Therapist and group contact as variables in the behavioral treatment of obesity.

Randomly assigned 29 obese females (average age 48.7 yrs), to 1 of 3 experimental conditions: (a) a "standard" behavioral treatment (SBT) group emphasizing self-management techniques (Ss attended group therapy meetings weekly for 10 wks, then monthly for 6 mo and were given a weight control manual); (b) a group receiving the weight control manual via mail with little professional contact (MMC); and (c) a waiting list control condition. Results reveal a superiority of both treatment conditions over the control condition at posttreatment. SBT Ss did significantly better than MMC Ss at posttreatment but not at the 6-mo follow-up. Weight loss for MMC Ss was minimal. The use of "do-it-yourself" treatment manuals is challenged. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical series in the behavioral treatment of obesity.

This article reviews the seven large scale clinical series reported to date which used behavioral treatments to effect weight loss in obese patients. Treatment completion and weight loss data are compared with those obtained in other treatments and with benchmark data. It is concluded that weight losses in "live-in" clinics are considerable, and surpass those generally reported in the literature. In outpatient clinics, which are more representative of current obesity treatment, weight losses appear similar to those found in other treatments, and provide no evidence for the superiority of behavioral interventions. However, low drop-out rates, lack of negative side effects, and low-risk may still make the behavioral treatment of obesity the treatment of choice in many clinical settings. Criteria for reports of clinical series are described. New directions for treatment and research are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral choice treatment promotes continuing weight loss: Preliminary results of a cognitive–behavioral decision-based treatment for obesity.

Twenty-four obese women were randomly assigned to 1 of 2 group treatments: behavioral choice treatment (BCT) or traditional behavioral treatment (TBT). BCT uses decision theory to promote moderate behavior change that can be comfortably, and therefore permanently, maintained. Groups completed a moderate-intensity walking program and obtained feedback from computerized eating dairies. The TBT group evidenced greater weight loss at posttreatment. However, the TBT group also evidenced a trend to regain weight, whereas the BCT group continued a slow weight loss during follow-up. Exercise followed a similar pattern. Both groups decreased in restraint and increased in self-esteem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multi-modal behavioral approach to the treatment and management of essential hypertension.

Explored the efficacy of a multimodal behavioral approach for the treatment and long-term management of essential hypertension in a 24-yr-old male. Generalization techniques and community measurements were integral components of treatment as well as data collection procedures. Blood pressure was brought within the normotensive range and stabilized without the use of anti-hypertensive medications. Normal readings were maintained throughout a 6-mo follow-up period. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ten-year outcomes of behavioral family-based treatment for childhood obesity.

Reports 10-yr treatment outcomes for obese children in 4 randomized treatment studies. At 10 yrs, 34% decreased percentage overweight by 20% or more, and 30% were not obese. Significant effects were observed when parents and children were targeted and reinforced for weight loss in comparison with nontargeted controls and for children given lifestyle or aerobic exercise in comparison with a calisthenics control. 34% of the variance in change in percentage overweight was predicted from sex, baseline percentage overweight, self-monitoring weight, meals eaten at home, and family and friends' support for eating and exercise. Results show long-term changes in children depend on the treatment, and evidence converges on the importance of the family and other sources of support for eating and activity change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-control techniques as an alternative to pain medication.

A 65-yr-old retired army officer with a productive work history was admitted to a psychiatric ward with symptoms of chronic abdominal pain and social withdrawal. For several years his pain had been managed with Talwin (pentazocine), which was self-administered intramuscularly 6 times/day. The patient was taught self-control of his pain through a program of relaxation, covert imagery, and cognitive relabeling. He was then withdrawn from medication by diluting the Talwin with increasing proportions of normal saline. Follow-up showed the patient to be socially active, without medication, and more successfully controlling his pain. Results are discussed in terms of punishment, self-attribution of change, the nature of pain, and the ethical issues involved in instituting a treatment procedure without the completely informed consent of the patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Matching smokers to treatment: Self-control versus social support.

This study involved 137 participants who were assessed on 12 relevant predictor variables and then randomly assigned to social support or self-control treatment. Outcome across treatments was predicted by cotinine levels, treatment history, previous abstinence, happiness, self-efficacy, and perceived social support for quitting. Social support treatment was more effective than self-control treatment for participants with high baseline self-control orientation scores and participants with high self-efficacy scores. All other hypothesized Subject?×?Treatment interaction effects were nonsignificant. The study provided an example of a coherent approach to matching research and demonstrated the difficulty involved in providing treatments that are different enough from each other to benefit different smokers. Matching research has important theoretical value but may have limited potential for improving smoking treatment effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-control and therapist-control: The medical model in behavioral clothing.

