Effects of four maintenance programs on the long-term management of obesity.

This study evaluated the effectiveness of four posttreatment programs designed to enhance the long-term maintenance of weight loss. Mildly and moderately obese adults (N?=?123) were randomly assigned to one of the following five conditions: (a) behavior therapy only; (b) behavior therapy plus a posttreatment therapist-contact maintenance program; (c) behavior therapy plus posttreatment therapist contact plus a social influence maintenance program; (d) behavior therapy plus posttreatment therapist contact plus an aerobic exercise maintenance program; or (e) behavior therapy plus posttreatment therapist contact plus both the aerobic exercise and social influence maintenance programs. All posttreatment programs were conducted in 26 biweekly sessions during the year following behavioral treatment for obesity. At an 18-month follow-up evaluation, all four conditions that combined behavior therapy with a posttreatment maintenance program yielded significantly greater long-term weight losses than behavior therapy alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintenance strategies for the treatment of obesity: An evaluation of relapse prevention training and posttreatment contact by mail and telephone.

129 21–57 yr old moderately obese volunteers who averaged 57% over ideal weight were randomly assigned to 1 of 6 experimental conditions in a 3?×?2 factorial design. Three treatment conditions (nonbehavioral therapy, behavior therapy, or behavior therapy plus relapse prevention training) were crossed with 2 posttreatment conditions (posttreatment client–therapist contact by telephone and mail or no posttreatment contact). All treatments produced substantial initial weight losses, but Ss tended to regain weight during the follow-up period. Posttreatment client–therapist contact by mail and telephone significantly enhanced the maintenance of weight loss for groups that received nonbehavioral treatment or behavior therapy plus relapse prevention training, but it did not improve maintenance for groups that received behavior therapy only. At 12-mo follow-up, the only condition that maintained its mean posttreatment weight loss was the one that received behavior therapy plus relapse prevention training and posttreatment contact. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlled trial of very low calorie diet, behavior therapy, and their combination in the treatment of obesity.

Assessed the effectiveness of a combined program of low calorie diet (400–500 kcal) and behavior therapy in treating obesity. 50 women (average age 43.9 yrs) and 9 men (average age 44.7 yrs), averaging 89% overweight, were randomly assigned to 1 of 3 conditions: (a) low calorie diet alone, (b) behavior therapy alone, or (c) low calorie diet plus behavior therapy (combined treatment). Mean weight losses for the 3 conditions at the end of treatment were 14.1, 14.3, and 19.3 kg, respectively; losses for combined treatment were significantly greater than those for the other 2 conditions. At 1-yr follow-up, mean weight losses for the diet alone, behavior therapy alone, and combined-treatment conditions were 4.6, 9.5, and 12.9 kg, respectively; and losses for combined treatment were significantly greater than for the diet alone condition. 29% of the combined-treatment and 44% of the behavior therapy alone Ss maintained weight losses within 2 kg of their end-of-treatment weight; none of the diet-alone Ss met this criterion. Ss in all 3 conditions achieved significant reductions in blood pressure at posttreatment, but only those receiving behavior therapy alone and combined treatment showed significant decreases in depression. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of behavioral therapy for chronic low back pain: A component analysis.

The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic exercise only (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildy disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of peer support and therapist contact on long-term weight loss.

This study evaluated the effectiveness of two posttreatment programs designed to enhance the maintenance of weight loss. Eighty-five obese clients were randomly assigned to either (a) behavior therapy plus a peer-support maintenance program, (b) behavior therapy plus a therapist-contact maintenance program, or (c) behavior therapy only. At a 7-month follow-up session, the therapist-contact program resulted in significantly greater maintenance of weight loss compared with the peer support and behavior therapy only conditions. However, by the time of an 18-month follow-up assessment, overall relapse rates were equivalent across conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Behavior therapy for obesity: A comparative investigation of long-term efficacy.

