Role of self-efficacy in rehabilitation outcome among chronic low back pain patients.

Examined the role of self-efficacy beliefs in the rehabilitation of 45 low back pain patients participating in a 3-wk rehabilitation program. Increments in self-efficacy beliefs during the rehabilitation program were not associated with improved patient functioning at discharge from the program. However, in support of the theorized role of self-efficacy in behavior change, these increments in self-efficacy significantly predicted better patient functioning and less reported pain at the 6-mo follow-up assessment. Implications of these findings for the rehabilitation of low back pain patients are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Monetary contracts in weight control: Effectiveness of group and individual contracts of varying size.

89 overweight adult males (aged 35–57 yrs) drawn from a community population sample were assigned randomly to 1 of 6 treatment groups for weight reduction. All groups participated in a 15-wk behaviorally oriented program. Each involved a monetary contract in which participant deposits were returned contingent on weight lost. The program goal was 30 pounds lost. Groups varied in (a) amount of deposit ($30, $150, or $300) and (b) type of contract (refunds contingent on either individual or mean group performance). It was found that group contracts were associated with significantly more weight loss than individual contracts. This difference was maintained over 1-yr follow-up. Amount of deposit was positively, although weakly, related to short-term treatment outcomes. However, the short-term advantage of the larger contracts disappeared rapidly with time. Neither type nor amount of deposit significantly affected participation rates. Overall weight losses in the study were large. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior change, weight loss, and physiological improvements in Type II diabetic patients.

53 obese 30–70 yr olds with Type 2 diabetes treated by diet only or oral medication were assigned to a behavior-modification, nutrition-education, or standard-care treatment condition to investigate whether behavior modification would improve short- and long-term results of weight control programs for Ss. The behavior-modification and nutrition-education groups met weekly for 16 wks and were given the same information on nutrition, exercise, and diabetes; however, strategies to change eating behavior were used in the behavior-modification condition. The standard-care condition was identical to the nutrition-education condition except that Ss met only 4 times over the 16-wk treatment period. Results indicate that behavior-modification Ss lost more weight than either the nutrition-education or standard-care Ss during the 16-wk treatment period. However, at 16-mo follow-up, differences in weight loss across treatment conditions were not significant. Physiological parameters and mood improved with initial weight loss, but these changes were not maintained. Physiological changes appeared more directly related to weight loss than to treatment condition. Changes in weight were related to improved eating and exercise habits, and modest weight losses of 4.6–23.6 kg produced significant improvements in blood-sugar control. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evaluation of a television-delivered behavioral weight loss program: Are the ratings acceptable?

This experiment evaluated the efficacy of television delivery of a behavioral weight reduction program. Seventy-one overweight adults were randomly assigned to a live-contact weight loss group that was videotaped for viewing by other groups, a live-contact group that was not videotaped, a television-delivered group that observed the videotaped weight loss sessions, or a waiting-list control group. Participants in all 3 treatment groups lost significantly more weight during the 8-week treatment program than those in the waiting-list control group. There were no significant weight loss differences among the 3 treatment groups during the program. These weight changes were maintained at 3-month follow-up. At 15-month follow-up, the television-delivered group and the live-contact group maintained their weight losses, whereas the videotaped group did not. Cost-effectiveness analyses indicated that the television-delivered group received the most cost-effective treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of a multicomponent maintenance program on long-term weight loss.

Following a standard regimen of behavioral weight loss treatment, 43 21–60 yr old moderately obese clients received either 6 booster sessions or 6 sessions of training in the use of a maintenance program consisting of self-help group meetings and client–therapist contacts by mail and telephone. Results of 15- and 21-mo follow-up assessments revealed that the multicomponent program significantly enhanced the maintenance of weight loss. (4 ref) (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)     

The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial.