A case report by P. Levendusky and L. Pankratz (see PA, Vol 54:Issue 4) raises the important ethical dilemma of when and under what circumstances is the deception of a patient by a therapist acceptable. While Levendusky and Pankratz insist that their deception was in the "best interests" of the patients, one can question whether these interests can be determined without the active participation of the patient. Despite the authors' adherence to a behaviorally based treatment regime, they seem to have implicitly adopted a traditional medical model: the doctor knows best. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evaluation of parental problem-solving training in the behavioral treatment of childhood obesity.

The current investigation evaluated the efficacy of including parental problem-solving training in a behavioral weight-reduction program for obese children. Children and their parents were randomly assigned to a problem-solving, behavioral, or instruction-only weight-loss group. Children in the problem-solving group lost significantly more weight and decreased their percent overweight and body-mass indices significantly more during the 8-week treatment program than either behavioral or instruction-only subjects. These differences were maintained at the 3- and 6-month follow-up sessions. Only those parents in the problem-solving group significantly increased their problem-solving skills during the program. Child weight loss was significantly correlated with increases in parental problem-solving ability from pretreatment to posttreatment and from posttreatment to the 6-month follow-up. This evidence supports the conclusion that problem-solving training is a desirable addition to a behavioral weight-loss program for children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Freedom of choice and behavioral change.

Used a 3?×?2 (Treatment?×?Population) factorial design with repeated measures (pretest/posttest) to evaluate the effects of perceived freedom of choice on behavior change in a therapy analog study. 90 Ss were assigned to 3 groups that varied in the amount of perceived choice given to Ss in determining the type of training procedure used for speed-reading enhancement. Experimental conditions were crossed with 2 populations of Ss to examine 2 levels of perceived freedom. Half of the Ss were psychology undergraduates required to participate in psychology experiments, and the remaining half were volunteers. The main dependent variable was the amount of change in reading rate. A marginally significant increase in reading speed was obtained by volunteers in comparison to psychology student participants. Ss who perceived that they were given a choice in training procedures improved significantly more in reading speed than Ss who lost the freedom of choice. No changes in reading comprehension were noted. Findings are discussed in terms of the relationship between freedom of choice and performance in a behavior change program. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Problems of food absorption with reference to age and obesity

In 1,000 obese persons and 250 persons with normal weight detailed nutrition anamneses concerning the average daily intake of calories, carbohydrates, protein, fats, cholesterol, saturated and repeatedly unsaturated fatty acids were made. Obese persons took less food than persons with normal weight--findings which are to be explained by the different habits of eating in the dynamic (the hyperalimentation takes place above all here) and in the static phase of obesity. There were no age tendencies in women, whereas in men, beginning with the 4th decade of life, all the nutrients were taken in a smaller quantity than in adolescence.     

Weight loss and behavior change 1 year after behavioral treatment for obesity.

Reports a 1-yr follow-up study of 88 of the 1st 108 clients to complete a behavioral weight reduction program at Stanford University's Eating Disorders Clinic. On the average, Ss maintained their in-treatment weight loss over the follow-up period, but there was marked variability and a low correlation between in-treatment and posttreatment performance. Ss reported significant changes in their eating behavior after treatment, but these changes were only weakly related to weight changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validity of expectancy theory as a within-person behavioral choice model for sales activities.

Using 62 female life insurance sales representatives (mean age 36.5 yrs) in Japan, the present study hypothesized, based on an expectancy model of choice, that when choosing among 6 types of policies to sell, Ss would more frequently choose the policy associated with the larger force score. Ss were required to fill out a questionnaire containing measures of the expectancy of sales success, the valence for 4 self-generated outcomes, and the instrumentality of sales success for those outcomes. The number of policies sold was used as an index of performance for each policy. An overall contingency table based on the item ranks indicated significant relationships between force and performance. The average within-person Pearson product-moment correlation coefficient for force and performance for those 6 policy types was .50. Implications for expectancy theory as a within-person choice model and some methodological problems involved in the present study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multicenter trial of fluoxetine as an adjunct to behavioral smoking cessation treatment.

