SPECIAL SERIES: COGNITIVE AND BEHAVIORAL TREATMENTS OF OBESITY AND EATING DISORDERS
Eric F. Wagner, Ph.D., Associate Editor
Introduction
Lucene Wisniewski and Eric F. Wagner
Women, Weight, and Smoking: A Cognitive Behavioral Approach to Women's Concerns About Weight Gain Following Smoking Cessation
Michele D. Levine, Marsha D. Marcus, and Kenneth A. Perkins
Management of the Bariatric Surgery Patient: Is there a Role for the Cognitive Behavior Therapist?
Melissa A. Kalarchian and Marsha D. Marcus
Incorporating Motivational Interviewing Into Behavioral Obesity Treatment
Vicki DiLillo, Nicole J. Siegfried, and Delia Smith West
The Application of Dialectical Behavior Therapy to the Treatment of Eating Disorders
Lucene Wisniewski and Elizabeth Kelly
Food Refusal by Infants and Young Children: Diagnosis and Treatment
Irene Chatoor and Jody Ganiban
Cognitive Behavioral Interventions in the Management of Severe Pediatric Obesity
Marsha D. Marcus, Michele D. Levine, Melissa A. Kalarchian, and Lucene Wisniewski
REGULAR ARTICLES
The GIFT Program for Major Depression
Michael A. Friedman, Esteban V. Cardemil, Jackie Gollan, Lisa A. Uebelacker, and Ivan W. Miller
Treatment of Paruresis in the Context of Benign Prostatic Hyperplasia: A Case Report
Gregory M. Rogers
Employing Behavioral Methods to Improve the Context of Care in a Public Psychiatric Hospital: Realizing Improvements in the Interpersonal Behavior of Direct-Care Providers
Dennis C. Donat and Gerald F. McKeegan
BOOK REVIEW James Herbert, Ph.D., Section Editor
D. H. Barlow, Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic (2nd ed.)
Reviewed by Lindsay S. Ham
ABSTRACTS
Special Series Introduction: Cognitive and Behavioral Treatments of Obesity and Eating Disorders
Lucene Wisniewski and Eric F. Wagner
The intent of this special series is to provide clinicians and researchers alike with an overview of current treatment developments in two areas of enormous public health concern: obesity and eating disorders. In an effort to move the field forward in the cognitive-behavioral treatment of obesity and eating disorders, the authors assembled six articles presenting current perspectives on the state of the science in critical topic areas. Topics that will be discussed include: women who would like to quit smoking but have concerns about weight gain; the bariatric surgery patient; food refusal in young children, a family-based CBT approach to the treatment of severe pediatric obesity and the application of established approaches for addictions (i.e., motivational interviewing) and borderline personality disorder (i.e., dialectic behavior therapy) to the treatment of obesity and eating disorders. Each article provides an overview and some practical information for the reader to keep in mind when approaching these populations.
Women, Weight, and Smoking: A Cognitive Behavioral Approach to Women's Concerns About Weight Gain Following Smoking Cessation
Michele D. Levine, Marsha D. Marcus, and Kenneth A. Perkins
Many women endorse concerns about the weight gain that commonly accompanies an attempt to quit smoking. These weight-concerned women smokers also are less likely to be successful in their cessation efforts, and several approaches to treating postcessation weight concerns among smokers have been studied. We recently have documented the superiority of a cognitive-behavioral treatment (CBT) designed to decrease women's concerns about postcessation weight gain as compared to previously studied approaches. In this article, we briefly review the literature on weight concerns for women smokers and present details of a cognitive-behavioral approach to women's concerns about smoking-related weight gain and its integration into standard smoking cessation treatment program. In addition, ongoing treatment research to improve the longer-term outcome of weight-concerned women smokers is discussed.
Management of the Bariatric Surgery Patient: Is there a Role for the Cognitive Behavior Therapist?
Melissa A. Kalarchian and Marsha D. Marcus
Bariatric surgery has been recommended as a treatment for patients with clinically severe obesity (National Institutes of Health Consensus Development Panel, 1992). Although surgery leads to significant, long-term weight loss for a majority of patients, 20% of patients fail to lose a significant amount of weight or experience significant weight regain (Benotti & Forse, 1995). Currently, there is little evidence to suggest who will or will not achieve satisfactory weight loss after bariatric surgery. In this article, we provide background information on the procedures of gastric bypass and gastroplasty, the associated risks and complications, and outcomes. We review studies on the relationship of psychological variables to weight loss after operation, including recent findings that binge eating may be associated with poorer long-term outcomes. We outline several important roles the cognitive behavior therapist can play in treating individuals in the preoperative, postoperative, and longer-term adjustment phases. The cognitive behavior therapist can make a significant contribution to the management of the bariatric surgery patient and in the development and evaluation of interventions to enhance compliance and maximize weight loss, psychosocial functioning, and health-related quality of life after surgery.
Incorporating Motivational Interviewing Into Behavioral Obesity Treatment
Vicki DiLillo, Nicole J. Siegfried, and Delia Smith West
Motivational interviewing may be an appealing addition to a comprehensive behavioral weight loss program. Behavioral strategies have been shown effective in achieving modest weight reduction; however, not all individuals are successful at initial weight loss and many struggle with continued weight maintenance. Theory-based strategies that may enhance overall treatment efficacy or facilitate behavior change for specific clients are needed. Motivational interviewing has been demonstrated effective in facilitating behavior change in addictive disorders, and preliminary applications as an adjunct to obesity treatments are promising. The article presents fundamentals of motivational interviewing and specific examples of applications within a behavioral weight control program.