Despite considerable clinical interest, attempts to link perceived self-efficacy with successful weight control have had mixed success. Definitive data on prospective associations between self-efficacy and weight loss are particularly sparse. This study examined relationships between self-efficacy beliefs, weight control behaviors, and weight change among individuals participating in a weight loss trial (N = 349, 87% women). Cross-sectionally, eating and exercise self-efficacy beliefs were strongly associated with corresponding weight loss behaviors. Self-efficacy beliefs prospectively predicted weight control behavior and weight change during active treatment but not during follow-up. Mediational models indicate that people's weight control behaviors mediate the impact of self-efficacy on weight change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral weight-loss intervention at the worksite: Feasibility and maintenance.

Investigated the feasibility of conducting a behavioral weight-loss program at the worksite and evaluated the effectiveness of a structured-maintenance training protocol. A total of 133 20–60 yr olds in 3 groups completed a 10-wk behavioral treatment program. The treatment program included organizational behavior modification techniques in addition to traditional small-group behavior-therapy procedures for weight control. After treatment, 2 groups received a 4-session structured-maintenance program, and 1 group served as a nonspecific (contact time) control. Follow-ups were conducted at 3 and 6 mo. Although attrition rates were high, the results indicate that the 3 groups lost a significant amount of weight during the 18 wks of treatment plus maintenance training. There were no differential effects of either weight loss or attrition among the 3 groups over the course of treatment or maintenance. Comparison of the structured- vs nonspecific-maintenance training groups at 3- and 6-mo follow-up indicates that the structured training group maintained their weight loss significantly better than the nonspecific control group. Results are interpreted to be consistent with the hypothesis that the skills required to lose weight are different from skills necessary to maintain weight loss over time. Although behavioral weight-loss programs at the worksite appear feasible, high attrition remains a significant problem. Results are discussed in terms of cost-effectiveness of worksite weight-loss intervention and directions for future research. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Obese binge eaters: Affect, cognitions, and response to behavioral weight control.

The present study compared obese female binge eaters and nonbinge eaters of comparable age and weight on mood, diet behavior, and responses to a standard versus modified behavioral weight-control program. The modified behavioral program emphasized meal regularity, intake of complex carbohydrates, and activity as an alternate to overeating. Binge eaters reported significantly more depressive symptomatology, psychological distress, and maladaptive diet behavior than nonbinge eaters at pretreatment and at all subsequent assessments. Furthermore, binge eaters were more likely to drop out of treatment. No differences in weight loss at posttreatment occurred between binge eaters and nonbinge eaters, but binge eaters regained significantly more weight than nonbinge eaters at 6-month follow-up. Differences in weight loss between the groups were not significant at the 1-year follow-up, and no significant differences between the standard and modified treatment conditions were observed. Marked differences between binge eaters and nonbinge eaters in affect and cognitions appeared to persist despite behavioral treatment. (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)     

Restraint, weight loss, and variability of body weight.

Restrained and unrestrained Ss (n?=?24) were weighed daily for a 6-wk period and again 6 mo later in order to determine whether dietary restraint or relative body weight is the better predictor of weight variability. Restraint was a significantly better predictor of naturally occurring weight fluctuations than was relative body weight. Furthermore, the 2 factors of the Restraint Scale, Concern for Dieting and Weight Fluctuations, were both significant predictors of weight variability. We propose that exaggerated weight fluctuations are not a natural concomitant of higher body weight but possibly the consequence of a cycle of dieting and overeating, which seems to preclude actual weight loss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Success attributions for stopping smoking during pregnancy, self-efficacy, and postpartum maintenance.

Relapse prevention has focused on failure, not success attributions. This study of 392 privately insured women who stopped smoking during pregnancy found that the stability dimension of success attributions for pregnancy smoking cessation predicted abstinence at all postpartum time points (i.e., 6 weeks and 3, 6, and 12 months); for 277 women who continued abstinence to 6 weeks postpartum, the 6-week postpartum stability attribution predicted later time points, as did 6-week self-efficacy. Internality predicted smoking at the next time point only, and controllability was not a predictor. More than 50% said the baby was the reason for pregnancy smoking cessation, and 6-week abstinence; stability and internality ratings varied but not controllability. An exploratory test of the relation of self-efficacy and success attributions indicated that self-efficacy fully mediated the effect of stability. Success attributions may merit more attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotherapy in weight loss treatment.