Both individual and group behavior therapies were compared to a stringent social pressure program in the treatment of 72 obese females (mean age, 41.5 yrs) with a long-standing history of obesity (mean, 15.9 yrs) and inability to lose weight or maintain a weight loss. Following an 8-wk treatment phase, half of each treatment condition received 4 additional booster sessions and the remaining half simply reported for regularly scheduled follow-up weigh-ins at 3, 6, 9, and 12 mo, respectively. Both behavioral treatments were significantly superior to the social-pressure therapy at posttreatment. However, whereas the 2 group treatments resulted in successful maintenance of treatment-produced weight reduction, Ss treated with individual behavior therapy showed substantial relapse at long-term follow-up. It is hypothesized that initial treatment success and subsequent maintenance of weight loss are governed by partially different processes. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of aerobic exercise on depression.

43 depressed undergraduate women were randomly assigned to either an aerobic exercise treatment condition in which they participated in strenuous exercise, a placebo treatment condition in which they practiced relaxation exercises, or a no-treatment condition. Aerobic capacity was assessed before and after a 10-wk treatment period. Self-reported depression was assessed before, during, and after the treatment period. Results show that Ss in the aerobic exercise condition had reliably greater increases in aerobic capacity and reliably greater decreases in depression than did Ss in the placebo or no-treatment condition. There was a reduction in depression that was independent of treatment; it is suggested that a no-treatment control condition is a necessity in research on depression. It is concluded that findings provide clear evidence that participation in a program of strenuous aerobic exercise is effective for reducing depression. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of a self-control approach and an emotional coping approach to the treatment of obesity.

Compared the relative effectiveness of a self-control program that emphasized modification of external environmental-eliciting cues for eating behavior with an induced affect program aimed at decreasing eating behavior as a response to emotional states. Data from 40 female Ss indicate that although the self-control group lost significantly more of their proportion overweight than any of the other groups and significantly more pounds than the control groups at posttreatment assessment, they did not demonstrate continued treatment superiority during the follow-up period. It appears that some continued treatment contact may be critical for continued weight loss by self-control Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults.

Compared the effects of 2 psychotherapies based on divergent conceptualizations of depression in later life. 75 older adults diagnosed with major depressive disorder were assigned randomly to problem-solving therapy (PST), reminiscence therapy (RT), or a waiting-list control (WLC) condition. Participants in PST and RT were provided with 12 weekly sessions of group treatment. Dependent measures, taken at baseline, posttreatment, and 3-mo follow-up, included self-report and observer-based assessments of depressive symptomatology. At posttreatment, both the PST and the RT conditions produced significant reductions in depressive symptoms, compared with the WLC group, and PST Ss experienced significantly less depression than RT Ss. Moreover, a significantly greater proportion of Ss in PST vs RT demonstrated sufficient positive change to warrant classification of their depression as improved or in remission at the posttreatment and follow-up evaluations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of group- versus home-based exercise in the treatment of obesity.

This study examined the effects of 2 aerobic exercise regimens on exercise participation, fitness, eating patterns, treatment adherence, and weight changes in 49 obese women undergoing a year-long behavioral weight loss program. Participants were assigned randomly to weight loss treatment plus either group- or home-based exercise. All participants were instructed to complete a moderate-intensity walking program (30 min/day, 5 days/week). Group exercise participants were provided with 3 supervised group exercise sessions per week for the 1st 26 weeks and with 2 sessions per week thereafter. Home exercise participants were instructed to complete all exercise in their home environment. After 6 months, both conditions displayed significant improvements in exercise participation, fitness, eating patterns, and weight loss. At 12 months, the home-based program showed superior performance to the group condition in exercise participation and treatment adherence; at 15 months, participants in the home program demonstrated significantly greater weight losses than those in the group program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A self-control behavior therapy program for depression.

