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The use of sensory deprivation in a programme of weight control Borrie, Roderick Allen 1977

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THE USE OF SENSORY DEPRIVATION IN A PROGRAMME OF WEIGHT CONTROL by RODERICK ALLEN BORRIE B . S c , Denison U n i v e r s i t y , 1969 M.A., Temple U n i v e r s i t y , 1973 A THESIS SUBMITTED IN PARTIAL FULFILMENT FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES i n the Department of Psychology We accept t h i s t h e s i s as conforming to the req u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA August, 1977 (c)Roderick A l l e n B o r r i e , 1977 In presenting th is thes is in p a r t i a l fu l f i lment of the requirements for an advanced degree at the Un ivers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f ree ly ava i lab le for reference and study. I fur ther agree that permission for extensive copying of th is thes is by h is representat ives . It is understood that copying or pub l ica t ion of th is thes is fo r f inanc ia l gain sha l l not be allowed without my writ ten pe m i s s i o n . Department of The Univers i ty of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 for scho la r ly purposes may be granted by the Head of my Department or i i ABSTRACT Sensory d e p r i v a t i o n has been used i n a number of c l i n i c a l contexts e i t h e r as a form of therapy by i t s e l f or i n conjunction w i t h other t h e r a -p e u t i c techniques. The c h a r a c t e r i s t i c s of i n c r e a s i n g p e r s u a s i b i l i t y and r e c e p t i v i t y to th e r a p e u t i c input make sensory d e p r i v a t i o n an a t t r a c t i v e t o o l f o r many v a r i e t i e s of behaviour change. In past research sensory de-p r i v a t i o n has been used i n the treatment of poor s e l f image, autism, phobias, and smoking. This study was designed to extend previous research i n which sensory d e p r i v a t i o n was used to s u c c e s s f u l l y moderate or e l i m i n a t e h e a l t h endangering behavior. In the research on smoking the technique was used i n conjunction w i t h appropriate messages to help p s y c h o l o g i c a l l y addicted smokers to stop smoking (Suedfeld, 1973). The present p r o j e c t a p p l i e d the sensory d e p r i v a t i o n technique to the problem of o b e s i t y caused by overeating. The design was a 2 x 2 f a c t o r i a l w i t h the major v a r i a b l e s being (1) sen-sory d e p r i v a t i o n (SD) versus non-confinement (NC), and (2) therapeutic mes-sages (M) versus no messages (NM). Subjects were 39 female volunteers between the ages of 20 and 56 who responded to announcements of an experimental weight l o s s programme. The subjects were assigned to one of the four experimental groups which were equated f o r weight, age, and m a r i t a l s t a t u s . Sensory d e p r i v a t i o n con-s i s t e d of l y i n g i n a dark, q u i e t chamber f o r 24 hours; the messages consisted of two sets of communications concerning weight l o s s . The f i r s t set of messages was concerned w i t h body o r i e n t a t i o n , r e l a x a t i o n , and c o n t r o l l i n g urges; the second set d e a l t w i t h s p e c i f i c b e h a v i o u r a l s e l f - c o n t r o l techniques. The group which r e c e i v e d both sensory d e p r i v a t i o n and messages heard the messages i i i d uring t h e i r stay i n sensory d e p r i v a t i o n . F o l l o w i n g the experimental t r e a t -ment, a l l subjects were given a standard d i e t manual and standardized i n ^ s t r u c t i o n s i n i t s use. Subjects were seen p e r i o d i c a l l y over the f o l l o w i n g s i x months. The weight l o s s data at s i x months show a s i g n i f i c a n t i n t e r a c t i o n be-tween sensory d e p r i v a t i o n and message. The combined treatment (SDM mean = 5.87 Kg) was s u p e r i o r to the other three groups (SDNM mean = 1.08 Kg, NCM mean = .67 Kg, NCNM mean = 2.36 Kg). There were no s i g n i f i c a n t changes i n s k i n f o l d measurements. The weight l o s s data at two months showed a s i g n i f i -cant message e f f e c t w i t h those who heard the messages l o s i n g 3.14 Kg versus 1.23 Kg f o r those who d i d not. Weight l o s s over the f i n a l four months showed a c o n d i t i o n e f f e c t w i t h those who had sensory d e p r i v a t i o n l o s i n g 1.58 Kg, w h i l e the nonconfined subjects gained .98 Kg. These r e s u l t s are discussed i n terms of the m o t i v a t i n g c h a r a c t e r i s t i c s of sensory d e p r i v a t i o n . When va r i o u s demographic and behavioural data were regressed on weight change, three s i g n i f i c a n t p r e d i c t o r s emerged. The f a c t s were that the more d i f f i c u l t y the subject a n t i c i p a t e d , the more weight she l o s t ; the stronger her motive to please her spouse, the l e s s weight she l o s t ; and the more she was concerned w i t h e a t i n g s l o w l y , the more weight she l o s t . The r e s u l t s are discussed i n terms of t h e i r i m p l i c a t i o n s f o r future treatments of o b e s i t y . The present study i s a l s o discussed i n comparison w i t h other sensory d e p r i -v a t i o n s t u d i e s and other o b e s i t y treatment s t u d i e s . ±-' i v TABLE OF CONTENTS Page ABSTRACT i i TABLE OF CONTENTS . i v LIST OF TABLES AND FIGURES v i ACKNOWLEDGEMENT v i i INTRODUCTION 1 The Therapeutic Use of Sensory D e p r i v a t i o n ..... _ Treatment of Overweight i f Concepts of Obesity 20 Methodological Considerations 28 Rat i o n a l e f o r the Treatment Used i n This Study ..... 32 DESIGN OF THE STUDY . 35. METHOD Subjects 35 Procedure ..... 36 Group One - Sensory d e p r i v a t i o n w i t h messages 38 Group Two - Sensory d e p r i v a t i o n w i t h no messages 40 Group T h r e e - Unconfined w i t h Messages 40 Group Four - Nonconfined w i t h no messages 41 Follow-up Sessions 41 Measures 42 Weight, h e i g h t , and s k i n f o l d 42 Demographic data 43 M o t i v a t i o n a l data 43 P e r s o n a l i t y measures 44 Spouse involvement ..... 46! S e l f monitoring ... .. 47( Two month i n t e r v i e w 47/ S i x month i n t e r v i e w 48' V Table of Contents (cont'd) Page RESULTS 50 Intergroup d i f f e r e n c e s .... 50 R e l a t i o n s h i p s between measures .... 51 Group s i z e and the a n a l y s i s of drop outs .... 53 Weight change .... 55 S k i n f o l d measurement change .... 62 A n a l y s i s of other dependent measures .... 62 Regression i n v o l v i n g weight change .... 64 Unanalyzed data .... 65 DISCUSSION 67 M o t i v a t i o n a l e f f e c t s .... 69 Comparison w i t h other SD st u d i e s .... 71 Comparison w i t h other weight r e d u c t i o n s t u d i e s .... 72 Treatment of methodological problems .... 75 P r e d i c t o r s of weight l o s s .... 76 Data c o l l e c t i o n .... 78 Subject r e a c t i o n to the programme .... 80 Treatment format .... 82 Relevance to t h e o r i e s of o b e s i t y .... 83 I n d i v i d u a l d i f f e r e n c e s .... 86 CONCLUSION 89 FOOTNOTE 90a BIBLIOGRAPHY 91 APPENDIX A: I n d i v i d u a l case s t u d i e s 105 APPENDIX B: Newspaper a r t i c l e s used to r e c r u i t subjects .... 154 APPENDIX C: Message t r a n s c r i p t s 156 APPENDIX D: Forms used i n the study 174 v i LIST OF TABLES AND FIGURE Page TABLE 1 Summary of C o r r e l a t i o n s .... 52 TABLE 2 Weight l o s s at s i x months 57 TABLE 3 Weight l o s s at two months 58 TABLE 4 Weight l o s s over l a s t four months .... 60 TABLE 5 S k i n f o l d measurement change -s i x months .... 61 TABLE 6 Summary of weight r e d u c t i o n s t u d i e s . . . . 74 FIGURE 1 Weight change over s i x months 61 v i i ACKNOWLEDGMENTS I wish to express my g r a t i t u d e to the many people who a s s i s t e d me i n innumerable ways on t h i s p r o j e c t . To P r o f e s s o r P e t e r Suedfeld, my advisor f o r the past four years and my d i r e c t o r on t h i s d i s s e r t a -t i o n , I wish to express deep a p p r e c i a t i o n f o r h i s encouragement, c r i t i -cism, p a t i e n c e , and o c c a s i o n a l , w e l l placed m o t i v a t i o n a l boosts. My thanks go to Dr. Ralph Hakstian f o r h i s sound s t a t i s t i c a l advice and h i s k i n d words throughout the p r o j e c t , and to Dr. Demitrios P a p a g e o r g i s - \ f o r h i s c l i n i c a l advice e a r l y i n the p r o j e c t and humourous comments w h i l e I was seeing s u b j e c t s . I am g r a t e f u l to Dr. Richard S t u a r t f o r h i s a s s i s t a n c e and advice i n designing the study, and to Drs. L a r r y Ward and M e l v i n Lee f o r t h e i r help i n the planning stages of the p r o j e c t . I want to thank Carmenza Ramirez f o r her as s i s t a n c e i n t a k i n g the s k i n f o l d measurements and Margaret Byrne f o r her help i n scheduling sub-j e c t s . S p e c i a l thanks are due to C a r o l B o r r i e who not only provided much encouragement and support but di d much of the typing and e d i t i n g of ear-l i e r d r a f t s . To my f r i e n d s , not mentioned s p e c i f i c a l l y here, but who provided much support through the e n t i r e p r o j e c t , I o f f e r my s i n c e r e a p p r e c i a t i o n . F i n a l l y , though perhaps most important, I wish to thank each sub-j e c t who p a r t i c i p a t e d i n the study, o f t e n i n s p i t e of much discouragement. I hope that I have taught you at l e a s t a f r a c t i o n of what you have taught to me. INTRODUCTION 1 For many years researchers have been i n t e r e s t e d i n the p s y c h o l o g i c a l e f f e c t s of reduced sensory s t i m u l a t i o n . Over short periods of a few hours to s e v e r a l days, t h i s procedure i s most commonly known as sensory d e p r i v a t i o n . Research on human a d u l t s exposed to temporary c o n d i t i o n s of sensory d e p r i v a t i o n has i n v e s t i g a t e d i t s e f f e c t on such heterogeneous v a r i a b l e s as biochemistry, p e r s u a s i b i l i t y , EEG a c t i v i t y , and ego s t r e n g t h (see Zubek, 1969). This d i v e r s i t y of research p u r s u i t s i s promoted by the nature of sensory d e p r i v a t i o n , which, r a t h e r than being a research paradigm w i t h the mandates of s p e c i f i c t h e o r i e s and concepts, i s a technique or method whose a p p l i c a b i l i t y i s l i m i t e d only by the r e -searcher's imagination. The concern of t h i s research r e p o r t i s the a p p l i c a t i o n of sensory - d e p r i v a t i o n i n a t h e r a p e u t i c context. S p e c i f i c a l l y t h i s report i s an i n -v e s t i g a t i o n of the use of sensory d e p r i v a t i o n w i t h t h e r a p e u t i c messages i n a programme of weight l o s s . Sensory d e p r i v a t i o n i n t h i s programme was used as a t h e r a p e u t i c f a c i l i t a t o r i n conjunction w i t h more conventional techniques of b e h a v i o r a l s e l f c o n t r o l f o r weight l o s s (Stuart and Davis, 1972). While sensory d e p r i v a t i o n was the major experimental concern of t h i s study, i n terms of time i t a c t u a l l y was a small p o r t i o n of the pro-gramme; i n f a c t , the length of time that each subject followed the pro-gramme was s i x months whereas the s i n g l e s e s s i o n i n sensory d e p r i v a t i o n was only 24 hours. The p l a n of t h i s chapter i s to begin w i t h a review of the t h e r a p e u t i c uses of sensory d e p r i v a t i o n and d i s c u s s the c h a r a c t e r i s t i c s of the sensory d e p r i v a t i o n experience which have provided the r a t i o n a l e f o r the d i f f e r e n t 2 research approaches. F o l l o w i n g t h i s , a b r i e f background i n the treatment of o b e s i t y w i l l be presented w i t h a summary of the r e l e v a n t t h e o r i e s of overweight and a d i s c u s s i o n of treatment problems. Next, the r a t i o n a l e . f o r a p p l ying sensory d e p r i v a t i o n to the problem of weight l o s s w i l l be examined w i t h a f i n a l comment on the problems inherent i n o b e s i t y research and the design of t h i s study. The Therapeutic Use of Sensory D e p r i v a t i o n While there i s a long-standing i n t e r e s t i n the p o s s i b l e uses of sen-sory d e p r i v a t i o n as a form of or a i d to therapy, the number of e m p i r i c a l i n v e s t i g a t i o n s i s q u i t e s m a l l , e s p e c i a l l y i n comparison to the enormous body of sensory d e p r i v a t i o n research i n general. A type of sensory d e p r i -v a t i o n i s reported to have been used as e a r l y as ancient Greece (Kouretas, 1967) ; however systematic research i n t o i t s c l i n i c a l use began only i n the mid-1950's s h o r t l y a f t e r the f i r s t sensory d e p r i v a t i o n research of any k i n d began. Some of the i n i t i a l s t u d i e s looked at the b e n e f i c i a l e f f e c t s of mere-l y spending a p e r i o d of time i n c o n d i t i o n s of sensory d e p r i v a t i o n (Azima and Cramer-Azima, 1956; H a r r i s , 1959; Cohen, Rosenbaum, Dobie and G o t t l i e b , 1959; Gibby, Adams, and Ca r r e r a , 1960; Cleveland Reitman and Bentinck, 1963; Reitman and Cleveland, 1964; Cooper, Adams, and Cohen, 1965). Other s t u d i e s have combined sensory d e p r i v a t i o n w i t h t h e r a p e u t i c communications designed to t r e a t a s p e c i f i c problem (Gibby and Adams, 1961; Robertson, 1965; Adams, Robertson, and Cooper, 1966; Suedfeld, Landon, Pargament and E p s t e i n , 1972; Suedfeld and I k a r d , 1974; Barnes, 1976; Kammerman, • >1977) or w i t h some other therapy aids such as v i s u a l p r e s e n t a t i o n s 3 ( P a t r i c k , 1965; Suedfeld and Smith, 1973; Suedfeld and Buchanan, 1974). In a d d i t i o n some have used sensory d e p r i v a t i o n to enhance the e f f e c t i v e -ness of another separate therapy method (Schechter, ShWley, Sexauer and Tousieng, 1969; Maier, 1970; M a r t i n , Roush, and N i c h o l s o n , 1967; Suedfeld and Best, 1977). While we might ca t e g o r i z e the c l i n i c a l uses of sensory d e p r i v a t i o n according to whether i t i s used alone, w i t h t h e r a p e u t i c communications, or w i t h other therapy methods, there i s a great deal of overlap between stu d i e s i n the use of these methods. For example, most of the s t u d i e s that used t h e r a p e u t i c communications a l s o i n c l u d e d a c o n t r o l group .tEat-ex-perienced sensory d e p r i v a t i o n without the communications. In a d d i t i o n , communications have been in c l u d e d w i t h sensory d e p r i v a t i o n i n s t u d i e s using a combination of therapy techniques (Suedfeld and Best, 1977). Therefore, i t w i l l be more u s e f u l to d i s c u s s t h i s body of research i n r e l a t i o n to the e f f e c t s of the sensory d e p r i v a t i o n experience that they were attempting to u t i l i z e . Some of the i n i t i a l c l i n i c a l s t u d i e s that used sensory d e p r i v a t i o n by i t s e l f attempted to examine the r e a c t i o n s of p s y c h i a t r i c p a t i e n t s to r e -duced sensory i n p u t . An e a r l y study (Azima and Cramer-Azima, 1956) placed 14 p a t i e n t s i n t o four days of sensory d e p r i v a t i o n and reported such bene-f i c i a l e f f e c t s as increased responsiveness to the t h e r a p i s t , enhanced s e l f -a s s e r t i v e n e s s , and increased d e s i r e to s o c i a l i z e . H a r r i s (1959) reported no b e h a v i o r a l improvements i n 12 schizophrenics f o l l o w i n g a short session wearing t r a n s l u c e n t goggles and l i s t e n i n g to white noise but they d i d seem more t o l e r a n t of the s i t u a t i o n than normals. Cohen e_t a__. (1959) compared the r e a c t i o n s of s i x p s y c h i a t r i c p a t i e n t s and four normal subjects who 4 experienced one hour w i t h t r a n s l u s c e n t goggles and white n o i s e . Again, there were no r e p o r t s of b e h a v i o r a l improvement. Gibbey e_t a l . (1960) reported symptom improvements i n 30 p s y c h i a t r i c p a t i e n t s which l a s t e d up to a week a f t e r a six-hour s e s s i o n l y i n g i n a q u i e t room w i t h eyes covered and ears plugged. These p a t i e n t s also e x h i -b i t e d an increased d e s i r e f o r s o c i a l contact and an increased awareness of the i n t e r n a l causes of p e r s o n a l problems. Another r e p o r t from the same study (Cooper, Adams and Gibby, 1962) added that p a t i e n t s showed a s i g n i -f i c a n t increase i n ego s t r e n g t h on the Rorschach. Although t h i s study d i d D not i n c l u d e a nonconfined c o n t r o l group, a study w i t h such a group (Cleveland, Reitman and Bentinck, 1963) found no d i f f e r e n c e between the sensory d e p r i -v a t i o n group and nonconfined group on pathology r a t i n g s . They concluded that sensory d e p r i v a t i o n o f f e r s " l i t t l e promise" as a treatment of behavior d i s o r d e r s but i n ;another .paper f romothe!:same, js.tudy "i(Reitman. and Cleveland, 1964) they do' report improvements in.'^body image' and increased - t a c t i l e ' s e n s i t i v i t y . These divergent r e s u l t s are most probably explained by d i f f e r e n c e s i n sensory d e p r i v a t i o n techniques: the Gibby et a l . (1960) study used a reduc-t i o n of absolute s t i m u l a t i o n l e v e l by covering s u b j e c t s ' eyes w i t h cotton and plugging t h e i r e a r s , whereas the Cleveland e_t aT. (1963) experiment used a r e d u c t i o n of stimulus p a t t e r n i n g without reducing stimulus i n t e n s i t y . Up to t h i s point the term sensory d e p r i v a t i o n has been used to describe both methods,,; however there i s a d i s t i n c t i o n to be made between the two. The r e d u c t i o n of absolute l e v e l of s t i m u l a t i o n i s r e f e r r e d to as sensory d e p r i v a t i o n w h i l e the r e d u c t i o n of stimulus p a t t e r n i n g without reducing i n t e n s i t y i s known as perceptual d e p r i v a t i o n ( R o s s i , 1969). U n f o r t u n a t e l y , 5 a c a r e f u l i n v e s t i g a t i o n of the d i f f e r e n t i a l t h e r a p e u t i c e f f e c t s of the two procedures has never been c a r r i e d out. In a recent review of the c l i n i c a l relevance of sensory d e p r i v a t i o n , Suedfeld (1975a) suggests that sensory d e p r i v a t i o n " d r a s t i c a l l y magnifies many f a c t o r s which should maximize the p a t i e n t ' s responsiveness to therapy: s e n s i t i v i t y to one's own thoughts, memories, and emotions; dependence upon the t h e r a p i s t , the d e s i r e f o r and reward value of s o c i a l i n t e r a c t i o n ; r e -ceptiveness to communications; a need f o r c o g n i t i v e s t r u c t u r e ; increased flow of primary process m a t e r i a l . I t a l s o f a c i l i t a t e s r e l a x a t i o n , m i n i -mizes d i s t r a c t i o n , and e l i m i n a t e s cues that i n normal environments e l i c i t undesired behavior" (p. 98). Some of these f a c t o r s , such as the minimiza-t i o n of d i s t r a c t i o n and the increase i n receptiveness to communication have l e d s e v e r a l researchers to study the p o s s i b i l i t y of enhancing the effeetiveness,, of ther a p e u t i c messages. A c t u a l l y , the i d e a that sensory d e p r i v a t i o n might increase the e f f e c t i v e n e s s of persuasive or edu c a t i o n a l m a t e r i a l s was par t of the o r i g i n a l impetus behind sensory d e p r i v a t i o n r e -search (Scott et_ a l . , 1959) . I f sensory d e p r i v a t i o n would i n c r e a s e the at t e n t i v e n e s s of the i n d i v i d u a l , i t would increase the impact of the ma-t e r i a l presented. P a r t of t h i s increased impact was p o s t u l a t e d to r e s u l t from a heightened need f o r s t i m u l a t i o n caused by the severe r e d u c t i o n i n stimulus l e v e l . Notwithstanding, some disagreement concerning the p r e c i s e d e f i n i t i o n of t h i s need f o r stimulus or i n f o r m a t i o n , there i s general agreement that sensory d e p r i v a t i o n does lead to stimulus-seeking behavior. Since the evidence i n support of t h i s has been thoroughly reviewed by both Schultz (1965) and Jones (1969) , a b r i e f sampling of t h i s evidence w i l l s u f f i c e 6 here. The d o c t o r a l d i s s e r t a t i o n of Bexton (Bexton, Heron, and S c o t t , 1954) provided the f i r s t i n d i c a t i o n that sensory d e p r i v a t i o n created an "eagerness f o r s t i m u l a t i o n " , Bexton's s u b j e c t s , when allowed to l i s t e n to r a t h e r b o r i n g m a t e r i a l as much as they wished, chose to l i s t e n f a r more f r e q u e n t l y i n the l a t t e r h a l f of t h e i r stay i n sensory d e p r i v a t i o n . Comparing subjects i n sensory d e p r i v a t i o n w i t h c o n t r o l s u b j e c t s , S c o t t , Bexton, Heron, and Doane (1959) found that the former chose to l i s t e n to recorded t a l k s more o f t e n than the l a t t e r . In a seven-day long s e s s i o n , subjects confined i n sensory d e p r i v a t i o n chose to l i s t e n to r a t h e r d u l l stock market reports s i g n i f i c a n t l y more of t e n than d i d nonsensorally deprived subjects (Smith, Myers and Johnson, 1967), In a d d i t i o n , as the du r a t i o n of the se s s i o n increased so d i d the d i f f e r e n c e between groups; those i n sensory d e p r i v a t i o n chose to l i s t e n i n c r e a s i n g l y more the longer they stayed. When subjects were asked why they chose to l i s t e n , the most frequent response was a d e s i r e to "hear a vo i c e or other meaningful sound" (Smith, et a l . , 1967). These researchers suggested that t h e i r f i n d i n g s support the concept of a d r i v e f o r sensory v a r i a t i o n which increases w i t h l e n g t h of d e p r i v a t i o n . In general, the f i n d i n g s from other research i n t h i s area also i n d i -cate that s e v e r e l y reduced e x t e r n a l s t i m u l a t i o n r e s u l t s i n an increased d e s i r e f o r s t i m u l a t i o n w i t h a preference f o r high i n f o r m a t i o n (see Jones, 1969), and that t h i s d e s i r e w i l l vary among i n d i v i d u a l s depending on recent s t i m u l a t i o n l e v e l s (Zuckerman, 1969; Haggard, As, and Borgen, 1970). The t y p i c a l experience of the subject who i s placed i n sensory d e p r i v a t i o n i s i n i t i a l l y pleasant or at l e a s t an i n t e r e s t i n g r e s p i t e from the usual stimu-l u s confusion i n normal c o n d i t i o n s . When the i n i t i a l r e l a x i n g n o v e l t y 7 wears o f f , the s u b j e c t begins to wish that something would happen. The nature of the s t i m u l a t i o n comes to matter l e s s so that m a t e r i a l which normally might be avoided becomes sought a f t e r or at l e a s t more acceptable. As S c o t t et_ a l . (1959) put i t , "the subject becomes so bored t h a t any form of s t i m u l a t i o n i s b e t t e r than nothing at a l l " (p. 208). This stimulus need may c o n t r i b u t e to the p a t i e n t ' s receptiveness to t h e r a p e u t i c messages that are heard i n c o n d i t i o n s of sensory d e p r i v a t i o n . A number of s t u d i e s have obtained b e n e f i c i a l e f f e c t s using t h i s combination f o r a v a r i e t y of problems, one of the e a r l i e s t being a study by Gibby and Adams (1961). They combined four hours of sensory d e p r i v a t i o n w i t h a 14 minute tape r e c o r d i n g designed to improve the p a t i e n t ' s s e l f concept. This study was a 2 x 2 f a c t o r design which i n c l u d e d sensory d e p r i v a t i o n witht..vi •• a message, sensory d e p r i v a t i o n o n l y , message o n l y , and t e s t - r e t e s t c o n t r o l groups. Measuring changes i n p a t i e n t s ' s e l f - e v a l u a t i o n s , Gibby and Adams (1961) found that combined sensory d e p r i v a t i o n and tape produced a f a r greater improvement i n s e l f e v a l u a t i o n s than any of the c o n t r o l condi-t i o n s . Combining three hours of sensory d e p r i v a t i o n w i t h i n d i v i d u a l l y p r e-pared tapes o r i e n t e d to the unique problems of each p a t i e n t , Adams, Robert-son and Cooper (1966) found the combination s u p e r i o r to sensory d e p r i v a t i o n alone or no treatment i n producing b e h a v i o r a l improvements. The improvements reportedpalsod.included increases i n dominance, ego s t r e n g t h , s e l f - a c c e p -tance, and sense of personal adequacy, A study w i t h l e s s p o s i t i v e r e s u l t s (Robertson, 1965) reported that sensory d e p r i v a t i o n w i t h a taped message was no b e t t e r i n i n c r e a s i n g p a t i e n t self-acceptance than e i t h e r sensory de-p r i v a t i o n or the message by i t s e l f . A reason f o r the l a c k of d i f f e r e n c e between conditions ..." i n t h i s study may have been the delay of a week be-8 tween treatment and post-treatment t e s t i n g . In a recent study that i n v o l v e d l y i n g p a r t i a l l y submerged i n a warm s a l i n e s o l u t i o n , Kammerman (1977) found that the^combination of sensory-d e p r i v a t i o n and a standardized tape r e c o r d i n g produced changes i n MMPI scores that d i d not occur i n sensory d e p r i v a t i o n only or no treatment groups. Kammerman f e e l s that t h i s method of sensory d e p r i v a t i o n "provides f o r maximum contact w i t h the unconscious." ( E a r l y , 1975). While the sen-sory d e p r i v a t i o n only group evidenced increased ego stre n g t h and defensive-ness, the group that heard the message i n sensory d e p r i v a t i o n demonstrated s i g n i f i c a n t l y i n c reased i n s i g h t , decreased i m p u l s i v i t y , and more emotional s t a b i l i t y i n t h e i r MMPI p r o f i l e s . A group of s t u d i e s of t h i s type that emerged more from work on i n -creased s u g g e s t i b i l i t y induced by sensory d e p r i v a t i o n (Suedfeld, 1965; Suedfeld and Vernon, 1966) than from i n t e r e s t i n i t s c l i n i c a l uses are those by Suedfeld and h i s colleagues. Based on the s i z e a b l e body of evidence that sensory d e p r i v a t i o n increases s u s c e p t i b i l i t y to persuasion attempts ( f o r review see Suedfeld, 1969), an experiment was designed aimed at going be-yond merely changing s u b j e c t i v e reports of a t t i t u d e to change a c t u a l be-h a v i o r p a t t e r n s on an i s s u e of personal importance, inducing the i n d i v i d u a l to stop smoking (Suedfeld, Landon, Pargament, and E p s t e i n , 1972). Sensory d e p r i v a t i o n had been used p r e v i o u s l y i n an attempt to change smoking beha-v i o r i n a study by P a t r i c k (1965). However h i s treatment of one hour of percep t u a l d e p r i v a t i o n followed by an anti-smoking f i l m was not s i g n i f i c a n t -l y b e t t e r than the f i l m alone i n reducing smoking behavior over a three hour follow-up p e r i o d . For the Suedfeld ejr a_L. (1972) study subjects were r e c r u i t e d without reference to any attempt to q u i t t i n g smoking and r e l e v a n t 9 i n d i v i d u a l smoking data were obtained from an i n i t i a l r e c r u i t i n g i n t e r -view; a l l s u b jects were heavy smokers. The study was a f a c t o r i a l design i n v e s t i g a t i n g sensory d e p r i v a t i o n versus no sensory d e p r i v a t i o n and a b r i e f antismoking message v v s ; no message. Sensory d e p r i v a t i o n c o n s i s t e d of l y i n g i n a completely dark, sound^attenuated chamber f o r a p e r i o d of 24 hours, and the antismoking message discussed the h e a l t h hazards of smoking and l a s t e d l e s s than three minutes. Three months f o l l o w i n g the s e s s i o n c o n t r o l s u bjects w i t h n e i t h e r sensory d e p r i v a t i o n .nor the message under normal conditions were smoking s l i g h t l y l e s s . Subjects who under-went sensory d e p r i v a t i o n , e i t h e r w i t h or without the message, had decreased t h e i r r a t e of smoking by 38%. This i s p a r t i c u l a r l y f a s c i n a t i n g since sub-j e c t s i n the sensory d e p r i v a t i o n only group had received no mention of c i g a r e t t e s . Pursuing these i n t r i g u i n g r e s u l t s , Suedfeld and Ikard (1974) t e s t e d the hypothesis that the l a c k of e f f e c t of the anti-smoking message was due to i t s b r e v i t y . They therefore expanded the message to a dozen antismoking communications and spaced them at d i f f e r e n t i n t e r v a l s throughout sensory d e p r i v a t i o n . The a d d i t i o n a l f a c t o r of i n i t i a l m o t i v a t i o n was used by r e -c r u i t i n g subjects s p e c i f i c a l l y f o r an experimental method to q u i t smoking. The 36 s u b j e c t s , a l l heavy smokers c l a s s i f i e d as " p s y c h o l o g i c a l l y a d d i c t e d " on the Tomkins-Ikard Smoking Questionnaire, were assigned to one of four groups set up as i n the previous study (Suedfeld e_t al_. , 1972) . At the three month follow-up, the sensory deprivation—message group had reduced t h e i r smoking rat e by 70% and the sensory d e p r i v a t i o n only group was smok-in g about 50% l e s s . The message only group had cut down t h e i r smoking about 40% w h i l e the no treatment c o n t r o l s were b a s i c a l l y unchanged, smoking 10 at t h e i r o r i g i n a l r a t e . A f t e r a f u l l year, the combined sensory d e p r i -v a t i o n groups were smoking 48% l e s s w i t h a much smaller d i f f e r e n c e between groups; the combined non-sensory d e p r i v a t i o n subjects were smoking only 16% l e s s than t h e i r o r i g i n a l r a t e . Follow-up a f t e r two years showed these r e s u l t s to be q u i t e s t a b l e . Of the sensory d e p r i v a t i o n s u b j e c t s , 25% were completely abstinent and many others were smoking considerably below t h e i r pretreatment l e v e l (Suedfeld, 1976). These s t u d i e s do demonstrate the powerful i n f l u e n c e of sensory d e p r i -v a t i o n i n changing behavior. However, they do not n e c e s s a r i l y support the hypothesis that sensory d e p r i v a t i o n increases s u g g e s t i b i l i t y to outside i n f l u e n c e . In one study (Suedfeld et_ a l _ . , 1972) both sensory d e p r i v a t i o n groups evidenced equal amounts of smoking re d u c t i o n regardless of whether the message was heard. In:.the other study (Suedfeld and I k a r d , 1974) there was an i n i t i a l d i f f e r e n c e i n smoking r e d u c t i o n between the sensory d e p r i -v a t i o n groups w i t h and without anti-smoking messages, but the d i f f e r e n c e ' at three months was small and lessened considerably over the course of the next year. Sensory d e p r i v a t i o n alone was s u f f i c i e n t i n both s t u d i e s to reduce smoking behavior s i g n i f i c a n t l y . This r e s u l t i s not i n -t e r p r e t a b l e s o l e l y i n terms of i n f o r m a t i o n need, enhanced i n f o r m a t i o n v a l u e , and increased s u g g e s t i b i l i t y . A p a r t i a l e x p l a n a t i o n may be found i n some of the e a r l i e r s t u d i e s on the e f f e c t s of mere exposure to sensory d e p r i v a t i o n . Even without messa-ges, sensory d e p r i v a t i o n was reported to make p a t i e n t s more se l f - u n d e r s t a n d -i n g , s e l f - a c c e p t i n g , and a l s o more aware that t h e i r own problems were the r e s u l t of inner c o n f l i c t (Gibby et a l . , 1960). By removing d i s t r a c t i n g e x t e r n a l s t i m u l i , sensory d e p r i v a t i o n forces one to focus a t t e n t i o n on 11 i n t e r n a l s t i m u l i , such as memories, d e s i r e s and f a n t a s i e s . At the time of the smoking st u d i e s by Suedfeld and h i s c o l l e a g u e s , the p u b l i c was being inundated w i t h antismoking propaganda which may have created a general low l e v e l d e s i r e i n many smokers to q u i t . When t h i s i s combined w i t h the personal experience of spending 24 hours without c i g a r e t t e s and i n most cases not missing them (Suedfeld & I k a r d , 1974) a very t h e r a p e u t i c experience may r e s u l t . Recently the e f f e c t i v e n e s s of the sensory d e p r i v a t i o n technique (Suedfeld and I k a r d , 1974) has been compared to that of the Fi v e Day P l a n to q u i t smoking (McFarland and Folkenbery, 1964) i n a comparative study by Barnes (1976) . Except f o r s l i g h t l y modified sensory d e p r i v a t i o n f a c i -l i t i e s , the Sensory D e p r i v a t i o n c o n d i t i o n was i d e n t i c a l to the 24 hour procedure of Suedfeld & Ikard (1975). Subjects i n the F i v e Day P l a n condi-t i o n p a r t i c i p a t e d i n f i v e 2-1/2 hour l e c t u r e sessions on f i v e consecutive evenings. S i x months f o l l o w i n g treatment 53% of the Fi v e Day P l a n group reported abstinence as compared to 58% of the Sensory D e p r i v a t i o n group. Although t h i s d i f f e r e n c e between treatments i s not s t a t i s t i c a l l y s i g n i f i -cant, the /§u,ccess r a t e of both smoking treatment programmes i s q u i t e im-p r e s s i v e . In s e v e r a l other s t u d i e s Suedfeld and h i s colleagues (Suedfeld and Smith, 1973; Suedfeld and Buchanan, 1974; Suedfeld and Hare, 1977) attemp-ted to u t i l i z e a combination of s e v e r a l e f f e c t s of sensory d e p r i v a t i o n to a l l e v i a t e the i r r a t i o n a l f e a r f e l t by snake phobics. I t was reasoned that i f phobics were given an opportunity a f t e r a p e r i o d of sensory d e p r i v a t i o n to look at s l i d e s of the object of t h e i r f e a r , i n t h i s case snakes, the increased stimulus need would cause them to request to see the s l i d e s and 12 have a more p o s i t i v e e v a l u a t i o n of them. In a d d i t i o n the s l i d e s would be viewed i n a s t a t e of r e l a x a t i o n induced by sensory d e p r i v a t i o n which would create a form of d e s e n s i t i z a t i o n to the s l i d e s . Using s e l f r e p o r t , beha-v i o r a l , and p h y s i o l o g i c a l measures of f e a r the most recent study (Suedfeld and Hare, 1977) compared a group of phobics who chose to view snake s l i d e s a f t e r f i v e hours of sensory d e p r i v a t i o n , w i t h two c o n t r o l groups of s i m i -l a r phobics. On the w r i t t e n and b e h a v i o r a l approach t e s t s , the experimen-t a l subjects showed s i g n i f i c a n t l y l e s s f e a r . However, t h i s was ;not e v i -denced on the p h y s i o l o g i c a l t e s t s . Not only do these s t u d i e s support the use of sensory d e p r i v a t i o n i n the reduction of phobias but they a l s o r e p r e -sent an ingenious attempt to u t i l i z e some of the unique t h e r a p e u t i c p o s s i -b i l i t i e s of sensory d e p r i v a t i o n . I t i s s u r p r i s i n g that a technique w i t h such c l i n i c a l p o t e n t i a l has not been incor p o r a t e d i n t o more areas of therapy as an adjunct to other techniques. U n f o r t u n a t e l y , the use of sensory d e p r i v a t i o n as a f a c i l i t a -t o r of other t h e r a p e u t i c techniques has not been examined very f u l l y . As Suedfeld (1975a) suggests, the poor exchange of research f i n d i n g s between s p e c i a l i z e d areas may be the reason behind t h i s l a c k of research. Another p o s s i b i l i t y f o r i t s neglect i s the negative aura which has t y p i c a l l y sur-rounded sensory d e p r i v a t i o n i n the popular l i t e r a t u r e . However, i t appears that there i s a renewal of i n t e r e s t i n the-area evidenced i n the s c i e n t i f i c (Suedfeld, 1975a, V; 1976; Kammerman, ..'1.9JZ-)iss) and popular presses (Smith, 1976; E a r l y , 1975). P a r t of t h i s i n t e r e s t i s due to the development of a more p o s i t i v e a t t i t u d e toward sensory d e p r i v a t i o n (Suedfeld, 1975a, b) and to the d i s p e l l i n g of some of the negative ideas which have been a s s o c i a t e d w i t h the technique (e.g., Heron, 1957). 