Investigated the effects of hypnosis as a treatment for weight loss among women. The sample consisted of 60 women (aged 20–65 yrs) who were at least 20% overweight and were not in any other treatment program. Six client variables (suggestibility, self-concept, quality of family origin, age of obesity onset, education level, and socioeconomic status [SES]) and 1 process variable (multimodal imagery) were analyzed in relation to the dependent variable (weight loss). Two experimental groups, hypnosis plus audiotapes and hypnosis without audiotapes, and the control group were investigated for weight loss immediately after treatment and again after a 6-mo follow-up. The primary hypothesis that hypnosis is an effective treatment for weight loss was confirmed, but the 7 concomitant variables and the use of audiotapes were not significant contributors to weight loss. (26 ref) (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)     

Psychological effects of weight loss and regain: A prospective evaluation.

This study prospectively assessed the psychological effects of weight loss and regain (i.e., weight cycling) in obese women. Measures of mood, binge eating, restraint, disinhibition, and hunger were obtained from 55 participants at baseline, after 6 months of treatment, and 58 months posttreatment. Women lost 21.1 ± 8.4 kg after 6 months of treatment but were 3.6 ± 10.9 kg above baseline weight at the time of the follow-up. Contrary to expectations, after this 21-kg cycle of weight loss and regain, women reported significant improvements in mood and binge eating, as well as reductions in hunger and disinhibition. Restraint was unchanged from baseline to follow-up. These data suggest that weight loss and regain are not associated with long-term adverse psychological effects. The findings also confirm earlier reports of significant weight regain after treatment and underscore the need for research to improve the maintenance of weight loss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Covert modeling-hypnosis in the treatment of obesity.

Investigated the efficacy of a covert modeling/hypnosis treatment package in the control of obesity. 48 overweight female volunteers (who had been administered the Harvard Group Scale of Hypnotic Susceptibility, Eating Patterns Questionnaire, and Rotter's Internal–External Locus of Control Scale) were randomly assigned to 1 of the following groups: (a) covert modeling/hypnosis, (b) covert modeling, (c) no-model scene control, and (d) minimal treatment (where Ss received a shortened version of the covert modeling/hypnosis procedure following an 8-wk no-treatment period). Results indicate a significant effect for weight loss from pretreatment to follow-up across all groups combined. Proportion weight loss measures indicated significantly greater weight loss only for the covert modeling/hypnosis group as compared to the no-model controls. Implications for combining behavior therapy and hypnotic techniques are discussed. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Common and specific process factors in cardiac rehabilitation: Independent and interactive effects of the working alliance and self-efficacy.

Objective: Therapeutic processes in cardiac rehabilitation programs are virtually unexamined. Models were tested by which changes in the working alliance between patient and staff (agreement on goals/tasks; emotional bond) may affect outcomes in conjunction with changes in patient self-efficacy to change their diets and increase exercise. Design: Cardiac patients (n = 79) participated in a 12-week program, and completed assessments at early, mid, and late treatment. Main Outcome Measures: Changes in cardiac depression, physical health, perceived exertion during exercise, rate/pressure product at submaximal exercise tolerance, weight loss, return to work, total fat intake. Results: Early-treatment changes in agreement on goals/tasks were related to changes in psychosocial factors and perceived exertion during exercise independent of effects of changes in self-efficacy. Early-treatment changes in goals/tasks and self-efficacy interacted to predict changes in cardiorespiratory fitness, weight loss, and return to work such that patients high on both goals/tasks and self-efficacy showed the most gains. Conclusion: Sound therapeutic relationships between patients and staff may play an important role in facilitating the achievement of a wide-range of salutary outcomes during cardiac rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of the therapist in the self-control of obesity.

The role of the therapist was varied in a weight reduction program with 24 male and 24 female graduate students. When meetings with the therapist were "faded out" over the duration of the 10-wk treatment period, Ss lost significantly more weight compared to Ss who met with the therapist on a regular basis. A follow-up conducted 6 mo after therapy showed that Ss who had regularly met with the therapist during the treatment period had gained back all the weight they had lost during treatment; they no longer differed from controls. Ss who had had the therapist faded out, however, maintained their losses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)