of 7803 participants. The content of TAU was classified as follows: 1) Basic descriptions of TAU lacking a detailed account as well as reference to local or national guidelines, 2) Moderate description of TAU including reference to national or local guidelines or a detailed description 3) Advanced description of TAU including references to national guidelines and a detailed description containing five key concepts: early assessment, accessibility, psychological treatment, medication, somatic examination. 18 studies had basic, 11 moderate, and 3 advanced descriptions of TAU. LIMITATIONS: The limitations were that only studies published in English were included. CONCLUSIONS: The current study provides an assessment tool with three classification levels for TAU. The description of TAU is still insufficient in RCT studies conducted in primary care, which may affect the interpretation of results. In future research a detailed description of TAU is recommended.

Psychological flexibility and the gains of acceptance-based treatment for post-bariatric surgery: six-month follow-up and a test of the underlying model.

UNLABELLED: Research highlights • Bariatric surgery is associated with dramatic weight loss. • Follow-up studies show that many surgery patients continue to struggle with self-stigma, body dissatisfaction and emotional eating. • To date we are aware of only three published randomized controlled trials evaluating psychological interventions in combination with bariatric surgery. • Acceptance and Commitment Therapy (ACT) targets psychological flexibility: acceptance to have difficult feelings and thoughts, while at the same time engaging in vital healthy activities. • The present study shows significant improvements in the ACT group as compared with (TAU) after treatment as usual at a 6-month follow-up and shows that the mechanism of change may be psychological flexibility. • Results from this study indicate the possibility of optimizing bariatric surgery outcomes by adding interventions targeting psychological flexibility. SUMMARY: 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.

Development and validation of a new questionnaire measuring eating disordered behaviours post bariatric surgery.

Contextualization of post-surgery circumstances in terms of key behaviours and emotions related to eating is crucial for reliable screening. Disordered eating post surgery is characterized by frequent snacking and a sense of loss of control over food intake. The purpose of this study was to evaluate the psychometric properties of a short self-report questionnaire entitled Disordered Eating after Bariatric Surgery (DEBS). Results indicate that the DEBS possesses satisfactory psychometric properties in terms of reliability, validity, internal consistency and test-retest reliability. The DEBS may facilitate both systematic clinical evaluation and future research within the area of bariatric surgery.