13 One of the e a r l i e r uses of sensory d e p r i v a t i o n as a t h e r a p e u t i c f a c i l i t a t o r was i n the treatment of esophoria, a d i s o r d e r i n which the eyes -tend to deviate inward. M a r t i n , Roush, and Nicholson (1967) used a form of v i s u a l t r a i n i n g f o l l o w i n g a b r i e f exposure to sensory d e p r i v a -t i o n . Subjects who r e c e i v e d t h i s treatment showed s i g n i f i c a n t l y more improvement than the c o n t r o l groups who had other combinations of t r e a t -ment. Another use has been the i n c o r p o r a t i o n of a reduced stimulus en-vironment i n t o the treatment of a u t i s t i c c h i l d r e n (Schechter, S h i r l e y , Sexauer, and Toussieng, 1969; Maier, 1970). In these s t u d i e s the p a t i e n t l i v e d i n a low stimulus l e v e l environment and was v i s i t e d d a i l y by a t h e r a p i s t . I t was f e l t that l i v i n g i n a room w i t h a minimum amount of l i g h t , constant low sound l e v e l , a minimum of inanimate o b j e c t s , and m i n i -mum personal contact e x c l u s i v e of the t h e r a p i s t would make the a u t i s t i c c h i l d l e s s defensive and much more r e c e p t i v e to human contact. One c h i l d , t r e a t e d w i t h t h i s technique f o r 76 days, showed remarkable improvement i n h i s c o n d i t i o n (Maier, 1970). In an extension of the e a r l i e r research on smoking (Suedfeld, 1973), Suedfeld and Best (1977) have combined the techniques of s e l f - m o n i t o r i n g and s a t i a t i o n smoking w i t h sensory d e p r i v a t i o n and antismoking messages. This combination has not only had a remarkable success r a t e but has also produced some i n t e r e s t i n g s i d e e f f e c t s , such as i n i t i a t i n g a weight l o s s programme and being b e t t e r able to cope w i t h very s t r e s s f u l s i t u a t i o n s . The advantages of the combination of techniques are s e v e r a l . Monitoring of smoking behavior and s a t i a t i o n smoking b r i n g the p a t i e n t to the sensory d e p r i v a t i o n s e s s i o n w i t h both an increased understanding of h i s own smok-ing behavior and a very negative f e e l i n g about smoking more. A f t e r a day 14 of s a t i a t i o n smoking the d e s i r e to smoke has been tem p o r a r i l y reduced to almost nothing. The sensory d e p r i v a t i o n provides not o n l y a 24 hour time out from smoking but also a chance to engage i n some i n t r o s p e c t i o n p a r t i c u l a r l y regarding smoking and one's d e s i r e to q u i t . The antismoking messages serve to d i r e c t the p a t i e n t ' s thoughts to t h i s problem and to provide u s e f u l i n f o r m a t i o n about the reasons f o r and problems of q u i t t i n g smoking. In a d d i t i o n to b o l s t e r i n g the p a t i e n t ' s m o t ivation about q u i t -t i n g , the sensory d e p r i v a t i o n s e s s i o n also becomes a d i s t i n c t s t a r t i n g p o i n t f o r the i n d i v i d u a l . The 24 hours of sensory d e p r i v a t i o n i s analo-gous to a r i t e of passage a f t e r which the person emerges i n t o h i s new r o l e as nonsmoker. A f t e r an extremely auspicious p i l o t study using t h i s technique (Suedfeld and Best, 1977) a l a r g e r s c a l e i n v e s t i g a t i o n c u r r e n t l y i n pro-gress i s producing even more promising r e s u l t s (Suedfeld^,& Best; i n press) , Using 15 subjects per c o n d i t i o n t h i s study i s a comparison of the sensory d e p r i -v a t i o n smoking treatment, s a t i a t i o n smoking, and a combination of the two techniques. At the time of t h i s w r i t i n g , follow-up at 6 months shows 73% abstinence f o r the group w i t h combined sensory d e p r i v a t i o n and s a t i a t i o n treatments. This i s f a r s u p e r i o r to e i t h e r technique s e p a r a t e l y : 25% abstinence f o r s a t i a t i o n only and 27% f o r sensory d e p r i v a t i o n . P r e l i m i n a r y data from a 12 month follow-up of t h i s study show the combined sensory d e p r i v a t i o n and s a t i a t i o n c o n d i t i o n to be h o l d i n g at 75% abstinence. The e f f e c t i v e n e s s of these two treatments appears to be a d d i t i v e when the techniques are used together. I t i s the success of t h i s research which l e d to the present study. I t was reasoned that i f sensory d e p r i v a t i o n can c o n t r i b u t e to the success-15 f u l treatment of smoking i t might a l s o enhance the e f f e c t i v e n e s s of treatment of another d i f f i c u l t personal problem — o b e s i t y . Treatment of the Overweight The s i t u a t i o n f a c i n g the overweight i n d i v i d u a l seeking to l o s e weight i s a complex and confusing one. Having made the i n i t i a l d e c i s i o n to l o s e weight, the choice of a s u i t a b l e technique must be made from an enormous supply of a v a i l a b l e methods. The simple d e c i s i o n to go on a d i e t to l o s e weight i s complicated by the extreme overabundance of spe-c i a l d i e t s each making s p e c i a l claims to weight r e d u c t i o n ; a recent guide . l i s t s over 60 d i f f e r e n t a v a i l a b l e weight l o s s d i e t s (Berland, 1974). I f one chooses to put the burden of d e c i s i o n on h i s p h y s i c i a n the number of a l t e r n a t i v e s m u l t i p l i e s . Even going the route of the d i e t p i l l i s not simple. A recent review of medical treatments (Samuel and Burland, 1974) describes ten d i f f e r e n t amphetamines and numerous other v a r i e t i e s of drugs used i n weight r e d u c t i o n . There a l s o e x i s t a number of more extreme and more questionable a l t e r n a t i v e s , such as the use of levodopa to induce vo m i t i n g , s t e r e o t a c t i c e l e c t r o c o a g u l a t i o n of the l a t e r a l hypothalamic area, and the increase of c a l o r i c output by means of cholestyramene. While none of these medical techniques has proven to be e f f e c t i v e i n pro-ducing l o n g - l a s t i n g r e s u l t s , the more d r a s t i c i n t e s t i n a l bypass has become a v i a b l e a l t e r n a t i v e notwithstanding the considerable r i s k i n v o l v e d (Quaade, 1974). In s p i t e of t h i s tremendous d i v e r s i t y of techniques, the prognosis f o r s u c c e s s f u l weight l o s s and maintenance of that l o s s i n the treatment of o b e s i t y has t r a d i t i o n a l l y been extremely poor (Stunkard and McLaren-16 Hume, 1959). Stunkard (1974, p. 196) r e c e n t l y summarized the s i t u a t i o n p r i o r to the emergence of b e h a v i o u r a l techniques w i t h f i v e p r o p o s i t i o n s : (1) Most obese people do not enter treatment f o r o b e s i t y . (2) Of those who do enter treatment, most w i l l not remain .... (3) Of those who remain, most w i l l not l o s e much weight .... (4) Of those who l o s e weight, most w i l l r e g ain i t . . . . (5) Many w i l l pay a h i g h p r i c e f o r t r y i n g . " Since the i n t r o d u c t i o n of behaviour m o d i f i c a t i o n , r e p o rts of s u c c e s s f u l treatment f o r overweight i n d i v i d u a l s have s i g n i f i c a n t l y increased (Stunkard, 1974). The promising success of b e h a v i o u r a l techniques f o r weight l o s s has created a s i z e a b l e amassment of research l i t e r a t u r e , and f o r t u n a t e l y , the l a s t few years have seen a number of e x c e l l e n t reviews of the area ( S t u a r t , 1973; Abramson, 1973; H a l l and H a l l , 1974; Stunkard, 1974; Leon, 1976). In a d d i t i o n most recent c o l l e c t i o n s of readings i n the f i e l d of behaviour m o d i f i c a t i o n c o n t a i n at l e a s t a few papers on the treatment of o b e s i t y (Patterson et alii., 1974; Yates, 1975; L e i t e n b e r g , 1975). As one researcher i n the area has put i t , the body of l i t e r a t u r e on the treatment of o b e s i t y has become obese i t s e l f (Richard B. S t u a r t , personal communication). For t h i s reason the review presented here w i l l be somewhat s e l e c t i v e , e x t r a c t -i n g the r e p r e s e n t a t i v e h i g h l i g h t s . The i n i t i a l s u c c e s s f u l use of b e h a v i o r a l s e l f - c o n t r o l methods i n the treatment of o b e s i t y was a study by F e r s t e r , Nurnberger and L e v i t t (1962) who reported a weight l o s s of 15 pounds i n 15 weeks of treatment. They reasoned that lengthening the chain of responses r e q u i r e d of the i n d i v i d u a l - before engaging i n 'eatlng:jV''ithe"1'desi"rie.;(toi'. eat-wdul'd^be-uweakened. 17 The f i r s t long-term success i n the f i e l d i s a study by Stuart (1967) which Stunkard (1974) r e f e r s to as a "landmark i n the treatment of o b e s i t y " . Stuart's treatment was a 12-week comprehensive s e l f - c o n t r o l package w i t h followup at one year. His e i g h t subjects l o s t from 26 to 47 pounds w i t h an average l o s s of 38 pounds over the 12 months, Stuart (1971) r e p l i c a t e d these r e s u l t s w i t h an e q u a l l y s u c c e s s f u l study that i n c l u d e d a delayed treatment c o n t r o l group, which d i d not l o s e weight over the treatment p e r i o d . These s t u d i e s provided the b a s i s f o r S t u a r t ' s l a t e r b e h a v i o u r a l s e l f - c o n -t r o l programme (Stua r t & Davis, 1972). This programme contains s p e c i f i c b e h a v i o u r a l recommendations designed to help the i n d i v i d u a l e s t a b l i s h con-t r o l over food i n t a k e and energy expenditure. In a d d i t i o n to concentrating on the e a t i n g response i t s e l f , as i n the F e r s t e r e_t a l . (1962) study, the Stuart (1971) p l a n a l s o focused on con-t r o l l i n g the antecedents and consequences of e a t i n g . An example of c o n t r o l -l i n g the antecedents of e a t i n g i s the r e s t r i c t i o n of the s e t t i n g i n which e a t i n g i s permitted. The i n d i v i d u a l i s allowed to eat only i n one p a r t i c u -l a r room, i n one seat at the t a b l e , and using a s p e c i f i c placemat. An ex-ample of a step f o r c o n t r o l l i n g the consequences of e a t i n g i s the mainten-ance of d a i l y records of c a l o r i e s consumed and weight change. This'technique was also" extended-toathe:'control of energy consumption by having the i n d i -v i d u a l keep a d a i l y record of c a l o r i e s expended on e x e r c i s e . The e n t i r e programme i n c l u d e s 18 such beh a v i o u r a l steps which can be i n d i v i d u a l l y t a i l o r e d to achieve c o n t r o l of e a t i n g and e x e r c i s e . Since the i n i t i a l s u c c e s s f u l study of Stuart (1967), a number of other s t u d i e s have shown behaviour m o d i f i c a t i o n to produce more weight l o s s than a no treatment c o n t r o l c o n d i t i o n ( H a r r i s , 1969); a s o c i a l pressure 18 technique and a n o n - s p e c i f i c therapy (Wollersheim, 1970); w i l l power ( J e f f r e y and Christensen, 1972); and more t r a d i t i o n a l group therapy (Penick, F i l i o n , Fox and Stunkard, 1971). These st u d i e s used treatment periods ranging from 9 to 12 weeks';"' the standard procedure being a v i s i t w i t h the t h e r a p i s t at l e a s t once a week. Hagen (1974) suggested that t h i s frequent contact w i t h the t h e r a p i s t was unnecessary and that the ac-t u a l t h e r a p e u t i c content of the b e h a v i o r a l techniques was powerful enough. He t e s t e d the i d e a that the w r i t t e n p r e s e n t a t i o n of the b e h a v i o r a l steps i n a manual form could be as e f f e c t i v e without v i s i t s w i t h a t h e r a p i s t , by comparing three treatment c o n d i t i o n s — contact only, manual on l y , and manual pl u s contact-—with a no treatment c o n t r o l group. A f t e r a 10-week treatment p e r i o d and four-week followup a l l three treatment groups had s i g n i f i c a n t l y more weight l o s s than the no treatment c o n t r o l group and there were no s i g n i f i c a n t d i f f e r e n c e s among treatment groups. The manual only technique or " b i b l i o t h e r a p y " had proven as e f f e c t i v e as treatments w i t h t h e r a p i s t c o n t a c t . Although Hagen's b i b l i o t h e r a p y d i d not i n v o l v e a c t u a l v i s i t s w i t h the t h e r a p i s t over the course of treatment, i t d i d i n c l u d e weekly correspondence and homework assignments which c o n s t i t u t e d a form of t h e r a p i s t contact. In a t h e s i s by Fernan (1973, c i t e d i n Stunkard, 1974) Hagen's study was r e -p l i c a t e d w i t h an a d d i t i o n a l group without even these forms of t h e r a p i s t contact. This group r e c e i v e d the manual but had no f u r t h e r contact of any k i n d except f o r post-treatment and followup weigh-ins. While the Hagen s t y l e b i b l i o t h e r a p y group d i d as w e l l as the same group i n Hagen's (1974) study, the manual/no contact group l o s t l e s s weight than the c o n t r o l group w i t h no treatment. The minimal w r i t t e n contact appears to be a necessary 19 f a c t o r i n the success of the b i b l i o t h e r a p y technique. There seems to be some aspect of t h e r a p i s t contact, perhaps m o t i v a t i o n a l , that i s needed i n a d d i t i o n to the content of the behavioural s e l f - c o n t r o l programme. Since the i n i t i a l success ( S t u a r t , 1967) and subsequent a f f i r m a t i o n of the e f f e c t i v e n e s s of behavioural techniques i n the treatment of over-e a t i n g ( H a r r i s , 1969; W o l l e r s h e i n , 1970; S t u a r t , 1971; Penick, F i l i o n , Fox and Stunkard, 1971; Abrahms and Allen, 1974), researchers have turned t h e i r a t t e n t i o n to s p e c i f i c elements of the programme content other than t h e r a p i s t contact. The keeping of records on one's own c a l o r i e i n t a k e and weight, or s e l f - m o n i t o r i n g , has proven to be an important p a r t of the ap-proach (Romanczyk, 1974). I t s most e f f e c t i v e when s e l f - m o n i t o r i n g occurs p r i o r to r a t h e r than f o l l o w i n g a c t u a l food i n t a k e ( B e l l a c k , Rozensky, and Schwartz, 1974). Mahoney and h i s a s s o c i a t e s (Mahoney, Moura, and Wade, 1973; Mahoney, 1974) have i n v e s t i g a t e d the e f f e c t s of s e l f - r e w a r d i n con-j u n c t i o n w i t h a b e h a v i o u r a l weight l o s s programme. Self-reward proved to be more e f f e c t i v e i n producing weight l o s s than s e l f - m o n i t o r i n g or s e l f -punishment (Mahoney e_t a l . , 1973) and i t was b e t t e r when self - r e w a r d was f o r h a b i t change r a t h e r than weight l o s s (Mahoney, 1974). Other forms of behaviour m o d i f i c a t i o n that have been used i n the treatment of the overweight are a v e r s i v e c o n d i t i o n i n g (Kennedy and F o r e y t , 1968; Foreyt and Kennedy, 1971), covert s e n s i t i z a t i o n (Cautela, 1967; Meynen, 1970; Janda and Rimm, 1972), and experimenter-controlled r e i n f o r c e -ment ( A y l l o n , 1963; Harmatz and Lapuc, 1968; H a l l , 1972). These techniques have been found to be e f f e c t i v e at l e a s t during the course of treatment but have not produced as c o n s i s t e n t long-term maintenance of weight l o s s as 20 s i t u a t i o n management techniques where the i n d i v i d u a l c o n t r o l s h i s own ea t i n g s e t t i n g and behavior (Abramson, 1973; Leon, 1976). In a d d i t i o n to being l e s s e f f e c t i v e i n the long run, each of these other techniques has more s p e c i f i c problems. Both ave r s i v e c o n d i t i o n i n g , which i s the p a i r i n g of d e s i r e d food cues w i t h noxious s t i m u l i , and covert s e n s i t i z a t i o n , a technique where the i n d i v i d u a l i s n e g a t i v e l y s e n s i t i z e d to some t a r g e t food, have the disadvantage of being d i r e c t e d toward a few s p e c i f i c pro-blem foods and not to a broad range of e a t i n g . Reinforcement by the ex-perimenter l i k e w i s e does not t y p i c a l l y modify general e a t i n g behaviour but rewards l o s s e s i n weight achieved by any means. As Mahoney (1974) has shown i n h i s study of s e l f - r e w a r d , reinforcement of changed e a t i n g h a b i t s i s much more e f f e c t i v e i n maintaining continued weight l o s s than i s r e i n -forcement of weight l o s s i t s e l f . Concepts of Obesity The s u p e r i o r i t y of treatment techniques f o r overweight that r e l y on s i t u a t i o n a l management can be b e t t e r understood by examining some of the current c o n c e p t u a l i z a t i o n s of o b e s i t y and i t s causes. Human ob e s i t y has been d i v i d e d i n t o s e v e r a l e t i o l o g i c a l c a t e g o r i e s : hypothalamic, endocrine, p h y s i c a l i n a c t i v i t y , d i e t a r y , g e n e t i c , and drug-induced (Bray, 1974). Of these f a c t o r s , p h y s i c a l i n a c t i v i t y and d i e t a r y patterns are re s p o n s i b l e f o r the m a j o r i t y of overweight problems; the other e t i o l o g i c a l forms are comparatively rare (Bray, 1974). These major f a c t o r s can be t r a n s l a t e d i n t o i n s u f f i c i e n t energy expenditure and excessive i n t a k e of c a l o r i e s , two problems which r e q u i r e b e h a v i o u r a l r a t h e r than medical s o l u t i o n s . The problem of p h y s i c a l i n a c t i v i t y i s f i r m l y embedded i n the l i f e s t y l e and a t t i t u d e s of our c u l t u r e . The m a j o r i t y of the po p u l a t i o n does 21 not g e n e r a l l y engage i n p h y s i c a l a c t i v i t y to earn a l i v i n g , and has a l a r g e p o r t i o n of l e i s u r e time. Combine t h i s w i t h a high value on labour s a v i n g , step-reducing conveniences and a preponderance of sedentary l e i s u r e a c t i v i t i e s , and the r e s u l t i s a s o c i e t y of very i n a c t i v e people. In f a c t , i f an i n d i v i d u a l wants to l e a d a more a c t i v e l i f e i t i s necessary to go out of h i s way to get i t . In our s o c i e t y p h y s i c a l a c t i v i t y may r e -quire the a v a i l a b i l i t y of s p e c i a l f a c i l i t i e s or the a b i l i t y to a f f o r d pro-per equipment, or i f nothing e l s e , a good deal of personal m o t i v a t i o n . In a d d i t i o n to improved a t t i t u d e s and m o t i v a t i o n toward p h y s i c a l a c t i v i t y , treatment of t h i s problem re q u i r e s that the i n d i v i d u a l ' s environment be manipulated to f a c i l i t a t e and encourage increased energy expenditure (Stuart and Davis, 1972; J e f f r e y , i n p r e s s ) . On an i n d i v i d u a l l e v e l t h i s can i n c l u d e such steps as d a i l y graphing of one's energy expenditure (Stuart and Davis, 1972) or personal progress on a p a r t i c u l a r e x e r c i s e pro-gramme (e.g., Cooper, 1975) and avoiding such energy-saving devices as e l e -v ators and e s c a l a t o r s . A more g l o b a l p r e s c r i p t i o n would i n c l u d e the es-tablishment of n a t i o n a l standards f o r r e c r e a t i o n a l f a c i l i t i e s , employer sponsored f i t n e s s programmes, and t a x a t i o n p o l i c i e s that encourage p h y s i c a l - a c t i v i t y ( J e f f r e y , 1976). The problem r e c e i v i n g the greatest a t t e n t i o n has been that of d i e t a r y h a b i t s , s p e c i f i c a l l y o vereating. Once researchers were able to look beyond the r a t h e r c i r c u l a r e x p l a n a t i o n that the obese were simply gluttonous, they began to search f o r d i f f e r e n c e s i n i n d i v i d u a l c h a r a c t e r i s t i c s other than e a t i n g h a b i t s . The t h e o r e t i c a l question of whether p e r s o n a l i t y f a c t o r s e x i s t which p r e c i p i t a t e o b e s i t y i s often s i m p l i f i e d to why some people overeat and others do not. One reason f o r the popular n o t i o n that obese 22 persons were merely very h e d o n i s t i c was the common b e l i e f t h a t people should eat when they are hungry and that everyone should be hungry only when h i s stomach i s empty. I t was Cannon (Cannon and Washburn, 1912) who claimed that the perception of stomach co n t r a c t i o n s was the experience of hunger. However, since s t u d i e s such as one i n which a man w i t h h i s stomach removed s t i l l f e l t hunger (MacDonald, I n g l e f i n g e r , and B e l d i n g , 1947), the r e l a t i o n s h i p between stomach co n t r a c t i o n s and hunger i s thought to be l e s s absolute. Further i n v e s t i g a t i o n s of g a s t r i c m o t i l i t y and hun-ger i n r e l a t i o n to the obese have demonstrated that w h i l e stomach contrac-t i o n s have only a weak i n f l u e n c e on hunger, obese persons have a poorer c o r r e l a t i o n between c o n t r a c t i o n s and hunger than nonobese (Coddington and Bruch, 1970; Stunkard and Fox, 1971). These d i f f e r e n c e s , however, are not enough to account f o r the d i f f e r e n c e s i n food i n t a k e between obese and nonobese persons (Stunkard and Fox, 1971). Bruch (1973) has incorporated the concept of poor hunger awareness i n t o her ps y c h o a n a l y t i c explanation of o b e s i t y . Poor p e r c e p t i o n of b o d i l y s t a t e s , Bruch suggests, leads to the m i s i n t e r p r e t a t i o n of various emotional s t a t e s as hunger. E s s e n t i a l l y a developmental ps y c h o a n a l y t i c i n t e r p r e t a -t i o n , Bruch's theory suggests that by co n s t a n t l y and a u t h o r i t a t i v e l y con-t r a d i c t i n g the childi!i" sown f e e l i n g s , overbearing parents cause the c h i l d to m i s t r u s t h i s own sensations and never l e a r n to l a b e l them a p p r o p r i a t e l y . Since the c h i l d i s not allowed to f e e l "unhappy"'! the a l t e r n a t i v e i s that he "must" be f e e l i n g hungry. Most of the supporting evidence that Bruch (1973) o f f e r s i s i n the form of i n d i v i d u a l case s t u d i e s , but i t i s i n t e r -e s t i n g to note the contrast s between her concept of m i s l a b e l l i n g and the c o g n i t i v e - a r o u s a l theory of Schachter (1971) . 23 Schachter's theory i s b a s i c a l l y a m o d i f i c a t i o n of W i l l i a m James' - e a r l i e r theory of emotion (1890)whichstates that a f e e l i n g o r emotion i s produced by a combination of a s t a t e of p h y s i c a l a r o u s a l and knowledge of the s i t u a t i o n . The s t a t e of a r o u s a l makes one aware of the f e e l i n g as a personal experience, but the a c t u a l l a b e l i n g of the s p e c i f i c emotion i s the r e s u l t of the c o g n i t i v e assessment of the s i t u a t i o n (Schachter, 1964). Obese i n d i v i d u a l s , according to Schachter, are r e l a t i v e l y unaf-f e c t e d by i n t e r n a l cues l i k e hunger and emotions, but are o v e r l y i n f l u -- enced by e x t e r n a l f o o d - r e l a t e d cues. -Slochower (1976) has p o s i t e d that w h i l e the p o s i t i o n s of Schachter and Bruch appear to be c o n f l i c t i n g p o i n t s of view, they are a c t u a l l y r e l a t e d . Since the i n t e r n a l l y generated v i s c e r a l responses of d i f f e r e n t emo-ti o n s are r e l a t i v e l y s i m i l a r , i t would be q u i t e p o s s i b l e to " m i s l a b e l " a f e e l i n g by misjudging the s i t u a t i o n . I t might be p o s s i b l e , f o r i n s t a n c e , to mistake the f e e l i n g of "a n x i e t y " f o r the f e e l i n g of "hunger.'1!-! For the obese then i t might be that "hunger" i s the l a b e l i n a p p r o p r i a t e l y a p p l i e d to any number of emotional responses. The problem w i t h t h i s argument i s that the v i s c e r a l responses f o r d i f f e r e n t emotions, w h i l e being s i m i l a r i n many i n s t a n c e s , do have d i f f e r e n t p a t t e r n s (Lacey, 1967), p a r t i c u l a r l y f o r f e e l i n g s as g r o s s l y d i f f e r e n t as " a n x i e t y " and "hunger!1"' In f a c t , f e a r i s reported to suppress g a s t r i c c o n t r a c t i o n s (Cannon, 1929). Schachter's s o l u t i o n to t h i s problem i s a hypothesized d i f f e r e n c e be-tween obese and normal-weight persons on the dimension of i n t e r n a l - e x t e r n a l o r i e n t a t i o n (Schachter, 1971). He suggests that obese i n d i v i d u a l s are more e x t e r n a l l y and l e s s i n t e r n a l l y o r i e n t e d than t h e i r nonobese counter-p a r t s . This p a r t i c u l a r o r i e n t a t i o n of the obese predisposes them to be 24 l e s s aware or l e s s d i s c e r n i n g of i n t e r n a l hunger cues and more r e a d i l y aware of e x t e r n a l cues i n t h e i r immediate enviornment. Instead of ea t i n g when the f e e l i n g of hunger d i c t a t e s , the e x t e r n a l l y o r i e n t e d per-son eats when the appropriate cues f o r e a t i n g are p r e s e n t — e . g . , the presence of food or others e a t i n g , the time of day, e t c . This e x t e r n a l o r i e n t a t i o n combined w i t h the over-abundance of food cues i n our s o c i e t y would r e a d i l y e x p l a i n the current prevalence of o b e s i t y . Schachter and h i s a s s o c i a t e s (e.g., Schachter, 1971; Schachter and Rodin, 1974) have amassed considerable experimental evidence i n support of the hypothesis that obese persons are more e x t e r n a l l y o r i e n t e d than nonobese persons. As a demonstration of the poor hunger d i s c r i m i n a t i o n of the obese, Schachter, Goldman, and Gordon (1968) found that the obese eat j u s t as much when t h e i r stomachs are f u l l as when they are empty, and that f e a r does not a f f e c t t h e i r i n t a k e . Normal-weight c o n t r o l subjects ate l e s s when they were f u l l and when they were f r i g h t e n e d . Evidence f o r the obese being more dependent on e x t e r n a l cues than nonobese comes from a study by Schachter and Gross (1968) . U t i l i z i n g a t r i c k c l o c k that e i t h e r slowed down or speeded up i n r e l a t i o n to a c t u a l time, they found that obese persons ate more when time was speeded up and l e s s when time was slowed down than d i d nonobese i n the same s i t u a t i o n . When other pleasant food cues such as mealtime s o c i a l i z i n g and p l e a s i n g t a s t e are e l i m i n a t e d from the e a t i n g s i t u a t i o n , the obese eat f a r l e s s than do normal weight persons (Hashim and V a n l t a l i e , 1965). Another study ( N e s b i t t , 1968) a l s o provided evidence that the obese are more a f f e c t e d by the t a s t e of food. The heavier subjects were, the more they ate when 25 the food was good t a s t i n g . When the food had quinine added there was no d i f f e r e n c e i n consumption among overweight, normal weight, and underweight groups. A very i n t e r e s t i n g demonstration of the e f f e c t of the presence of food on the e a t i n g p a t t e r n s of the overweight i s another study by N e s b i t t (1968). He presented overweight, underweight, and normal weight subjects w i t h a lunch which c o n s i s t e d of e i t h e r one O;K three sandwiches w i t h "doz-ens more" a v a i l a b l e i n a nearby r e f r i g e r a t o r to which s u b j e c t s were i n v i -ted to help themselves. The underweight and normal weight subjects ate about the same number of sandwiches i n both the one sandwich and the three sandwich c o n d i t i o n s . The overweight s u b j e c t s , on the other hand, were a f f e c t e d considerably by the manipulation. In the one sandwich c o n d i t i o n , they ate l e s s than e i t h e r of the other groups (M = 1.48 sandwiches versus M's of 1.5 and 1.96 f o r underweight and normal-weight s u b j e c t s , r e s p e c t i v e -l y ) ; and i n the three sandwich c o n d i t i o n they ate c o n s i d e r a b l y more than the other two groups (M = 2.32 versus M's of 1.62 and 1.88). A number of s t u d i e s i n v e s t i g a t i n g the e x t e r n a l i t y hypothesis have been performed comparing overweight and normal weight subjects on general tasks other than e a t i n g behaviour (see Schachter and Rodin, 1974). P l i n e r (1973) found obese subjects to be more responsive than normals i n time e s t i m a t i o n to s a l i e n t e x t e r n a l cues, but l e s s responsive when cues were of low s a l i e n c e . Obese su b j e c t s have a l s o been found to be more d i s t r a c t a b l e than normals when performing a proofreading task, p a r t i c u l a r l y when the d i s t r a c t i o n was of an emotional nature (Rodin, 1974). In a number of t e s t s r e q u i r i n g e x t e r n a l o r i e n t a t i o n , obese subjects d i d b e t t e r than normal 26 weight subjects (Rodin, Herman, and Schachter, 1974): they had f a s t e r r e a c t i o n times on a d i s c r i m i n a t i o n t ask; they had more complete r e c a l l of s l i d e s a f t e r a b r i e f p e r s e n t a t i o n ; and they had f a s t e r r e c o g n i t i o n of t a c h i s t o s c o p i c a l l y presented words. In a more recent study, Rodin and Slochower (1976) used some of these measures of i n t e r n a l - e x t e r n a l o r i e n t a t i o n to p r e d i c t changes i n weight and e a t i n g behaviour. At a summer camp, they tes t e d normal-weight c h i l -dren f o r e x t e r n a l i t y and then measured t h e i r weights bi-weekly over a two month p e r i o d . Since meals were served i n such a way that the c h i l d r e n had f r e e access to food that was p l e n t i f u l and v i s i b l e , i t was p r e d i c t e d that the more e x t e r n a l l y o r i e n t e d would gain more weight. This hypothesis was g e n e r a l l y supported s i n c e the more e x t e r n a l l y responsive c h i l d r e n gained more weight than c h i l d r e n lower on e x t e r n a l i t y . Not a l l of the r e s u l t s , however, have been supportive of Schachter's hypothesis. Using Rotter's (1966) t e s t to measure i n t e r n a l versus e x t e r -n a l locus of c o n t r o l ( I - E ) , Gormanous and Lowe (1975) found no d i f f e r e n c e s i n the locus of c o n t r o l scores of normal weight and obese s u b j e c t s . In h i s b r i e f note concerning f a l s e assumptions about the obese, Mahoney (1975) s t a t e s that the evidence f o r the e x t e r n a l i t y i s equivocal and c i t e s a review of Wooley and Wooley (1975) to support t h i s . Slochower (1976) has suggested that the e x t e r n a l i t y i s by no means a general c h a r a c t e r i s t i c of the obese and she provides evidence that overeating i s s t r o n g l y i n f l u e n c e d by f a c t o r s other than e x t e r n a l food cues. In her study, she found support f o r the " m i s l a b e l l e d emotion" hypothesis. Her obese subjects ate much more when they could not i d e n t i f y the cause of t h e i r own high a r o u s a l (manipu-l a t e d by means of f a l s e biofeedback) than when they were given a reason 27 f o r i t s occurrence. Slochower a l s o found that obese subjects reported s i g n i f i c a n t l y more arou s a l r e d u c t i o n f o l l o w i n g e a t i n g than d i d normal weight s u b j e c t s . These f i n d i n g s suggest t h a t the obese e i t h e r m i s i n -t e r p r e t arousal as being hunger or they eat as a means to reduce a r o u s a l . I t i s a l s o p o s s i b l e that both of these mechanisms are working to some extent simultaneously. The c o n f l i c t i n g evidence on the issu e of i n t e r n a l versus e x t e r n a l o r i e n t a t i o n does not negate the importance of the theory; on the contrary, i t emphasizes the complexity of the e x t e r n a l i t y concept. The i d e a of e x t e r n a l i t y i s not a new one; i t has been used f o r many years under such terms as f i e l d dependence-independence (Witkin e_t a l _ . , 1954), locus of c o n t r o l ( R o t t e r , 1966), and i n t r o v e r s i o n - e x t r o v e r s i o n (Eysenck, 1960; Jung, 1933). Each of these conceptions of personal o r i e n t a t i o n has v a r -i o u s measurement techniques a s s o c i a t e d w i t h i t . The f a c t that there are so many d i f f e r e n t constructs and measuring devices of the i n t e r n a l - e x t e r -n a l dimension suggests that i t i s a many faceted concept c o n t a i n i n g more than one dimension or sub-dimension. Even w i t h i n the s i n g l e concept of perceived locus of c o n t r o l ( R o t t e r , 1966) , a number of dimensions have been found to e x i s t . Reid and Ware (1974), f o r example, have f a c t o r analyzed three separate subscales from the Locus of C o n t r o l S c a l e , s e l f c o n t r o l , s o c i a l systems c o n t r o l , and f a t a l i s m . A t e n t a t i v e s o l u t i o n to be drawn from t h i s s i t u a t i o n i s that a multi-method approach i s necessary i n any attempt to measure i n t e r n a l - e x t e r n a l o r i e n t a t i o n . 