A behavior therapy program based on a self-control model of depression was evaluated against a nonspecific group therapy condition and a waiting list control group, 28 depressed volunteer female Ss ages 18–48 were administered a psychological test battery including the Beck Depression Inventory and the MMPI and randomly assigned to 1 of the 3 experimental conditions. The experimental therapy procedure consisted of a 6-wk group treatment program that sequentially focused on modifying self-monitoring, self-evaluation, and self-control skills. In each phase specific self-control principles were discussed in conjunction with behavioral homework assignments involving activity schedules. The self-control therapy Ss showed significantly greater reduction in depression on self-report and behavioral measures. Self-control Ss also showed greater improvement in overall pathology on the MMPI. There was some evidence that self-control Ss improved on specific measures of self-control behavior. A 6-wk follow-up generally confirmed maintenance of improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of a social problem-solving therapy approach for unipolar depression.

26 depressed Ss participated in 1 of 3 conditions: problem-solving therapy (PST), problem-focused therapy (PFT), and waiting-list control (WLC). The PST group was based on a systematic model of social problem solving, whereas the PFT condition was conceptualized as a legitimate group-therapy regimen. Treatment was conducted over 8 1.5–2 hr weekly sessions. Outcome measures included the Beck Depression Inventory, Rotter's Internal–External Locus of Control Scale, and the Minnesota Multiphasic Personality Inventory (MMPI) Depression scale. PST Ss reported a significant decrease in their depression, which covaried with concurrent increases in problem-solving effectiveness and the adoption of an internal locus-of-control orientation. This improvement was maintained at a 6-mo follow-up. PST Ss reported significantly lower posttreatment depression scores than either the PFT or the WLC groups. Additional analyses indicated these changes to be clinically meaningful. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utilization of adverse rapid smoking in groups: Efficacy of treatment and maintenance procedures.

18 Ss who had been smoking for an average of 18.5 yrs and were currently smoking an average of 23.6 cigarettes/day participated in a smoking-reduction program that attempted to assess the initial effectiveness of a rapid-smoking procedure administered to groups. Efficacy of maintenance was investigated through the use of a control procedure and 2 presumed maintenance-enhancing strategies: in vivo booster sessions and telephone booster sessions. Results indicate that although 90% of all Ss were abstinent after treatment, booster sessions had no significant effect on maintenance of treatment gains. Within-group analyses showed that although both experimental groups significantly relapsed between posttreatment and the 3-mo follow-up, control Ss did not. Results are discussed in terms of self-set and the attribution of behavior change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of antiemetics and reduced radiation fields on acute gastrointestinal morbidity of adjuvant radiotherapy in stage I seminoma of the testis: a randomized pilot study

OBJECTIVE: To assess the long term effects of weight loss with and without additional aerobic and weight training exercises on exercise tolerance and cardiorespiratory fitness in obese women. EXPERIMENTAL DESIGN: Randomized prospective study for an approximately one-year community setting. PATIENTS: 31 healthy obese women volunteers (age 42.8 yrs +/- 6 SD) recruited by community advertisement. INTERVENTION: All subjects underwent a weight loss program consisting of low calorie diet and behavior therapy for a minimum of 46 weeks. They were randomly assigned to one of the four groups. Group A: diet alone, Group B: diet plus aerobic exercise program in a supervised group setting, Group C: Diet plus weight training and Group D: diet plus weight training plus aerobic exercise program. MEASURES: Exercise time (Tex) peak sustained workload (Wp), peak oxygen consumption (VO2), oxygen pulse and the rate of change of VO2 on recovery (VO2rec) were measured at the beginning and after 47.5 weeks +/- 1.5 SD, of the program. RESULTS: All subjects lost weight and achieved increased Tex and lowered resting VO2. VO2 peak and VO2 peak kg-1 increase in Groups B and D only. O2 pulse and VO2rec improved in group D. Improvements in exercise time correlated significantly with initial exercise time and weight loss. CONCLUSIONS: Weight loss increase Tex irrespective of participation in an exercise program. However, evidence of improved aerobic fitness occurred only in groups performing aerobic exercise.     

