Maintenance of weight loss after obesity treatment: is continuous support necessary?

OBJECTIVE: This study examined outcome differences of 109 obese subjects, who participated in a 10-week cognitive-behavioral inpatient treatment followed by either a weight maintenance program or a follow-up period without professional support. METHODS: Self-rated weight loss, eating behaviors, and general psychopathology were assessed several months before treatment, when subjects were admitted, at discharge, and at the 6-, 12-, and 18-month follow-ups. Structured interviews for mental disorders and eating pathology were conducted additionally. RESULTS: The mean weight of the sample at baseline was 127 kg. Weight loss of the total sample amounted to 8.0 kg (6.3%) and was completely maintained during the follow-up period. Significant reductions of eating and general psychopathology were observed at the 18-month follow-up. The outcome in the maintenance condition did not significantly differ from the outcome in the control condition. CONCLUSIONS: Weight regain after obesity treatment is not inevitable, but continuous patient-therapist contacts do not distinctly improve treatment effects.     

The effects of a public address system on the off-task behavior of elementary physical education students

The purpose of this study was to determine the effects of teacher feedback delivered via a public address system on the off-task behavior of elementary-school physical education students. A multiple baseline design across three classes was used in this investigation. Results indicated a consistent decline in off-task behavior when the public address feedback system was used.     

Treating a Chronically Depressed Adolescent Female Using the Cognitive Behavioral Analysis System of Psychotherapy: A Case Study

A case is presented of an adolescent female with double depression who was treated using the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). CBASP is designed to teach a social problem-solving procedure called Situational Analysis (SA). Generalized treatment effects were measured through monitoring of diagnostic status, two administrations of the Minnesota Multiphasic Personality Inventory-Adolescent, weekly administrations of the Child Depression Inventory, and acquisition performance ratings on the SA task. The results showed that CBASP appeared to be an effective treatment. The double depressive disorder remitted, and the patient learned to identify behavioral consequences as well as target and attain her interpersonal goals. CBASP can be effective for adolescents, although modifications of the adult form of the therapy may be necessary.     

Might Relationship “Techniques” Extend the Reach, Efficacy, and Efficiency of the Psychotherapies? The Challenge of Treatment-Resistant Outpatients

Study-based clinical observations and two premises are presented as indications for a need to identify therapeutic relationship techniques or the like that can extend the reach and efficiency of the psychotherapies. The premises are: (1) advances in psychotherapy practice and research now highlight one of the field's most longstanding challenges, signified by terms like treatment resistance; and (2) some proportion of outpatients whose problems are resistant to the psychotherapies (and medications) have marked limitations in the capacity to relate positively and productively to others, including therapists. Thus, ironically, they cannot optimally utilize a treatment modality that largely has developed to ameliorate problems relating to others.     

Drug discrimination under concurrent variable-ratio variable-ratio schedules

Pigeons were trained to discriminate 5 mg/kg pentobarbital from saline under concurrent variable-ratio (VR) VR schedules, in which responses on the pentobarbital-biased lever were reinforced under the VR schedule with the smaller response requirements when pentobarbital was given before the session, and responses on the saline-biased key were reinforced under the VR schedule with the larger response requirements. When saline was administered before the session, the reinforcement contingencies associated with the two response keys were reversed. When responding stabilized under concurrent VR 20 VR 30, concurrent VR 10 VR 40, or concurrent VR 5 VR 50 schedules, pigeons responded almost exclusively on the key on which fewer responses were required to produce the reinforcer. When other doses of pentobarbital and other drugs were substituted for the training dose, low doses of all drugs produced responding on the saline-biased key. Higher doses of pentobarbital and chlordiazepoxide produced responding only on the pentobarbital-biased key, whereas higher doses of ethanol and phencyclidine produced responding only on this key less often. d-Amphetamine produced responding primarily on the saline-biased key. When drugs generalized to pentobarbital, the shape of the generalization curve under concurrent VR VR schedules was more often graded than quantal in shape. Thus, drug discrimination can be established under concurrent VR VR schedules, but the shapes of drug-discrimination dose-response curves under concurrent VR VR schedules more closely resemble those seen under interval schedules than those seen under fixed-ratio schedules. Graded dose-response curves under concurrent VR VR schedules may relate to probability matching and difficulty in discriminating differences in reinforcement frequency.     