28 Methodological Considerations Regardless of the t h e o r e t i c a l background of any treatment f o r the obese, the iss u e of primary importance i s the success of the treatment. The problem of measuring the success of a programme or the r e l a t i v e success of one type of treatment over another has been the focus of s e v e r a l recent papers i n the area ( S t u a r t , 1973; H a l l and H a l l , 1974; J e f f r e y , 1975; F r a n z i n i and Grimes, 1976). These papers have c i t e d a number of s p e c i f i c problem areas that vary across s t u d i e s . Some of these areas r e q u i r e s t a n d a r d i z a t i o n f o r v a l i d comparison of d i f f e r e n t treatment methods, w h i l e other areas merely r e q u i r e more d e t a i l e d r e p o r t i n g of r e s u l t s . A number of the problems are concerned w i t h the subjects themselves. Methods of subject s e l e c t i o n have created a l i t e r a t u r e on the treatment of o b e s i t y which i s based l a r g e l y on s l i g h t l y overweight c o l l e g e students ( S t u a r t , 1973; F r a n z i n i and Grimes, 1976). There i s a need to r e c r u i t s u b jects from wider ranges of s o c i a l s t a t u s and age to i n s u r e greater g e n e r a l i z a b i l i t y of r e s u l t s . In l i n e w i t h t h i s i t has been suggested ( S t u a r t , 1973; H a l l and H a l l , 1974; F r a n z i n i and Grimes, 1976) that more i n d i v i d u a l data be reported than the usual minimal i n c l u s i o n of age and weight. A l s o more a t t e n t i o n should be pa i d to the r e l a t i o n s h i p between treatment success and demographic v a r i a b l e s r a t h e r than merely person-a l i t y v a r i a b l e s ( H a l l and H a l l , 1974). Another o f t e n c i t e d problem i s the r e p o r t i n g of data from subjects who terminate before completing the programme ( S t u a r t , 1973; J e f f r e y 1975; Baekelund and Lundwall, 1975). I t i s important that the procedures used to handle drop-outs be described 29 i n research r e p o r t s , and attempts should be made to minimize subject a t t r i t i o n ( S t u a r t , 1973; J e f f r e y , 1975). One method f o r reducing the drop-out ra t e i s to r e q u i r e the subject to put down a monetary deposit whose r e t u r n i s based on good attendance ( F r a n z i n i and Grimes, 1976). A second major problem area i n the treatment of o b e s i t y l i e s i n the r e p o r t i n g of data. As mentioned above, more d e t a i l e d r e p o r t i n g of i n d i -v i d u a l data other than age and weight has been suggested; a frequent shortcoming c i t e d i s the use of weight and height as the so l e measures of o b e s i t y . I t has been argued that using weight and weight change as the s o l e measures of o b e s i t y and of treatment success does not n e c e s s a r i -l y provide complete and r e l i a b l e r e s u l t s s i n c e weight i s not always a - good measure of body f a t ( S t u a r t , 1973; H a l l and H a l l , 1974; J e f f r e y , 1975). To provide a more complete i n d i c a t i o n of o b e s i t y , i t has been proposed that s k i n f o l d measurements be taken i n a d d i t i o n to weight mea-surements ( S t u a r t , 1973; F r a n z i n i and Grimes, 1976b). In a d d i t i o n , the manner of c o l l e c t i n g data has been l i s t e d as a com-mon problem ( S t u a r t , 1973; F r a n z i n i and Grimes, 1976). Since i t has been found that data regarding e a t i n g patterns and weight which i s provided by the overweight subjects themselves i s very u n r e l i a b l e (Stuart and Davis, 1972; Leon and Chamberlain, 1973), i t i s recommended that e x p e r i -menter c o l l e c t e d data be used r a t h e r than those c o l l e c t e d by the s u b j e c t . F u r t h e r , i n regard to data c o l l e c t i o n , Stuart (1973) has a l s o s t r e s s e d the importance' of e v a l u a t i n g subject response to the procedure i t s e l f . This i s i n a d d i t i o n to the weight and s k i n f o l d changes used to judge treatment success. The s u b j e c t s ' e v a l u a t i o n of the programme and sug-gestions f o r improvements can give the researcher needed i n s i g h t s i n t o 30 reasons f o r the success or f a i l u r e of a treatment. A l s o Stuart (1973) suggests that other e f f e c t s of the treatment on the subject need to be evaluated. P o s s i b l e problems may occur due to the induced behaviour or weight changes. For t h i s reason measurements of v a r i a b l e s , such as sub-j e c t mood and a t t i t u d e need to be i n c l u d e d . The t h i r d and f i n a l source of problems i n the comparison of t r e a t -ment programmes l i e s i n the design of the treatments themselves. There has been no set format regarding the length of treatment or of follow-up a f t e r treatment. I r r e g u l a r i t y of f o l l o w up has been named c o n s i s t e n t l y as a problem i n treatment comparison ( S t u a r t , 1973; H a l l and H a l l , 1974; J e f f r e y , 1975). Behavioural treatments of o b e s i t y have ranged from p e r i -ods of four weeks to four and one h a l f months w i t h the mode being 10 to 15 weeks; follow-ups a f t e r treatment f o r these same s t u d i e s have ranged from none at a l l to one year (Leon, 1976). C a l l i n g f o r longer follow-ups H a l l and H a l l (1974) recommended that subjects be followed f o r at l e a s t s i x months. Another c r i t i c i s m r a i s e d has been the use of d i f f e r e n t d i e t pro-grammes when the type of d i e t p l a n i s not the a c t u a l focus of the r e -search a t t e n t i o n . S t u a r t (1973) has encouraged the use of standardized treatment plans (e.g., Stuart and Davis, 1972) when i n v e s t i g a t i n g v a r i a -b l e s other than the d i e t program i t s e l f . Of even gr e a t e r importance i s the s t a n d a r d i z a t i o n of the d e l i v e r y of s e r v i c e across treatment c o n d i t i o n s w i t h i n a given study. I t i s important that subjects r e c e i v e the same a t t e n t i o n i n a l l aspects other than the experimental v a r i a b l e . Services such as i n t e r v i e w s , weigh-ins, and d i e t s , should a l l be c a r e f u l l y 31 standardized f o r a l l subjects across c o n d i t i o n s ( S t u a r t , 1973). S i m i -l a r l y , the use of d i f f e r e n t t h e r a p i s t s should be balanced across groups ( S t u a r t , 1973) and t h e r a p i s t expectancies should be equated ( P a u l , 1969). Much of the problem of d i f f e r e n t t h e r a p i s t s and t h e r a p i s t expectancy can be a l l e v i a t e d by c a r e f u l s t a n d a r d i z a t i o n of i n t e r v i e w procedures across c o n d i t i o n s ( S t u a r t , personal communication). One a d d i t i o n a l suggestion f o r improved e v a l u a t i o n of va r i o u s t r e a t -ment techniques i s the i n c l u s i o n of an index of cost e f f e c t i v e n e s s ( J e f f r e y , 1975). This index might be a r a t i o of the mean treatment time or cost per subject over the mean weight r e d u c t i o n . This i s an e x c e l l e n t suggestion but can e a s i l y be d i s t o r t e d depending on how i t i s a p p l i e d . For example Barnes (1976) assessed cost e f f e c t i v e n e s s i n her comparison of sensory d e p r i v a t i o n treatment and the Five Day Pl a n f o r smoking. D i -v i d i n g the t o t a l cost of treatment by an index of smoking re d u c t i o n per subject she found the F i v e Day Plan to be more e f f e c t i v e r e l a t i v e to i t s cost than was sensory d e p r i v a t i o n . This comparison was u n f a i r and d i s t o r -ted s i n c e the cost of her sensory d e p r i v a t i o n treatment i n c l u d e d the four sensory d e p r i v a t i o n rooms. This cost was spread over her very small num-ber of s u b j e c t s . In the short run sensory d e p r i v a t i o n treatment was more c o s t l y than the Jp'ive Day P l a n ; however, s i n c e the cost of such equipment i s a one time expense, the cost e f f e c t i v e n e s s index f o r sensory d e p r i v a -t i o n treatment would decrease w i t h the number of subjects t r e a t e d w h i l e that of the F i v e Day Pl a n remains constant. A l s o , the costs of the Five Day P l a n were g r e a t l y reduced s i n c e m a t e r i a l s and personnel were donated f o r the purposes of her study. 32 Ra t i o n a l e f o r the treatment used i n t h i s study The design of the weight c o n t r o l programme that comprises t h i s study i s based on consi d e r a t i o n s of the c h a r a c t e r i s t i c s both of sensory d e p r i v a t i o n and of"the obese as e x t e r n a l l y o r i e n t e d i n d i v i d u a l s . As was mentioned i n the e a r l i e r d i s c u s s i o n of the c l i n i c a l a p p l i c a t i o n of sensory d e p r i v a t i o n , sensory d e p r i v a t i o n appears to make i n d i v i d u a l s more responsive to therapy (Suedfeld, 1975a). I t may do t h i s by i n c r e a s -i n g dependency on the t h e r a p i s t and receptiveness to communication, and at the same time making one's own co g n i t i o n s more s a l i e n t . I n d i v i d u a l s have been found to be both more p e r s u a s i b l e and b e t t e r able to r e c a l l m a t e r i a l heard during sensory d e p r i v a t i o n (Suedfeld, 1969). These are valua b l e features f o r the treatment, of any problem. I t was decided to i n v e s t i g a t e t h i s r o l e of sensory d e p r i v a t i o n as an educator to f a c i l i t a t e the l e a r n i n g of m a t e r i a l geared toward changing e a t i n g h a b i t s . The spe-c i f i c h a b i t s to be learned were those behavioural s e l f - c o n t r o l techniques , described by Stuart and Davis (1972). By i n c r e a s i n g simultaneously r e c e p t i v i t y to e x t e r n a l input and the s a l i e n c e of i n t e r n a l l y generated thoughts, sensory d e p r i v a t i o n creates a s i t u a t i o n of forced i n t r o s p e c t i o n w i t h more a t t e n t i o n being p a i d to therapist-generated advice i n t h i s endeavour. For the e x t e r n a l l y o r i e n t e d obese person, t h i s increased focus on i n t e r n a l s t i m u l i may be very t h e r a -p e u t i c . With proper guidance the obese i n d i v i d u a l may be able to become b e t t e r attuned to the i n t e r n a l cues of hunger. This assumes that i f the i n d i v i d u a l becomes more i n t e r n a l l y o r i e n t e d , there w i l l be l e s s dependence on the e x t e r n a l cues f o r e a t i n g . 33 Sensory d e p r i v a t i o n has also been found to f a c i l i t a t e r e l a x a t i o n (Suedfeld, 1975a), This q u a l i t y should be very u s e f u l i n d e a l i n g w i t h obese persons. As Bruch (1973) has suggested, much of the obese per-son's overeating i s i n s t i g a t e d by a n x i e t i e s . I f given an a l t e r n a t i v e to e a t i n g f o r the r e d u c t i o n of a n x i e t y , the obese person may be b e t t e r able to avoid overeating i n emotional s i t u a t i o n s . For these reasons i t was decided to p a i r the r e l a x i n g q u a l i t i e s of sensory d e p r i v a t i o n w i t h a p r o g r e s s i v e r e l a x a t i o n e x e r c i s e . The i n i t i a l success of a c h i e v i n g deep r e l a x a t i o n i n the sensory d e p r i v a t i o n s e s s i o n should encourage the i n d i v i d u a l to p r a c t i c e the e x e r c i s e again under normal circumstances. Another q u a l i t y of sensory d e p r i v a t i o n i s that i t " e l i m i n a t e s cues that i n the normal environment e l i c i t undesired behavior" (Suedfeld, 1975a, p. 98). This i s p a r t i c u l a r l y appropriate because i t should pro-vide the obese person w i t h an impressive demonstration that h i s hunger i s e x t e r n a l l y generated. In the absence of food cues the e x t e r n a l l y o r i e n t e d obese person should experience very l i t t l e hunger during the sensory d e p r i v a t i o n s e s s i o n . As i n the s t u d i e s w i t h smokers, where going 24 hours without having or wanting a c i g a r e t t e was an impressive e x p e r i -ence (Suedfeld et a l . , 1972; Suedfeld and I k a r d , 1974), the experience of 24 hours w i t h l i t t l e or no hunger should be a dramatic one. As mentioned p r e v i o u s l y , t h i s study planned to use b e h a v i o r a l s e l f -c o n t r o l techniques along w i t h the s e s s i o n of sensory d e p r i v a t i o n . Judg-ing from the s u p e r i o r success r a t e of the combined techniques of Suedfeld and Best ( i n prep., 1977) over e i t h e r technique s i n g l y , i t was f e l t that by p a i r i n g a weight c o n t r o l method already proven to be e f f e c t i v e (such as that of Stuart and Davis,\1972), w i t h sensory d e p r i v a t i o n , the o v e r a l l 34 e f f e c t i v e n e s s should be g r e a t l y increased. Not s p e c i f i c a l l y designed to t e s t the e f f e c t i v e n e s s of s e l f - c o n t r o l techniques, t h i s study i s a t e s t of the added e f f e c t i v e n e s s of the components of sensory d e p r i v a t i o n treatment. The separate components-—the sensory d e p r i v a t i o n s e s s i o n and the therapeutic communications—were examined both s e p a r a t e l y and i n combination. Though t h i s i n v e s t i g a t i o n i s not a d i r e c t t e s t of behaviour-a l s e l f - c o n t r o l methods of weight r e d u c t i o n , . c o n t r o l of the many problems inherent i n research of the behavioural treatment of o b e s i t y i s important. As these problems have already been l i s t e d i t i s not necessary to d e t a i l them here. However some of the features of t h i s study designed to handle these problems are as f o l l o w s : using subjects sampled from a broad range of s o c i a l status and age; using s k i n f o l d as w e l l as weight measurements;using experimenter c o l l e c t e d data; f o l l o w i n g up subjects f o r a six-month p e r i o d ; s t a n d a r d i z i n g i n t e r v i e w procedures; r e p o r t i n g handling of and data on drop-outs; e v a l u a t i n g subject responses to and f e e l i n g s about the programme; and r e p o r t i n g more thoroughly on i n d i v i d u a l s u b j e c t s . 35 DESIGN OF THE STUDY The study i n c o r p o r a t e d two independent v a r i a b l e s i n a 2 x 2 f a c -t o r i a l design: 1) sensory d e p r i v a t i o n (SD) versus nonconfinement (NC) p r i o r to i n d i v i d u a l i n s t r u c t i o n i n the d i e t and e x e r c i s e programmes, and 2) p r e s e n t a t i o n (M) versus non p r e s e n t a t i o n (NM) of ther a p e u t i c communications during the 24 hour p e r i o d p r i o r to personal i n s t r u c t i o n i n the programme. The four treatment groups i n t h i s design are 1) sen-sory d e p r i v a t i o n w i t h messages (SD-M), 2) sensory d e p r i v a t i o n w i t h no messages (SD-NM), 3) nonconfined w i t h messages (NC-M), and 4) nonconfined without messages (NC-NM). Subjects i n a l l four groups were given the same programme i n s t r u c t i o n s and follow-up i n t e r v i e w s over a s i x month p e r i o d . Data were analyzed as f o l l o w s : (1) a m u l t i v a r i a t e a n a l y s i s of v a r i -ance on i n i t i a l demographic and p e r s o n a l i t y data f o r the four treatment groups and f o r the experimental groups plus a group of drop-outs; (2) a 2 x 2 a n a l y s i s of variance of weight and s k i n f o l d changes i n the fou r treatment groups; (3) a 2 x 2 x 7 repeated-measures a n a l y s i s of variance on weight over the s i x month p e r i o d ; and (4) re g r e s s i o n analyses of weight changes on demographic and b e h a v i o r a l measurements. In a d d i t i o n a l a r g e amount of i n d i v i d u a l data i s reported i n i n d i v i d u a l case s t u d i e s . (See Appendix A), METHOD Subjects Responding to two a r t i c l e s published i n major l o c a l newspapers and a l i v e broadcast r a d i o i n t e r v i e w , a l a r g e number of women volunteered to 36 p a r t i c i p a t e i n an experimental weight l o s s programme. The newspaper a r t i c l e s ireqiujested women between the ages of 20 and 55 years who were at l e a s t 25% overweight to p a r t i c i p a t e i n a s i x month programme that could i n c l u d e a 24 hour s e s s i o n of sensory d e p r i v a t i o n . (See Appendix tit). With i n f o r m a t i o n gathered i n the i n i t i a l telephone i n t e r v i e w , sub-j e c t s were matched f o r age, m a r i t a l s t a t u s , and percentage overweight. The upper end of the recommended weight range f o r medium framed women was used to c a l c u l a t e percentage overweight f o r a l l s u b jects ( M e t r o p o l i -tan L i f e Tables, 1958). Subjects who i n d i c a t e d t h a t they were d i a b e t i c or hypoglycemic were excluded. From these matched groups, s u b j e c t s were assigned randomly to the four treatment groups. Subjects' ages ranged from 21 to 57 years w i t h a mean age of approximately 41. The percenta-ges of excess weight ranged from 25% to 130%. The i n i t i a l design c a l l e d f o r 12 subjects i n each of the four groups. An attempt was made i n the e a r l y stages of the study to keep the numbers balanced among the groups; t h e r e f o r e , e a r l y drop-outs were replaced from the l i s t of v o l u n t e e r s . No attempt was made to replace subjects who terminated during the l a t e r stages of the study. Subjects were seen i n -d i v i d u a l l y throughout the programme. Procedure Subjects s e l e c t e d from the l i s t of volunteers were telephoned to arrange f o r a p r e l i m i n a r y i n t e r v i e w . Scheduling of s p e c i f i c times f o r in t e r v i e w s was at the subject's convenience throughout the study. At the f i r s t i n t e r v i e w the subject was b r i e f e d about the procedure f o r the e n t i r e s i x month study and demographic and p e r s o n a l i t y data were c o l l e c t e d . 37 At t h i s time the subject was als o requested to leave a deposit i n the form of a $25.00 check made payable t o the Canadian Heart Fund. Each subject signed an agreement s t a t i n g that she would f o r f e i t her deposit i f she f a i l e d to attend a l l scheduled s e s s i o n s . In a c t u a l f a c t , the deposit was returned to a l l those who completed the f i n a l s i x month follow-up regardless of other attendance. In a d d i t i o n to g i v i n g i n f o r m a t i o n regarding, personal h i s t o r y , weight, and h e i g h t , subjects also completed a Motive C h e c k l i s t designed f o r t h i s study, the Locus of C o n t r o l questionnaire (Reid and Ware, 1974) , a p o r t a b l e v e r s i o n of the Rod and Frame Test ( W i t k i n e_t al_. , 1954) , and S e l f - M o n i t o r i n g Scale (Snyder, 1974), the Autonomic P e r c e p t i o n Scale (Mandler, Mandler, and U v i l l e r , 1958), the Barber S u g g e s t i b i l i t y Scale (Barber, 1965), and the Personal C a u s a l i t y Questionnaire (Peevers, B l a s c o v i c h , and Secord, 1974). Subjects were given a form on which they were to procure t h e i r p h y s i c i a n ' s approval f o r t h e i r p a r t i c i p a t i o n i n the programme. F u r t h e r , where a p p r o p r i a t e , a d e s c r i p t i o n of the programme was sent home to the s u b j e c t s ' spouse or roommate along w i t h a form so-l i c i t i n g support f o r t h i s weight l o s s attempt. An attempt was a l s o made to i n v o l v e t h i s other person by asking f o r some d e s c r i p t i v e i n f o r m a t i o n about the subject's e a t i n g h a b i t s . During the f i r s t i n t e r v i e w subjects were i n s t r u c t e d to record de-t a i l s of t h e i r e a t i n g behavior u n t i l the next s e s s i o n without a l t e r i n g t h e i r e a t i n g p a t t e r n i n any s i g n i f i c a n t manner. Each subject was given a s e l f - m o n i t o r i n g booklet w i t h spaces marked f o r s p e c i f i c i n f o r m a t i o n . concerning each e a t i n g s i t u a t i o n . In a d d i t i o n to r e c o r d i n g foods and q u a n t i t i e s , subjects were to note the date, p l a c e , time, other people 38 present, whether others were e a t i n g , whether food was present before e a t i n g , and p r i o r a c t i v i t y f o r each e a t i n g s i t u a t i o n . A time was sche-duled f o r the next i n t e r v i e w to be h e l d one week l a t e r . Each subject was b r i e f e d as to the procedure f o r the next sessions appropriate f o r the group to which she had been assigned. The e n t i r e procedure f o r the f i r s t s e s s i o n took between one and one-half to two and one-half hours depending on the i n d i v i d u a l subject's speed. The second s e s s i o n comprised the experimental manipulation. The procedure f o r a l l sessions except t h i s one was i d e n t i c a l f o r subjects i n a l l groups. At the beginning of the second s e s s i o n the subject's weight was measured and the s e l f - m o n i t o r i n g m a t e r i a l and p h y s i c i a n ap-p r o v a l forms were c o l l e c t e d . A female research a s s i s t a n t took measure-ments of i n f r a s c a p u l a r and t r i c e p s k i n f o l d s using a Lange S k i n f o l d C a l i p e r . The treatment procedures were as f o l l o w s : Group One - Sensory d e p r i v a t i o n w i t h messages (SD-M) Subjects reported to the l a b o r a t o r y at 12 noon, were b r i e f e d again about the procedure and were given a form to s i g n s t a t i n g that they understood the procedure and were w i l l i n g to p a r t i c i p a t e (see Appendix D) . A f t e r an o r i e n t a t i o n to the sensory deprivation^ffha^%rr:aricl..^!tta. food and t o i l e t f a c i l i t i e s , s ubjects were given a few minutes alone i n the chamber to change i n t o comfortable c l o t h i n g . Subjects were requested to leave watches and any other d i s t r a c t i n g ^ o t f j e c t s s o u ^ When the subject s i g n a l l e d that she was comfortable the l i g h t was turned o f f and sensory d e p r i v a t i o n began. Sensory d e p r i v a t i o n c o n s i s t e d of l y i n g on a f i r m bed i n a dark, q u i e t room ( I n d u s t r i a l A c o u s t i c s Model 404-A). L i q u i d food ( v a n i l l a 39 Metrecal) and water were i n thermos b o t t l e s next to the bed and were a v a i l a b l e ad l i b through p l a s t i c tubes pinned near the head of the bed. A chemical t o i l e t was l o c a t e d i n the chamber at the foot of the bed. I n s t r u c t i o n s were given requesting the subject not to move around or make unnecessary noi s e . She was als o Informed that a monitor would be on duty i n an adjacent room f o r the e n t i r e 24 hours and that the subject could leave the chamber at any time should she become too uncomfortable. T h i s , she was t o l d , would end her par t i n the experiment. A f t e r one hour and 45 minutes each sensory d e p r i v a t i o n subject was asked to e s t i -mate the amount of time that had passed and her response was recorded. At three hours (approximately 3:00 p.m.) the subject was wakened and informed that she would be hearing a tape recorded message. The f i r s t set of messages was played at t h i s time. At 20 hours (a p p r o x i -mately 9:00 a.m.) the subject was awakened again and the second set of messages was played. At 24 hours the subject was reawakened and informed that she had completed the f u l l 24 hour s e s s i o n and that the l i g h t would be turned on. The two sets of messages were one hour long and 45 minutes l o n g , r e s p e c t i v e l y . The f i r s t set contained a d i s c u s s i o n of the problems of c o n t r o l l i n g urges and c a r i n g f o r one's body, a r e l a x a t i o n e x e r c i s e , a body o r i e n t a t i o n e x e r c i s e , and an e x e r c i s e on d e a l i n g w i t h emotional s i t u a t i o n s without e a t i n g . The second set contained n u t r i t i o n a l informa-t i o n , f a c t s about d i e t i n g , suggestions f o r c o n t r o l l i n g e a t i n g behaviours, and suggestions f o r i n c r e a s i n g energy expenditure (See Appendix C f o r the complete t r a n s c r i p t s of the recorded messages). 40 Immediately f o l l o w i n g the sensory d e p r i v a t i o n s e s s i o n the subject was interviewed about her r e a c t i o n s to the experience she had j u s t com-p l e t e d (See Appendix A f o r s p e c i f i c r e a c t i o n s ) . Next the subject was provided w i t h a copy of the d i e t manual (Stuart and Davis, 1972) and the s p e c i f i c s of t h i s p l a n were reviewed w i t h her. S p e c i a l a t t e n t i o n was p a i d to the mechanics of the d i e t ; r e c o r d i n g and graphing c a l o r i e i n t a k e and output, and the b e h a v i o r a l steps s p e l l e d out i n the Stuart and Davis (1972) manual. This p a r t of the procedure was i d e n t i c a l f o r a l l subjects i n a l l four groups. Subjects were then scheduled f o r another s e s s i o n to be h e l d one week l a t e r . Group Two - Sensory d e p r i v a t i o n w i t h no messages (SD-NM) The procedure f o r subjects i n t h i s group was i d e n t i c a l to that used w i t h Group One except no mention was made of the messages and the tapes were not played. The subject was t o l d , as were a l l sensory d e p r i -v a t i o n subjects , that she should use the se s s i o n to concentrate on her-s e l f and her problem of l o s i n g weight. Except f o r the absence of the messages and being awakened at those times, the procedure bef o r e , during and a f t e r sensory d e p r i v a t i o n was the same as f o r Group One. Group Three - Nonconfined w i t h messages (NC-M) The subjects who recei v e d only the message p o r t i o n of the treatment reported to the la b o r a t o r y on two consecutive days. In order to c o n t r o l f o r the ti m i n g and spacing of the message p r e s e n t a t i o n , these subjects were scheduled to hear the f i r s t set at 3:00 p.m. on one day and 9:00 a.m. on the f o l l o w i n g morning. On r e p o r t i n g to the l a b o r a t o r y on the f i r s t day, the subject's forms and other data were c o l l e c t e d and she was l e d to a room where she would hear the f i r s t set of messages. The subject l a y 41 comfortably on a bed f o r t h i s p r e s e n t a t i o n and the l i g h t s were dimmed but not turned o f f completely. On completion of the f i r s t set of mes-sages, the subject was reminded of the next day's appointment and ex-cused to r e t u r n home. On the f o l l o w i n g day the subject heard the second set of messages under the same circumstances as on the previous day. At the completion of the tape, the subject was given personal i n s t r u c t i o n i n the p l a n and presented w i t h the d i e t manual as mentioned above. A t h i r d appointment was made f o r one week l a t e r . Group Four - Nonconfined without messages (NC-NM) This group of subjects r e c e i v e d n e i t h e r message p r e s e n t a t i o n nor exposure to sensory d e p r i v a t i o n . A f t e r weighing i n and handing i n the r e q u i r e d m a t e r i a l s , these subjects were given personal i n s t r u c t i o n i n the d i e t and e x e r c i s e programme, and given the d i e t manual, as o u t l i n e d above. Another s e s s i o n was arranged f o r the f o l l o w i n g week. Follow-up sessions The f i v e follow-up sessions were arranged to be one week, one month, two months, four months, and s i x months a f t e r the second s e s s i o n , which was the treatment s e s s i o n . In g e n e r a l , t h i s timetable was followed w i t h some i n d i v i d u a l v a r i a t i o n s due to personal scheduling problems and con-f l i c t s . At each follow-up s e s s i o n , the subject's weight was measured and recorded. The subject's own personal records of c a l o r i e i n t a k e , output, and weight were discussed but not c o l l e c t e d . Each s e s s i o n l a s t e d between one h a l f and one hour i n length. The one week, one month, and four month follow-up sessions were b a s i -c a l l y reviews of the m a t e r i a l covered i n the f i r s t i n s t r u c t i o n s e s s i o n , o 42 Subjects were asked about t h e i r own implementation of and r e a c t i o n s to the eleven b e h a v i o r a l steps o u t l i n e d i n the Stuart and Davis (1972) pro-gramme. Suggestions were made f o r i n d i v i d u a l improvements i n c a r r y i n g out these steps w i t h s p e c i a l focus on problems brought up by the subject. Other than reviex^ing these b e h a v i o r a l steps and noting i n d i v i d u a l pro-gress, there were no other standardized procedures f o r these s e s s i o n s . The two month and s i x month follow-up sessions proceded i n b a s i c a l l y the same manner but were more standardized. These i n t e r v i e w s followed a s p e c i f i c set of i n f o r m a t i o n gathering questions. The two month f o l l o w -up questions.were designed to measure the extent to which the subject was c a r r y i n g out each step of the programme and the r e a c t i o n s of the subje c t to the programme and her progress up to that p o i n t . The s i x month i n t e r -view was designed to tap r e a c t i o n s to the e n t i r e programme and to gather suggestions on the strong and weak p o i n t s of the procedure. S k i n f o l d measurements were taken again by the same female research a s s i s t a n t at t h i s f i n a l s e s s i o n . Also at t h i s follow-up s e s s i o n the subject's data deposit check was returned. Measures Weight, h e i g h t , and s k i n f o l d . Weight and height were measured on a Health-O-Meter balance s c a l e w i t h m e t r i c readings. Therefore, weight i s reported i n kilograms (1 Kilogram = 2.2 l b s . ) and height i n centimeters. Weight measurements were taken w i t h the subject dressed but without shoes. An attempt was made to schedule the subject at the same time o f day f o r each session to c o n t r o l f o r f l u c t u a t i o n i n weight over the course of the day. However, t h i s was not always p o s s i b l e due to i n d i v i d u a l scheduling problems. 43 S k i n f o l d measurements were made w i t h a Lange S k i n f o l d C a l i p e r at the i n f r a s c a p u l a r and t r i c e p s i t e s . An average of three measurements taken at each s i t e was used to account f o r s l i g h t v a r i a t i o n s i n measure-ment. These p a r t i c u l a r s k i n f o l d s i t e s have been recommended as good i n -d i c a t o r s of o v e r a l l body f a t and as being c l e a r l y measureable i n a l l but sever e l y obese cases (Tanner. & Whitehouse, 1975). These measurements were made by a female research a s s i s t a n t . Demographic data. In a d d i t i o n to name, age, and m a r i t a l s t a t u s , the subject was asked about e d u c a t i o n l e v e l , number of c h i l d r e n , and occupation. Information r e l e v a n t s p e c i f i c a l l y to weight was d e s i r e d weight, age at onset of overweight, perceived cause of overweight, pre-vious d i e t attempts and amounts l o s t as a r e s u l t of those attempts. The subject's a c t i v i t y l e v e l was i n q u i r e d i n t o by asking the kinds and f r e -quencies of s p o r t s , hobbies, and e x e r c i s e she engaged i n . Estimates of smoking and a l c o h o l consumption were made through s e l f r e p o r t s . F i n a l l y the subject was asked her motives f o r e n r o l l i n g i n the programme and the amount of d i f f i c u l t y she a n t i c i p a t e d i n c a r r y i n g out the programme. For the l a t t e r measure the subject estimated d i f f i c u l t y on a scal e of zero (minimum) to 100 (maximum d i f f i c u l t y ) . M o t i v a t i o n a l data. A Motive C h e c k l i s t was designed f o r t h i s study to measure the importance to the s u b j e c t , of each of a number of motives f o r l o s i n g weight. The l i s t i n c l u d e d improving appearance, improving h e a l t h , demonstrating s e l f c o n t r o l , i n v o l v i n g s o c i a l o p p o r t u n i t i e s , im-proving employment o p p o r t u n i t i e s , preparing f o r an upcoming event, and p l e a s i n g one's spouse or f r i e n d s . According to Stuart (personal communi-cat i o n ) these are the most commonly c i t e d motives f o r j o i n i n g weight 44 r e d u c t i o n programmes. A f t e r each motive the subject c i r c l e d a number from one (not at a l l important) to f i v e (very important). P e r s o n a l i t y measures. The various p e r s o n a l i t y t e s t s used i n t h i s study were s e l e c t e d f o r t h e i r relevance to i n t e r n a l - e x t e r n a l o r i e n t a t i o n . As was mentioned e a r l i e r , t h i s c h a r a c t e r i s t i c seems to be multidimension-a l and i t was hoped that a more complete understanding would be gained by using s e v e r a l d i f f e r e n t approaches. The r a t i o n a l e f o r attempting to mea-sure t h i s o r i e n t a t i o n i s based on the theory of Schachter (1971). The i n t e n t i o n was to analyze the r e l a t i o n s h i p between these p e r s o n a l i t y mea-sures and success at l o s i n g weight at the conclusion of the programme. F i e l d dependence-independence ( W i t k i n e t a l . , 1954) was measured wi t h a p o r t a b l e Rod-and-Frame Test. The score from t h i s t e s t was the t o t a l absolute judgment e r r o r summed over e i g h t t r i a l s . The construct of i n t e r n a l versus e x t e r n a l c o n t r o l ( R o t t e r , 1966) was another r e l e v a n t measure. The Reid and Ware (1974) v e r s i o n of t h i s s c a l e was used since i t has been d i v i d e d i n t o three separate dimensions: f a t e , s o c i a l systems c o n t r o l , and s e l f - c o n t r o l . The f a t e dimension measures the extent to which people b e l i e v e that l u c k , f a t e , or fortune govern personal achievements or outcomes. The s o c i a l systems c o n t r o l dimension r e f l e c t s the amount of c o n t r o l people f e e l they have over s o c i a l and po-l i t i c a l f orces and events. The s e l f c o n t r o l dimension i s i d e n t i f i e d by the perceived amount of c o n t r o l over one's own d e s i r e s , impulses and emo-t i o n s (Reid and Ware, 1974). This s c a l e c o n s i s t s of 45 forced choice items. Another s c a l e r e l a t e d to the Locus of Co n t r o l s c a l e i s the Personal C a u s a l i t y Scale (Peevers, B l a s c o v i c h , and Secord, 1974). This q u e s t i o n -45 n a i r e i s designed to c a t e g o r i z e the i n d i v i d u a l . a s personal or e x t e r n a l regarding the locus of c a u s a l i t y . The major d i f f e r e n c e between t h i s i d e a and the Locus of C o n t r o l i s that the Personal C a u s a l i t y Scale mea-sures perceived c a u s a l i t y i n i n t e r p e r s o n a l r e l a t i o n s h i p s . The s c a l e c o n s i s t s of "35 questions about'everyday i n t e r p e r s o n a l s i t u a t i o n s to which p a r t i c i p a n t s respond i n t h e i r own words" (Peevers et a l . , 1974, p. 1 ) . In a d d i t i o n to c a t e g o r i z i n g i n d i v i d u a l s on locus of c a u s a l i t y , t h i s t e s t a l s o y i e l d s a score that i n d i c a t e s the degree of perceived i n -t e n t i o n a l i t y that others have i n t h e i r a c t i o n s toward the i n d i v i d u a l . One suggestion from the hypothesis that the obese are more e x t e r n a l -•~ l y o r i e n t e d i s that the obese are unable'ltpadascriminatetiniternal cues. To tap t h i s aspect of i n t e r n a l - e x t e r n a l o r i e n t a t i o n the Autonomic Per-c e p t i o n Scale (Mandler, Mandler, and U v i l l e r , 1958) was administered. This s c a l e was designed to measure the extent an i n d i v i d u a l i s aware of autonomic a c t i v i t y . I t has a l s o been suggested that the s c a l e i s a c t u a l l y measuring the degree to which i n d i v i d u a l s tend to be concerned about autonomic a c t i v i t y (McFarland, 1975). This i n t e r p r e t a t i o n of the t e s t would a l s o be very p e r t i n e n t to the problem of o b e s i t y , p a r t i c u l a r l y i f t h i s score i s pre-d i c t i v e of weight l o s s . Another v a r i a b l e that i s r e l a t e d to i n t e r n a l - e x t e r n a l o r i e n t a t i o n i s s u g g e s t i b i l i t y . The extent to which i n d i v i d u a l s are r e c e p t i v e to ex-t e r n a l suggestions v a r i e s considerably and might be an added dimension to the concept of i n t e r n a l i t y - e x t e r n a l i t y . The Barber S u g g e s t i b i l i t y Scale was used to measure t h i s v a r i a b l e . ^ A l t h o u g h i t i s u s u a l l y con-s i d e r e d to be a measure of hypnotic s u g g e s t i b i l i t y , the t e s t i s standard-i z e d and r e q u i r e s no hypnotic i n d u c t i o n (Barber, 1965). The t e s t was 46 administered i n tape recorded form to i n s u r e a standard procedure. The only p r i o r i n s t r u c t i o n s were as f o l l o w s : " I am now going to p l a y a tape r e c o r d i n g . I would l i k e you to c l o s e your eyes, r e l a x and l i s t e n to the i n s t r u c t i o n s on the tape." The t e x t and s c o r i n g procedure followed d i r e c t l y from Barber (1965). The t e s t y i e l d s two separate scores: an o b j e c t i v e s u g g e s t i b i l i t y score which i s the amount of a c t u a l compliance w i t h the i n s t r u c t i o n s ; and a s u b j e c t i v e s u g g e s t i b i l i t y score which r e -f l e c t s the extent to which the subject f e l t the suggested e f f e c t as op-posed to merely going along w i t h the i n s t r u c t i o n s to please the e x p e r i -menter. Since the importance of the s e l f i n c o n t r o l l i n g weight l o s s has been demonstrated to be greater than the importance of some e x t e r n a l c o n t r o l (e.g., J e f f r e y , 1974) the a b i l i t y to observe and c o n t r o l one's own beha-v i o r may be a c o n t r i b u t i n g f a c t o r i n s u c c e s s f u l weight l o s s . The S e l f -M o n i t o r i n g Scale was designed to measure s e l f - o b s e r v a t i o n and s e l f - c o n t r o l of expressive behavior and s e l f p r e s e n t a t i o n (Snyder, 1974). The g e n e r a l i -z a t i o n from how-aware one i s of expressing h i s own a t t i t u d e s or emotions to how aware he i s of h i s own e a t i n g behavior i s not a l a r g e or unreason-able one. Spouse Involvement. The s o c i a l nature of the problem of any d i e t and e x e r c i s e p l a n makes s o c i a l support extremely necessary, p a r t i c u l a r l y support from one's f a m i l y and spouse. Although t h i s study d i d not deal d i r e c t l y w i t h the f a m i l i e s of the p a r t i c i p a t i n g s u b j e c t s , an attempt was made to s o l i c i t spouse support by sending some m a t e r i a l home f o r p e r u s a l and completion. This technique has been suggested by S t u a r t (personal communication). The m a t e r i a l provided a b r i e f d e s c r i p t i o n of the p l a n and suggested that the spouse read the d i e t manual. In a d d i t i o n the spouse was asked to complete a q u e s t i o n n a i r e concerning the subject's e a t i n g h a b i t s (See Appendix D). I t was f e l t that t h i s would at l e a s t serve as a p u b l i c statement by the subject that she was n: attempting to l o s e weight. Most, but not a l l , of the subjects had a spouse or other w i t h whom they were l i v i n g . S e l f M o n i t o r i n g . Recent research on the e f f e c t s of s e l f - m o n i t o r i n g has shown i t to be e f f e c t i v e i n i n c r e a s i n g the i n d i v i d u a l ' s awareness of h i s own e a t i n g p a t t e r n s (Stuart and Davis, 1972) and i n a c t u a l l y c o n t r i -b u t i n g to weight l o s s (Mahoney, 1974). This l a t t e r r o l e of s e l f monitor-i n g has been found to be l e s s long l a s t i n g and i s l i m i t e d to monitoring that precedes the e a t i n g behaviour (Romanczyk, 1974). Since i n the pre-sent study t h i s measure was intended to increase awareness and provide the experimenter w i t h i n f o r m a t i o n about the s u b j e c t s ' normal e a t i n g h a b i t s , post monitoring, or s e l f monitoring a f t e r having eaten, was used to r e -duce r e a c t i v i t y to the monitoring procedure. Each subject was given a s m a l l s e l f monitoring booklet and i n s t r u c -ted to f i l l out one page f o r each i n c i d e n t of e a t i n g whether i t was a f u l l meal or a very small, snack. The subject was i n s t r u c t e d to use the s e l f monitoring booklet f o r one week s t a r t i n g immediately a f t e r the i n i -t i a l i n t e r v i e w u n t i l the next s e s s i o n . I t was also made c l e a r that the subject was not to change her e a t i n g h a b i t s since the purpose of s e l f monitoring was to g a i n , i n s i g h t about her present p a t t e r n . Two month i n t e r v i e w . The t h i r d follow-up s e s s i o n occurred, a f t e r e i g h t weeks had passed s i n c e the i n s t r u c t i o n s e s s i o n . A standardized interview: was used to assess the s u b j e c t s ' progress up to that p o i n t (see Appendix D). Subjects were asked to estimate the percentage of days 48 they had been on and o f f t h e i r d i e t and on and o f f t h e i r e x e r c i s e p l a n . Since graphs were not examined as a r e g u l a r p a r t of the f o l l o w - u p s , they were asked whether they were a c t u a l l y graphing as i n s t r u c t e d . To assess the extent to which subjects were f o l l o w i n g the s p e c i f i c b e h a v i o r a l s t e p s , they were asked to estimate percentage of p o s s i b l e time they engaged i n those steps. The h a b i t s measured i n t h i s way were: eat-i n g i n one place (when home); not doing anything e l s e when e a t i n g ; keep-i n g problem foods out of s i g h t and reach; working on s p e c i f i c problem t i m e s j g e t t i n g help from ot h e r s ; using a s m a l l e r p l a t e ; measuring p o r t i o n s ; keeping low c a l o r i e foods a v a i l a b l e ; e a t i n g s l o w l y ; and using a payoff p l a n . The subject was asked i f her a t t i t u d e toward e a t i n g had changed,if she f e l t b e t t e r about h e r s e l f , and i f she f e l t h e a l t h i e r . These questions were answered on a f i v e p o i n t s c a l e . Using the same s c a l e "of 0 to 100 as i n the i n i t i a l i n t e r v i e w , subjects estimated the amount of d i f f i c u l t y they had had to that p o i n t and how much d i f f i c u l t y they a n t i c i p a t e d over the next four months. Inq u i r y was a l s o made i n t o the subject's o p i n i o n of the manual and the number of times she had read i t . F i n a l l y subjects were asked about t h e i r r e a c t i o n s to the s p e c i f i c features of the programmes which d i f f e r e d between groups, i . e . , sensory d e p r i v a t i o n and messages. Subjects were only asked about the features they had r e c e i v e d . S i x month i n t e r v i e w . (See Appendix D). This i n t e r v i e w was de-signed to assess s u b j e c t s ' f i n a l r e a c t i o n s and to get ideas and suggest-ions from subjects on the strong and weak p o i n t s of the programme. Sub-j e c t s responded on f i v e p o i n t s c a l e s to the questions of how s u c c e s s f u l or unsuccessful they f e l t the programme had been, how much t h e i r a t t i t u d e 49 toward e a t i n g had changed, how much t h e i r a t t i t u d e toward t h e i r h e a l t h had changed, whether they f e l t b e t t e r about themselves, and whether they f e l t h e a l t h i e r . Subjects a l s o responded o r a l l y to s e v e r a l open ended questions about the programme's most important aspects, worst aspects and how the programme could be improved. Subjects a l s o described t h e i r g r e a t e s t problems and what they had learned about themselves. Questions concerning i n t e n t i o n s to continue using the d i e t and e x e r c i s e programmes and the p r o b a b i l i t y of achie v i n g goal weight were also i n c l u -ded. F i n a l l y , the subject was allowed any general comments and asked i f she would be w i l l i n g to r e t u r n again i n the future f o r a f u r t h e r f o l l o w -up. 50 RESULTS Intergroup d i f f e r e n c e s . In a d d i t i o n to the i n i t i a l e f f o r t to equate groups f o r weight, age, and m a r i t a l s t a t u s , a check was made to evaluate the equivalence of the groups on the p e r s o n a l i t y measures and other demo-graphic v a r i a b l e s . One-way m u l t i v a r i a t e analyses of varia n c e (MANOVAs) were performed on th;ese dependent v a r i a b l e s using blocks of s i x or eight v a r i a b l e s at a time. Since the s m a l l e s t number of subjects i n any of the treatment groups was n i n e , no more than nine v a r i a b l e s could be ana-l y z e d at one time.. V a r i a b l e s were analyzed on groupings which . l o g i c a l l y 'seemed-1-to Belong together-. There were no s i g n i f i c a n t d i f f e r e n c e s among the groups on any of the data from the i n i t i a l s e s s i o n . The MANOVA on the v a r i a b l e s age, h e i g h t , i n i t i a l weight, number of years overweight, t r i c e p s k i n f o l d , i n f r a s c a p u l a r s k i n f o l d , number of c h i l d r e n , and years of education produced a l i k e l i h o o d r a t i o c r i t e r i o n w i t h a s s o c i a t e d F_(with 24 and 82 df) of .495 = .675, p_ >.50jj). L i k e w i s e , the MANOVA i n c l u d i n g as dependent v a r i a b l e s the Rod and Frame Test, the S e l f M o nitoring S c a l e , the t o t a l Locus of Contr o l s c o r e , Autonomic p e r c e p t i o n , the s u b j e c t i v e and o b j e c t i v e Barber Suggesti-b i l i t y Scale scores, and the locus and i n i t i a t i o n scores from the Personal C a u s a l i t y Questionnaire showed no s i g n i f i c a n t d i f f e r e n c e s 1/^ ' = .543, F(24,82) = .797, £ >.50fJ. N e i t h e r were there s i g n i f i c a n t d i f f e r e n c e s be-tween amounts of d r i n k i n g or smoking, a n t i c i p a t e d d i f f i c u l t y , or on the three separate s c a l e s of the Locus of C o n t r o l s c a l e tX^ = .543, F_(21,82) = .945, p_ >.5Q^]. The MANOVA f o r the items on the motive c h e c k l i s t (appear-ance, h e a l t h , s e l f c o n t r o l , s o c i a l o p p o r t u n i t y , employment o p p o r t u n i t y , 51 preparing f o r an event, or p l e a s i n g spouse) d i d however, y i e l d a s i g n i -f i c a n t group d i f f e r e n c e ;[.__ = .338, __(21,84) = 1.835, p_ <.05;]':; however, w i t h the greatest c h a r a c t e r i s t i c root ( g c r ) , no s i g n i f i c a n t d i f f e r e n c e s were found (gcr = .4048, S_ = 3, M = 1.5, N = 13.5, p_ >.05). In summary, the four experimental groups were equ i v a l e n t on the demographic and per-s o n a l i t y data. R e l a t i o n s h i p s between measures. A l l of the p h y s i c a l , demographic and p e r s o n a l i t y data were test e d f o r i n t e r c o r r e l a t i o n s on the 39 subjects who completed the study. Since the number of c o r r e l a t i o n s i n v o l v e d i s q u i t e l a r g e , the .01 s i g n i f i c a n c e l e v e l was used, (see Table 1). Age, as might be expected, was p o s i t i v e l y r e l a t e d to years overweight Cr = .55) and n e g a t i v e l y r e l a t e d to the importance of improving s o c i a l oppor-t u n i t i e s (r_ = -.48). Age was a l s o n e g a t i v e l y c o r r e l a t e d w i t h the objec-t i v e score on Barber's S u g g e s t i b i l i t y Scale (_r = -.44). Older subjects were l e s s s u g g e s t i b l e . Height and i n i t i a l weight were s i g n i f i c a n t l y c o r r e l a t e d but at a s u r p r i s i n g l y low r_ = .40. I n i t i a l weight was a l s o p o s i t i v e l y c o r r e l a t e d w i t h the two s k i n f o l d measures: weight and t r i c e p s k i n f o l d w i t h an _r of .62, and weight and i n f r a s c a p u l a r s k i n f o l d w i t h an r of .63. The two s k i n f o l d measures were more h i g h l y c o r r e l a t e d w i t h each other than w i t h i n i t i a l weight (r_ = .85). Weight and s k i n f o l d s were s i g n i f i c a n t l y c o r r e -l a t e d w i t h very few other v a r i a b l e s . There was a s i g n i f i c a n t though low c o r r e l a t i o n between weight and t o t a l Locus of C o n t r o l score ( r = .41), demonstrating a tendency f o r the h e a v i e r subjects to be more e x t e r n a l l y o r i e n t e d . However a c o r r e l a t i o n of .41 i s not p a r t i c u l a r l y c o n c l u s i v e . Summary of. C o r r e l a t i o n s 1 2 3 Cojpela t i ^ n s 8 9 10 11 12 13 14 15 16 17 Age 1 Weight 2 .04 Height 3 .09 .40 Years Overweight 4 .55 .12 -.10 Tricep S k i n f o l d 5 .38 .62 .22 .25 I n f r a s c a p u l a r S k i n f o l d 6 .31 .63 .16 .21 .85 Years of Educa-t i o n 7 -.27 -.24 -.24 -.36 -.26 Motive to Improve S o c i a l Opportuni-ty 8 -.48 .21 -.04 -.32 05 .03 .05 Motive to Improve Employment Oppor--.06 .46 t u n i t y 9 -.09 .08 -.38 -.13 .02 .03 Motive to Please Spouse 10 .27 .12 -.04 .02 .15 .15 -.10 .007 .13 B. S u g g e s t i b i l i t y -.06 -.06 Sc. Object. 11 -.44 .25 .25 -.34 .19 .18 -.16 .27 S u g g e s t i b i l i t y .02 .04 .63 Sc. Sub. 12 -.30 .24 .01 -.17 .41 .35 -.24 .20 LOC T o t a l 13 .01 •41 .16 .08 .28 .38 .17 .19 .17 .02 .05 LOC Fate 14 .12 .28 .09 .10 .28 .37 -.14 -.10 .18 .01 .03 .09 .69 LOC SSC 15 .05 .32 .15 .10 .18 .16 -.07 .17 .07 .34 .18 .04 .63 .03 LOC S e l f C o n t r o l 16 -U7 .26 .09 -.08 .12 .26 -.01 .32 .19 -.05 -.18 -.18 .75 .47 .15 Autonomic Percep- .04 .21 .33 .18 .43 .06 t i o n 17 .24 .47 .15 .44 .38 .36 -.19 -.05 .04 .33 Weight Change -6 months 18 .07 .09 .004 -.05 .11 .15 -.04 .04 .03 .40 .08 -.10 -.03 -.08 .07 -.07 .22 • ho Weight was a l s o n e g a t i v e l y r e l a t e d to years of education (r_ = -.47) more h i g h l y educated subjects tended to be l i g h t e r . The score on the Autonomic Per c e p t i o n s c a l e was p o s i t i v e l y c o r r e l a t e d w i t h i n i t i a l weight (r = .47) r e f l e c t i n g a tendency f o r heavier subjects to report more awareness or concern f o r autonomic a c t i v i t y . There was a l s o one other c o r r e l a t i o n of s k i n f o l d w i t h a p e r s o n a l i t y v a r i a b l e . I n f r a s c a p u l a r s k i n f o l d was p o s i t i v e l y r e l a t e d to the S u b j e c t i v e s c a l e on Barber's S u g g e s t i b i l i t y Scale (r_ = .41). Subjects w i t h more f a t tended to be more s u g g e s t i b l e . There were a number of s i g n i f i c a n t c o r r e l a t i o n s between subscales of the d i f f e r e n t q u e s t i o n n a i r e s and between the d i f f e r e n t s c a l e s them-s e l v e s , Several of the motives f o r j o i n i n g the progamme on the motive c h e c k l i s t were r e l a t e d . The motive to improve s o c i a l opportunity was p o s i t i v e l y r e l a t e d to the motive to improve employment opportunity (r_ = .46), and the motive to prepare f o r some upcoming event was c o r r e l a t e d (_: = ,51) w i t h the importance of p l e a s i n g one's spouse. On the Locus of C o n t r o l q u e s t i o n n a i r e the subscales Fate and S e l f C o n t r o l were p o s i t i v e l y c o r r e l a t e d (r_ = .47). The Objective and Subjective subscales of the Barber S u g g e s t i b i l i t y Scale were f a i r l y s t r o n g l y c o r r e l a t e d (r_ = .63), There were a l s o two i n t e r c o r r e l a t i o n s between d i f f e r e n t s c a l e s . The Personal C a u s a l i t y score was s i g n i f i c a n t l y c o r r e l a t e d w i t h the amount the subject claimed to smoke (_r = .41). This r e f l e c t s a tendency f o r those who are more e x t e r n a l l y o r i e n t e d on t h i s measure to smoke to a greater degree. E x t e r n a l i t y on t h i s measure i s the amount one perceives others (as opposed to s e l f ) as being responsible f o r i n t e r p e r s o n a l events. F i n a l l y , the Autonomic P e r c e p t i o n score was p o s i t i v e l y r e l a t e d to the S o c i a l Systems C o n t r o l subscale of the Locus of C o n t r o l s c a l e ( r = .43); 54 the more aware the subject was of her own p h y s i o l o g i c a l a c t i v i t y the more she f e l t s o c i a l systems to be out of her c o n t r o l . Group S i z e and A n a l y s i s of Drop Outs. The i n i t i a l design c a l l e d f o r 12 subjects i n each of the four groups. However, s i n c e subjects were seen completely on an i n d i v i d u a l b a s i s they d i d not a l l begin the programme at the same time. A number of subjects terminated the programme at v a r i o u s p o i n t s i n the progress of the study. In the i n i t i a l stages an attempt was made to replace these subjects w i t h others from the l i s t of v o l u n t e e r s . However, no replacements were made a f t e r three months from the beginning of the f i r s t s u b j e c t . Subjects who terminated a f t e r that p o i n t ^ a w e r e not replaced. As a r e s u l t the desi r e d c e l l s i z e s were not achieved, n e i t h e r were the f i n a l number of subjects i n each group equal. The SD-M group had 11 s u b j e c t s , the SD-NM group had 9 s u b j e c t s , the NC-M group had 9 s u b j e c t s , and the NC-NM group had 10 s u b j e c t s . To avoid d i s -t o r t i o n s i n the r e s u l t s caused by a n a l y s i s of unequal c e l l designs, two subjects from the SD-M group and one subject from the NC-NM group were randomly dropped f o r the m u l t i v a r i a t e and u n i v a r i a t e analyses of varia n c e and the repeated measures a n a l y s i s . ^ T h e i r data are i n c l u d e d i n a l l other analyses. There was a t o t a l of 15 subjects who terminated before the pro-gramme's co n c l u s i o n . Of these, s i x terminated a f t e r the i n i t i a l i n t e r -view and therefore were not presented w i t h any.of the treatments'. Three subjects l e f t the sensory d e p r i v a t i o n s e s s i o n e a r l y . Two of these, one i n the SD-M group and one i n the SD-NM group, terminated the s e s s i o n a f t e r f i v e hours of sensory d e p r i v a t i o n . The t h i r d s u b j e c t , who had been 55 assigned to the SD-M group, l e f t a f t e r 45 minutes of sensory d e p r i v a t i o n . In accordance w i t h a previous understanding these subjects terminated the programme at t h i s time. One, however,was allowed to continue u n o f f i c i a l l y and she i s discussed i n the next chapter. The remaining dropouts from the study were as f o l l o w s : two subjects (one NC-M, one NC-NM) terminated a f t e r the i n s t r u c t i o n s e s s i o n ; two subjects (one SD-NM, one NC-NM) t e r -minated a f t e r the one week f o l l o w up; one'subjects (NC-M) terminated a f t e r the one month f o l l o w up; and two subjects (one NC-M, one NC-NM) terminated a f t e r the two month f o l l o w up. Several other subjects ex-pressed a d e s i r e to q u i t when they were discouraged by poor progress. These subjects were encouraged to continue and responded to t h i s encour-agement by remaining ihtsthe programme. In order to t e s t f o r systematic d i f f e r e n c e s i n demographic and per-s o n a l i t y v a r i a b l e s which d i s t i n g u i s h e d the drop-outs from the other groups of s u b j e c t s , a f u r t h e r s e r i e s of m u l t i v a r i a t e analyses of v a r i a n c e was performed. These analyses i n c l u d e the subjects who. dropped out as a separate group compared to the experimental groups. The o v e r a l l t e s t of the m u l t i v a r i a t e n u l l hypothesis by the l i k e l i h o o d r a t i o c r i t e r i o n revealed no s i g n i f i c a n t d i f f e r e n c e s f o r the v a r i a b l e s age, h e i g h t , years overweight, a n t i c i p a t e d d i f f i c u l t y , i n i t i a l weight, years of education, - or number of c h i l d r e n (A = .658, F O D = .704, p >.50); nor f o r scores — —_,o,J_oU on the Rod and Frame t e s t , Locus of C o n t r o l t e s t , Autonomic P e r c e p t i o n , the Objective and Subj e c t i v e s c a l e s of the Barber S u g g e s t i b i l i t y Scale, and the locus and i n i t i a t i o n s c a l e s of the Personal C a u s a l i t y Scale (A = .647, F_2g = .733, p_ >.50). The v a r i a b l e s d r i n k i n g , smoking, 56 S e l f M o nitoring Scale, and the Fate, SSC, and S e l f C o n t r o l subscales of the Locus of C o n t r o l were al s o not s i g n i f i c a n t (;_v = .652, = ,860, p_ >.50). As i n the a n a l y s i s of the four experimental groups, the l i k e l i h o o d r a t i o c r i t e r i o n was s i g n i f i c a n t f o r the motive v a r i a b l e s ; appearance, h e a l t h , s e l f c o n t r o l , s o c i a l o p p o r tunity, employment oppor-t u n i t y , upcoming event, and please spouse (A = .399, F„_ = 1.66, — —zo,±oU p_ <,05), However, using the greatest c h a r a c t e r i s t i c root approach t h i s t e s t was not s i g n i f i c a n t (gcr = .301, S_ = 4, M = 1, N = 21, p_>.05). The o v e r a l l f i n d i n g of these analyses i s that the dropouts were not sys-t e m a t i c a l l y d i f f e r e n t on the p e r s o n a l i t y and demographic measures taken from those who d i d not drop out. This r e s u l t i s discouraging i n that no good p r e d i c t o r of e a r l y terminators emerged. Weight Change. The dependent v a r i a b l e of most i n t e r e s t i s the t o t a l weight change over the e n t i r e s i x month p e r i o d . An a n a l y s i s of variance (ANOVA) of weight change at the end of the programme showed no s i g n i f i -cant main e f f e c t s (SD F 1 3 2 = 2.72, p_ >,10; Message 3 2 = 1.70, p_ >.20) However there was a s i g n i f i c a n t i n t e r a c t i o n (F^ ^  = 7.43, p_ <.01) be-tween environment type and message. The l a r g e s t weight change occurred i n the SD-M group (Mean l o s s = 5.87 kg) and the second most s i g n i f i c a n t change occurred i n the NC-NM group which had a mean l o s s of 2.36 kg. . M u l -t i p l e comparisons using , vkthe Neuman-Reujis';;^ *. mean weight l o s s of SD-M group to be s i g n i f i c a n t l y (p_ <.05) greater than the mean l o s s of each of the other three groups (Table 2). In a d d i t i o n to o v e r a l l weight l o s s f o r the s i x month p e r i o d , the pa t t e r n of weight change over time was als o examined. This was done i n two d i f f e r e n t ways. The f i r s t was to analyze weight l o s s over d i f f e r e n t 57 TABLE 2 Weight Loss Means Over S i x Months Sensory Non- Message D e p r i v a t i o n confined Means Messages 5.87 Kg* .67 Kg* 3.27 Kg No Messages 1.08 Kg* 2.36 Kg* 1.72 Kg Condit i o n Means 3.48 Kg 1.52 Kg S i g n i f i c a n t i n t e r a c t i o n at p <.01 58 TABLE 3 Weight Loss Means Over F i r s t Two Months Sensory D e p r i v a t i o n Non-Confiried Message Means Messages 3,67 Kg 2.61 Kg 3.14 Kg No Messages .11 Kg 2.35 Kg 1.23 Kg Con d i t i o n , Means 1.89 Kg 2.48 Kg S i g n i f i c a n t main e f f e c t at p_ <.05 59 p e r i o d s . ANOVA of weight change over the f i r s t two months p e r i o d showed no s i g n i f i c a n t environment e f f e c t (F_ < 1) but a s i g n i f i c a n t message e f f e c t (F_^ 22 = 4.00, p_ = .05). Those who had heard the messages l o s t an average of 3.13 kg versus 1.23 kg. f o r those who had not heard the messages. The environment by message i n t e r a c t i o n was m a r g i n a l l y s i g -n i f i c a n t at two months (F^ ^  = 3.00, p_<.10). Means f o r 2 month weight l o s s are presented i n Table 3. Weight change during the l a s t f o u r month p e r i o d was als o analyzed. Here ANOVA revealed the message e f f e c t (F_<1) to be n o n s i g n i f i c a n t and the i n t e r a c t i o n (F^ ^  = '2.88, p < .10) to be ma r g i n a l l y s i g n i f i c a n t . There was a s i g n i f i c a n t environment main e f f e c t Q?l 22 = 7.60, p < .01) f o r change during t h i s p e r i o d . The mean change i n the l a s t f o u r months f o r those who had spent 24 hours i n sensory de-p r i v a t i o n was a l o s s of 1.58 kg versus a gain of .98 kg f o r those who were nonconfined. Table 4 contains mean weight lo s s e s f o r the l a s t four month p e r i o d . To examine the p a t t e r n of weight change f u r t h e r a repeated measures ANOVA was performed on a l l of the weight measurements over the s i x month p e r i o d . I f a subject had missed a se s s i o n and consequently had a missing data c e l l , the average of the two adjacent sessions f o r that subject was used. This a n a l y s i s y i e l d e d a s i g n i f i c a n t t r i a l x environment i n t e r a c t i o n e f f e c t <^J2 = 2.27, p_< .05) and a l s o a s i g n i f i c a n t t r i a l x environment x message i n t e r a c t i o n (F^. = 4.21, p_ < .001). The t r i a l by message e f f e c t was of b o r d e r l i n e s i g n i f i c a n c e (F^ = 2.06, p_=.06). For the a c t u a l trends of t h i s data see Figure 1. These f i n d i n g s r e f l e c t the e a r l i e r f i n d i n g s from the ANOVA on the d i f f e r e n t time p e r i o d s , the groups w i t h messages l o s i n g most i n the f i r s t 2 months and the sensory d e p r i v a -t i o n groups l o s i n g most weight over the l a s t four months. This combination TABLE 4 Weight Loss Means Over the Last Four Months (negative numbers = weight gain) Sensory D e p r i v a t i o n Non-Confined Message Means Messages 2.20 Kg -1.93 Kg .13 Kg No Messages .97 Kg -.02 Kg .48 Kg Con d i t i o n Means 1.58 Kg -.98 Kg * S i g n i f i c a n t main e f f e c t at p_ <.01 61 TABLE 5 Mean S k i n f o l d Changes Over S i x Months ( p o s i t i v e number = l o s s ) T r l c e p Sensory Non- Message D e p r i v a t i o n Confined Means Message 1.93 mm 2.71 mm 2.32 mm No Message 2.04 mm .64 mm 1.34 mm Con d i t i o n Means 1.99 mm 1.68 mm In f r a s c a p u l a r Sensory Non- Message D e p r i v a t i o n . Confined Means Message 2.36 mm 2.61 mm 2.48 mm No Message 3.82 mm 1.21 mm 2.52 mm Con d i t i o n Means 3.09 mm 1.91 mm produces the i n t e r a c t i o n e f f e c t w i t h the SD-M group l o s i n g most weight over the e n t i r e s i x months. S k i n f o l d Measurement Change. I n f r a s c a p u l a r and t r i c e p s k i n f o l d measurements were taken at the beginning of the programme and again at the f i n a l s i x month s e s s i o n . ANOVA of change i n each of these dependent v a r i a b l e s y i e l d e d no s i g n i f i c a n t d i f f e r e n c e s . A l l F r a t i o s were l e s s than one w i t h the exception of the environment x message i n t e r a c t i o n f o r the i n f r a s c a p u l a r measure (F^ ^  = 1-38, p_ <.10). A repeated measures ANOVA al s o y i e l d e d no s i g n i f i c a n t d i f f e r e n c e between groups on these v a r i a b l e s (see Table 5) , This complete l a c k of s i g n i f i c a n t f i n d i n g s w i t h the s k i n -f o l d measures i s p a r t i c u l a r l y i n t e r e s t i n g i n view of the r e l a t i o n between weight change and s k i n f o l d change. S i x month weight change was s i g n i f i -c a n t l y c o r r e l a t e d w i t h i n f r a s c a p u l a r s k i n f o l d change (r_ = .50, p_ <.002, and to t r i c e p s k i n f o l d change (r_ = .40, p_ <.01). The c o r r e l a t i o n between change i n the two s k i n f o l d measures was .67 (p_ <.0001). 1  Analyses of other dependent v a r i a b l e s . ANOVA's were c a r r i e d out on the other data which were c o l l e c t e d at the two and s i x month ses s i o n s . S i g n i f i c a n t d i f f e r e n c e s between sensory d e p r i v a t i o n versus nonconfined sub-j e c t s were found on the number of c a l o r i e s of e x e r c i s e they claimed to average d a i l y (F^ 3 2 = 4.54, p_< .05; SD mean = 271 vs. NC mean = 149). These two groups a l s o d i f f e r e d i n the percentage of time they reported they were t r y i n g to slow down t h e i r e a t i n g (F_^ ^  = 8.13, p_ <.01; SD mean = 69% v s . NC mean = 40%). These were the only s i g n i f i c a n t r e s u l t s from the data c o l l e c t e d a t two months. At s i x months, there was a s u r p r i s i n g f i n d i n g that those who had the messages reported s i g n i f i c a n t l y l e s s a t t i t u d e change toward e a t i n g (M mean = 3.11) than those who d i d not have the messages (NM mean =3.72) (__., ^ 0 = 64 - 4.61, p_ < .05). In a d d i t i o n there was a s i g n i f i c a n t environment, x mes-sage i n t e r a c t i o n on the amount the subjects reported f e e l i n g b e t t e r about themselves (F^ ^ ~ 6*93, p_ = < .01). The extent to which the subject f e l t b e t t e r about h e r s e l f seemed to correspond w i t h the amount of weight l o s t (SD-M mean =3.56, SD-NM mean =2.33, NC-M mean = 2.22, NC-NM mean = 3.22). These were the only s t a t i s t i c a l l y s i g n i f i c a n t s i x month data aside from the weight data. Regressions i n v o l v i n g weight change. To f u r t h e r explore the f a c -t o r s which c o n t r i b u t e to s u c c e s s f u l weight l o s s aside from the manipulated experimental v a r i a b l e s , m u l t i p l e regressions were performed w i t h the i n i t i a l demographic data and w i t h the two month behavioural data as pre-d i c t o r s of weight change.i In the demographic r e g r e s s i o n , the p r e d i c t o r v a r i a b l e s were age, years overweight, d r i n k i n g p a t t e r n , a n t i c i p a t e d d i f -f i c u l t y , motive to please spouse, Rod and Frame Test, S e l f - M o n i t o r i n g score, Autonomic P e r c e p t i o n , i n i t i a l weight, and number of c h i l d r e n . Most of these p r e d i c t o r v a r i a b l e s were s e l e c t e d because of t h e i r h i g her c o r r e -l a t i o n s w i t h weight change at s i x months. A stepwise m u l t i p l e r e g r e s s i o n of s i x month weight change on these v a r i a b l e s produced only two s i g n i f i -cant p r e d i c t o r v a r i a b l e s . These were the amount of a n t i c i p a t e d d i f f i c u l t y w i t h a standardized r e g r e s s i o n c o e f . f i c i e n t (beta: c o e f f i c i e n t ) of .38 ( p_< .01, b i v a r i a t e r_ between s i x month weight change and t h i s p r e d i c t o r = .40) and motive to please spouse w i t h a standardized r e g r e s s i o n c o e f f i c i e n t of -.38 (p_< .01, b i v a r i a t e r_= -.40). A n t i c i p a t e d d i f f i c u l t y was a p o s i -t i v e p r e d i c t o r , i . e . , the more d i f f i c u l t y the subject expected i n c a r r y i n g out the d i e t the more weight she l o s t . Motive to please spouse was a negative p r e d i c t o r , i . e . , the more important l o s i n g weight i n order to 65 please her spouse was, the l e s s weight the subject l o s t . This w i l l be discussed more thoroughly i n the D i s c u s s i o n s e c t i o n . A second r e g r e s s i o n was done usi n g the behaviour report data from the two month i n t e r v i e w as p r e d i c t o r s f o r s i x month weight change. The p r e d i c t o r v a r i a b l e s were c a l o r i e p lan being used, percentage of the s t i c k -i n g to d i e t , average d a i l y c a l o r i e s of e x e r c i s e , percentage of time the subject ate i n one p l a c e , percentage of time she avoided other a c t i v i t i e s w h i l e e a t i n g , amount of reported help from o t h e r s , percentage of time she used a s m a l l e r p l a t e , and the percentage of time she t r i e d to eat more s l o w l y . Stepwise m u l t i p l e regressions of (a) two month weight change and (b) s i x month weight change on these v a r i a b l e s y i e l d e d almost i d e n t i c a l r e s u l t s . The one s i g n i f i c a n t p r e d i c t o r v a r i a b l e was the percent age of time the subject reported to be attempting to eat s l o w l y . For the s i x month weight change the standardized r e g r e s s i o n c o e f f i c i e n t was .46 L(p_ <.005-.,bivariate _r = .46) and f o r the two month weight change i t was .42 (p_ <.01^bivariate r_ = .42). This r e s u l t i n d i c a t e s that the more the sub-j e c t reported being concerned w i t h e a t i n g slowly the more weight she l o s t . Unanalyzed data. Two other measures d i d not provide enough informa-t i o n to be adequately analyzed s t a t i s t i c a l l y . These were the estimate of time during sensory d e p r i v a t i o n and the pre-treatment s e l f monitoring of e a t i n g . The time estimate was included because of i t s p o s s i b l e value i n p r e d i c t i n g drop-outs from SD i n a p o p u l a t i o n which had been hypothesized to have a high l e v e l of s t r e s s i n a low stimulus environment. While the e a r l y t e r m i n a t i o n r a t e from sensory d e p r i v a t i o n of 13% (3/23) i s higher than the normal r a t e of 5% reported by Suedfeld (1976) , the s m a l l number 66 of drop-outs make i t d i f f i c u l t to analyze the d i f f e r e n c e s i n time estima-t i o n between those who l e f t e a r l y and those who d i d n ' t . The a v a i l a b l e data are -reduced even f u r t h e r s i n c e one drop-out l e f t sensory d e p r i v a t i o n a f t e r 45 minutes, before time e s t i m a t i o n was measured. The mean e r r o r i n e s t i m a t i o n of those subjects who s u c c e s s f u l l y completed the sensory de-p r i v a t i o n s e s s i o n was .61 hour o f f the 1.75 hours of a c t u a l time. The e r r o r s i n estimate f o r drop-outs were .75 and 1.75 hours (mean = 1.25 hours). The data from s e l f monitoring were both incomplete and p o o r l y reported. While most subjects d i d hand i n t h e i r forms a f t e r the f i r s t week, few handed i n t h e i r monitoring forms f o r the f i n a l week. In the i n i t i a l moni-t o r i n g many sub j e c t s had not monitored f o r a complete week and some kept t r a c k f o r as l i t t l e as one day. The most c o n s i s t e n t l y reported data were the amount and type of food consumed, although the amount was o f t e n r e -corded q u i t e vaguely. With these data an attempt was made to estimate the p r e - d i e t d a i l y c a l o r i e consumption. Even though t h i s estimate was sometimes l i t t l e more than a rough guess from the a v a i l a b l e i n f o r m a t i o n , i t d i d demonstrate the u n r e l i a b i l i t y of subject reported data. The mean reported c a l o r i e consumption was 1047 c a l o r i e s per day before the beginning of the d i e t . This was lower than the lowest c a l o r i e p l a n which was sug-gested f o r the s u b j e c t s , i . e . , a 1200 c a l o r i e d i e t . Due to the general i n c o n s i s t e n c i e s i n these data, no f u r t h e r analyses were performed. Some of the other data from the s i x month i n t e r v i e w were not ana-l y z e d due to t h e i r n o n - q u a n t i t a t i v e nature. These data were c h i e f l y con-cerned w i t h the s u b j e c t s ' f i n a l impressions of the programme and suggest-ions f o r i t s improvement. These data are reported and discussed i n the next s e c t i o n . DISCUSSION The f i n d i n g s supported the p r e d i c t i o n that 24 hours of sensory d e p r i v a t i o n combined w i t h t h e r a p e u t i c messages would enhance the e f f e c t -iveness of a standard b e h a v i o r a l weight l o s s programme. The s i x month weight change r e s u l t s show the group r e c e i v i n g t h i s treatment to have been c l e a r l y more s u c c e s s f u l than the other three groups. The average weight l o s s of t h i s group was twice that of the next most s u c c e s s f u l group. Since each i n d i v i d u a l received i d e n t i c a l treatment aside from t h i s i n i t i a l m a n ipulation, i t may be concluded that sensory d e p r i v a t i o n combined w i t h t h e r a p e u t i c messages can be a t h e r a p e u t i c f a c i l i t a t o r i n a programme of weight c o n t r o l . These f i n d i n g s are a c t u a l l y more complex when the p a t t e r n of weight change among the other groups i s considered. The s i x month follow-up showed n e i t h e r an environmental nor a message e f f e c t on weight l o s s . I n -stead i t was the i n t e r a c t i o n between these two v a r i a b l e s that was s i g n i f i -cant. An understanding of t h i s c o n f i g u r a t i o n can be gained by examining the p a t t e r n of l o s s over time. At two months those who had heard the t h e r a p e u t i c messages had l o s t more weight than those who had not heard them, regardless of environmental c o n d i t i o n . This r e s u l t a t t e s t s to the e f f e c t i v e n e s s of the messages used which included h e a l t h i n f o r m a t i o n , r e -l a x a t i o n e x e r c i s e s and d i s c u s s i o n s of m o t i v a t i o n , i n a d d i t i o n to d i e t and e x e r c i s e i n f o r m a t i o n . Many of the subjects who heard the messages com-mented favourably on the m a t e r i a l and s e v e r a l requested t r a n s c r i p t s of the tape. (For s t a n d a r d i z a t i o n purposes these requests were p o l i t e l y refused!'