The authors evaluated the efficacy of fluoxetine hydrochloride (Prozac; Eli Lilly and Company, Indianapolis, IN) as an adjunct to behavioral treatment for smoking cessation. Sixteen sites randomized 989 smokers to 3 dose conditions: 10 weeks of placebo, 30 mg, or 60 mg fluoxetine per day. Smokers received 9 sessions of individualized cognitive-behavioral therapy, and biologically verified 7-day self-reported abstinence follow-ups were conducted at 1, 3, and 6 months posttreatment. Analyses assuming missing data counted as smoking observed no treatment difference in outcomes. Pattern-mixture analysis that estimates treatment effects in the presence of missing data observed enhanced quit rates associated with both the 60-mg and 30-mg doses. Results support a modest, short-term effect of fluoxetine on smoking cessation and consideration of alternative models for handling missing data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Combined behavioral and pharmacologic treatment for obesity: Predictors of successful weight maintenance.

Fenfluramine treatment in combination with behavior therapy has produced better weight loss but greater recidivism than behavioral treatment alone. The present study tested a different anorectic agent, diethylpropion hydrochloride (Tenuate), with a 20-week cognitive-behavioral (CB) therapy program. A placebo plus CB therapy and a CB therapy alone condition were also included. All treatment conditions showed significant weight loss, with the Tenuate/CB group doing better than the other groups only during the latter half of the drug treatment period. At 6-month follow-up, Tenuate/CB subjects showed significant regain, whereas the other groups did not. By 1 year, however, none of the groups showed further significant weight gain. Predictors of greater weight loss included (a) greater initial weight loss, (b) agreement with the philosophy that a specified low calorie diet would not have helped the program, and (c) stronger feelings (among Tenuate/CB subjects in particular) of self-efficacy regarding weight control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of adding behavioral treatment to opioid detoxification with buprenorphine.

This trial assessed whether behavioral treatment improves outcome during a 26-week outpatient opioid detoxification. Thirty-nine opioid-dependent adults were assigned randomly to a buprenorphine dose-taper combined with either behavioral or standard treatment. Behavioral treatment included (a) a voucher incentive program for providing opioid-free urine samples and engaging in verifiable therapeutic activities and (b) the community reinforcement approach, a multicomponent behavioral treatment. Standard treatment included lifestyle counseling. Fifty-three percent of the patients receiving behavioral treatment completed treatment, versus 20% receiving standard treatment. The percentage of patients achieving 4, 8, 12, and 16 weeks of continuous opioid abstinence were 68, 47, 26, and 11 for the behavioral group and 55, 15, 5, and 0 for the standard group, respectively. Behavioral treatment improved outcomes during outpatient detoxification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contributions from behavioral theories of choice to an analysis of alcohol abuse.

Behavioral theories of choice are applied to an analysis of the conditions under which alcohol consumption emerges as a highly preferred activity from among a set of available activities. The approach highlights two classes of variables as important determinants of alcohol preference: (a) direct constraints on access to alcohol and (b) availability of other reinforcers and constraints on access to them. A selective review of studies of human and animal alcohol and drug self-administration indicates that preference for alcohol and drug consumption (a) varies inversely with direct constraints on consumption and (b) varies inversely with the availability of alternative reinforcers and directly with constraints on access to them. Environmental conditions under which alcohol consumption emerges as a highly preferred activity may thus involve minimal constraints on access to alcohol and sparse alternative reinforcers and/or heightened constraints on access to them. The latter variables may be more important in determining alcohol consumption in natural environments. A research application to alcoholic relapse is described, and general implications for clinical research in natural environments are explored. Limitations of the approach and its complementary relation to other approaches to studying alcohol abuse are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-control treatment of aggression in a 16-yr-old male.

Describes the treatment procedure for an adolescent male with an 11-yr history of severe temper outbursts. He was apparently successfully treated by a self-control treatment program. The case demonstrates that self-control training is a useful approach when environmental control is very limited, and it shows the relevance of A. Bandura's reciprocal interaction model of behavior as a rationale for the conduct of self-control training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-control as habit, drive, and incentive.

Discusses the difference between those responses which are intrinsically and extrinsically rewarding. Self-control is considered as the exercise of choice among molar response alternatives and as the regulation of behavior through biofeedback mechanisms. The self-control of those responses which are intrinsically rewarding but undesirable is discussed. It is postulated that (a) self-control drive results from fear-frustration being associated with lack of self-control, (b) self-control is learnable, and (c) there are positive and negative incentives for self-control. It is suggested that such a model of self-control can lead to an understanding of inter- and intraindividual differences in behavior control and of the engagement in undesirable, intrinsically rewarding behaviors as an assertion of self-control. Since self-control may be learned, it may be taught, and the principles of behaviorism are applied to an analysis of methods. Implications for smoking treatment programs are noted. It is concluded that the self-control drive needs to be associated with smoking behavior and the habits of not smoking to be practiced. (30 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)