The formation of a generalized categorization repertoire: effect of training with multiple domains,samples, and comparisons

The present experiment explored the effects of three variables on the spontaneous categorization of stimuli in perceptually distinct and novel domains. Each of six stimulus domains was created by morphing two images that were the domain endpoints. The endpoints of the domains were male and female faces, two abstract drawings, a car and a truck, two banded-elevation satellite land images, a tree and a cat, and two false-color satellite images. The stimulus variants at each end of a domain defined two potential perceptual classes. Training was conducted in a matching-to-sample format and used stimuli from one or two domains, one or three variants per class as samples, and one or three variants per class as comparisons. The spontaneous categorization of stimuli in the untrained stimulus domains showed the emergence of a generalized categorization repertoire. The proportion of spontaneously categorized stimuli in the new domains was positively related to the number of domains and samples used in training, and was inversely related to the number of comparisons used in training. Differential reaction times demonstrated the discriminability of the stimuli in the emergent classes. This study is among the first to provide an empirical basis for a behavior-analytic model of the development of generalized categorization repertoires in natural settings.     

Sea lions and equivalence: expanding classes by exclusion

Experiments have shown that human and nonhuman subjects are capable of performing new arbitrary stimulus-stimulus relations without error. When subjects that are experienced with matching-to-sample procedures are presented with a novel sample, a novel comparison, and a familiar comparison, most respond by correctly selecting the novel comparison in the presence of the new sample. This exclusion paradigm was expanded with two California sea lions that had previously formed two 10-member equivalence classes in a matching-to-sample procedure. Rather than being presented with a novel sample on a given trial, the sea lions were presented with a randomly selected familiar member of one class as the sample. One of the comparisons was a randomly selected familiar member of the alternative class, and the other was a novel stimulus. When required to choose which comparison matched the sample, the subjects reliably rejected the familiar comparison, and instead selected the unfamiliar one. Next, the sea lions were presented with transfer problems that could not be solved by exclusion; they immediately grouped the new stimuli into the appropriate classes. These findings show that exclusion procedures can rapidly generate new stimulus relations that can be used to expand stimulus classes.     

The Dental Subscale of the Children's Fear Survey Schedule: Predictive Value and Clinical Usefulness

This study reports on the predictive value and clinical usefulness of the Dutch parental version of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Parents of 718 children (4–12 years) completed this CFSS-DS version before or during the child's visit. The dentist rated the child's dental fear during treatment on a 5-point Likert-type Scale from 1 (not afraid at all) to 5 (very afraid). Reliability analysis was performed, and correlation coefficients between the two measures were calculated. The reliability of the scale proved to be high (Cronbach's = .93) and significant correlation coefficients were found (r = .58 and r = .68, p < .01). The negative predictive value of the CFSS-DS was high (.96), whereas its positive predictive value was relatively low (0.41). It was concluded that the CFSS-DS might be of clinical value as a screening device of dental fear, whereas its predictive value of fearful behavior should not be overestimated.     

Psychosocial Treatment Strategies in the MTA Study: Rationale, Methods, and Critical Issues in Design and Implementation

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first multisite, cooperative agreement treatment study of children, and the largest psychiatric/psychological treatment trial ever conducted by the National Institute of Mental Health. It examines the effectiveness of Medication vs. Psychosocial treatment vs. their combination for treatment of ADHD and compares these experimental arms to each other and to routine community care. In a parallel group design, 579 (male and female) ADHD children, aged 7–9 years, 11 months, were randomly assigned to one of the four experimental arms, and then received 14 months of prescribed treatment (or community care) with periodic reassessments. After delineating the theoretical and empirical rationales for Psychosocial treatment of ADHD, we describe the MTA's Psychosocial Treatment strategy applied to all children in two of the four experimental arms (Psychosocial treatment alone; Combined treatment). Psychosocial treatment consisted of three major components: a Parent Training component, a two-part School Intervention component, and a child treatment component anchored in an intensive Summer Treatment Program. Components were selected based on evidence of treatment efficacy and because they address comprehensive symptom targets, settings, comorbidities, and functional domains. We delineate key conceptual and logistical issues faced by clinical researchers in design and implementation of Psychosocial research with examples of how these issues were addressed in the MTA study.Deceased     

Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7–9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.