.) These p o s i t i v e r e a c t i o n s came from both groups who had heard the messages, 68 but more f r e q u e n t l y from those i n the nonconfined group. In f a c t s e v e r a l sensory d e p r i v a t i o n subjects reported that they d i d not r e a l l y remember the s p e c i f i c messages. The u s e f u l content of the messages com-bined w i t h the favourable r e a c t i o n s toward them might account f o r a l a r g e p a r t of the two month message e f f e c t . The message e f f e c t , however, was no longer present at s i x months. This reduced e f f e c t i v e n e s s was probably due to the l o s s of r* impact as a r e s u l t of g r a d u a l l y f o r g e t t i n g the message content. Most of the r e -quests to hear the tape again and f o r copies of the tape were l a t e r i n the programme; some subjects s t a t e d they needed a boost by hearing the tapes again. An important f a c t o r i n the poorer progress l a t e r i n the study was infrequent contact w i t h the experimenter. In f a c t , i n the f i n a l i n t e r v i e w , the most common suggestion for. improving the programme was to have more frequent v i s i t s . In the H a t e r p o r t i o n of the study, follow-up sessions were one or two months apart and apparently t h i s was not frequent enough. Having to report to be weighed provided a strong m o t i v a t i o n a l f a c t o r f o r the m a j o r i t y of subjects regardless of treatment group, s i n c e most sub-j e c t s l o s t more weight i n the f i r s t two months than over the l a s t four months. The weight change curve f o r the combined groups shows a l e v e l i n g of the l o s s curve that resembles the usual r e t e n t i o n curve i n l e a r n i n g . However, there was an i n t e r e s t i n g between-group d i f f e r e n c e f o r weight change during t h i s p e r i o d . The s i g n i f i c a n t main e f f e c t f o r environment at t h i s time was due to continuedweight l o s s at a slow r a t e among those who had sensory d e p r i v a t i o n w i t h or without messages, w h i l e the nonconfined group e i t h e r gained weight or remained the same. The sensory d e p r i v a -t i o n w i t h message group continued to l o s e at the same r a t e up u n t i l the l a s t two months when there was some slowing of the l o s s r a t e . The sen-sory d e p r i v a t i o n group without messages d i d not r e a l l y begin l o s i n g weight u n t i l a f t e r the two month f o l l o w up (See Figure 1 ). The combination of messages which were more e f f e c t i v e over the f i r s t two months w i t h sensory d e p r i v a t i o n which was more e f f e c t i v e over the l a s t four months makes the f i n a l s i x month r e s u l t s more understandable. The combined e a r l y e f f e c t i v e n e s s of the messages w i t h the l a t e r e f f e c t i v e -ness of sensory d e p r i v a t i o n e x p l a i n s why the sensory d e p r i v a t i o n w i t h messages was the most e f f e c t i v e treatment. M o t i v a t i o n a T l E f f e c t s The f i n d i n g that those who had sensory d e p r i v a t i o n l o s t more weight during the l a s t four months suggests that sensory d e p r i v a t i o n may provide some s o r t of m o t i v a t i o n a l boost or increase i n r e s o l v e . I n the group which had sensory d e p r i v a t i o n without messages t h i s was something of a "sleeper e f f e c t " i n that they had l o s t very l i t t l e weight during the f i r s t two months. Another f i n d i n g which supports the id e a of a m o t i v a t i o n a l boost i s the d i f f e r e n t i a l dropout rat e between the groups. A f t e r the be-ginning of the a c t u a l d i e t programme, i . e . , a f t e r the s e s s i o n c o n t a i n i n g i n s t r u c t i o n s i n the d i e t and e x e r c i s e p l a n , there was only one dropout from the combined sensory d e p r i v a t i o n groups and that one was i n the no message treatment. The nonconfined groups had a t o t a l of s i x dropouts, three i n each group. Not only d i d the sensory d e p r i v a t i o n groups l o s e more weight i n the l a s t four months, but they had f a r fewer dropouts 70 during the e n t i r e programme. This i s strong evidence f o r a m o t i v a t i o n a l e f f e c t of sensory d e p r i v a t i o n . There were a l s o three subjects who terminated the sensory d e p r i v a -t i o n s e s s i o n e a r l y and were t h e r e f o r e forced to drop out of the programme. However, the reasons f o r dropping out of sensory d e p r i v a t i o n are q u i t e d i f f e r e n t from those f o r dropping out of an ongoing d i e t regimen. Sub-j e c t s terminate the sensory d e p r i v a t i o n s e s s i o n because they f i n d i t too b o r i n g or too u p s e t t i n g to continue; subjects drop out of a d i e t programme c h i e f l y because they are not l o s i n g weight and are discouraged. Neverthe-l e s s , even w i t h these d i f f e r e n t motives, i t i s conceivable that the sen-sory d e p r i v a t i o n experience served to screen out those who were poo r l y motivated and hence to reduce the l a t e r dropout r a t e . The case of one subject speaks against t h i s p o s s i b l e i n t e r p r e t a t i o n . The subject who terminated sensory d e p r i v a t i o n a f t e r 45 minutes was ex-tremely upset at the time and also anxious not to be excluded from the r e s t of the programme. In order to comfort her at the time, she was t o l d she would not be excluded. She was, i n f a c t , put through the r e s t of the s i x months r e c e i v i n g the same treatment as a l l other s u b j e c t s . She com-p l e t e d the e n t i r e s i x months even though her weight l o s s was not l a r g e . While her data were not i n c l u d e d i n any group, she does provide evidence that the motives f o r remaining i n sensory d e p r i v a t i o n and f o r remaining i n the d i e t programme may be q u i t e d i f f e r e n t . The f a c t that subjects dropped out of the programme because they were disappointed w i t h t h e i r own progress has other i m p l i c a t i o n s f o r the r e s u l t s . The data of dropouts were excluded from a l l analyses except the i n i t i a l analyses of demographic v a r i a b l e s . Had i t been p o s s i b l e to 71 i n c l u d e t h e i r weights at s i x months, the o v e r a l l r e s u l t s would most probably have been qu i t e d i f f e r e n t . The f a c t that dropouts l o s t l e s s weight and the d i f f e r e n t i a l d i s t r i b u t i o n of dropouts among the groups suggest that the r e s u l t s as they stand are on the conservative side.' I f the dropouts w i t h t h e i r n e g l i g i b l e weight l o s s could have been included i n the f i n a l analyses, the other groups, e s p e c i a l l y the nonconfined groups, would have had s i g n i f i c a n t l y l e s s weight l o s s e s than the sensory d e p r i -v a t i o n w i t h message group which had no dropouts. This may account at l e a s t i n p a r t f o r the r e l a t i v e success of the nonconfined - no message group which had three subjects who dropped out of the study. Comparison w i t h other SD Studies I t i s i n t e r e s t i n g to compare the procedure i n t h i s study w i t h those used i n the sensory d e p r i v a t i o n smoking s t u d i e s . In the Suedfeld and Ik a r d experiment (1974) the sensory d e p r i v a t i o n and message v a r i a b l e s were manipulated i n the same way as i n the present study. As mentioned p r e v i o u s l y , sensory d e p r i v a t i o n treatments w i t h and without messages were of comparable e f f e c t i v e n e s s . In the present study the sensory d e p r i v a -t i o n group without messages d i d very poorly r e l a t i v e to the group w i t h messages. The most l i k e l y e x p l a n a t i o n f o r t h i s d i f f e r e n c e l i e s i n the d i f f e r e n t natures of the problems being d e a l t l w i t h . Smoking i s an a l l or nonerc type of problem w h i l e overeating i s not. Obesity i s a problem that i s t i e d much more c l o s e l y w i t h the person's s e l f image and perhaps r e -qu i r e s more e x t e r n a l i n f l u e n c e to modify behavior than does smoking. For these;;reasons the messages may have been more i n f l u e n t i a l i n t h i s study than i n the smoking study. In the smoking study (Suedfeld and 72 I k a r d , 1974), however, sensory d e p r i v a t i o n was not working as an adjunct to some other treatment; i t and the messages represented the e n t i r e treatment. A more recent study by Suedfeld and Best ( i n preparation) examined sensory d e p r i v a t i o n ' s r o l e as a t h e r a p e u t i c f a c i l i t a t o r i n the treatment of the smoking problem. The combination of a sensory d e p r i v a t i o n p l u s messages treatment w i t h a s e l f - m o n i t o r i n g plus s a t i a t i o n smoking t r e a t -ment was much more e f f e c t i v e than e i t h e r treatment alone. In f a c t , the e f f e c t i v e n e s s of the two techniques appeared to be a d d i t i v e . This smoking study i n v o l v i n g a combination of techniques, has more i n common w i t h the present study, which combined sensory d e p r i v a t i o n With a weight plan (Stuart and Davis, 1972). Comparison With Other Weight Reduction Studies Another important comparison f o r t h i s s t u d y . i s w i t h other i n v e s t i g a -t i o n s of weight programmes. Unfortunately such a comparison i s not w i t h -out i t s problems. This study was designed to t e s t whether sensory d e p r i -v a t i o n and messages aided an already t e s t e d weight p l a n . The treatment p e r i o d c o n s i s t e d c h i e f l y of one 24-hour sensory d e p r i v a t i o n s e s s i o n w i t h a one-hour i n s t r u c t i o n p e r i o d afterwards. The f i v e follow-up sessions over the next 24 weeks cannot, however, be s a i d to be t o t a l l y f r e e of th e r a p e u t i c e f f e c t . Not only was there some r e i t e r a t i o n of p o i n t s i n the p l a n , but the contact i t s e l f and the n e c e s s i t y of weighing oneself have been shown to have therapeutic e f f e c t s (Hagen, 1974). One problem there-fore l i e s i n d i s t i n g u i s h i n g the a c t u a l l e n g t h of treatment from the l e n g t h of follow-up i n the present study. While i t i s probably i n c o r r e c t to say that treatment c o n s i s t e d only of the sensory d e p r i v a t i o n and i n -73 s t r u c t i o n , i t i s a l s o wrong to say that treatment l a s t e d f o r s i x months. Another method of assessing treatment length i s the amount of contact w i t h the experimenter. Measured i n t h i s way, treatment i n t h i s study c o n s i s t e d of s i x t h e r a p i s t sessions each of which was one hour long. The 24-hour sensory d e p r i v a t i o n s e s s i o n i n v o l v e d no t h e r a p i s t contact. In other o b e s i t y s t u d i e s that used more than one or two s u b j e c t s , the length of treatment v a r i e d between four weeks and eighteen weeks w i t h follow-ups ranging from none at a l l to one year. T y p i c a l l y , contact w i t h the experimenter was on a weekly b a s i s throughout the treatment p e r i o d . Generally treatment sessions were i n groups r a t h e r than i n d i v i d u a l l y . For comparison purposes a summary of the r e s u l t s of other s t u d i e s which used behaviour management techniques i s presented i n Table 6. This t a b l e i s adapted from Leon (1976) and i n c l u d e s only s t u d i e s w i t h more than two sub-j e c t s . The r e s u l t s of the present study have been t r a n s l a t e d i n t o pounds f o r more d i r e c t comparison. For t h i s t a b l e , treatment i n the present study i s considered the f i r s t two-month p e r i o d and the follow-up i s the s i x month data. This i s a r a t h e r a r b i t r a r y d i s t i n c t i o n b u t , as mentioned above the d e f i n i t i o n of treatment length i s d i f f i c u l t i n t h i s study. The sensory d e p r i v a t i o n session and enough of the experimenter contact d i d occur during the f i r s t two months to warrant t h i s d e l i n e a t i o n i n the t a b l e . An o v e r a l l comparison of the r e s u l t s of the current study w i t h the r e s u l t s of the other s t u d i e s i n Table 6 show the present procedure to be on a par w i t h most of the others. The r e s u l t s at 2 months f o r the sensory d e p r i v a t i o n w i t h message treatment i s comparable to eleven weeks of TABLE 6 (Adapted from Leon, 1976) Study No. of S's Treatment Weight Loss (lbs); Follow-up Weight l o s s P eriod _ _ , _ P e r i o d pretreatment-, , v P r e - End of -^ -i i (wks) . ^ follow-up treatment treatment Present Study St u a r t (1967) Stuart (1971) H a r r i s (1969) Wollersheim (1970) Hagen (1974) 39 8 6 21 79 89 Penick, F i l i o n , Fox & Stunkard (1971) 32 12 15 9-11 12 10 12 SD-M SD-NM NC-M NC-NM treatment delayed t r e a t , A versive cond, C o n t r o l 8.07 .23 5.73 5.17 12.0 15.0 +5.0 8.1 6.9 4 mos. S o c i a l Pressure 5.4 No n s p e c i f i c 6.9 Learning 10.33 Co n t r o l +2.39 Contact Manual & Con-t a c t Manual Co n t r o l Behav. Mod. Group Ther-apy 11.94 15.00 12.00 1.80 53% > 20 l b . 33% > 30 l b . 13% > 40 l b . 24% > 20 l b . 12 mo. 3-6 mos. 1 mo. 2 mo. 1 mo. 3 mo. 12.91 2.39 1.48 5.19 37.7 35.0 21.0 11.1 9.9 +3.6 3.54 6.52 8.61 12.27 13.34 10.50 .11 53% 40% 27% 29% 18% 12% 20 l b . 30 l b . 40 l b . 20 l b . 30 l b . 40 l b . Table 6 (cont'd) Abrahms and A l l e n 49 9 (1974) H a l l (1972) 14 10 Harmatz & Lapuc (1963) 21 6 H a r r i s & Bruner (1971) 32 12 J e f f r e y <? C h r i s t i a n 43 18 (1972) Mahoney, Mowra & Wade 53 4 (1973) Monetary 11.67 2 mo. 11.17 Beh a v i o r a l 12.19 12.28-Soc. Reinf. 8.09 11.25 C o n t r o l +1.70 +1.16 Experimenter C o n t r o l l e d 10.1 S e l f C o n t r o l l e d 5.6 Di e t 0 1 mo. 0 Group Therapy 4.90 2.94 Behavior. Mod. 7.8 13.66 S e l f C o n t r o l 7.4 10 mo. .6 Contract 13,4 +11.3 A t t e n t i o n -Placebo +1.5 +9.4 Behav. Ther. 16.31 4-1/2 mo. 16.31 W i l l Power 5.09 Co n t r o l 1.70 S e l f Reward 6.4 4 mo. 11.5 S e l f Punishment 3.7 7.3 Both 5.2 12.0 S e l f M o n i t o r i n g .8 4.5 Information Con. 1.4 3.2 75 ave r s i v e c o n d i t i o n i n g ( H a r r i s , 1969), nine weeks of s o c i a l reinforcement (Abrahms and A l l e n , 1974), s i x weeks of behaviour m o d i f i c a t i o n (Harmatz and Lapuc, 1968), or 12 weeks of a s e l f - c o n t r o l treatment ( H a r r i s and Bruner, 1971), to name a few. The present study compares f a v o r a b l y w i t h the others i n the pe r i o d between treatment and f i n a l follow-up. The ma-j o r i t y of other treatments showed e i t h e r maintenance of the weight l o s t or a c t u a l weight gain during the f o l l o w up p e r i o d . By c o n t r a s t , both of our sensory d e p r i v a t i o n groups l o s t weight during the follow-up p e r i o d . • O v e r a l l , the present procedure appears no l e s s e f f e c t i v e than other - techniques and co n s i d e r i n g the amount of t h e r a p i s t time i n v o l v e d i s - gener-a l l y more c o s t - e f f i c i e n t . The next step f o r f u r t h e r i n v e s t i g a t i o n s i s to combine sensory d e p r i v a t i o n and ther a p e u t i c messages w i t h a r e g u l a r weekly contact schedule. This treatment procedure i s c u r r e n t l y being studied w i t h extremely encouraging i n i t i a l r e s u l t s ( B o r r i e , i n pr o g r e s s ) . Treatment of Methodological Problems A d d i t i o n a l comparative e v a l u a t i o n of the present study can be made regarding the handling of methodological problems common i n o b e s i t y r e -search. These problems were s p e l l e d out i n d e t a i l i n the f i r s t chapter. D i r e c t comparison w i t h s p e c i f i c s t u d i e s w i l l not be made here; i n s t e a d an examination w i l l be made of the manner i n which the present study accounted f o r these problems and how s u c c e s s f u l t h i s e f f o r t was. One step taken to meet the o b j e c t i o n s r a i s e d about subject popula-t i o n s was the recruitment of subjects from a more general p o p u l a t i o n than u n i v e r s i t y students. This assured a wider age range and broader s o c i a l background i n the experimental sample. The age range was between 21 and 76 57 years. While no d i r e c t measure of s o c i a l status was taken, the l e v e l of education ranged from grade 9 to postgraduate degrees. Other evidence i n favour of t h i s sample being very g e n e r a l i z a b l e to the po p u l a t i o n of obese women i s that a large p r o p o r t i o n of the sample had p r e v i o u s l y t r i e d such commercial weight programmes as Weight Watchers and TOPS. Also the degree of weight problems covered a broad range. Complaints h'ave been made against the poor r e p o r t i n g of i n d i v i d u a l data i n the l i t e r a t u r e . The present study recorded a l a r g e amount of per-sonal data, both demographic and p e r s o n a l i t y , and these data were ana-l y z e d both i n checking f o r group d i f f e r e n c e s and to attempt to di s c o v e r p r e d i c t o r s of success. Not only were the experimental groups equivalent on these demographic and p e r s o n a l i t y v a r i a b l e s , but there were no d i f f e r -ences between the subjects who remained i n the programme and those who t e r -minated e a r l y . More d e t a i l e d r e p o r t i n g of the various i n d i v i d u a l data can be found i n Appendix A. Toward s o l v i n g the problem of dropouts,.steps were taken to lower a t t r i t i o n r a t e s by r e q u i r i n g a 25 d o l l a r deposit that would be returned at the completion of the programme. While t h i s may have reduced the dropout r a t e somewhat, the f a c t that the deposit was to go to a worthy c h a r i t y , the Canadian Heart Fund, made f o r f e i t u r e l e s s unpleasant. In f a c t s e v e r a l subjects p r e f e r r e d to donate t h e i r deposit even a f t e r s u c c e s s f u l l y com-p l e t i n g the programme. P r e d i c t o r s of Weight Loss The search f o r demographic and p e r s o n a l i t y p r e d i c t o r s of success y i e l d e d only three s i g n i f i c a n t p r e d i c t o r s - one m o t i v a t i o n a l , one expecta-77 t i o n a l , and one b e h a v i o u r a l . The m o t i v a t i o n a l p r e d i c t o r was the impor-tance of p l e a s i n g one's spouse. The stronger t h i s motive was, the l e s s s u c c e s s f u l the subject was i n the programme. The i m p l i c a t i o n here i s that when one i s t r y i n g to l o s e weight f o r someone e l s e , even a very c l o s e other, there i s a poorer chance of succeeding. In order f o r the person to have the greatest l i k e l i h o o d of success i n l o s i n g weight that person must want to do i t f o r h e r s e l f . This f i n d i n g i s p a r a l l e l e d by one case i n the Suedfeld & Ikard (1973) smoking study i n which one unsuccessful subject admitted that she r e a l l y only j o i n e d the study i n order to p l a c a t e her f a m i l y who wanted her to q u i t smoking. The expectation v a r i a b l e that p r e d i c t e d weight l o s s was the amount of d i f f i c u l t y that the subject a n t i c i p a t e d she would have i n s t i c k i n g to the programme. Those who f e l t i t would be more d i f f i c u l t l o s t more weight than those who thought i t would be e a s i e r . This f i n d i n g i m p l i e s that a r e a l i s t i c view of the hardship i n v o l v e d i n l o s i n g weight i s an important f a c t o r . Losing weight i s hard work and at times d i s a p p o i n t i n g , and an e a r l y r e a l i z a t i o n of t h i s f a c t helps one to deal w i t h i t . On the other hand, un r e a l expectations of an easy or "magical" s o l u t i o n lead to poor progress. The f i n a l p r e d i c t o r was the behavioural s e l f - r e p o r t of how much e f -f o r t the subject was making to slow down her e a t i n g . Those who reported e a t i n g s l o w l y a greater percentage of the time l o s t greater amounts of weight than those who reported e a t i n g s l o w l y l e s s of the time. This was the only behavioural f a c t o r that d i d p r e d i c t weight l o s s . This i s a l s o the behaviour step that i s l i n k e d most c l o s e l y w i t h the a c t u a l i n g e s t i o n of food. I t i s q u i t e probable', that more concern w i t h t h i s step .is an 78 expression of increased awareness of the e a t i n g process. Since over-e a t i n g i s the major cause of overweight,increased a t t e n t i o n to the a c t u a l performance of the act of e a t i n g i s one very d i r e c t b e h a v i o r a l s o l u t i o n . The f a c t that these p a r t i c u l a r v a r i a b l e s were the only s i g n i f i c a n t p r e d i c t o r s of weight l o s s has some fortunate i m p l i c a t i o n s f o r the t r e a t -ment of o b e s i t y . While these three p r e d i c t o r s are q u i t e d i f f e r e n t from one another, they do have the common feature of being changeable and t r a i n a b l e v a r i a b l e s r a t h e r than permanent subject v a r i a b l e s . One way to e x p l a i n the advantage of these p r e d i c t o r s f o r treatment i s to consider p o s s i b l e a l t e r n a t i v e p r e d i c t o r s . I f , f o r i n s t a n c e , a demographic v a r i a b l e l i k e number of c h i l d r e n or a p e r s o n a l i t y v a r i a b l e l i k e f i e l d dependence had been the best p r e d i c t o r of success, then those not possessing the " r i g h t q u a l i t y " on these f a c t o r s would have a poor prognosis s i n c e there i s l i t t l e hope of changing that q u a l i t y . But as i t i s , each of the v a r i -ables found to be a good p r e d i c t o r i s manipulable. This i s because i n each case the v a r i a b l e i s r e l a t e d to a t t i t u d e s that can be changed. Treat-ment of o b e s i t y can e a s i l y i n c o r p o r a t e increased emphasis on the impor-tance of expecting d i f f i c u l t y , of l o s i n g weight f o r y o u r s e l f and not f o r o t h e r s , and of e a t i n g slowly at a l l times. Considering t h i s , i t i s pro-bable that the emphasis on a t t i t u d e change i n the c o n d i t i o n w i t h sensory d e p r i v a t i o n and messages c o n t r i b u t e d to i t s greater success. However, there were no s i g n i f i c a n t intergroup d i f f e r e n c e s on these three v a r i a b l e s to support t h i s hypothesis. Data C o l l e c t i o n As mentioned e a r l i e r a l a r g e r amount and v a r i e t y of i n d i v i d u a l data 79 were c o l l e c t e d and reported. Moreover, c r u c i a l data such as weight were c o l l e c t e d by the experimenter r a t h e r than r e l y i n g on subject r e p o r t . A great deal has been s a i d against using absolute weight change as the sol e c r i t e r i o n of success. For t h i s reason, measurements of s k i n f o l d s were i n c l u d e d i n the present study. While there was some c o r r e l a t i o n between I n i t i a l - w e i g h t - , a r i d - s k i n f o l d measurements, as w e l l as between weight change and s k i n f o l d change, there were no s i g n i f i c a n t treatment e f f e c t s on the s k i n f o l d v a r i a b l e . This r e s u l t might be viewed as a statement against the e f f e c t i v e n e s s of the treatment; however, i t i s more probably a demon-s t r a t i o n of the u n r e l i a b i l i t y of s k i n f o l d measures. Even f o r a w e l l t r a i n e d and p r a c t i c e d i n d i v i d u a l , i t i s d i f f i c u l t to get the exact same readings w i t h repeated measurements (Mayer, 1968; Grimes & F r a n z i n i , 1976) . For t h i s reason an average of three separate measurements at each s i t e was used i n t h i s study. A more c r i t i c a l problem i s the f a c t that the c o r r e l a t i o n s between weight change and s k i n f o l d changes were a c t u a l l y q u i t e s m a l l . The h i g h e s t , between weight change and i n f r a s c a p u l a r s k i n f o l d , was only .50 which leaves much room f o r v a r i a t i o n . A c t u a l l y many subjects showed weight change i n one d i r e c t i o n and s k i n f o l d change i n the other, or weight change and no s k i n f o l d change, or v i c e v e r s a . Many of the subjects showed d i f f e r e n -t i a l change f o r the d i f f e r e n t s k i n f o l d s i t e s . I t seems then, that s k i n -f o l d measurements may be much more i n f l u e n c e d by such f a c t o r s as type and q u a n t i t y of e x e r c i s e (Grimes & F r a n z i n i , 1976), and ther e f o r e are not e s p e c i a l l y r e l i a b l e c r i t e r i a f o r o v e r a l l f a t l o s s . I t i s probable that i n the case of l a r g e r weight lo s s e s s k i n f o l d measures might be a more va l u a b l e c r i t e r i o n v a r i a b l e . I t i s al s o p o s s i b l e that by i n c l u d i n g a l a r g e r number 80 of s k i n f o l d s i t e s r e l i a b i l i t y might have been increased. However, i n t h i s study the two s i t e s reported to be most i n d i c a t i v e of o v e r a l l body f a t were used (Tannen & Whitehouse, 1975). Subject r e a c t i o n to the programme Another feature i n c l u d e d i n t h i s study was a suggestion by Stuart (1973) to record s u b j e c t s ' responses to the programme i t s e l f . Each sub-j e c t was asked whether she f e l t the programme had been s u c c e s s f u l , whe-ther she f e l t b e t t e r i n general about h e r s e l f , whether she f e l t h e a l t h i e r and what she f e l t the good and bad p o i n t s of the programme were. Opinions of programme success, f e e l i n g b e t t e r about o n e s e l f , and f e e l i n g h e a l t h i e r were a l l i n t e r e o r r e l a t e d but more importantly they were each r e l a t e d to weight change. This was most pronounced w i t h the f e e l i n g of the programme's success. L o g i c a l l y , the more weight the subject l o s t the more s u c c e s s f u l she f e l t the programme was. The most frequent responses to the question concerning the programme's best aspects were: the book (28% of the subjects mentioned t h i s ) , the d i e t i t s e l f (28%) , and the e x e r c i s e (33%). Although e x e r c i s e was men-tioned the most f r e q u e n t l y many subjects a l s o commented that i t would have been good i f they had been able to s t i c k to i t . I t i s a l s o i n t e r e s t i n g to note that nine of the 11 who l i s t e d the book as the best feature had not heard the tape recorded messages. However only two subjects s a i d the tape was one of the best aspects of the programme. Others; o f t e n mentioned "best" features were r e g u l a r checks (18%) , becoming aware of e a t i n g h a b i t s (15%) , and e a t i n g i n one place (18%). The sensory d e p r i v a t i o n s e s s i o n was mentioned as a "best" aspect by only three (15%) of the 20 subjects who 81 experienced i t but another 15% reported that they d i d not know whether i t had been b e n e f i c i a l or not. On the other hand 20% of the sensory d e p r i v a t i o n s u b j e c t s l i s t e d sensory d e p r i v a t i o n as the programme's worst aspect. The most f r e q u e n t l y mentioned "worst" features were the infrequency of follow-up v i s i t s (28%) having to keep records (18%), and the inconvenient l o c a t i o n of the pro-gramme (13%). With suggestions f o r improvement of the programme there was much more consensus. Twenty-six (66%) subjects suggested that more contact would be h e l p f u l and 11 (28%) thought that meeting i n groups would be an improvement. The only other improvement mentioned by more than three subjects was to hear the taped messages again (15%). A l l s i x of these subjects were i n the message only group. Three of the sensory de-p r i v a t i o n subjects s a i d they would have l i k e d another s e s s i o n of sensory d e p r i v a t i o n . Several other improvement suggestions were made by only one or two subjects but seem worth mentioning because of t h e i r p o t e n t i a l usefulness to other programmes. I t was suggested that the book d i d not provide enough s p e c i f i c e x e r c i s e m a t e r i a l and that more d i r e c t i o n should be given i n e x e r c i s e w i t h the p o s s i b l e i n c l u s i o n of group e x e r c i s e sessions. One subject suggested that i t would be of b e n e f i t both to the i n d i v i d u a l and to the programme i f p a r t i c i p a n t s had the option to volunteer time to work f o r the programme. A s s i s t a n c e provided i n t h i s way might be a good way to meet some of the other suggestions, such as. more l i t e r a t u r e a v a i l a b l e , more contact w i t h f a m i l i e s to gain t h e i r support, and a longer programme i n general. 82 Treatment Format The t h i r d major area of methological o b j e c t i o n s i s that of the ac-t u a l treatment format. The steps taken i n t h i s study to meet these pro-blems were to use a standard d i e t form, to use standardized i n t e r v i e w and follow-up procedures, and to f o l l o w subjects f o r at l e a s t s i x months. The standard d i e t and e x e r c i s e p l a n used was that i n the booklet S l i m  Chance i n a Fat World (Stuart and Davis, 1972) which had the advantage of being a tested,commercially a v a i l a b l e product. Standardized handling of subjects was achieved by using prepared data c o l l e c t i o n forms which r e -quired s p e c i f i c i n t e r v i e w questions. D i f f e r e n c e s i n experimenter-subject contact occurred only when subjects asked questions about s p e c i f i c person-a l problems. Response to these questions was made as standard as p o s s i b l e by u s i n g the t e x t and the taped message content as g u i d e l i n e s . Neverthe-l e s s i t cannot be s a i d that each subject received p r e c i s e l y the same t r e a t -ment word f o r word. I t i s doub t f u l though that such minor d i s c r e p a n c i e s i n subject handling would have had any n o t i c e a b l e e f f e c t on the o v e r a l l r e s u l t s . This i s so e s p e c i a l l y s i n c e there i s no reason to suspect any systematic between-group d i f f e r e n c e s i n treatment. Relevant to t h i s l a s t p o i n t i s an iss u e which remained a problem i n t h i s study as w e l l . Throughout the study subjects were seen by only one experimenter who knew the r e l e v a n t hypotheses and p r e d i c t i o n s of the study. During the running of the study, however, the experimenter was concerned only w i t h the welfare and progress of each subject as an i n d i v i d u a l and t r i e d as much as p o s s i b l e to ignore treatment group d i s t i n c t i o n s . This was made e a s i e r by the f a c t that there was no group p a t t e r n to the sche-83 d u l i n g of i n t e r v i e w s and follow-ups. In most res p e c t s , then, the metho-d o l o g i c a l problems seem to have been handled s a t i s f a c t o r i l y i n t h i s study. Relevance to t h e o r i e s of o b e s i t y One important c o n s i d e r a t i o n yet to be discussed i s how the present f i n d i n g s r e f l e c t on r e l e v a n t t h e o r i e s of o b e s i t y . While not designed s p e c i f i c a l l y to t e s t any p a r t i c u l a r theory of o b e s i t y , the study d i d i n -clude data r e l e v a n t to Schachter's suggestions of i n t e r n a l - e x t e r n a l o r i e n -t a t i o n d i f f e r e n c e s i n the obese and nonobese. A l l subjects were test e d on a b a t t e r y of measures r e l a t e d to t h i s d i f f e r e n c e i n o r i e n t a t i o n . Most of these measures were not r e l a t e d to the s u b j e c t s ' i n i t i a l weight, though there were exceptions. Heavier subjects d i d e x h i b i t higher e x t e r n a l i t y scores on the Locus of C o n t r o l t e s t . This was true only f o r the t o t a l Locus of C o n t r o l score and not f o r the i n d i v i d u a l subscales, which sug-gests that perhaps e x t e r n a l i t y i n overweight i n d i v i d u a l s i s a very general f a c t o r . I f t h i s i s so, i t may be that the other measures of e x t e r n a l i t y were too s p e c i f i c i n content to tap the i n t e r n a l - e x t e r n a l dimension ade-quately. On the other hand, the c o r r e l a t i o n between Locus of C o n t r o l and i n i t i a l weight, although s t a t i s t i c a l l y s i g n i f i c a n t , was only l a r g e enough to describe a s l i g h t tendency. I t i s a l s o i n t e r e s t i n g that t h i s p a r t i c u l a r measure has f a i l e d to d i s c r i m i n a t e weight groups i n other s t u d i e s (Gormanous and Lowe, 1975). Another measure r e l a t e d to i n i t i a l weight was the Autonomic Percep-t i o n score. More awareness of autonomic a c t i v i t y was reported by heavier s u b j e c t s . This i s e x a c t l y the opposite to what Schachter's hypothesis would p r e d i c t , which i s that the heavier subject should e x h i b i t l e s s 84 awareness of i n t e r n a l cues. This p a r t i c u l a r measure, being a s u b j e c t i v e s e l f - r e p o r t s c a l e , may a c t u a l l y be measuring concern about.body f u n c t i o n r a t h e r than awareness of i n t e r n a l a c t i v i t y . McFarland (1975) found t h i s measure to be a poor p r e d i c t o r of a subject's a b i l i t y to perceive h i s own a c t u a l heart a c t i v i t y . I n t e r p r e t e d as a measure of i n t e r n a l concern, the present f i n d i n g provides some support f o r the m i s l a b e l e d emotion hypothe-s i s . Overweight persons are more focused on i n t e r n a l f u n c t i o n s but are not able to c l e a r l y perceive and d i f f e r e n t i a t e those f u n c t i o n s . One of the major reasons f o r i n c l u d i n g the various measures of ex-t e r n a l i t y was to t e s t the p o s s i b i l i t y that some aspect of i n t e r n a l - e x t e r n a l d i f f e r e n c e s could p r e d i c t i n d i v i d u a l success i n a programme based l a r g e l y on manipulating e x t e r n a l cues. The key to the Stuart and Davis (1972) p l a n i s to c o n t r o l one's environment i n order to encourage d e s i r a b l e beha-v i o r s and discourage undesireable ones. There was wide v a r i a t i o n on sub-j e c t s ' scores f o r a l l . of the measures!-)' however, none of the measures proved to be at a l l r e l a t e d to success. As mentioned e a r l i e r , the absence of a p e r s o n a l i t y v a r i a b l e that p r e d i c t s success i n l o s i n g weight i s expedient Tor the tireatmentjiPiff o b e s i t y , but could be d e l e t e r i o u s to an o b e s i t y theory based on p e r s o n a l i t y d i f f e r e n c e s . Even i f c o n s i s t e n t d i f f e r e n c e s e x i s t between obese and normal weight persons i n o r i e n t a t i o n measures (a hypothesis not t e s t e d i n t h i s s t u d y ) , the usefulness of such d i f f e r e n c e s i s lessened i f they cannot be used to p r e d i c t success i n weight l o s s attempts. I t i s true that Rodin and Slotfhowerl (1976) used e x t e r n a l i t y measures s u c c e s s f u l l y to p r e d i c t weight gain i n c h i l d r e n who were l i v i n g i n a novel environment. However, these 85 researchers a l s o found that those who l o s t weight i n the same s i t u a t i o n scored higher e x t e r n a l i t y than those whose weight remained constant. Although Rodin and Slochower (1976) used e x t e r n a l i t y measures which d i f -f e r ed from those used i n the present study, the d i f f e r e n c e between t h e i r s u c c e s s f u l p r e d i c t i o n and the present l a c k of success at p r e d i c t i o n i s probably b e t t e r explained by the change of environment. Their subjects - were i n a s i t u a t i o n e n t i r e l y d i f f e r e n t '\f.com the home s e t t i n g , w h i le the subjects i n t h i s study (and i n most other treatment s t u d i e s ) c a r r i e d out the programme i n t h e i r normal everyday environment. The former s i t u a t i o n had no h a b i t patterns l i n k e d to e a t i n g cues i n the s e t t i n g except food i t -s e l f , whereas the l a t t e r s i t u a t i o n has a w e l l e s t a b l i s h e d set of e a t i n g h a b i t s t i e d f i r m l y to the stimulus patterns of a f a m i l i a r environment. I t may be that e x t e r n a l i t y does p l a y a part i n e s t a b l i s h i n g h a b i t s i n a novel s i t u a t i o n , but i t d i d not p r e d i c t success i n weight l o s s a t -tempts i n a f a m i l i a r environment. At l e a s t t h i s i s true w i t h the measures of e x t e r n a l i t y used i n t h i s study. In a f a m i l i a r s i t u a t i o n an important f a c t o r would be the ease w i t h which one can e x t i n g u i s h e x i s t i n g h a b i t s and l e a r n new ones. Perhaps a measure of t h i s would make a b e t t e r p r e d i c t o r of success than measures of e x t e r n a l i t y . Singh (1973) has suggested that overeating can be b e t t e r understood as an i n a b i l i t y to i n h i b i t a w e l l learned response than a d i f f e r e n c e i n e x t e r n a l o r i e n t a t i o n . While not s p e c i f i c a l l y t e s t i n g ease of e x t i n c t i o n , Singh d i d f i n d that obese sub-j e c t s were l e s s able than normal weight subjects to suppress response ten-dencies when s i t u a t i o n a l demands were changed. This i n a b i l i t y to suppress an ongoing response would seem to be r e l a t e d to ease of e x t i n c t i o n and r e l e a r n i n g . 