Newsletter
Volume 30| 2007 | Number 2
Behavioral Medicine
By Drs. Joseph Cautilli & Craig Thomas
One of the most dynamic SIG’s within ABA, the Behavioral Medicine SIG is committed to forging new alliances in combating behavioral and environmental aspects of disease and illness. With a very diverse membership, the SIG takes both a preserving history of behavior analysis in behavioral medicine and promoting the future approach to its work. Through its relatively short history, behavior analysis exerted considerable impact on the development of the field of behavioral medicine. This impact has created a whole new line of assessments and interventions for the treatment of self-injury, feeding disorders, sleep problems, obesity, pain, CP, and smoking reduction. The SIG focuses on continuing and extending the legacy of that impact. The SIG serves a role in getting the message out to providers and the population
in general.
What is the message? A brief review of the literature shows that APA’s Task Force (1999) on the promotion of empirically supported treatments list multi-component operant therapy, as a well established treatment for pain (Turner & Clancy, 1988; Turner et al., 1990). In addition, behavioral intervention for obesity (Epstein et al., 1994; Wheler & Hess, 1976) is listed as well established. Behavioral treatment to obesity is becoming the alternative to fad diets. Patients treated with a comprehensive group behavioral approach lose roughly nine per cent of initial weight in 20 to 26 weeks of treatment. In their review article, Wadden and Foster (2000) reviewed and summarized the results from prospective randomized trials published in four behavioral journals from 1974 to 1999. Although the rate of weight loss induced by behavioral therapy has remained constant for the last 25 years, total weight loss has more than doubled because treatment duration
has increased.
However, behavioral treatments are not without problems. It is common for subjects to regain weight after cessation of therapy. Most patients will regain 35% of their lost weight within one year; however, the critical feature is that most patients still maintain a medically important weight loss of at least five per cent of initial body weight after the end of one year. Continued behavior therapy does not lead to additional weight loss, but is maybe important for maintaining weight loss. Several studies have found important long-term treatment effects for comprehensive behavior modification programs. Björvell & Rossner (1992) examined data from the longest reported study that evaluated the effect of behavior modification therapy on body weight in extremely obese subjects. These subjects totaling 68, both men and women, (pretreatment body mass index: 41 kg/m2) were treated in an intensive behavioral treatment program every weekday for six weeks. This treatment was followed by continuous booster sessions for the next four years. Following the four years of the treatment program, the subjects experienced a mean weight loss of 12.6 kg (27% of excess body weight). Long-term follow-up data were obtained for 72% of the initial participants showing that weight loss was maintained over the next 12 years. These data demonstrate that it is possible for long tem weight reduction through behavior and lifestyle modification therapy. And efforts to address the problems of long term gains continue (see Anderson, Simmons,
& Milnes, 2005).
In addition to the above, APA’s Task Force (1999) lists multiple operant based behavioral techniques such as biofeedback as having efficacy. Biofeedback is listed as probably efficacious for a number of stress related problems. These include EMG biofeedback for chronic pain (Flor & Birbaum, 1993; Newton-John et al., 1995), thermal biofeedback for Raynaud’s syndrome (Freedman et al., 1983), thermal biofeedback plus autogenic relaxation training for migraine (Blanchard et al., 1978; Sargent, et al., 1986) and tension headaches (Blanchard, et al., 1980). Here again, behavioral research continuing in many areas including vocal distress (Warnes, & Allen, 2005), gastric acid (Welgan, 1974) and epilepsy (Wyler, Robbins, Dodrill, 1979). Most insurance companies cover the costs of operant behavioral intervention such as biofeedback for pain. In addition, many behavior analysts currently work in the hospital setting with clinically ill populations.
What has the SIG done to get the message out? This has been a very prosperous year for the SIG. Under the leadership of Craig Thomas and with the support of various SIG members including, but not limited to Duane Lundervold, Andrew Scherbarth, Tobias Lundgren, and other SIG members, the SIG has produced a pamphlet series. This series covers the basics of behavior analysis in behavioral medicine and the areas that it has shown efficacy including those areas discussed above and others like pediatric feeding and self-injury. The SIG hopes that the pamphlet series will be picked up by ABA and available for sale to behavioral practitioners for their offices.