Sequencing of behavior therapy and pharmacotherapy for obesity.

Investigated 2 sequences of combining behavior therapy and pharmacotherapy to determine if anorexic medication could be used effectively to facilitate initial weight loss without compromising the long-term effects of behavior therapy. 91 18–30 yr old women, averaging 31% overweight, participated in a 16-wk treatment program with follow-up assessments scheduled 4 mo and 1 yr later. Anorexic medication, fenfluramine HCl, enhanced weight loss whenever it was introduced, but it was more effective when introduced 8 wks into the behavior therapy program rather than initially. Ss in this sequence (later medication) had lost the most weight (9.3 kg) by the end of treatment, significantly more than those receiving either medication or behavior therapy only. These Ss, however, regained weight once treatment was terminated so that by the 1-yr follow-up, the conditions were not significantly different. Ss in the other sequence (initial medication) maintained their weight loss after medication was terminated as long as they continued to receive behavior therapy; however, they too regained weight once all treatment was terminated. Thus, anorexic medication demonstrated a surprisingly strong effect when introduced midway through a behavior therapy program, when the rate of loss typically slows, but this initially beneficial effect was not maintained during the follow-up period. A post hoc exploration of the data indicates that medication was particularly helpful to Ss who did not initially respond well to behavior therapy. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

One-year behavioral treatment of obesity: Comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy.

Compared the weight losses of 49 obese women (mean age 39.31 yrs) randomly assigned to a 52-wk behavioral program combined with either moderate or severe caloric restriction. Ss in the balanced deficit diet (BDD) condition were prescribed a 1,200-kcal/day diet throughout treatment, and those in the very-low-calorie diet (VLCD) condition were given a 420-kcal/day liquid diet for 16 wks and a 1,200-kcal/day diet thereafter. The VLCD Ss lost significantly more weight than the BDD Ss at all periods through Week 26, at which time mean losses were 21.45 and 11.86 kg, respectively. VLCD Ss, however, regained weight during the next 26 wks of weekly therapy and during a 26-wk weight maintenance program that provided biweekly meetings. Mean weight losses at the end of the maintenance program were 10.94 and 12.18 kg, respectively. Reports of binge eating declined in both groups, and no relationship was observed between binge eating and weight loss or attrition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of replication techniques in the modification of minimal dating behavior.

Compared the effectiveness of 4 behavioral techniques in the treatment of 59 male undergraduate volunteers who reported minimal dating behavior. The techniques differed in type and amount of feedback which S received. Ss were divided into 2 control conditions; 2 intermediate treatment conditions which permitted either observation only or observation and rehearsal; and 2 conditions which permitted videotape self-observation of just-completed behavior. Those Ss receiving videotape self-observation were judged significantly higher on the basis of posttreatment changes on a simulated dating task than the control and intermediate-treatment groups. Results indicate that a realistic clinical problem can be modified by behavioral feedback techniques. Interactions between target behavior and choice of treatment are discussed. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Broad-spectrum behavioral approach to smoking cessation: Effects of social support and paraprofessional training on the maintenance of treatment effects.

Conducted 2 treatment programs to determine the efficacy of a multi-component smoking intervention and various maintenance procedures. Prior to Program 1, 60 smokers were randomly assigned to 1 of 3 experimental conditions—a smoking abstinence program (SAP), a smoking abstinence program plus social support (SAP-SS), a smoking abstinence program plus social support and paraprofessional training (SAP-SS-PT)—or to 1 of 2-control conditions—effort control (EC) or a waiting list (WL). Individuals assigned to EC and WL conditions became treatment participants (EC-SAP-SS, WL-SAP-SS) during Program 2 and received training from SAP-SS-PT Ss. Results indicate that social support and paraprofessional training tended to facilitate maintenance, although 6-mo follow-up data revealed considerable relapse across treatment conditions. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)