86 A measure of t h i s r e l e a r n i n g would be easy to e s t a b l i s h ; the sub-j e c t could o v e r l e a r n some simple response and then go through e x t i n c t i o n of that response w i t h the simultaneous l e a r n i n g of an a l t e r n a t i v e r e -sponse. The number of t r i a l s to e x t i n c t i o n as w e l l as t r i a l s to l e a r n i n g the new response might then provide v a l u a b l e i n f o r m a t i o n on the subject's prognosis i n t h i s s o r t of programme. I n d i v i d u a l D i f f e r e n c e s Recently Leon Roth (T1977) a f t e r .a.gfchorough review o f the t h e o r e t i c a l i s -sues i n ob e s i t y has concluded that the "search f o r a u n i t a r y explanation of o b e s i t y does not, at present, appear to be a f r u i t f u l avenue of ex p l o r a -t i o n , and the evidence s t r o n g l y suggests that o b e s i t y i s not a u n i t a r y syndrome" (1977, p. 138). The search f o r i n d i v i d u a l d i f f e r e n c e s that can e x p l a i n o b e s i t y and p r e d i c t success of treatment has l a r g e l y been disap-p o i n t i n g . Leon N v& ;;Ro"th .(1977)'-concluded, that ^few^personality c h a r a c t e r i s t i c s common to obese persons can be considered causative f a c t o r s . Even a v a r i -able such as i n i t i a l weight which c o n s i s t e n t l y has been found to be p o s i -t i v e l y c o r r e l a t e d w i t h weight l o s s (Murray, 1975), was not a s i g n i f i c a n t f a c t o r i n the present study. For a measure to be a good p r e d i c t o r of treatment success i t should be s p e c i f i c as to the manner of the treatment f o r which i t i s p r e d i c t i v e ( J e f f r e y , 1972; Leon, 1976). Since the most s u c c e s s f u l behavioural methods of d e a l i n g w i t h o b e s i t y are those that r e q u i r e a r e l e a r n i n g of e a t i n g h a b i t s (Leon, 1976) , a measure of the a b i l i -ty to unlearn and r e l e a r n a response would be rel e v a n t i n f o r m a t i o n . How-ever, i t would not be by any means complete. E a t i n g h a b i t s are not s o l i -t a r y i s o l a t e d behaviours; they are interwoven i n t o every aspect of the person's l i f e . For the obese i n p a r t i c u l a r , food h a b i t s may have a 87 uniquely c e n t r a l importance i n l i f e . The s p e c i f i c p a t t e r n of e a t i n g h a b i t s and t h e i r i n t e r r e l a t e d n e s s to other h a b i t s and cues i n the per-son's l i f e should be the main concern of the behavioural programme. This c o n s t e l l a t i o n of i n t e r r e l a t e d h a b i t s i s where the important i n d i v i -dual d i f f e r e n c e s l i e . I t i s al s o where the key to s u c c e s s f u l treatment of weight problems l i e s . This study, w h i l e paying a t t e n t i o n to a l a r g e q u a n t i t y of personal data that were analyzed or reported i n Appendix A, d i d not inc o r p o r a t e fchese data i n t o the treatment programme f o r the i n d i v i d u a l s u b j e c t . A t r u l y success-oriented treatment would have to do t h i s ; however, the r e -s t r i c t i o n s imposed by research c o n s i d e r a t i o n s make t h i s a rare i n c l u s i o n i n weight s t u d i e s . Keeping t h i s i n mind, the present study was not i n -tended to be a "best" treatment method. I t was rat h e r a t e s t of sensory d e p r i v a t i o n as a.therapeutic f a c i l i t a t o r i n a minimal-contact weight pro-gramme. The f i n d i n g s o f f e r strong evidence that sensory d e p r i v a t i o n w i t h messages increases programme e f f e c t i v e n e s s . Even without messages, sen-sory d e p r i v a t i o n appeared to provide some long-term e f f e c t s to the sub-j e c t s ' m o t i v a t i o n . I t i s important to keep i n mind the r e l a t i o n of sensory d e p r i v a t i o n to the r e s t of the procedure. The a c t u a l exposure to sensory d e p r i v a t i o n was a s i n g l e 24-hour p e r i o d p r i o r to being i n s t r u c t e d i n the a c t u a l d i e t programme to be used. The f o l l o w i n g s i x months of follow-up were b a s i c a l -l y data c o l l e c t i n g times, although i f the subject brought up s p e c i f i c problems they were discussed. Hence, the follow-up sessions d i d i n c l u d e some f u r t h e r i n s t r u c t i o n which c o n s i s t e d of r e i t e r a t i n g p o i n t s contained 88 i n the programme already o u t l i n e d . However contact over s i x months was minimal and, as mentioned e a r l i e r , seen as inadequate by most s u b j e c t s . Thus the r o l e of sensory d e p r i v a t i o n was designed to be an adjunct to a complete weight c o n t r o l programme. P a r t of the explanation f o r the increased e f f e c t i v e n e s s of the sen-sory d e p r i v a t i o n treatment may l i e i n the way i n d i v i d u a l d i f f e r e n c e s , so troublesome i n a standardized programme, a f f e c t the sensory d e p r i v a t i o n experience. I t has been w e l l documented (e.g., Jones, 1969) that i n a s i t u a t i o n where e x t e r n a l s t i m u l a t i o n has been removed, the i n d i v i d u a l seeks to r a i s e h i s l e v e l of i n p u t . With no ready means to increase ex-t e r n a l s t i m u l a t i o n , the i n d i v i d u a l i n sensory d e p r i v a t i o n turns to i n -t e r n a l s t i m u l a t i o n — h i s own thoughts, f a n t a s i e s , r e v e r i e s , dreams, e t c . — to achieve a more d e s i r a b l e input l e v e l . This experience of increased a t -t e n t i o n to i n t e r n a l s t i m u l i w i l l be a completely unique i n d i v i d u a l one, d i f f e r e n t from that of any other person (see Suedfeld and B o r r i e , i n p r e s s ) . Thus, sensory d e p r i v a t i o n , by f o r c i n g the i n d i v i d u a l to focus a t t e n t i o n oh hi m s e l f and to c l o s e l y examine h i s thoughts and f e e l i n g s , provides a f l e x i b l e treatment that accommodates i n d i v i d u a l d i f f e r e n c e s not only i n p e r s o n a l i t y but also i n h a b i t patterns and i n t e r r e l a t i o n s h i p s . Since i n d i v i d u a l r e a c t i o n s to sensory d e p r i v a t i o n have been l i s t e d i n Appendix A, a d e t a i l e d accounting w i l l not be made here. However, the ther a p e u t i c power of t h i s experience i s e x e m p l i f i e d by case #SDNM-9. This woman reported that during sensory d e p r i v a t i o n she f e l t extremely dependent upon the monitor who was outside the chamber. She d i d not l i k e to f e e l this.dependent, and the unpleasantness of the f e e l i n g helped her to r e a l i z e that i n most aspects of her l i f e she was a very dependent 89 person who r a r e l y r e l i e d s o l e l y on her own d e c i s i o n about anything. She a l s o found she never d i d anything that was only f o r her own b e n e f i t . Other persons were always the m o t i v a t i n g forces behind her a c t i o n s . She reported that her experience i n sensory d e p r i v a t i o n had made her i n i t i a l -l y aware of t h i s and she was g r a d u a l l y t a k i n g steps to r e s o l v e the pro-blem and become master of her own l i f e . I n c i d e n t a l l y she f e l t t h i s r e -s u l t was of greater personal s i g n i f i c a n c e than her progress i n the weight programme. S i m i l a r p o s i t i v e s i d e - e f f e c t s of sensory d e p r i v a t i o n have been reported by Suedfeld and Best (1977) i n a recent smoking study. Conclusion In c o n c l u s i o n , . t h i s study has demonstrated that sensory d e p r i v a t i o n can act as a t h e r a p e u t i c f a c i l i t a t o r e s p e c i a l l y when combined w i t h t h e r a -p e u t i c communications. Subjects who r e c e i v e d t h i s combined 24-hour t r e a t -ment were b e t t e r able to c a r r y out a standard behavioural programme of weight reduction than those who had only p o r t i o n s or none of t h i s combina-t i o n . In a d d i t i o n , t h i s treatment seemed to provide a m o t i v a t i o n a l boost as evidenced by continued weight l o s s and lower dropout r a t e . The reasons f o r the e f f e c t i v e n e s s of t h i s combined treatment are l e s s c l e a r . The i n -d i v i d u a l nature of the sensory d e p r i v a t i o n experience allows f o r s e v e r a l simultaneous e x p l a n a t i o n s . AmongTfchese explanations are that sensory de-p r i v a t i o n promotes i n t r o s p e c t i o n , allows one to r e f l e c t on current problems, helps the i n d i v i d u a l increase h i s awareness of i n t e r n a l cues, serves as a s p e c i f i c s t a r t i n g p o i n t f o r the programme, and/or provides a p r e l i m i n a r y t e s t of the i n d i v i d u a l ' s m o t i v a t i o n . With each i n d i v i d u a l any, a l l or none of these may be part of the sensory d e p r i v a t i o n experience. 90 F u r t h e r , the f i n d i n g s of t h i s study support the hypothesis that therapeutic communication i s made more e f f e c t i v e when i t i s heard i n sensory deprivation.. I t i s important to note that t h i s f i n d i n g i s d i f -f e r e n t from the previous smoking st u d i e s where ther a p e u t i c messages had l i t t l e e f f e c t on the f i n a l outcome of the treatment. This d i f f e r e n c e can be a t t r i b u t e d to 1) the d i f f e r e n c e s i n the problems being t r e a t e d and 2) the d i f f e r e n c e s i n message length and content. F i n a l l y , the i m p l i c a t i o n s f o r f u t u r e s t u d i e s d e r i v i n g from t h i s study are twofold. In the area of the treatment of overweight i n d i v i d u a l s , the f i n d i n g s suggest that sensory d e p r i v a t i o n can be a va l u a b l e adjunct to therapy, e s p e c i a l l y when combined w i t h a more powerful i n d i v i d u a l l y o r i e n -ted weight-loss programme. In the area of sensory d e p r i v a t i o n research, t h i s study suggests that sensory d e p r i v a t i o n as a therapy technique needs to be explored f u r t h e r and a p p l i e d to a wider v a r i e t y of problems. A l s o , more a t t e n t i o n should be p a i d to the v a r i a b l e s of s u b j e c t i v e experience that occur i n sensory d e p r i v a t i o n . Greater knowledge of t h i s f a c t o r may suggest new areas to which the method might be a p p l i e d . 90a FOOTNOTE ''"To create groups of equal s i z e f o r the MANOVA's and ANOVA's, subjects SDM-2 SDM-5, and SDNC-5 were randomly s e l e c t e d to be omitted from these analyses. Since subject SDNC-5 d i d very w e l l i n the programme, a second set of analyses was performed o m i t t i n g a d i f f e r e n t subject from the SD-NC group. The r e s u l t s from these analyses d i f f e r e d very l i t t l e from the f i r s t analyses and d i d not change which e f f e c t s were s t a t i s t i c a l l y s i g n i f i c a n t . The r e s u l t s reported are those of the f i r s t analyses w i t h the o r i g i n a l randomly s e l e c t e d subjects omitted. 91 BIBLIOGRAPHY Abrahms, J.L., & A l l e n , G.J, Comparative e f f e c t i v e n e s s of s i t u a t i o n a l programming, f i n a n c i a l pay-offs and group pressure' i n weight r e -d u c t i o n . Behavior Therapy, 1974, 5_, 391-400. Abramson, E.A. A review of b e h a v i o r a l approaches to weight c o n t r o l . Behavior Research and Therapy, 1973, __, 547-556. Adams, H.B., Robertson, M.H,, & Cooper, G.D. Sensory d e p r i v a t i o n and p e r s o n a l i t y change, J o u r n a l of Nervous and Mental D i s o r d e r s , 1966, 143, 256-265. A y l l o n , T. I n t e n s i v e treatment of p s y c h o t i c behavior by stimulus s a t i a -t i o n and food reinforcement. Behavior Research and Therapy, 1963, 1, 53-61. Azima, H., & Cramer-Azima, F.J. E f f e c t s of p a r t i a l p e r c e p t u a l i s o l a t i o n i n mentally d i s t u r b e d i n d i v i d u a l s . Diseases of the Nervous System, 1956, 17, 117-122. Baekeland, F,, & Lundwall, L. Dropping out of treatment: a c r i t i c a l r e -view. P s y c h o l o g i c a l B u l l e t i n , 1975, 82, 738-783. Barber, T,X, Measuring " h y p n o t i c - l i k e " s u g g e s t i b i l i t y w i t h and without "hypnotic induction/ 1"', Psychometric p r o p e r t i e s , norms and v a r i a b l e s i n f l u e n c i n g response to the Barber S u g g e s t i b i l i t y Scale. Psycholo- g i c a l Reports, 1965, 10, 809-844. Barnes, L . J . Comparative e f f e c t i v e n e s s of a Five Day P l a n and a Sensory D e p r i v a t i o n Program on Reduction and Abstinence from C i g a r e t t e  Smoking. Unpublished Master's Thesis, Dalhousie U n i v e r s i t y , 1976. 92 B e l l a c k , A.S., Rozensky, R. , & Schwartz, J . A comparison of two forms of s e l f - m o n i t o r i n g i n a b e h a v i o r a l weight r e d u c t i o n program. Behavior Therapy, 1974, 5_, 523-530. Berland, T. Rating the D i e t s . Skokie, I l l i n o i s : Consumer Guide, 1974. Bexton, W.H., Heron, W., & S c o t t , T.H. E f f e c t s of decreased v a r i a t i o n i n the sensory environment. Canadian J o u r n a l of Psychology, 1954, 8, 70-76. Bray, G.A. The v a r i e t i e s of o b e s i t y ,In G.A. Bray & J.E. Bethune (Eds.), Treatment and Mariagmerit of Obesity, N.Y.: Harper & Row, 1974. Bruch, H. E a t i n g D i s o r d e r s : Obesity, Anorexia-. Nervosa, and the Person  W i t h i n . N.Y.: B a s i c Books, 1973. Cannon, W.B. B o d i l y Changes i n B a i n , Hunger, Tear and ;Rage. N.Y.: Appleton, 1929. Cannon, W.B. , and Washburn, A.L. An explanation of hunger. American J o u r n a l of Physiology, 1912, 2A_, 441. Cautela, J . Covert s e n s i t i z a t i o n . P s y c h o l o g i c a l Reports, 1967, 20_, 459-460. Cleveland, S.E., Reitman, E.E., & B e r t i n c k , C. Therapeutic e f f e c t i v e n e s s of sensory d e p r i v a t i o n . Archives of General P s y c h i a t r y , 1963, 8^ , 455-460. Coddington, R.D., & Bruch, H. G a s t r i c p e r c e p t i v i t y i n normal, obese and s c h i z o p h r e n i c s u b j e c t s . Psychosomatics, 1970, 11_, 571-579. Cohen, B., Rosenbaum, G., Dobie, S., & G o t t l i e b , J . Sensory i s o l a t i o n : h a l l u c i n o g e n i c e f f e c t s of a b r i e f procedure. J o u r n a l of Nervous and  Mental D i s o r d e r s , 1959, 129, 486-491. 93 Cooper, G.D., Adams, H.B., & Cohen, L.D. Changes i n p e r s o n a l i t y a f t e r sensory d e p r i v a t i o n . J o u r n a l of Nervous and Mental D i s o r d e r s , 1965, 140, 103-118. Cooper, K.H. Aer o b i c s , N.Y.: Bantam Books, 1975. E a r l y , K. Insensate care: Removing s t i m u l i produces a response too. The Sciences, 1975, 15, 6-10. Eysenck, H.I. The Structure of Human P e r s o n a l i t y , N.K. Macmillan, 1960. Fernan, W. The r o l e of experimenter contact i n b e h a v i o r a l b i b l i o t h e r a p y  of o b e s i t y . Unpublished Master's Thesis, Pennsylvania State U n i -v e r s i t y , 1973. F e r s t e r , C.B., Nurnberger, J . I . , & L e v i t t , E.B. The c o n t r o l of e a t i n g . J o u r n a l of M a t h e t i c s , 1962, 1, 87-104. Foreyt, J.P., & Kennedy, W.A. Treatment of overweight by av e r s i o n t h e r a -py. Behavior Research and Therapy, 1971, ]_, 29-34. F r a n z i n i , L.R., & Grimes, W.B. Treatment s t r a t e g i e s f o r c l i n i c i a n s con-ducting weight c o n t r o l programs. Paper presented at the meeting of the Western P s y c h o l o g i c a l A s s o c i a t i o n , Los Angeles, A p r i l , 1976(a). F r a n z i n i , L.R., & Grimes, W.B. S k i n f o l d measures as the c r i t e r i o n of change i n weight c o n t r o l s t u d i e s . Behavior Therapy, 1976(b) 7_: 256-260. Gibby, R.G., Adams, H.B., & Carre r a , R.N. Therapeutic changes i n p s y c h i a -t r i c p a t i e n t s f o l l o w i n g p a r t i a l sensory d e p r i v a t i o n . Archives of General P s y c h i a t r y , 1960,.3_: 33-42. 94 Gibby, R.G., & Adams, H.B. Receptiveness of p s y c h i a t r i c p a t i e n t s to v e r b a l communication: An increase f o l l o w i n g p a r t i a l sensory and s o c i a l i s o l a t i o n . Archives of General P s y c h i a t r y , 1961, 5_, 366-370. Gormanous, G.K., & Lowe, W.C. Locus of c o n t r o l and o b e s i t y . P s y c h o l o g i - c a l Reports, 1975, 37, 30. Grimes, W.B., & F r a n z i n i , L.R. S k i n f o l d measurement techniques of e s t i - mating percent body f a t . Unpublished manuscript, 1976. Hagen, R.L. Group therapy versus b i b l i o t h e r a p y i n weight r e d u c t i o n . Behavior. Therapy, 1974, 5_, 222-234. '.9\ Hagga;yd4s' C. , Jjs,- A., & Bcfrgejr, C, S o c i a l i s o l a t e s and u r b a n i t i e s i n per-cep t u a l i s o l a t i o n . J o u r n a l of Abnormal Psychology, 1970, 79_, 1-9. H a l l , S.M. S e l f - c o n t r o l and t h e r a p i s t c o n t r o l i n the b e h a v i o r a l t r e a t -merit of overweight women. Behavior Research and Therapy, 1972, 10, 59-68. H a l l , S.M., & H a l l , R.G. Outcome and methodological c o n s i d e r a t i o n s i n be-h a v i o r a l treatment of o b e s i t y . Behavior Therapy, 1974, _5, 352-364. Harmatz, M.G., & Lapuc, P. Behavior m o d i f i c a t i o n of o v e r e a t i n g i n a psy-c h i a t r i c p o p u l a t i o n . J o u r n a l of C o n s u l t i n g and C l i n i c a l Psychology, 1968, 32, 583-587. H a r r i s , A. Sensory d e p r i v a t i o n and s c h i z o p h r e n i c s . J o u r n a l of Mental  Science, 1959, 105, 235-237. H a r r i s , M.B. S e l f - d i r e c t e d program f o r weight c o n t r o l . A p i l o t study. J o u r n a l of Abnormal Psychology, 1969, 74_, 263-270. 95 H a r r i s , M.B., & Bruner, C G . A comparison of a s e l f - c o n t r o l and a con-t r a c t procedure f o r weight c o n t r o l . Behavior Research and Therapy, 1971, 9_, 347-354. Hashim, S.A., & Van I t a l l i e , T.B. Studies i n normal and obese subjects with a monitored food dispensing device. Annals of the New York  Academy of Sciences, 1965, 131, 654-661. Heron, W. The pathology of boredom. S c i e n t i f i c American, 1957, 196, 52-56. James, W. The p r i n c i p l e s of psychology. New York: Henry H o l t , 1890. Janda, L.H., & Rlmm, D.C. Covert s e n s i t i z a t i o n i n the treatment of o b e s i t y . J o u r n a l of Abnormal Psychology, 1972, 80, 37-42. J e f f r e y , D.B. A comparison of the e f f e c t s of e x t e r n a l c o n t r o l and s e l f c o n t r o l on the m o d i f i c a t i o n and maintenance of weight. J o u r n a l of  Abnormal Psychology, 1974, 83, 404-410. J e f f r e y , D.B. A d d i t i o n a l methodological c o n s i d e r a t i o n s i n the b e h a v i o r a l treatment of o b e s i t y . A r e p l y to the H a l l and H a l l review of obe-s i t y . Behavior Therapy, 1975, _5, 96-97. J e f f r e y , D.B. A proposal f o r a macro environmental a n a l y s i s i n the pre-v e n t i o n and treatment of o b e s i t y . In B.Williams, S. M a r t i n , and J.P. Foreyt (Eds.), Obesity: B e h a v i o r a l approaches to d i e t a r y manage-ment, N.Y.: Brummer/Mazel, 1976, 20-29. J e f f r e y , D.B., & Christensen, E.R. E f f e c t of behavior therapy vs. " w i l l power" i n the management of o b e s i t y . J o u r n a l of Psychology, 1975, 90, 303-311. Jones, A. Stimulus-seeking behavior, i n J.P. Zubek, (Ed.), Sensory D e p r i - v a t i o n : F i f t e e n years of research. N.Y.: Appleton-Century-Crofts, 1969, 167-206. 96 Jung, C G . P s y c h o l o g i c a l Types, New York: Harcourt, 1933. Kammerman, M. P e r s o n a l i t y changes r e s u l t i n g from water-suspension sen-sory i s o l a t i o n . In Mv-;'Kaibmemari. (Ed.) Sensory l o c a t i o n and person- a l i t y Change. S p r i n g f i e l d , 111.: Charles C. Thomas, 285-301, 1977. Kennedy, W.A., & Foreyt, J . Cont r o l of e a t i n g behavior i n an obese pa-t i e n t by avoidance c o n d i t i o n i n g . P s y c h o l o g i c a l Reports, 1968, 22, 571-576. Kouretas, D. The o r a c l e of Trophotiius: A kind of shock-treatment a s s o c i a -ted w i t h sensory d e p r i v a t i o n i n ancient Greece. B r i t i s h J o u r n a l of  P s y c h i a t r y , 1968, 113, 1441-1446. Lacey, J . I . Somatic response p a t t e r n i n g and s t r e s s : Some r e v i s i o n s of a c t i v a t i o n theory. In M.H. Appley and R. Trumbull (Eds.), Psycho- l o g i c a l S t r e s s . N.Y.: Appleton-Century-Crofts, 1967, 14-37. Lei t e n b e r g , H. (Ed.), Handbook of behavior m o d i f i c a t i o n and behavior t h e r a - py. Inglewood C l i f f s , N.J,: P r e n t i c e - H a l l , 1976. Leon, G.R. Current d i r e c t i o n s i n the treatment of obesity"... P s y c h o l o g i c a l  B u l l e t i n , 1976, 83, 557-578. Leon, G.R., & Chamberlain, K. Emotional a r o u s a l , e a t i n g p a t t e r n s , and body image as d i f f e r e n t i a l f a c t o r s a s s o c i a t e d w i t h v a r y i n g success i n maintaining a weight l o s s , J o u r n a l of Consulting and C l i n i c a l Psy- chology, 1973, 40, 474-480. Leon, G.R., & Roth, L. Obesity: P s y c h o l o g i c a l causes, c o r r e l a t i o n s , and sp e c u l a t i o n s , P s y c h o l o g i c a l B u l l e t i n , 1977, 84, 117-139. MacDonald, P.M,, Inglefinge'r, F.J., & B e l d i n g , H.W. Late e f f e c t s of t o t a l gastrectomy i n man. New England J o u r n a l of Medicine, 1947, 237, 887. 97 McFarland, J.W., & Folkenberg, E.J, How to stop smoking i n f i v e days. Englewood C l i f f s , N.J.: P r e n t i c e - H a l l , 1964. McFarland, R.A. Heart ra t e perception and heart ra t e c o n t r o l . Psycho- phys i o l o g y, 1975, 12, 402-405. Mahoney, M.J. Self-reward and s e l f - m o n i t o r i n g techniques f o r weight c o n t r o l . Behavior Therapy, 1974, 5_, 48-57. Mahoney, M.J. Eat. f i c t i o n . Behavior Therapy, 1975, 6_, 416-418. Mahoney, M.J., Moura, N.G.M., & Wade, T.C. R e l a t i v e e f f i c a c y of s e l f -reward, self-punishment, and s e l f - m o n i t o r i n g techniques f o r weight l o s s . J o u r n a l of Consulting and C l i n i c a l Psychology, 1973, 40, 404-407. Maier, W.J. Sensory d e p r i v a t i o n therapy of an a u t i s t i c boy. American J o u r n a l of Psychotherapy, 1970, 25_, 228-245. Mandler, G., Mandler, J.M,, & U v i l l a r , E.T. Autonomic feedback: The perception of autonomic a c t i v i t y . J o u r n a l of Abnormal and S o c i a l Psychology, 1958, 5_5, 367-373. M a r t i n , D.G., Roush, P., & Nicholson, J,V. Increased e f f e c t of a v i s u a l t r a i n i n g procedure a f t e r sensory r e s t r i c t i o n . Psychbnomic Science, 1967, 8, 229-230. Mayer, J . Overweight: Causes, c o s t , and c o n t r o l . Englewood C l i f f s , N.J.: P r e n t i c e - H a l l , 1968. Me t r o p o l i t a n L i f e Insurance Company: New weight standards f o r men and women. S t a t i s t i c s B u l l e t i n , 1959, 40_, 1-4. Meynen, G.E. A comparative study of three treatment approaches w i t h the obese: r e l a x a t i o n , covert s e n s i t i z a t i o n and modified systematic de-s e n s i t i z a t i o n . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1970, 31(5-13) , ' -2998. 98 Murray, D.C. Treatment of :overweight: I . R e l a t i o n s h i p between i n i t i a l weight and weight change during behavior therapy of overweight i n d i v i d u a l s : A n a l y s i s of data from previous s t u d i e s . P s y c h o l o g i - c a l Reports, 1975, 37, 243-248. N i s b e t t , R.E. Taste, d e p r i v a t i o n , aad weight, determinants of e a t i n g be-h a v i o r . J o u r n a l of P e r s o n a l i t y and S o c i a l Psychology, 1968, 10, 107-116. P a t r i c k , R.O. P a r t i a l sensory depatterning and propaganda a s s i m i l a t i o n . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1965, 26_, 3488-3489. P a t t e r s o n , G.R., Merles, T.M., Matarazzo, J.D., Myers, R.A., Schwartz, G.E. , Si'Strupp^tHV'H? , (Eds. ) .Behavior Change 1974 , Chicago: A l d i n e , 1975. P a u l , G.L. Behavior m o d i f i c a t i o n research: Design and t a c t i c s . In C. M. Franks (Ed.), Behavior therapy: A p p r a i s a l and s t a t u s . New York, McGraw-Hill, 39-62. Peevers, B.H.,Blascovich, J . I . , & Secord, P.F. The Personal C a u s a l i t y Questionnaire, JSAS Catalogue of Selected Documents i n Psychology, 1974, 4, 15. Penick, S.B., F i l i o n , R., Fox, S., Stunkard, A. Behavior m o d i f i c a t i o n i n the treatment of o b e s i t y . Psychosomatic Medicine, 1971, 33, 49-55. P l i n e r , P. The e f f e c t of cue s a l i e n c e on the behavior of obese and nor-mal s u b j e c t s . J o u r n a l of Abnormal Psychology, 1973, 81, 226-232. Quaade, F. U n t r a d i t i o n a l treatment of o b e s i t y . In W.L. Burland, P.D. Samuel, & J . Yudkin (Eds.), Obesity Symposium, N.Y: C h u r c h i l l ' 7 L i v i n g s t o n e , 1974. 99 Reid, D.W. , & Ware, E.E. M u l t i d i m e n s i o n a l i t y of i n t e r n a l versus e x t e r n a l c o n t r o l : A d d i t i o n of a t h i r d dimension and non d i s t i n c t i o n of s e l f versus others. Canadian J o u r n a l of B e h a v i o r a l Science, 1974, 6, 131-142, Reitman, E.E., & Cleveland, S.E. Change i n body image f o l l o w i n g sensory d e p r i v a t i o n i n schizophrenic and c o n t r o l groups. J o u r n a l of Abnor- mal and S o c i a l Psychology, 1964, 68, 168-176. Robertson, M. Therapeutic e f f e c t i v e n e s s of v e r b a l communication under co n d i t i o n s of p e r c e p t u a l i s o l a t i o n . American P s y c h o l o g i s t , 1965, 20, 548. Rodin, J . E f f e c t of d i s t r a c t i o n on the performance of obese and normal s u b j e c t s . In S. Schachter and J , Rodin (Eds.), Obese Humans and  Rats, Potomac, Md: Laurence Erlbaum A s s o c i a t e s , 1974. Rodin, J , , Herman, C P . , & Schachter, S, Obesity and v a r i o u s t e s t s of e x t e r n a l s e n s i t i v i t y . I n S. Schachter and J . Rodin (Eds.), Obese  humans and Rats, Potomac, Md: Laurence Erlbaum A s s o c i a t e s , 1974. Rodin, J . , & Slochower, J . E x t e r n a l i t y i n the nonobese: E f f e c t s of en-vironmental responsiveness on weight. Journa l of P e r s o n a l i t y and  S o c i a l Psychology, 1976, 33, 338-344. Romanczyk, R.C S e l f monitoring i n the treatment of o b e s i t y : Parameters of r e a c t i v i t y . Behavior Therapy, 1974, 5_, 531-540. Rbtte-r, J.B. Generalized expectancies f o r i n t e r n a l versus e x t e r n a l con-t r o l of reinforcement. P s y c h o l o g i c a l Monographs, 1966, j_0, No. 1. Samuel, P.D,, & Burland, W.L. A review of the medicinal treatment of o b e s i t y . In W.L. Burland, P.D. Samuel, & J . Yudkin (Eds.), Obesity Symposium, N.Y.: C h u r c h i l l L i v i n g s t o n e , 1974. 100 Schachter, S. The i n t e r a c t i o n of c o g n i t i v e and p h y s i o l o g i c a l determinants of emotional s t a t e s . In L. Berkowitz (Ed,), Advances i n Experimen- t a l S o c i a l Psychology, 1964, V o l . 1, N.Y.: Academic Pres s . Schachter, S. Emotion, Obesity, and Crime, New York: Academic P r e s s , 1971. Schachter, S., Goldman, R. , & Gordon, A. The e f f e c t s of f e a r , food de-p r i v a t i o n , and o b e s i t y on e a t i n g . J o u r n a l of P e r s o n a l i t y and So- c i a l Psychology, 1968, 10, 91-97. Schachter, S., & Gross, L. Manipulated time and e a t i n g behavior. J o u r n a l  of P e r s o n a l i t y and S o c i a l Psychology, 1968, 1(D, 98-106. Schachter, S., & Rodin, J . Obese Humans and Rats, Potomac, Md: Erlbaum, 1974. Schechter, M.D., S h i r l e y , J.T., Sexauer, J.D., & Toussieng, P.W. Percep-t u a l i s o l a t i o n therapy: A new approach i n the treatment of c h i l d r e n using a u t i s t i c defenses. A p r e l i m i n a r y r e p o r t . J o u r n a l of the  American Academy of C h i l d P s y c h i a t r y , 1969, 8^ , 97. S c h u l t z , D.P. Sensory r e s t r i c t i o n : E f f e c t s oh, behavior,,N.Y.: Academic P r e s s , 1965. S c o t t , T.H., Bexton, W.H. , Heron, W., & Doane, B.K. C o g n i t i v e e f f e c t s of pe r c e p t u a l i s o l a t i o n . Canadian J o u r n a l of Psychology, 1959, 13, 200-209. Singh, D. Role of response h a b i t s and c o g n i t i v e f a c t o r s i n t e r m i n a t i o n of behavior of obese humans. J o u r n a l of P e r s o n a l i t y and S o c i a l  Psychology, 1973, 27, 220-238. Slochower, J . Emotional l a b e l i n g and overeating i n obese and normal weight i n d i v i d u a l s . Psychosomatic Medicine, 1976, 38, 131-139. 101 Smith, A. The b e n e f i t s of boredom. Psychology Today, 1976, 9_, 46-51. Smith, S., Myers, T.I*,, & Johnson, E. S t i m u l a t i o n seeking throughout seven days of sensory d e p r i v a t i o n . Perceptual and Motor S k i l l s , 1967, 25, 261-271. Snyder, M. S e l f monitoring of expressive behavior. J o u r n a l of Person- a l i t y and S o c i a l Psychology, 1974, 30, 526-537. S t u a r t , R.B. B e h a v i o r a l c o n t r o l of overeating. Behavior Research and Therapy, 1967, 5_, 357-365. S t u a r t , R.B. A three-dimensional program f o r the treatment of o b e s i t y . Behavior Research and Therapy, 1971, 9_, 177-186. S t u a r t , R.B. B e h a v i o r a l c o n t r o l of overeating: A status r e p o r t . Paper presented at the Fogerty I n t e r n a t i o n a l Center Conference on Obesity, Bethesda, Md., 1973. S t u a r t , R.B., & Davis, B. S l i m chance i n a f a t world: B e h a v i o r a l c o n t r o l of o b e s i t y . Champaign, 111: Research P r e s s , 1972. Stunkard, A.J. P r e s i d e n t i a l Address - 1974: From e x p l a n a t i o n to a c t i o n i n psychosomatic medicine: The case of o b e s i t y . Psychosomatic Medicine, 1975, 37_, 195-236. Stunkard, A.J., & McLaren-Hume, M. The r e s u l t s of treatment f o r o b e s i t y . Archives of I n t e r n a l Medicine, 1954, 103, 79-85. Stunkard, A.J., & Fox, S. The r e l a t i o n s h i p of g a s t r i c m o t i l i t y and hunger: Summary of the evidence. Psychosomatic Medicine, 1971, 33, 123-134. Suedfeld, P. A t t i t u d e manipulation i n r e s t r i c t e d environments: I . Con-ceptu a l s t r u c t u r e and response to propaganda. J o u r n a l of Abnormal  and S o c i a l Psychology, 1964, 68, 242-247. 102 Suedfeld, P. Changes i n i n t e l l e c t u a l performance and i n s u s c e p t i b i l i t y to i n f l u e n c e . In J.P. Zubek (Ed.), Sensory D e p r i v a t i o n : F i f t e e n  years of research, N.Y.: Appleton-Century-Crofts, 1969, 126-166. Suedfeld, P. Sensory d e p r i v a t i o n used i n the r e d u c t i o n of c i g a r e t t e smoking: A t t i t u d e change experiments i n an a p p l i e d context. J o u r n a l of A p p l i e d S o c i a l Psychology, 1973, 3_, 30-38. Suedfeld, P. The c l i n i c a l relevance of reduced sensory s t i m u l a t i o n . Canadian P s y c h o l o g i c a l Review, 1975(a), 16, 88-103. Suedfeld, P. The b e n e f i t s of boredom. Sensory d e p r i v a t i o n reconsidered. American S c i e n t i s t , 1975(b) 63, 60-69. Suedfeld, P. Using environmental r e s t r i c t i o n to i n i t i a t e long-term be- h a v i o r a l change. Paper presented at the 8th Banff I n t e r n a t i o n a l Conference on Behavior M o d i f i c a t i o n , Banff, A l t a . , 1976. Suedfeld, P., and Vernon, J . A t t i t u d e manipulation i n r e s t r i c t e d e n v i r o n -ments. I I . Conceptual s t r u c t u r e and the i n t e r n a l i z a t i o n of propagan-da r e c e i v e d as a reward f o r compliance. J o u r n a l of P e r s o n a l i t y and  S o c i a l Psychology, 1966, 3, 586-589. Suedfeld, P., Landon, P.B., Pargement, R., & E p s t e i n , Y.M. An experimen-t a l a t t a c k on smoking. ( A t t i t u d e manipulation i n r e s t r i c t e d en-vironments, IITJ'O; I n t e r n a t i o n a l J o u r n a l of the A d d i c t i o n s , 1972, ]_, 721-733. Suedfeld, P., & I k a r d , F.F. A t t i t u d e manipulation i n r e s t r i c t e d e n v i r o n -ments. IV. P s y c h o l o g i c a l l y addicted smokers t r e a t e d i n sensory d e p r i v a t i o n . B r i t i s h J o u r n a l of A d d i c t i o n , 1973, 68_, 170-176. Suedfeld, P., & I k a r d , F . F . The use of sensory d e p r i v a t i o n i n f a c i l i t a t i n g the reduction of c i g a r e t t e smoking. J o u r n a l of C o n s u l t i n g and  C l i n i c a l Psychology, 1974, 42_, 888-895. 103 Suedfeld, P., & Smith, C.A, P o s i t i v e i n c e n t i v e value of phobic s t i m u l i a f t e r b r i e f sensory d e p r i v a t i o n : P r e l i m i n a r y r e p o r t . P e r c e p t u a l  and Motor S k i l l s , 1973, 36_, 320. Suedfeld, P., & Buchanan, E. Sensory d e p r i v a t i o n and a u t o c o n t r o l l e d a v e r s i v e s t i m u l a t i o n i n the redu c t i o n of snake avoidance. Cana- dian J o u r n a l of Be h a v i o r a l Science, 1974, _5, 105-111. Suedfeld, P., & Best, J.A. S a t i a t i o n and sensory d e p r i v a t i o n combined i n smoking therapy: Some case st u d i e s and unexpected s i d e - e f f e c t s . ;;rx,:c:^.International Jo.ufrial of the A d d i c t i o n s , 1977, j_2, 337-359.' Suedfeld, P., & Hare, R.D. Sensory d e p r i v a t i o n i n the treatment of snake phobia. B e h a v i o r a l s e l f - r e p o r t and p h y s i o l o g i c a l e f f e c t s . Beha- v i o r Therapy, .1977, __, 240-250. Suedfeld, P., & Best, J.A. Mo n i t o r i n g , s a t i a t i o n smoking, and sensory d e p r i v a t i o n w i t h messages as techniques i n smoking c e s s a t i o n . In pr e p a r a t i o n . Tanner, J.M., & Whitehouse, R.H. Revised standards f o r t r i c e p s and sub-scapular s k i n f o l d i n B r i t i s h c h i l d r e n . Archives of Disease i n Childhood, 1975, 50, 142-145. W i t k i n , H.A., Lewis, H.B., Hertzman, M., Machover, K., Meissner, P.B., & Wapner, S. P e r s o n a l i t y through per c e p t i o n . New York: Harper, 1954. Wollersheim, J.P. E f f e c t i v e n e s s of group therapy based upon l e a r n i n g p r i n c i p l e s i n the treatment of overweight women. Jo u r n a l of  Abnormal Psychology, 1970, 76_, 462-474. 104 Wooley, O.W., & Wooley, S.C. The experimental psychology of o b e s i t y . In. T. S i l v e r s t o n e & J . Fincham (Eds.) , Obesity: Pathogenesis and  Management. Lancaster: Medical and T e c h n i c a l Pub. Co., 1975. Yates, A.J. Theory and p r a c t i c e i n behavior therapy. New York: Wiley, 1975. Zubek, J.P. . Sensory d e p r i v a t i o n : F i f t e e n years of research. New York: Appleton-Century-Crofts, 1969. Zuckerman, M. T h e o r e t i c a l f o r m u l a t i o n s : I . In J.P. Zubek (Ed.). Sensory  d e p r i v a t i o n : F i f t e e n years of research. N.Y.: Appleton-Century-C r o f t s , 1969, 407-432. 