{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T11:02:19Z","timestamp":1773226939775,"version":"3.50.1"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"9-10","funder":[{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Rehabilitation Research and Development Career Development","award":["1IK2RX000705-01"],"award-info":[{"award-number":["1IK2RX000705-01"]}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Effectiveness and Safety","award":["CIN13-413"],"award-info":[{"award-number":["CIN13-413"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Obesity is highly comorbid with psychological symptoms in veterans, particularly post-traumatic stress disorder (PTSD), depression, and anxiety. Obese veterans with comorbid psychological symptoms often display suboptimal weight loss and poor physical functioning when participating in weight management programs. The MOVE! program aims to increase healthy eating and physical activity to promote weight loss in obese veterans. Adequately addressing psychological barriers is necessary to maximize outcomes in MOVE! for veterans with PTSD, depression, and anxiety. We examined the preliminary outcomes of administering the Healthy Emotions and Improving Health BehavioR Outcomes (HERO) intervention. HERO is adjunctive cognitive-behavioral therapy to MOVE! that addresses PTSD, depression, and anxiety symptom barriers to engagement in physical activity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>All recruitment and study procedures were approved by the institutional review board and research and development committees of the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in Houston, Texas. Participants gave written informed consent before enrollment. Thirty-four obese veterans with a diagnosis of PTSD, depression, and\/or anxiety who were attending MOVE! were assigned to the 8-session HERO group or the usual care (UC) group. Veterans completed assessments of PTSD, depression and anxiety symptoms, physical activity, physical functioning, and weight at baseline, 8 and 16\u00a0weeks post treatment. Changes from baseline to 8- and 16-week follow-up on the self-report and clinician-rated measures were assessed, using independent samples t-tests and analyses of covariance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>At 8\u00a0weeks post treatment, participants in the HERO group had significantly higher step counts per day than participants in the UC group. Similarly, at 16\u00a0weeks post-treatment, participants in the HERO group continued to experience a significant increase in daily steps taken per day, as well as statistically and clinically significantly lower scores on the depression symptom and PTSD symptom severity. Participants in the HERO group also demonstrated significantly higher scores on the physical functioning inventory than participants in the UC group (44.1\u00a0\u00b1\u00a012.1 vs. 35.7\u00a0\u00b1\u00a010.7, P\u00a0=\u00a00.04) at 16\u00a0weeks post treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Findings of this small trial have important implications pending replication in a more rigorously designed large-scale study. Providing an adjunctive treatment to MOVE! that addresses psychological distress has potential benefits for psychological symptom reduction, engagement in healthy dietary habits, and greater physical activity for individuals who traditionally experience barriers to making positive weight management changes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaa145","type":"journal-article","created":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T07:28:01Z","timestamp":1596094081000},"page":"e1662-e1670","source":"Crossref","is-referenced-by-count":5,"title":["Using an Adjunctive Treatment to Address Psychological Distress in a National Weight Management Program: Results of an Integrated Pilot Study"],"prefix":"10.1093","volume":"185","author":[{"given":"Gina","family":"Evans-Hudnall","sequence":"first","affiliation":[{"name":"Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030"},{"name":"VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary O","family":"Odafe","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, University of Houston, Heyne building # 126, Houston, TX 77204"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrienne","family":"Johnson","sequence":"additional","affiliation":[{"name":"William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705"},{"name":"University of Wisconsin Center for Tobacco Research and Intervention, 1930 Monroe St., #200, Madison, WI 53711"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Armenti","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, University of Houston, Heyne building # 126, Houston, TX 77204"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"O\u2019Neil","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Medicine, One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030"},{"name":"Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan","family":"Lawson","sequence":"additional","affiliation":[{"name":"Department of Counseling Psychology, University of North Texas, 1155 Union Circle #311280, Denton, Texas 76203-5017"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa H","family":"Trahan","sequence":"additional","affiliation":[{"name":"Trahan Counseling, 631 Mill Street, Suite 101 San Marcos, Texas 78666"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fenan S","family":"Rassu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Medicine, One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030"},{"name":"Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,7,30]]},"reference":[{"issue":"15","key":"2020092112345000200_ref1","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1001\/archinternmed.2010.201","article-title":"Waist circumference and all-cause mortality in a large US cohort","volume":"170","author":"Jacobs","year":"2010","journal-title":"Arch Intern Med"},{"issue":"8","key":"2020092112345000200_ref2","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1056\/NEJMoa055643","article-title":"Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old","volume":"355","author":"Adams","year":"2010","journal-title":"N Engl J Med"},{"key":"2020092112345000200_ref3","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s11606-016-3962-1","article-title":"The obesity epidemic in the veterans health administration: prevalence among key populations of women and men veterans","volume":"32","author":"Breland","year":"2017","journal-title":"J Gen Intern Med"},{"issue":"4","key":"2020092112345000200_ref4","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jpsychores.2008.09.008","article-title":"Associations of obesity with psychiatric disorders and suicidal behaviors in a nationally representative sample","volume":"66","author":"Mather","year":"2009","journal-title":"J Psychosom Res"},{"issue":"6","key":"2020092112345000200_ref5","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/j.pnpbp.2006.03.027","article-title":"Posttraumatic stress disorder and body mass index in military veterans. 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