The Application of Dialectical Behavior Therapy to the Treatment of Eating Disorders
Lucene Wisniewski and Elizabeth Kelly
Dialectical behavior therapy (DBT) is a treatment that was originally designed to treat patients diagnosed with borderline personality disorder (BPD). Recent empirical evidence suggests that this treatment may also have some promise for the treatment of eating disorder patients. We propose that appropriately trained therapists may use the standard DBT model with some adjustments for an eating disorder diagnosis. These adjustments are both theoretical and practical and include broadening the biosocial theory, developing eating-disorder-specific dialectics, highlighting eating disorder behaviors in the treatment targets, expanding the diary card, and adding a nutrition skills module.
Food Refusal by Infants and Young Children: Diagnosis and Treatment
Irene Chatoor and Jody Ganiban
Parents report that 25% of toddlers exhibit food refusal. A subgroup of these children demonstrate such severe food refusal that their nutritional status is compromised, leading to the diagnosis of a feeding disorder. Although food refusal is common, and can pose a significant health risk for some children, few researchers and clinicians have described the different forms food refusal may take, or have related food refusal subtype to feeding disorders subtypes. Such critical issues must be addressed and discussed because different types of food refusal and feeding disorders may necessitate different treatment approaches. This review proposes that food refusal can be expressed in qualitatively different ways, including (a) unpredictable food refusal; (b) selective food refusal; and (c) fear-based food refusal. Furthermore, it is proposed that each form of food refusal gives rise to a qualitatively different feeding disorder: Unpredictable food refusal is associated with infantile anorexia; selective food refusal is related to sensory food aversions; and fear-based food refusal is central to a posttraumatic feeding disorder. Implications for the treatment of each type of feeding disorder are discussed.
Cognitive Behavioral Interventions in the Management of Severe Pediatric Obesity
Marsha D. Marcus, Michele D. Levine, Melissa A. Kalarchian, and Lucene Wisniewski
The prevalence of pediatric obesity has increased significantly, and the greatest increase in prevalence has occurred among the heaviest children. Severe pediatric obesity is associated with higher rates of medical and psychosocial morbidity than is milder obesity. Although the efficacy of family-based behavioral weight control programs in the treatment of moderate pediatric obesity is well established, there is little information on the treatment of severe obesity. We believe that family-based cognitive behavioral interventions, which focus on increasing healthy eating behaviors and physical activity and decreasing unhealthy eating and sedentary behaviors, are critical for these children. Treatment adaptations that address inappropriate eating among children, peer teasing, and poor body image also are useful in managing this high-risk population.
The GIFT Program for Major Depression
Michael A. Friedman, Esteban V. Cardemil, Jackie Gollan, Lisa A. Uebelacker, and Ivan W. Miller
Research suggests that group cognitive-behavioral therapy (CBT) can be an efficacious and potentially cost-effective treatment for major depression. Yet despite evidence of efficacy, there are limitations to the effectiveness of group CBT in actual clinical practice. We introduce the Group, Individual, and Family Treatment (GIFT) program that builds upon current CBT theory and technology, but has been modified to create a potentially more effective version of group CBT. In this article, we describe the of mental health upon which the GIFT program is based. We then describe how the GIFT program attempts to build upon existing group CBT programs by using an open-group format and repeated-group session format, and by the integration of individual and family-based interventions.
Treatment of Paruresis in the Context of Benign Prostatic Hyperplasia: A Case Report
Gregory M. Rogers
Paruresis, the inhibition of micturition in public restrooms, has been treated successfully by cognitive-behavioral therapy (CBT) with an exposure component. There are no reports of treatment for paruresis in the context of an organically based urinary dysfunction. This study examined the effectiveness of CBT for a 53-year-old male with chronic paruresis and benign prostatic hyperplasia (BPH). Coping skills training and in vivo exposure were applied in 21 sessions over a 12-week period. Pre- and posttreatment subjective units of distress (SUDS) ratings upon entering various public restroom situations were obtained. Data collected during exposure trials included latency of micturition, ratings of urinary volume, and SUDS ratings. Increased ability to urinate in public restrooms and reduced anxiety and urinary delays in the presence of others were achieved. Implications for the conceptualization of paruresis and the impact of BPH on its treatment are discussed.
Employing Behavioral Methods to Improve the Context of Care in a Public Psychiatric Hospital: Realizing Improvements in the Interpersonal Behavior of Direct-Care Providers
Dennis C. Donat and Gerald F. McKeegan
Many behaviorally trained scientist-practitioners have noted the poor utilization of behavioral technology in inpatient psychiatric treatment settings. However, few studies have examined how behavior change skills can be applied to address this organizational behavior problem. This article outlines a series of projects to develop and implement a training program for direct-care psychiatric staff in the use of behavioral methods in their daily staff-patient interactions. It outlines not only the strategy of program development and implementation but also the organizational issues that enhanced its implementation over time. A variety of organizational behavior change considerations are discussed. The authors emphasize that behavioral methods have value not only for improving direct patient care but also for improving the support for such efforts within the organization. The importance of applying behavior change skills to organizational behavior to improve the context of care is discussed.