In addition to the above, the SIG in partnership with the Behavior Analyst Online SIG and the Health, Sport, and Fitness, under the guidance of its chair Michael A. Kirkpatrick, is aggressively pursuing the 2008 Journal of Behavioral Analysis in Health, Sports, Fitness, and Medicine(BAHSFM). From the mission statement “This journal is for those interested in the application of behavioral principles for promoting wellness, enhancing fitness, and sports skills development, and ameliorating disease. The bi-directional interaction between physiology and behavior can be effectively mediated through the application of elementary principles of behavior. Behavior analysis has thereby exerted its influence in the fields of health and medicine, as well as in the enhancement of the safe and skillful performance that in turn facilitates well-being. Examples include but are not limited to the areas of exercise and dietary compliance, smoking cessation, stress reduction, diabetes management, obesity treatment, and the development of sport performance and safety skills that bring about healthy reinforcement-rich lifestyles less vulnerable to disease. This journal aims to foster a greater understanding of the impact of behavior analysis on health, sports, fitness, and behavioral medicine and seeks to publish conceptual and research articles in these areas. In addition, we seek to publish literature reviews and articles focused on behavior analytic contributions to health policy and problem reduction.”
In the coming year, we hope to start a series of position papers, discussing the importance that a behavior analytic practitioner can serve in hospital and primary care environments. We look to ongoing discussions with the Behavior Analyst Online SIG’s Behavior Analysis and Public Policy listserve to create opportunities for building bridges with physicians, hospitals, and primary care personal to employing behavior analysts as team members in their efforts to help patients heal. In short, we are a group strongly committed to using the science of behavior to help people get well from disease, illness, and injury. A business meeting was held in San Diego at the ABA convention to lay out an agenda for the next year and to discuss how to formalize our
membership process.
References
Anderson, D. A., Simmons, A. M., & Milnes, S.M. (2005).
Interventions for weight reduction: Facing the maintenance problem -IJBCT, 1. (4), 276.
Björvell, H, & Rossner, S. (1992). A ten-year follow-up of weight change in severely obese subjects treated in a combined behavioural modification programme. Int J Obes Relat Metab Disord; 16:623-625.
Blanchard, E. B., Andrasik, F., Ahles, T. A., Teders, S. J. & O’Keefe, D. (1980). Migraine and tension headaches: A meta-analytic review. Behavior Therapy, 11, 613-631.
Blanchard, E. B., Theobold, D. E., Williamson, D.A., Silver, B. V. & Brown, D. A. (1978). Temperature biofeedback in treatment of migraine headache. Archives of General Psychiatry, 35, 581-588.
Flor, H. Birbaumer, N. (1993). Comparison of the efficacy of electromyographic biofeedback, cognitive-behavior therapy, and conservative medical treatment in the treatment of chronic musculoskeletal pain. Journal of Consulting and Clinical Psychology, 61, 653-658.
Freedman, R. R., Lanni, P., Weing, P. (1983). Behavioral treatment of Raynaud’s disease. Journal of Consulting and Clinical Psychology, 51, 539-549.
Newton-John, T. R.O., Spence, S. H., Schotte, D. (1995). Cognitive behavior therapy versus EMG biofeedback in the treatment of chronic low back pain. Behavior Research and Therapy, 33, 691-697.
Sargent, J., Sollbach, P., Coyne, L., Spohn, H., & Sergenson, J. (1986). Results of a controlled experimental outcome study of non-drug treatment of the control of migraine headaches. Journal of Behavioral Medicine, 9, 291-323.
Task force on promotion and dissemination of psychological procedures (1995). Training in and dissemination of empirically-validated psychological treatment. The Clinical Psychologist, 48, 3-23.
Turner, J. A. & Clancy, S. (1988). Comparison of operant behavioral and cognitive-behavioral group treatment for chronic low back pain. Journal of Consulting and Clinical Psychology, 56, 261-266.
Turner, J. A., Clancy, S., McQuade, K. J. & Cardenas, D. D. (1990). Effectiveness of behavioral therapy for chronic lower back pain: A component analysis. Journal of Consulting and Clinical Psychology, 58, 573-579.
Wadden, T. A. & Foster, G. D. (2000). Behavioral treatment of obesity. Medical Clinics of North America, 84, 441-461.
Warnes, E. & Allen, K. D. (2005). Biofeedback treatment of paradoxical vocal fold motion and respiratory distress in an adolescent girl. Journal of Applied Behavior Analysis, 38, 529-532.
Welgan, P. R. (1974). Learned control of gastric acid secretions in ulcer patients. Psychosomatic Medicine, 36(5), 411-419.