105 APPENDIX A 106 Subject SDM-1 was a 37 year o l d married woman w i t h a 13 year o l d c h i l d , who worked managing the apartment b u i l d i n g i n which she a l s o r e s i d e d . Her s t a r t i n g weight was 92.4 Kg at 158 cm and her d e s i r e d weight was 61 Kg. She began to gain weight a f t e r the b i r t h of her c h i l d and a t t r i b u t e d t h i s gain to not enough a c t i v i t y and e a t i n g too much of the wrong, foods. She had p r e v i o u s l y t r i e d an a l l steak d i e t when she l o s t 9 pounds i n 9 days and Weight Watchers when she l o s t 20 pounds i n s i x weeks. Her reason f o r j o i n -i n g the study was that she f e l t she had t r i e d e v e rything e l s e and now needed a r e a l change i n l i v i n g s t y l e to conquer her weight problem. A f t e r SD she had very few comments on the experience except that i t was hot and s t u f f y . In the f i r s t week a f t e r SD she l o s t 1.3 Kg. At one month she s a i d she f e l t very determined and volunteered that she."used to t h i n k that psychology was a l o s t of bunk" but because of the ease w i t h which she was l o s i n g weight she no longer thought t h a t . At two months when asked i f SD had helped i n her progress she s a i d , "Yes, 100%". She had become so conscientious that she f e l t that things must have been s a i d w h i l e she s l e p t i n SD. In f a c t she f e l t that i t was so e f f e c t i v e that she "must have been brainwashed". While she f e l t the messages had helped she f e l t that having heard them i n SD made the biggest impression. At s i x months she had l o s t 8.6 Kg and s t i l l was very determined. Her a t t i t u d e toward e a t i n g had changed i n that she was t h i n k i n g about everything she ate. The most d i f f i c u l t o b s t a c l e to her progress was her husband who saw nothing wrong w i t h the way she was and t h e r e f o r e never gave her a s s i s -tance. Therefore she f e l t i t was e n t i r e l y up to her and t h i s was rewarding when she made progress. She s a i d at the end of the programme that she had learned to be p a t i e n t w i t h h e r s e l f and not become disgusted w i t h lapses be-cause she intends to be on the d i e t f o r the r e s t of her l i f e . 107 Subject SDM-2 was a 55 year o l d married woman who was employed p a r t time as a c l e r k . She began the programme at 76.4 Kg at 152 cm. Her d e s i r e d weight was 59 Kg. She began ga i n i n g weight a f t e r the b i r t h of the l a s t of her three c h i l d r e n , aged 32, 31, and 25. However she d i d not f e e l that she overate and claimed to be q u i t e a c t i v e . She j o i n e d the study p a r t l y because she was curious about the "new experience". A f t e r e i g h t hours i n SD she spoke to the monitor over the intercom and expressed doubts about the u s e f u l -ness of the experience. The monitor gave her reassurance and she completed the 24 hours although she complained of the chamber's s t u f f i n e s s . One week a f t e r SD she suggested that the SD experience had strengthened her r e s o l v e . She had l o s t 1.4 Kg, had q u i t d r i n k i n g and was e a t i n g much slower. At two months although she had l o s t only another .4 Kg, she s t i l l f e l t SD had helped. The thought of that experience made her f e e l she could accomplish the things she set out to do. The 24 hours of SD had been q u i t e an accomplish-ment. The message that had made the most impression on her was that she was r e s p o n s i b l e to h e r s e l f . At four months t h i s subject wanted to q u i t the programme. She had gained .8 Kg and f e l t very discouraged and embarrassed. Rather than c a l l , she sent a l e t t e r expressing her d e s i r e to q u i t . She was telephoned and t o l d of the importance of her s t a y i n g i n the programme even i f she gained weight. She remained i n the programme and returned at the s i x month f o l l o w up when she had gained another 1.6 Kg. She f e l t her l a r g e s t problems were m o t i v a t i o n a l . She spent a l o t of time alone and found t h i s to be when she a t e , and t h i s was l a r g e l y out of h a b i t r a t h e r than boredom. At the end of the programme she^ s t i l l f e l t that SD had boosted her m o t i v a t i o n but that i t hadn't l a s t e d and that perhaps a repeat s e s s i o n would help. While she claimed to normally be " q u i t e a strong person" the i n a b i l i t y to l o s e weight was bothersome. S t i l l she r e a l i z e d that she alone was the only one who could do i t . 108 Subject SDM-3 was a 24 year o l d f i r s t year u n i v e r s i t y student. She was s i n g l e and weighed75".3 Kg at 168.5 cm. Her d e s i r e d weight was 59 Kg. She. had been overweight s i n c e the age of ten and could not r e a l l y say what the cause of her overweight was although she d i d confess that she probably ate too much. She a l s o consumed a l c o h o l i c beverages f a i r l y r e g u l a r l y i n s o c i a l s i t u a t i o n s and smoked one pack of c i g a r e t t e s a day. Her only s t a t e d motiva-t i o n f o r j o i n i n g the study was to l o s e weight. During SD she had s e v e r a l dreams about being i n the chamber and things happening to her there. The f o l l o w i n g day outside the chamber she s a i d she f e l t very d i s o r i e n t e d and a n t i s o c i a l . At one week she had l o s t 2,5 Kg but at the next one month s e s s i o n had gained back 2 of those Kg. This was due to much e a t i n g and d r i n k i n g over, the Christmas h o l i d a y s . She returned to the plan w i t h the usual New Year's r e s o l v e . At two months she claimed she was "gung ho" again and was down to 71.7 Kg as proof. She s t i l l v i v i d l y r e c a l l e d the SD experience, p a r t i c u l a r l y the dreams she had there. In one of these dreams the l i g h t went on and some lady was standing there t e l l i n g her she couldn't go to the bathroom. In another dream the l i g h t was on again and she was l o o k i n g a t h e r s e l f i n a m i r r o r . She f e l t that SD had made the messages h i t harder. At the end of the s i x months her weight was back up to 73.5 Kg and she a t t r i b u t e d t h i s to not f o l l o w i n g the p l a n . The programme had made her much more aware of her e a t i n g h a b i t s , of healthy foods and of the importance of e x e r c i s e . She f e l t she had very l i t t l e s e l f c o n t r o l and needed someone standing over her "with a whip" to keep her i n l i n e . She d i d become aware of the f a c t that she eats most when she i s depressed and that she looks f o r excuses to be able to d r i n k or eat. She no longer f e l t i t was p o s s i b l e to reach her i n i t i a l goal weight and had lowered her expectations. 109 Subject SDM-4 was a 53 year o l d housewife with two c h i l d r e n aged 32 and 27. Her i n i t i a l weight was 113.75 Kg at 165.5 cm. Her goal weight was 68 Kg. Her weight gain began s i x months a f t e r g e t t i n g married at age 19. She explained that she ate at t h i s time because she was so happy. However s e v e r a l times she volunteered that she f e l t she may have gained weight i n order to become l e s s a t t r a c t i v e to some of her husband's f r i e n d s who were making advances. She j o i n e d the study because she wanted to l o s e weight i n a h e a l t h y way but f e l t she needed some guidance and someone who cared about her problem. Although she f e l t SD was too s t u f f y she d i d do a l o t of t h i n k -i n g . The darkness made her t h i n k about her b l i n d f a t h e r . She a l s o composed many l e t t e r s to her f r i e n d s . In one of her dreams someone came and took her . out of the chamber and l e d her to a banquet i n her honour. She sat at the head of the t a b l e because she was doing so w e l l on the programme. Even though everyone was e a t i n g a b i g meal and d r i n k i n g wine she had only j u i c e a f t e r which she returned to the chamber. On r e c a l l i n g the SD experience she com-p l a i n e d about the d i s i n f e c t a n t smell and a l s o claimed she was g e t t i n g q u i t e confused i n the l a s t few hours. At one week she had l o s t 2.6 Kg but complained that her husband was not being very cooperative. F o l l o w i n g t h i s she was i l l f o r 2 weeks and her doctor took her o f f a l l p r o t e i n . She d i d not l o s e weight during t h i s p e r i o d . At two months she d i d not f e e l that SD had helped; i n f a c t since SD she had not been able to sleep w e l l and she blamed t h i s on the SD experience. She d i d f e e l however that the messages had d e f i n i t e l y helped her and they came back to her. At t h i s p o i n t she was down to 107.0 Kg. At four months she had l o s t another 2 Kg and s a i d that she had s t a r t e d a contest w i t h a f r i e n d so that the f i r s t one to get to 160 l b s would get a r i n g worth $100. At s i x months she had not l o s t f u r t h e r weight. This was a t t r i b u t e d to the f a c t that she had been away to I s r a e l and had gained 2 Kg which she had 110 sinc e l o s t and that she had been i n the h o s p i t a l f o r two weeks where she couldn't stay on her d i e t . She f e l t that because she had been s i c k and i n the h o s p i t a l s e v e r a l times during the programme that she hadn't l o s t the weight that she wanted t o . However she f e l t that the programme had prevented her from g a i n i n g during that time and had made her much more able to cope w i t h problems without using food. She was s t i l l very deter-mined at the end of the programme and was planning to continue i t s use. I l l Subject SDM-5 was 49 years o l d , s i n g l e , and was not employed at any occupation., She weighed 86.7 kg at 161 cm. She had a grade 12 education and had been overweight since age 16. Her goal weight was 61 Kg. Her perceived cause of overweight was l o n e l i n e s s ; she overate to f i g h t boredom. She had p r e v i o u s l y been somewhat s u c c e s s f u l on Weight Watchers d i e t but had stopped s i x months e a r l i e r . She j o i n e d t h i s study because her doctor had ordered her to get her weight down. She d i d not p a r t i c u l a r l y l i k e SD and was bothered by the heat which caused a headache. A l s o she was not able to get r e l a x e d w i t h the r e l a x a t i o n messages and complained she was too uncomfortable to take much i n . One week a f t e r SD her weight was down to 86.5 Kg. She was q u i t e pleased w i t h the Stuart and Davis p l a n and was able to s t i c k w i t h 1200 c a l o r i e s , though she d i d not get much e x e r c i s e . By two months she had read through the book four times p l u s references to s p e c i f i c p a r t s . By t h i s time her weight was 84.7 Kg. At s i x months she was q u i t e pleased w i t h her progress. Her weight was 81.5 Kg and her blood pressure had gone down. The book, she e x p l a i n e d , pro-vided her w i t h a sense of communality of the problem; she wasn't the only one f i g h t i n g i t . Her major problems were f i t s of depression which l e d her to eat. The programme had made her more aware of her own f e e l i n g s of i n -f e r i o r i t y but a l s o of the f a c t that nobody could solve t h i s problem but h e r s e l f . 112 Subject SDM-6 was a 44 year o l d housewife w i t h f i v e c h i l d r e n aged 21, 19, 18, 16, and 6. Her height was 172 cm. and her i n i t i a l weight was 110.25 Kg. Her overweight began at age 30 and the only reason she could give f o r t h i s was that she i s c o n s t a n t l y n i b b l i n g . She j o i n e d t h i s study because she was " t i r e d of being f a t " , Her goal was 77 Kg. She was very r e s t l e s s during SD and was pleased when the 24 hours was up. She complained about nightmares about the a s s a s s i n a t i o n of Gandhi. This i s of i n t e r e s t i n that Gandhi's hunger s t r i k e s were used as an example i n one of the mes-sages . Thoughout the e n t i r e s i x months her weight v a r i e d very l i t t l e . She was i n t e r e s t e d i n more s o c i a l contact about her problem and j o i n e d a TOPS club and got some s o r t of contest going w i t h them. At two months she r e c a l l e d SD as a " t e r r i b l y i n t e r e s t i n g " experience. She d i d not f e e l i t had helped her weight but that i t had helped her to understand h e r s e l f . At s i x months she weighed 111.3 and a t t r i b u t e d her l a c k of success to her own l a z i n e s s . Losing weight was j u s t not important enough. She was very busy w i t h her f a m i l y and was not able to concentrate the e x t r a energy to s t i c k i n g to the d i e t . She saw the major problem of the programme as her own l a c k of s e l f d i s c i p l i n e . She f e l t that unless she got her head s t r a i g h t she would never get to her goal weight of 170 l b s . 113 Subject SDM-7 was a s i n g l e 23 year.'-, o l d woman who worked w i t h mental-l y retarded i n d i v i d u a l s . She began the programme at a weight of 102.85 Kg and height of 163 cm.; her goal weight was 57 Kg. She had been overweight s i n c e the age of 15 and saw the cause of her overweight as being insecure. When she began t h i s programme she had already been working at l o s i n g weight w i t h a regimen of d i e t and e x e r c i s e . She l i v e d i n a house w i t h a number of other people and i t was a c t u a l l y one of her g i r l f r i e n d s who o r i g i n a l l y signed her up f o r the programme. She d i d not l i k e the SD session and claimed to become " t e r r i b l y bored" a f t e r the f i r s t set of messages. At one p o i n t she woke up and f e l t extremely d i s o r i e n t e d and s e r i o u s l y considered terminating the s e s s i o n . She had f o r -gotten where she was. She was motivated r i g h t from the beginning and enthu-s i a s t i c a l l y took to the d i e t p l a n ; she was already c a r r y i n g out a r e g u l a r e x e r c i s e p l a n . At the one week f o l l o w up her weight was down to 98.9 Kg. E v a l u a t i n g the SD s e s s i o n a f t e r two months, she f e l t that the s e s s i o n had made her more aware of things but hadn't r e a l l y reached her "subconscious". She was e s p e c i a l l y impressed by the message about p r o t e c t i n g her body and would t h i n k about i t when she f e l t l i k e cheating. Although she had been down to 96.5 at one month, at two months her weight was back to 98.5; She was q u i t e depressed by t h i s since she had a wager w i t h one of her housemates that she would l o s t 50 l b over a p a r t i c u l a r p e r i o d . At four months her weight was s t i l l at 98.5. She explained that she had been e a t i n g junk food as a r e s u l t of depression. The underlying reason was that she was one month 'pregnant and was about to have the pregnancy terminated. 114 At the f i n a l s i x month se s s i o n her weight was down to 92.8 Kg. She s a i d she e s p e c i a l l y l i k e d the l o g i c a l , i n t e l l e c t u a l q u a l i t y of the pro-gramme but f e l t that i t had not r e a l l y caught on w i t h her u n t i l the l a s t two months. She f e l t that she had gained c o n t r o l over her d e s i r e to eat while s t i l l r e a l i z i n g she great pleasure she de r i v e s from food. She l i k e d the infrequency of the follow-ups e s p e c i a l l y because she hates to be t o l d what to do. She planned to continue the p l a n and f e l t i t was p o s s i b l e to reach her goal weight. 115 Subject SDM-8 was a 43 y e a r - ^ o l d housewife w i t h three c h i l d r e n the youngest being 10 years o l d . She a l s o worked part-time as a stenographer. Overweight s i n c e the age of 12 she f e l t that the major cause of her over-weight was that she was a compulsive eater. She began the programme at 77.7 Kg and gave her d e s i r e d weight as 57 Kg. Her height was 152 cm. The foods which were the biggest problem were c r a c k e r s , cheese, and wine r a t h e r than sweets. She had been on Weight Watchers d i e t one year p r e v i o u s l y and had l o s t 16 pounds, She j o i n e d t h i s programme because she f e l t a need to have someone to report t o . , She had no problems w i t h the SD s e s s i o n , i n f a c t she reported that i t was pleasant and she enjoyed i t as a very r e s t f u l experience. At one week her weight was 75.7 and she seemed q u i t e pleased w i t h her progress on 1200 c a l o r -i e s . At 2 months she was down to 73.0 Kg. Her daughters had been q u i t e supportive of her d i e t p l a n and she was g e t t i n g d a i l y l i g h t e x e r c i s e . She was very pleased w i t h the book and found i t to provide a l o t of m o t i v a t i o n . At the f i n a l s i x month s e s s i o n , she was again to 73.7 Kg even though she had been down to 71.9 Kg at 4 months. She a t t r i b u t e d the l o s s at 4 months to having been away i n Mexico and not being able to eat the food there. The gain i n the l a s t two months was due to not spending enough time on her-s e l f . She had been worr'iedabout problems w i t h her f a m i l y and t h i s l e d her to eat. This f a i l u r e at the end of the programme made her f e e l l i k e a t e r -r i b l e p r o c r a s t i n a t o r . She f e l t the programme was very s e n s i b l e but that she had done p o o r l y because she didn't take enough time f o r h e r s e l f . 116 Subject SDM-9 was a 43 year o l d housewife w i t h four c h i l d r e n between 11 and 23 years o l d . She began the programme weighing 72.5 Kg at 164 cm t a l l . Her goal weight was 60 Kg. Her only expressed motive f o r j o i n i n g the programme was to l o s e weight which had been a problem since her f i r s t c h i l d was born. She found the f i r s t few hours of SD very f r u s t r a t i n g and had d i f f i c u l -ty c oncentrating on the content of the messages once they were over. Her comment on the messages was that they a l l seemed very s e n s i b l e . Her weight was down to 71.8 Kg a f t e r one week on 1200 c a l o r i e s . She reported that the n i g h t f o l l o w i n g SD everything from the messages she had heard kept r e t u r n i n g to her a l l n i g h t long. At one month she was q u i t e disappointed w i t h the small weight l o s s she had had. In s p i t e of a vigorous e x e r c i s e programme, averaging 400 c a l o r i e s a day her weight was 71.6 Kg. At two months her weight was back up to 72.3 Kg. She had not been keeping r e g u l a r t r a c k of her d i e t and had slowed down i n her e x e r c i s e because she had begun t a k i n g accounting courses. A f t e r t h i s she cut her d i e t down between 800 and 900 c a l o r i e s and con-centrated on vegetables and meats i n e s s e n t i a l l y a low carbohydrate d i e t . At four months she was down to 68.5 Kg. Her f i n a l weight at s i x months was 67,4 Kg. She f e l t the most important p a r t of the programme had been the ex e r c i s e although she knew she should have done more. Her time i n SD d i d not impress her and she didn't t h i n k i t helped. She al s o f e l t that l e a r n i n g about proper h a b i t s was very important. 117 Subject SDM-10 was a 42 year o l d mother of four c h i l d r e n between the ages of 10 and 22 years. She was separated from her husband and c u r r e n t l y e n r o l l e d as a f u l l time u n i v e r s i t y student. She j o i n e d the programme weigh-in g 73.5 Kg at 154 cm t a l l and her goal was 55 Kg. Her overweight problem began a f t e r her second c h i l d around the age of 25. She enjoys e a t i n g but f e e l s she uses i t as a comfort. She claimed to have spent most of her 24 hours of SD s l e e p i n g . In l i n e w i t h t h i s she f e l l asleep during the r e l a x a t i o n message. A f t e r one week her weight had changed l i t t l e (73.9 Kg) however at one month i t was down to 69.3 Kg. She had not r e a l l y s t a r t e d the programme when she was supposed to but had delayed a couple of weeks. At two months she was back up to 71.0 and a t t r i b u t e d t h i s gain to a 2 week splurge at Christmas during which time she ate q u i t e a b i t and stopped e x e r c i s i n g . Ice cream was a p a r t i c u l a r problem w i t h her. At t h i s time when asked to r e c a l l the SD experience she s a i d that i t must have helped because i t had been e a s i e r f o r her to d i e t t h i s time than i t ever had before. This was the longest she had ever been on a d i e t . She could no longer r e c a l l the messages. A f t e r Christmas she had no t r o u b l e g e t t i n g back on the d i e t . At four months she was down to 66.0 Kg and was q u i t e pleased w i t h her progress. She f e l t b e t t e r and had more energy and a more p o s i t i v e outlook. At s i x months she weighed 67.4 Kg but was not p a r t i c u l a r l y discouraged by the gain which she a t t r i b u t e d to some personal problems and to having f i n a l examinations. Her biggest problems w i t h the p l a n had been that she runs a very unstructured household and therefore had d i f f i c u l t y planning her sche-dule. She found the i n t e l l e c t u a l and personal aspects of the programme ap-p e a l i n g and s t i l l could not say f o r sure that SD had helped her m o t i v a t i o n . 118 Subject SDM-11 was a 54 year o l d married woman w i t h f i v e c h i l d r e n between 18 and 32 years o l d . She was working three days a week as a se-c r e t a r y . Overweight became a problem at the age of 35 when the s t r e s s of r a i s i n g c h i l d r e n l e d her to eat. At that time she would overeat when she f e l t t i r e d . Overeating howeverwas not a problem at t h i s time. She began the programme weighing 82.75 Kg at 169 cm t a l l w i t h a goal weight of 64 Kg. At the beginning of the SD session she got panicky and t r i e d yoga br e a t h i n g techniques. This e v i d e n t l y worked f o r during the r e l a x a t i o n mes-sage she f e l l asleep. O v e r a l l , she. s a i d she enjoyed the experience but wouldn't want to repeat i t , At one week she had l o s t one k i l o g r a m and was q u i t e pleased w i t h the programme. She remained c o n s i s t e n t l y on 1500 c a l o r i e s w i t h a minimum of e x e r c i s e . At two months her weight was 77 Kg. She explained that everytime she was about to waiver from the d i e t she would r e c a l l the SD s e s s i o n and t h i n k "what was the sense of going through that i f I'm going to eat t h i s " . She f e l t that she was adopting a h e a l t h i e r a t t i t u d e toward food. At four months she weighed 73.5 Kg and at s i x months was down to 73 Kg. She was s t i l l very determined and now convinced that i t was something that she must do f o r h e r s e l f since others can't be depended upon to h e l p . Her a t t i t u d e toward food and h e a l t h had changed so that now i f she went "over-board" i t was more l i k e l y to be on bananas than on chocolate. The reason f o r her poorer progress i n the l a s t two months was that she f e l t she had been sabotaged by her husband who on one occasion brought home four huge choco-l a t e bars f o r her. Her daughter, who had been q u i t e s u p p o r t i v e , thought that her husband d i d not r e a l l y want her to l o s e weight. A l l of t h i s empha-s i z e d the f a c t that she must do i t on her own. When asked i f she thought reaching her goal weight was p o s s i b l e she s a i d " I t h i n k so - I'm going t o " . 119 Subject SDNM-1 was a 41 year o l d housewife w i t h four c h i l d r e n between 21 and 10 years o l d . She "weighed 87.6 Kg at 159 cm and had a goal weight of 61 Kg. She f i r s t began to gain weight at the age of 21 around the time of her f i r s t two c h i l d r e n ' s b i r t h s and gained again a f t e r the b i r t h of her l a s t c h i l d . She ate when she was nervous or upset and was g e t t i n g despar-ate about g e t t i n g the weight o f f . She smoked a l i t t l e more than a package a day and was a s o c i a l d r i n k e r . Sensory d e p r i v a t i o n was f a i r l y uneventful f o r her. She commented that once she had a cr a v i n g f o r a c i g a r e t t e and al s o that she had had a dream about being on a d i e t . During the f i r s t month she d i d q u i t e w e l l dropping down to 84.6 Kg, S h o r t l y a f t e r t h i s however, came the Christmas h o l i d a y s when she "dropped e v e r y t h i n g " . At two months her weight was back up to 87.1 Kg. She d i d comment however that everytime she ate she thought of the dark room. Over the next two months her whole f a m i l y went on a d i e t which added a l o t of support. At f o u r months her weight was back down to 84.4 Kg. At the f i n a l s i x month follow-up her weight was 86.0 Kg. She f e l t she had learned how to eat but not r e a l l y what to eat and thought that a more r i g i d d i e t would be b e t t e r f o r her. Her,biggest problem on the programme was "keeping her mouth shut". She f e l t very p o s i t i v e l y about SD and expressed a d e s i r e to repeat i t . 120 Subject SDNM-2 was a 39 year o l d married woman who worked i n the o f f i c e of a f a m i l y run business. She had three c h i l d r e n between 19 and 12 years o l d . Her weight was 118.5 Kg at a height of 161 cm. Her goal weight was 70 Kg. She had been overweight since the age of 16 and f e l t that the reason f o r t h i s onset was that she became somewhat hypoglycemic at that age. Her most immediate concern f o r g e t t i n g her weight o f f was w i t h problems i n her ankles caused by having to support such excess weight. She went through SD without a problem except f o r an o v e r r i d i n g concern f o r her purse which had been l e f t outside the chamber. She also thought about why she couldn't l o s e weight and about her 12 year o l d c h i l d at home. At the one week f o l l o w up her weight was down to 117.7 Kg. In general sessions w i t h t h i s subject were longer than usual as she would t a l k about her many problems w i t h her fa m i l y and p a r t i c u l a r l y w i t h her o l d e s t son who would get i n t o numerous f i n a n c i a l problems. She seemed to f i n d some p l e a s u r e . i n going on about how miserable her l i f e was. At one month her weight was up to 119.25 Kg. , She explained that she was " r e t a i n -i n g f l u i d s " and had been s t i c k i n g p e r f e c t l y to the d i e t , She was planning to go to C a l i f o r n i a f o r an extensive t e s t i n g of hypoglycemia. The next time she was seen was at three months when her weight was 123,5 Kg, She.reported having been f a i t h f u l l y on 1200 c a l o r i e s but that something was haywire i n her body. Her t e s t s f o r hypoglycemia had been p o s i t i v e and she had been given a s p e c i a l l i s t of foods that she should eat. At f o u r months her weight was up to 126.3 Kg. She reported that she was s t i l l on the d i e t and that she was using the u r i n e t e s t f o r k e t o s i s . Her t e s t s showed that she was i n k e t o s i s and should thus be burning f a t . 121 At the f i n a l s i x month session she r e l a t e d that she had been given p i l l s to r e l e a s e f l u i d . Her weight at t h i s time was back down to 121.4 Kg. She f e l t that t h i s was good but that she should have been l o s i n g a l l along. However she was not worried about i t si n c e she knew that there was something p h y s i c a l l y wrong that was causing her to r e t a i n f l u i d . She nevertheless f e l t she had learned about good e a t i n g h a b i t s and had been f a i r l y s u c c e s s f u l . She expressed some f r u s t r a t i o n that the doctors could not seem to discover what her problem was. She f e l t the SD session was of no b e n e f i t to her and that a l l she d i d was worry about her purse. 122 Subject SDNM-3 was a 48 year o l d housewife w i t h four c h i l d r e n between the ages 23 and 7. Her weight was 98.5 Kg and height was 162 cm. She had been overweight since the age of e i g h t and saw the cause of her overweight as two much food. She f e l t she d i d not overeat but that she needed very l i t t l e food. Her goal weight was 61 Kg. She found SD very tedious and was not able to r e l a x completely. At 23-1/2 hours she wanted to leave but was persuaded to stay because of the short time l e f t . Most of her time i n SD was spent l i s t e n i n g to her b o d i l y processes and p l a y i n g "games w i t h the l i g h t i n my mind". For s e v e r a l days a f t e r SD she was d i s t u r b e d w i t h problems g e t t i n g to sleep and w i t h poor d i g e s t i o n , At one week her weight was down to 97 Kg and she was q u i t e pleased w i t h the d i e t regimen. A f t e r that she q u i t smoking and d i d not stay on the d i e t as w e l l . Her one month weight was 96.7 Kg. Her weight at three months was 92.7 Kg, a l o s s that she a t t r i b u t e d to having been away i n Mexico f o r s e v e r a l weeks around Christmas. She had d i f f i c u l t y e a t i n g Mexican food and was sometimes i l l w i t h "Montezuma's revenge". Her r e f l e c t i o n s on the SD experience were that i t served as a f o c a l p o i n t ; i t was a break to cleanse the system and break o l d h a b i t s . Also when she thought of the ordeal she f e l t " i f you can do that you can do anything", At four months her weight was up to 94.3 Kg but she f e l t that " i n s p i t e - of everything the programme i s working". She was upset w i t h f a m i l y problems and thought that normally she would have gained much more. At the f i n a l s i x month f o l l o w up her weight was much the same at 94.9 Kg but she f e l t the programme had been s u c c e s s f u l s i n c e she normally gains 5 pounds a year. At 123 t h i s p o i n t she f e l t that SD had been p r e t t y devastating. . Having to take a long hard look at h e r s e l f had made her depressed. She claimed that s i n c e SD she had f e l t entombed and a t t r i b u t e d t h i s to the i s o l a t i o n of SD, f e e l -i n g b u r i e d f o r that time. She al s o was concerned that medical and p s y c h i a -t r i c f a c t o r s could have been s t r e s s e d more. She f e l t that i n order to reach her goal weight she would need medical help. 124 Subject SDNM-4 was a married woman, 43 years o l d , w i t h s i x c h i l d r e n between the ages of 8 and 21 years. She was,employed as an I n d u s t r i a l R e l a t i o n s O f f i c e r . Her s t a r t i n g weight was 83.5 Kg at 161.6 cm. She had gained weight a f t e r her f i r s t c h i l d but s a i d she didn't r e a l l y know why. Her major motive f o r l o s i n g weight,was to appear slimmer. She was very determined and thought she would have no d i f f i c u l t y i n reaching her goal of 68 Kg. Sensory d e p r i v a t i o n was uneventful except f o r some i n t e r e s t i n g dreams. In one she had l e f t the chamber and kept t r y i n g u n s u c c e s s f u l l y to get back i n . A more alarming dream was that the programme was being run by someone who hated f a t women and was gassing them i n the chamber. At one week her. weight was.down to 82 Kg, but at one month i t was back up to 84 Kg. She had gone on an e a t i n g binge that l a s t e d a week. At two months she had gained againnand was now 85.2 Kg. She had r e c e n t l y found that she was hypoglycemic and was going on a s p e c i a l d i e t plan f o r t h a t . A month a f t e r that she wrote to say that she was d i s c o n t i n u i n g the programme and going back to Weight Watchers where she had experienced p r i o r success. She s t a t e d that she needed the weekly weigh-in and the constant reminder to keep on the t r a c k . On the phone i t was explained to her that the programme was research and that her data were important. At the f i n a l s i x month meeting her weight was 84.2 Kg. She f e l t the programme was not s u c c e s s f u l but that i t might have been had she followed i t . She found the d e t a i l s of the d i e t regimen bothersome and too time consuming. She was puzzled as to why she couldn't get ser i o u s about l o s i n g weight. Her f i n a l comment was that she wondered what the 24 hours of SD was f o r . 125 Subject SDNM-5 was a 51 year o l d housewife w i t h one c h i l d 29 years o l d . Her weight was 79.3 Kg at 166 cm t a l l and her goal weight was 64 Kg. She f e l t that her overweight which began at age 30 was due to excessive e a t i n g and d r i n k i n g , p a r t i c u l a r l y between meal e a t i n g . Her d r i n k i n g con-s i s t e d of one or two c o c k t a i l s r e g u l a r l y before dinner. Two weeks p r i o r to j o i n i n g the programme she had begun a d i e t of her own c u t t i n g down on sugars and starches and had l o s t s i x pounds. She was also walking every other day. Her major motive f o r j o i n i n g the programme was to avoid becom-in g a "middle aged frump". She found the bed i n SD too hard and t h e r e f o r e described her e x p e r i -ence as uncomfortable and she reported having unusual dreams such as one about a h u r r i c a n e , The week f o l l o w i n g SD her weight was down to 78.4 Kg and at one month she was down to 77,1 Kg when she reported that she was t r y i n g to get i n t o h a b i t s that would l a s t her the r e s t of her l i f e . At the two month f o l l o w up a f t e r Christmas she had gained s l i g h t l y (77.5 Kg) but reported that she was stepping up her e x e r c i s e programme by going to e x e r c i s e c l a s s e s . Her husband had r e c e n t l y j o i n e d her on the plan and t h i s was good f o r her^motivation. This seemed to help her since at the four month s e s s i o n she was down to 75.0 Kg. The f i n a l s i x month f o l l o w up was q u i t e s u r p r i s i n g i n that her weight was back up to 79.5 Kg. She reported that she had been c o n s t a n t l y p i c k i n g at food and had d i f f i c u l t y l e a v i n g l i q u o r alone. She f e l t she needed more re g u l a r check ups i n order to keep on the p l a n . Otherwise she was pleased w i t h the programme but q u i t e disgusted w i t h h e r s e l f . 126 Subject SDNM-6 was a 33 year o l d married woman w i t h four c h i l d r e n be-tween the ages s i x and 13. She was employed as a keypunch operator. She weighed 69.4 Kg at 156 cm and had a goal weight of 54 Kg. She had been overweight f o r . 10 years seeing the cause as "babies and s u r g e r i e s " . Three months p r i o r to j o i n i n g the programme she had l o s t 34 pounds on Weight Watchers and had kept that weight o f f . She had been r e f e r r e d to t h i s pro-gramme by the Smoking C l i n i c at UBC. She d i d not f i n d SD unpleasant even though she was a b i t shaky at f i r s t and was o c c a s i o n a l l y very warm, She spent her time t h i n k i n g about d i e t i n g and about g e t t i n g things done f o r Christmas. A f t e r a w h i l e her "mind began f l i t t i n g " but she rela x e d and enjoyed i t . One week f o l l o w i n g SD her weight was 70.6 Kg which was down from the 71.3 she had been at the time of SD. At one month she was up to 71.9 Kg although she reported having been down to 68 Kg before becoming i l l around Christmas. While she was s i c k she didn't eat much but was r e t a i n i n g a l o t of f l u i d . Her p h y s i c i a n had t o l d her that her kidneys were not f u n c t i o n i n g p r o p e r l y . At two months her weight was up to 73.8 Kg. She f e l t that she had approached the programme w i t h too much of an a t t i t u d e that i t would be very easy. She was then s t a r t i n g to plan meals i n advance. At the four month f o l l o w up she weighed 74.8 Kg and reported g e t t i n g worse. She was now sneaking food and f e l t that she needed group support to keep her motivated. At s i x months she was down some to 72.7 Kg. This l o s s she a t t r i b u t e d to the f a c t that she had s t a r t e d smoking again at the same l e v e l as before going to the Smoking C l i n i c . She f e l t i f she had followed the programme p r o p e r l y i t would have worked. She a t t r i b u t e d her l a c k of w i l l power to having hunger urges which she had never r e a l l y experienced be-fore because she had always been smoking. The urges began when she q u i t 127 smoking. At the same time she s a i d her e a t i n g problem came mainly from s o c i a l pressure. This she thought would have been a s s i s t e d by more f r e -quent f o l l o w up v i s i t s . 