The Present Status of Operant Conditioning for the Treatment of Anorexia Nervosa

Abstract

Operant conditioning appears to be an effective short-term method of weight restoration in anorexia nervosa, although it may offer only modest advantages over alternative methods of inducing weight gain. Programs differ widely in the selection of treatment setting, target behaviors, positive and negative reinforcers, reinforcement schedules, facilitating conditions, and supplementary modalities employed, and it remains unclear how each of these variables may contribute to treatment outcome. The scarcity of long-term follow-up data after 20 years of investigation is puzzling; by default, the calculation of risk/benefit ratios has depended on the theoretical biases of the observer. The accumulation of clinical experience does appear to have had some moderating effect on the polarized positions initially assumed by the advocates and opponents of operant conditioning. The approach has gained acceptance as a useful but circumscribed component of multimodal treatment programs, and in recent years is often supplemented with a variety of behavioral and cognitive-behavioral strategies designed to deal with a broader range of anorexic symptomatology.

Multimodale Verhaltenstherapie der Anorexia nervosa im Kindes- und Jugendalter

“…Unter den verhaltenstherapeutischen Methoden sind historisch zuerst die operanten Methoden der Gewichtssteigerung als wirksam nachgewiesen worden [vgl. die Übersicht von Bemis, 1987]. Sie sind mindestens so gut wie andere Therapiemethoden -wie z.B.…”

“…Hierfür ist zu Beginn eine relative Deprivation materieller und sozialer Verstärker im Rahmen eines kontrollierten Behandlungssettings erforderlich, das in dieser Form in der Regel nur im stationären Milieu geschaffen werden kann. Nachdem in systematischen Analysen jeweils die Vor-und Nachteile einer Verstärkung des Essverhaltens oder der Gewichtszunahme evaluiert worden sind [Bemis, 1987;Steinhausen, 1999b] Vandereycken, 1995]. Schließlich kann die mehrheitlich als Folge der Anorexia nervosa auftretende oder auch komorbide Affektstörung eine Indikation für eine begleitende Psychopharmakotherapie abgeben.…”

Treatment and Outcome of Adolescent Anorexia nervosa

“…Behavioural therapy usually involves operant condi tioning or reinforcement procedures and cognitive meth ods [2,3], though in some instances, social skill training programmes may also be used. Operant conditioning is generally employed in the hospital setting.…”

Perceptions of bed rest by anorexic patients

“…Operant conditioning for anorexia nervosa is now a standard treatment for weight restoration in numerous medical and psychiatric centers worldwide (Bemis, 1987;Touyz, Beumont, Glaun, Phillips, & Cowie, 1984). The classic paradigm involves removal of privileges which are regained with weight increases.…”

“…However, a number of other experts (Bruch, 1978;Goodsitt, 1977Goodsitt, , 1985Bemis, 1987;Levenkron, 1985) believe the practice is a dangerous tactic that intensifies the sense of helplessness and hopelessness that originally Bruch (1978) maintained that ''uniformly my patients had experienced this program as brutal coercion, dehumanizing, reducing them to utter helplessness, nullifying whatever self-control they might have achieved in individual therapy' ' (p. 653). Given this harsh criticism, it is surprising that formal assessments of acceptability of this treatment have been omitted from most studies.…”