128 Subject SDNM-7 was a 52 year o l d married woman who worked as a Regis-tered Nurse at a major h o s p i t a l . She had three c h i l d r e n between 23 and 28 years o l d . Her i n i t i a l weight was 83.8 Kg at 162 cm. and her desi r e d weight was 61 Kg. She had been overweight f o r the past 10 years and a t t r i -buted her gain at that time to have been the r e s u l t of overe a t i n g t r i g g e r e d by emotional upset. She was j o i n i n g t h i s programme as a " l a s t d i t c h e f f o r t " s ince nothing e l s e had worked; on S t i l l m a n ' s quick weight l o s s d i e t she had l o s t .75 pounds and on a completely l i q u i d d i e t had l o s t 1.5 pounds. At the time of SD her weight was up to 84.5 Kg. She reported no d i f f i -c u l t i e s w i t h SD; i t was n e i t h e r unpleasant nor uncomfortable but she didn't want to repeat i t . One week f o l l o w i n g SD her weight was down to 82.6 Kg and at the one month f o l l o w up was 82.5 Kg. This slow progress was discouraging and she reported that she was planning on f a s t i n g 2 days a week. At two months she was 84.1 Kg and was con s i d e r i n g f a s t i n g 3 days a week. She reported f o l l o w i n g the d i e t c a r e f u l l y and f a s t i n g 2 days a week, however she s t i l l had some problem w i t h snacking i n the evening. At four months she reported that she had ceased f a s t i n g because she was becoming d i z z y . Her weight was down to 81.6 Kg. At the f i n a l s i x month se s s i o n her weight was 82.0 Kg. She found i t d i f f i c u l t to keep the programme going w i t h such slow weight l o s s . She was p a r t i c u l a r l y f r u s t r a t e d by t h i s . She d i d not f e e l that she could even reach her goal weight but was planning to s t i c k w i t h the programme to avoid gaining any more. 129 Subject SDNM-8 was a 25 year o l d woman who worked as a Registered Nurse. Her i n i t i a l weight was 75.3 Kg at 164 cm and her goal weight was 51 Kg. She had been overweight s i n c e 18 and saw the cause as being away from home which r e s u l t e d i n o v e r e a t i n g , e a t i n g starchy foods, and d r i n k i n g beer. She j o i n e d t h i s programme because she was not f e e l i n g very good about h e r s e l f and her weight. She reported that SD was much b e t t e r than she had a n t i c i p a t e d ; she had been wormed about the l a c k of Communication but a c t u a l l y found i t q u i t e r e -l a x i n g . One week f o l l o w i n g SD her weight was 73.5 Kg. A f t e r one month she reported that SD had been a s t a r t i n g p o i n t f o r her good progress, although she reported that being s i c k around Christmas time c o n t r i b u t e d to her cur-rent weight of 71.0 Kg. At two months she reported averaging 500 c a l o r i e s of e x e r c i s e a day and that she was on her 1500 c a l o r i e d i e t about 60% of the time. Her weight how-ever, had changed very l i t t l e (70.9 Kg) at that time. She showed l i t t l e p r o -gress at four months w i t h a weight of 70.6 Kg. She reported having had a number of f a m i l y w o r r i e s that l e d her to eat and that she had stopped keeping records of what she was e a t i n g . On the other hand she s a i d that the i d e a of not e a t i n g p i e and other such f a v o r i t e foods had stuck w i t h her. At the f i n a l s e s s i o n her weight was back to 70.9 Kg and she f e l t she needed to be pushed more to keep up the p l a n . Nevertheless she f e l t she had gained a h e a l t h i e r a t t i t u d e about the kinds of foods to eat and was e a t i n g l e s s sweets. She was impressed w i t h the whole p l a n but a t t r i b u t e d her poor progress to her own l a z i n e s s . 130 Subject SDNM-9 was a 40 year o l d housewife w i t h two c h i l d r e n aged 4 and 6. She o c c a s i o n a l l y worked as a s o c i a l worker. Her weight was 71.3 Kg at 155 cm w i t h a goal weight of 55 Kg. She had been overweight since the age of 12 and a t t r i b u t e d her weight problem to her binge e a t i n g . Occasion-a l l y she would go on binges and eat high carbohydrate foods. While she d i d not f i n d SD to be s t r e s s f u l she d i d not p a r t i c u l a r l y en-joy i t . She expressed a d e s i r e to get up and do and see t h i n g s . Toward the end of her session she reported " v i s u a l experiences w i t h shapes and l i g h t s " . She d i d not p a r t i c u l a r l y t h i n k about food or d i e t i n g but she d i d get hungry. F i n i s h i n g the allotment of Metrecal she repeatedly requested and r e c e i v e d more. She consumed a t o t a l of 10 cans of Metrecal and asked f o r more j u s t p r i o r to being l e t out at the end of 24 hours. Over the f i r s t two months she showed v i r t u a l l y no change i n weight; her weight at one week, one month and 2 months were 71.6 Kg, 71.4 Kg., and 71.0 Kg r e s p e c t i v e l y , She reported her most d i f f i c u l t time being when she f e l t pleased w i t h h e r s e l f and her progress. At two months she r e l a t e d an i n t e r e s t -i n g personal experience that stemmed from the SD s e s s i o n . While i n SD she f e l t tense and was unable to r e l a x however was made aware that t h i s t e n sion was the r e s u l t of f e e l i n g extremely dependent on other people. This made her aware of the extent to which she looked to others f o r l e a d e r s h i p . Even having to ask f o r more food i n SD made her aware of t h i s dependence and made her r e s e n t f u l of i t . She a l s o r e a l i z e d the':f.emotional r o l e that food p l a y s i n her l i f e ; her stomach had been tense i n SD and she i n t e r p r e t e d t h i s as hunger pangs and wanted to s t r e t c h out her stomach. At four months her weight was down to 68.5 Kg. She reported she had been working on making d e c i s i o n s f o r h e r s e l f and t r y i n g to do things f o r h e r s e l f . At the f i n a l s i x month session she was down to 65.9 Kg but s a i d 131 that she hadn't l o s t any weight during the l a s t month. Because she had been s t i c k i n g c a r e f u l l y to the programme she was discouraged and had t r i e d to withdraw from the programme. She f e l t she had f i n a l l y been able to focus on the problem which r e a l l y centered on her own m o t i v a t i o n and that she had a much h e a l t h i e r a t t i t u d e about food. She f e l t she had gained a great deal of i n s i g h t i n t o the emotional reasons f o r her e a t i n g and that she was now able to be more independent, look out f o r h e r s e l f and r e l y l e s s on the opinions of o t h e r s . A l o t of t h i s progress she a t t r i b u t e d to her one s e s s i o n of SD, 132 Subject NCM-1 was a 33 year o l d a r t i c l e d student of law. Her i n i -t i a l weight was 85.1 Kg at 167 cm. t a l l and her d e s i r e d weight was 59 Kg. She had been overweight since:" around ten years o l d and saw the cause of the problem as her mother's use of food as a s i g n of a f f e c t i o n . This pro-blem was a c o n t i n u i n g one i n that she s t i l l l i v e d w i t h her mother who con-tinued to use food i n t h i s way. P i e s and p a s t r y were c o n s t a n t l y present and her mother always made sure that she was e a t i n g "enough". Another p o s s i b l e i n f l u e n c e on her weight was that she took b i r t h c o n t r o l p i l l s c o n s t a n t l y to avoid the unpleasantness of menstruation. Because of a h e c t i c schedule and a number of problems at home she was not able to r e t u r n u n t i l one month a f t e r hearing the messages, at which time her weight was 85.7 Kg. Her boyfriend's mother was s e r i o u s l y i l l and t h i s s t r e s s had prevented her from g e t t i n g s t a r t e d on the d i e t . At two months she was down to 82.5 Kg. She was s t i c k i n g to a d i e t of 1350 c a l o r i e s and g e t t i n g r e g u l a r moderate e x e r c i s e . She was r e c e i v i n g no support from her mother which presented q u i t e a problem since her mother prepared her food. She expressed a d e s i r e to become more independent from her mother but complained that t h i s was impossible because of her mother's manipula-t i v e n e s s . Even the p o s s i b i l i t y of marrying and moving out was met w i t h t h r e a t s of s u i c i d e o r . l o s s of i n h e r i t a n c e . This subject was not seen again u n t i l the f i n a l s i x month s e s s i o n when her weight was up to 90.0 Kg. Her complete l a c k of f a m i l y support was seen as the reason f o r her f a i l u r e . Her mother was c o n s t a n t l y t r y i n g to sabotage her e f f o r t s and her b o y f r i e n d would say. " a l l you have to do i s eat l e s s " . She s t i l l used food as a reward and comfort whenever any s t r e s s or discom-f o r t arose. Food, she had found, was the only uncomplicated pleasure she had. One t h i n g she f e l t she had gained was), a more thorough understanding of 133 the complexity of her problem. She was not " j u s t a f a t s l o b " but i n many ways was a v i c t i m of her environment, 134 Subject NCM-2 was a 57 year o l d housewife who had had two c h i l d r e n however, one had r e c e n t l y been k i l l e d . Throughout the s i x months she was i n mourning and o c c a s i o n a l l y became q u i t e emotional. Her I n i t i a l weight was 93.8 Kg at 166 cm and her goal was to weight 68 Kg. Her weight had been gained at three d i f f e r e n t ages: 14, 24 and 51. The reason f o r her problem was her use of food as a comfort i n time of s t r e s s . One week f o l l o w i n g the messages her weight was 92.8 Kg and at one month was down to 90.2 Kg. She reported that she l i k e d the f a c t that n e i t h e r the book nor I was ever negative and s i n c e there were no forbidden f r u i t i t was e a s i e r to not eat things. She had been using the r e l a x a t i o n e x e r c i s e to curb her e a t i n g urges, At two months her weight was 89.7 Kg and she had been o f f the d i e t over the Christmas h o l i d a y s . Her husband had been very supportive of the plan she was f o l l o w i n g . At four months her weight was 88.0 Kg and she reported hav-ing been o f f the programme again f o r about a month. Her doctor suggested that she was suppressing her g r i e f too much. She was s t i l l using the r e l a x a -t i o n e x e r c i s e and found i t very u s e f u l i n d e a l i n g w i t h her g r i e f . This pleased her as she d i d n ' t want to take drugs f o r i t . At the f i n a l s i x month se s s i o n her weight was 87.1 Kg. She was not as concerned about l o s i n g weight but was s t i l l very concerned w i t h her h e a l t h . She was pleased w i t h the e f f e c t s her e x e r c i s e had had i n making her f e e l b e t t e r . The major problem had been her g r i e f which had a l s o depressed her and l e d her to eat f o r comfort. She f e l t that w h i l e she was very l a z y about l o s i n g weight that she could do i t . 135 Subject NCM-3 was a 41 year o l d married woman who ran a f l o r i s t shop. She had f o u r c h i l d r e n between the ages of 5 and 19. Her i n i t i a l weight was 108.3 Kg at 170 cm and her goal weight was.;70Kg. She had become overweight w i t h her l a s t pregnancy. She speculated that s i n c e she had been remarried perhaps she was more content, however, she also overate when she was upset. Her weight at t h i s p o i n t was causing her problems w i t h her back and her doctor had ordered her to reduce. A f t e r the s e s s i o n w i t h the messages t h i s subject had great d i f f i c u l t y i n making any of the scheduled appointments. The major c o n f l i c t was the f a c t that she was c h i e f l y r e s p o n s i b l e f o r her s t o r e j The f i r s t f o l l o w up f o r her was a f t e r two months when her weight was 107.5 Kg. She f e l t she was having d i f f i c u l t y because she needed someone to report t o . Also she had gone o f f the d i e t at Christmas time. Because she went away f o r a h o l i d a y she was not seen again u n t i l the f i n a l s i x month se s s i o n when her weight was 106.9 Kg. She f e l t t hat she was more conscious of t a k i n g care of h e r s e l f but that running her st o r e was a d r a i n on her and made her nervous. This made her want to eat. She was not t h i n k i n g of s e l l i n g her s t o r e and thought that t h i s a c t i o n would help her l o s e weight. She f e l t that now she was able to f o l l o w a d i e t without becoming depressed about d e p r i v i n g h e r s e l f . 136 Subject NCM-4 was a 44 year o l d housewife w i t h s i x c h i l d r e n between - 11 and 23 years o l d . Her i n i t i a l weight was 8i2'..l Kg at 167 cm and her goal weight was 68 Kg. Her weight problem which she had had s i n c e the age of 15 was due mainly to poor e a t i n g h a b i t s . She was a fussy eater showing a preference f o r sweets and g e n e r a l l y avoiding many vegetables. Her m o t i v a t i o n f o r j o i n i n g the programme was that her problem had been aggravated by having r e c e n t l y given up smoking. One week f o l l o w i n g the p r e s e n t a t i o n of messages her weight was 81.6 Kg and a f t e r one month was down to 78.2. A f t e r t h i s she became q u i t e i n v o l v e d i n an e l e c t i o n campaign, during which she didn't f o l l o w the d i e t at a l l . For t h i s reason her weight went up to 79.1 Kg at two months. A f t e r the e l e c t i o n was over she returned to the d i e t only b r i e f l y due to a r a t h e r u p s e t t i n g home s i t u a t i o n . Problems between her husband and her which r e s u l t e d i n t h e i r s e paration produced s t r e s s that prevented her from s t i c k i n g c o n s c i e n t i o u s l y to the p l a n . At four months her weight was 79.0 Kg. At the f i n a l s i x month se s s i o n her weight was 76.9 Kg. She saw the major d i f f i c u l t y as her i n a b i l i t y to organize h e r s e l f . Her i n i t i a l com-mittment had f i r s t been i n t e r r u p t e d by the e l e c t i o n and then by harassment from her husband. A f t e r seeking f a m i l y counseling she and her husband were back together and g e t t i n g along much b e t t e r . She f e l t she had learned a l o t about her e a t i n g h a b i t s but s t i l l didn't understand her c r a v i n g f o r sweets. She now r e a l i z e d the importance of e x e r c i s e and was planning to s t a r t over on the programme. 137 Subject NCM-5 was a 44 year o l d woman,who worked as a c h i l d w e l f a r e s o c i a l worker. She had three c h i l d r e n between 15 and 19 from an e a r l i e r marriage but was c u r r e n t l y l i v i n g i n a Common Law s i t u a t i o n . Her weight was 76.5 Kg at 155 cm and her de s i r e d weight was 57 Kg. She had been overweight since the age of 13 and saw the cause of the problem being that e a t i n g was her response to s t r e s s and she was a very emotional per-son w i t h a l o t of s t r e s s . Her motive f o r j o i n i n g the programme was that r e c e n t l y her overweight was causing her to become f a t i g u e d e a s i l y . At one week f o l l o w i n g the messages her weight was 76.8 Kg. Because of her busy schedule she found very l i t t l e time to f o l l o w the d i e t or do any e x e r c i s e . At one month her weight was 78.0 Kg and she was wondering i f she r e a l l y d i d want to be thin.anyway. At two months she was the same weight at 78 Kg and she reported averaging about 2000 c a l o r i e s a day. Her Common Law spouse seemed to be sabotaging her d i e t by b r i b i n g her w i t h food because, she claimed, he l i k e d her to be f a t . She a l s o s a i d that up to that p o i n t she had made no r e a l commitment to the programme but i n t e n -ded to do so at the beginning of the year. At four months she weighed 79.5 Kg and complained o f being very de-pressed. She had been o f f a n t i depressants f o r a year but was now back on them. Her spouse was p r o v i d i n g no emotional support f o r her programme and she fouhdoherself having to become more independent. At the f i n a l s i x month session she weighed 77.7 Kg and a t t r i b u t e d t h i s l o s s to having j o i n e d TOPS programme i n the previous two weeks. She enjoyed the other women i n the programme and was on a high p r o t e i n d i e t . She f e l t the philosophy behind t h i s programme had been good but was not r i g h t f o r her, as she had great d i f f i c u l t y f o l l o w i n g the s t r u c t u r e . She 138 d i d n ' t l i k e being t o l d what to do or being t i e d to a c h a r t . She f e l t that she now had a b e t t e r o r i e n t a t i o n about why she should l o s e weight but didn' t f e e l t h i s a t t i t u d e change was the r e s u l t of the programme. 139 Subject NCM-6 was a 45 year o l d housewife w i t h four c h i l d r e n between 17 and 23. She a l s o worked i n a d e l i c a t e s s e n as a sales person. Her i n i t i a l weight was 95.25 Kg at 163 cm and her goal weight was 70 Kg. Hav-i n g been overweight s i n c e the age of 16 she saw overeating and l a c k of e x e r c i s e as the c h i e f causes. During her week of s e l f monitoring she discovered that she d i d much snacking w h i l e working the food counter at her job. A week f o l l o w i n g the message she weightejd-u 94.5 Kg but a f t e r one month was back up to 95.1. Her snacking at work was s t i l l a problem and she found i t d i f f i c u l t to f i n d the time f o r e x e r c i s e . At two months her weight was 93.7 Kg. To f i g h t her snacking at work she was b r i n g i n g raw vegeta-b l e s to her job and e a t i n g them i n s t e a d . She f e l t she had become much more aware of e a t i n g . At four months her weight was 94.7 Kg and by s i x months was back up to 95.6 Kg. The major problems were seen as never having time to do the e x e r c i s e that she knew was necessary and e a t i n g at work. The constant temptation of being surrounded by d e l i c a t e s s e n goodies was too much f o r her even though between meal e a t i n g was never a problem at home. She f e l t that she was weak w i l l e d and e a s i l y bored w i t h any programme. She had learned to slow down when she ate but continued to eat the wrong foods: 140 Subject NCM-7 was a 43 year o l d housewife w i t h f i v e c h i l d r e n be-tween 9 and 19 years o l d . Her i n i t i a l weight was 91.2 Kg at 156 cm and her goal weight was 64 Kg. She had been overweight s i n c e a f t e r the b i r t h of her f i r s t c h i l d when she had become much l e s s a c t i v e and began to overeat to cope w i t h boredom. One week a f t e r the messages her weight was 89.7 Kg and she showed very slow progress a f t e r that w i t h one and two month weights of 89.4 Kg and 88.4 Kg. She had been t a k i n g i n d e r o l f o r high blood pressure and f e l t that t h i s had slowed down her metabolism because she was s t i c k i n g to her 1350 c a l o r i e d i e t . At four months her weight was up to 90.4 Kg and at s i x months was up f u r t h e r to 92.9 Kg. She f e l t she had been unable to break her o l d h a b i t s and l e a r n new ones and she was confused about her m o t i v a t i o n . She wanted to l o s e weight but wasn't working at i t . She had stayed on the d i e t f o r two months but q u i t because her progress was so slow. She also expressed r e s i s t a n c e against the behavioural aspects of the programme. She voiced having qualms about behaviour theory s i n c e i t was outside r a t h e r than i n t e r n a l i n f l u e n c e . She saw the taped messages as an attempt at manipula-t i o n . On the other hand she saw h e r s e l f as being wishy washy w i t h no w i l l power. She was beginning to hate housework andthis made her eat a l o t around the house. In a d d i t i o n she was developing b u r s i t i s which she f e l t was a psychosomatic symptom of t h i s h a t r e d. She concluded that the pro-gramme i t s e l f was s u c c e s s f u l but she was not. 141 Subject NCM-8. was a 30 year o l d housewife w i t h two c h i l d r e n aged s i x and e i g h t . Her i n i t i a l weight was 111 Kg at 167.5 cm and her goal weight was 64 Kg. She had been heavy s i n c e the age of ei g h t but had become extremely heavy a f t e r her second c h i l d . Overeating had become, her response to depression and disappointment w i t h h e r s e l f . She had pre-v i o u s l y l o s t weight on TOPS and Weight Watcher programmes but had always gained the weight back. One week a f t e r hearing the messages her weight was down to 108.2 Kg. She was q u i t e pleased w i t h the 1700 c a l o r i e and the programme i n general. By one month she weighed 104.5 Kg and was s t i l l very e n t h u s i a s t i c about her steady progress. Her e x e r c i s e c o n s i s t e d of 5 minutes each morning and evening. At two months her weight was 102.2 Kg and although s t i l l pleased w i t h the d i e t she reported that she had been depressed f o r one week and had neglected p a r t s of the plan l i k e w r i t i n g things down. She was able to stay on the d i e t p l a n throughout the Christmas h o l i d a y s but " f e l l a p a r t " a f t e r -wards. She stopped keeping t r a c k and even took down her graphs. At four months her weight was 106.4 Kg. A f t e r that she was never able.to get back on the p l a n . She would s t a r t f o r a few days and then q u i t . She claimed she s t i l l wanted to do i t but couldn't f o l l o w through. Her s i x month weight was 107.9 Kg. While she washable to keep e x e r c i s i n g r e g u l a r l y she f e l t very s t u p i d about the way she was e a t i n g . When people s t a r t e d n o t i c i n g her weight l o s s she became overconfident and then s t a r t e d to s l i d e . This i s turn would give her the f e e l i n g she was l e t t i n g everyone down which would depress her. Then she would go back to food f o r c o n s o l a t i o n . She f e l t p a r t i c u l a r l y 142 f r u s t r a t e d knowing she could do i t but wasn't. She was much more aware of her weight. To succeed she f e l t i t would be necessary to i s o l a t e h e r s e l f from others, to shut out the comments of others. 143 Subject NCM-9 was a 44 year o l d housewife w i t h f i v e c h i l d r e n between the ages of 7 and 20. Her i n i t i a l weight was 94.5 Kg at 166.5 cm and her d e s i r e d weight was 66 Kg. She could not remember any p a r t i c u l a r age when her weight problem began; she had always had i t . Her overeating was an emotional response; e a t i n g when she was upset, tense, or bored. She f e l t t h i s programme might help her w i t h t h i s aspect. This subject was never able to f o l l o w the d i e t very c a r e f u l l y and subsequently d i d not show much weight change over the s i x months. At one week her weight was 94.4 Kg. At one month she refused to come i n f o r her appointment saying that she had been very depressed and had probably gained 5 pounds. She wanted to q u i t the programme at t h i s time. A f t e r some per-suasion she agreed to continue and came i n at the two month p e r i o d when her weight was 93.2 Kg. Although she had not been on the d i e t she had been very busy and e a t i n g was never a problem when she was "mentally busy". She found that having to concentrate on the mechanics of the d i e t only — made her hungrier. She was desperately l o o k i n g f o r some i n c e n t i v e that would motivate her to do i t . At four months her weight was back to 94.5 Kg and by s i x months was up to 96.6 Kg. She f e l t the programme should work f o r others but was not r i g h t f o r her; i t hadn't d e a l t enough w i t h her emotional problems. A recent r e s i d e n t of Vancouver she had no f r i e n d s and f e l t very a l i e n a t e d and i s o l a t e d . In a d d i t i o n her husband t r a v e l l e d f r e q u e n t l y . She f e l t a group s i t u a t i o n or a centre where she might volunteer time and f e e l use-f u l would have been much b e t t e r f o r her. 144 Subject NCNM-1 was a 21 year o l d woman who worked as a s e c r e t a r y . She had been overweight since l e a v i n g high school when she began e a t i n g to soo'tlv emotional, problems. Also at that time she became much l e s s ac-t i v e . Her i n i t i a l weight was 78 Kg at 161 cm and her goal weight was 55 Kg. One week a f t e r . b e g i n n i n g the d i e t she weighed 76.7 Kg and was ex-tremely e n t h u s i a s t i c about the pl a n . At that p o i n t i n any other programme she s a i d she would have q u i t . She was not able to come i n again u n t i l the two month se s s i o n when her weight was 74.0 Kg. Her problem e a t i n g time had been a f t e r work i n the e a r l y evening. To combat t h i s she had taken a second j o b . She was s t i c k i n g to a 1350 c a l o r i e d i e t and g e t t i n g about 150 c a l o r i e s of. e x e r c i s e every day. She was s t i l l pleased w i t h the plan and found the manual very u s e f u l . At four months her weight was 71.7 Kg. She claimed that where she used to t h i n k of food c o n s t a n t l y , c e n t e r i n g a l a r g e p a r t of her l i f e around i t , now she d i d not thi n k of i t o f t e n . At s i x months she weighed 71.1 Kg and was s t i l l enthused about the p l a n . She was pleased w i t h the continuous weight l o s s and also w i t h . f e e l i n g h e a l t h i e r and i n b e t t e r p h y s l c s l shape. Her bigg e s t problems had been going put to dinner w i t h others and snacking. However she now f e l t she was not as l a z y as she thought she was and that l o s i n g weight was not so hard i f you go about i t i n the proper way. 145 Subject NCNM-2 was a 32 year o l d housewife w i t h one c h i l d aged 5. She a l s o worked, as a Registered Nurse. Her i n i t i a l weight was 77.2 Kg at 153.2 cm and her goal weight, was 50 Kg. She became overweight s h o r t l y a f t e r she was married at age 23. She thought that because she f e l t happy and secure she began to overeat and to eat the wrong foods. She j o i n e d t h i s programme because i t was research, i t l a s t e d s i x months, and someone would be very i n t e r e s t e d i n her progress. She was a l s o c u r r e n t l y attending Weight Watchers and had l o s t 13 pounds thus f a r on i t . One week f o l l o w i n g the i n s t r u c t i o n session she weighed 77.1 Kg and at one month was down a b i t to 76.3 Kg. She was c o n s t a n t l y s h i f t i n g back and f o r t h between her 1350 c a l o r i e p l a n w i t h t h i s programme and Weight Watchers programme. At two months when her weight was 78.4 she decided that she would s t i c k to the Weight Watcher d i e t and the e x e r c i s e part of t h i s programme. At four months her weight was 77.2 Kg and she f e l t that she had gained some i n s i g h t i n t o h e r s e l f . She discovered that she f e l t great s e c u r i t y In having l o t s of food around the house, and always kept i t overstocked. She also claimed that she no longer cared about l o s i n g weight anymore because she was j u s t too l a z y . However she was pleased w i t h the book and had t o l d s e v e r a l people about i t and they had been doing w e l l on i t . At the f i n a l s i x month se s s i o n she was q u i t e disappointed w i t h the programme. Her weight was 75.0 Kg but she had intended that t h i s would be the " d i e t to end d i e t s " . On one hand she f e l t more contact and l i t e r a t u r e would have b e n e f i t t e d her attempt but on the other hand she resented being t o l d what to do and knew i t must be s e l f i n s t i g a t e d . She f e l t she had learned the importance of the proper a t t i t u d e but f e l t she didn't have i t . She was disappointed that the programme hadn't done more f o r her. 146 Subject NCNM-3 was a 36 year o l d housewife w i t h three c h i l d r e n be-tween 5 and 12. Her I n i t i a l weight was 80 Kg at 168 cm w i t h a goal weight of 59 Kg. She had been overweight s i n c e the b i r t h of her l a s t c h i l d and saw the cause as overeating i n response to boredom. One week a f t e r beginning the d i e t her weight was 78.9 and a f t e r one month was 77.3 Kg. She had not been f o l l o w i n g the programme e x a c t l y because she wasn't keeping t r a c k of c a l o r i e s and wasn't e x e r c i s i n g . I n -stead she was j u s t being c a r e f u l of what she ate and f o l l o w i n g some of the b e h a v i o u r a l steps. At two months she weighed 75.5 Kg and reported that she was concentrating on the l e a r n i n g of new e a t i n g h a b i t s . At the four month se s s i o n she reported that she had not been on a d i e t at a l l . Her weight was 76.0 Kg. She suggested that she would do b e t t e r i f she had some one e l s e on the programme that she could c a l l when she was l o s i n g her m o t i v a t i o n . At s i x months she weighed 75.4 Kg. Her main problem was l a c k i n g the proper i n c e n t i v e . Not being accountable to anyone i n the l a t t e r part of the plan had made i t easy to forget about i t . She was q u i t e disappointed w i t h h e r s e l f and f e l t the programme was good i n the g u i d e l i n e s i t set down. She knew that i f she wanted to l o s e weight badly enough i t would now be p o s s i b l e . 147 Subject NCNM-4 was a 48 year o l d housewife w i t h f i v e c h i l d r e n be-tween 16 and.28. Her i n i t i a l weight was 82.8 Kg at 163 cm and her goal weight was 61 Kg. She had s t a r t e d to gain weight w i t h the b i r t h of her f i r s t c h i l d but at the age of 40 had had a t u b a l l i g a t i o n and gained a l o t more. Her weight was 82.5 a f t e r one.week and 80.9 a f t e r one month. She was q u i t e disappointed w i t h t h i s slow progress s i n c e she was s t a y i n g f a i r l y c o n s i s t e n t l y w i t h 1200 c a l o r i e s . A f t e r t h i s she was found to d i a b e t i c and was put on an exchange plan d i a b e t i c d i e t . She remarked on the s i m i l a r i t i e s between the d i a b e t i c d i e t and t h i s programme d i e t . At two months her weight was 80.8 Kg. Suppertime was her biggest problem time. To combat t h i s she was e a t i n g ahead of the r e s t of the fa m i l y to she could then serve everyone e l s e . Her weight at 4 months was 81.8 Kg. She had been put on a 1121 c a l o r i e d i a b e t i c exchange p l a n but f e l t that i t was too much so she was planning on reducing i t to 900 c a l o r i e s . At the f i n a l s i x month s e s s i o n she weighed 80.2 Kg. She had been on the 900 c a l o r i e d i e t and sometimes even ate l e s s . Also f o r the l a t e s t three weeks she had been going to TOPS meetings. One of her major pro-blems had been the l a c k of support from her f a m i l y . They would make fun of her e f f o r t saying " Y o u ' l l never do i t " . She f e l t t hat she had learned to c o n t r o l her e a t i n g h a b i t s much b e t t e r and had discovered that she needed very l i t t l e food. 148 Subject NCNM-5 was a 26 year o l d married woman who was studying as an a r t student. Her i n i t i a l weight was 74.6 Kg at 158 cm and her goal weight was 53 Kg. She had been overweight since the age of s i x and she saw e a t i n g as an o u t l e t f o r f r u s t r a t i o n . She derived a great deal of comfort from food. A f t e r one week she was q u i t e pleased w i t h the mechanics of the p l a n and her weight was 71.9 Kg. She was f o l l o w i n g a 1200 c a l o r i e d i e t w i t h a s m a l l amount of r e g u l a r e x e r c i s e . At one month she weighed 70.5 Kg. Her weight at two months was down to 68.3 Kg and she was very pleased w i t h the s e n s i b i l i t y of the d i e t p l a n and emphasis on good e a t i n g h a b i t s . She was a l s o a t t e n d i n g TOPS meetings but had been disappointed because t h e i r emphasis was s o l e l y on l o s i n g as much weight as p o s s i b l e . At t h i s p o i n t her weight l o s s was beginning to be p h y s i c a l l y v i s i b l e and many of her f r i e n d s would compliment her. This f a c t plus the ease w i t h which she had l o s t weight made her f e e l a b i t cocky and she s t a r t e d to n i b b l e . However, t h i s got a b i t out of hand so she got back onto the programme s t r i c t l y . At four months her weight was 64.6 Kg. At the f i n a l s i x month se s s i o n she weighed 62.0 Kg but d i d not f e e l she had been e n t i r e l y s u c c e s s f u l because she s t i l l had bad h a b i t s which she o c c a s i o n a l l y would s l i p back i n t o . This plus d e a l i n g w i t h going out to eat had been her biggest problem. Otherwise she was f e e l i n g h e a l t h i e r than she ever had before and was planning to s t a r t studying dance. She was more confident i n her s e l f and pleased w i t h the i d e a of s i t u a t i o n a l c o n t r o l that was used i n t h i s programme. She s t i l l f e l t very committed and was going to continue using the p l a n . Her one o b j e c t i o n to the pro-gramme was having to pay f o r the d i e t manual. She i n i t i a l l y d idn't t h i n k she should have to pay f o r i t but l a t e r thought that owning i t h e r s e l f may have been h e l p f u l . 149 Subject NCNM-6 was a 43 year o l d married woman w i t h 4 c h i l d r e n between 11 and 16 and who worked as an orth o d o n t i c t e c h n i c i a n . Her i n i t i a l weight was 89.2 Kg at 167.5 cm and her de s i r e d weight was 68 Kg. She had been overweight s i n c e the age of 16 and her only perceived cause was that she j u s t l i k e d to eat. One week a f t e r s t a r t i n g her 1350 c a l o r i e d i e t her weight was 87.8 Kg. She als o was g e t t i n g f a i r l y r e g u l a r e x e r c i s e w i t h w a l k i n g , j o g g i n g , and gardening. Her weight at one month was 87.0 Kg. At two months she weighed 85.6 Kg and f e l t very good about the d i e t . She f e l t that she was ea t i n g more now than before the d i e t but that now she was e a t i n g the r i g h t foods. Furthermore she was not hungry and no longer craved sweets or candy. Her weight at four months was 83.5 and she claimed i t had been very d i f f i c u l t . During that p e r i o d she had been i l l and ate to f e e l b e t t e r . She also had been g e t t i n g no e x e r c i s e . At the f i n a l s i x month se s s i o n her weight was 86.6 Kg. She didn't know why she was doing i t but she had been " e a t i n g e v e r y t h i n g i n s i g h t " . Also she had gone away twice and both times had put on weight. Also she hadn't been e x e r c i s i n g . She found that managing to get r e g u l a r exer-c i s e was her bi g g e s t problem. She f e l t she was no longer as strong w i l l e d as she thought she had been. Recently her neighbor had died and i t made her t h i n k , "Why am I s u f f e r i n g ; I'd rat h e r die happy -• e a t i n g " . On the other hand she f e l t she was ea t i n g b e t t e r foods and was l e s s hungry than on other d i e t s . 150 Subject NCNM-7 was a 43 year o l d housewife w i t h three c h i l d r e n be-tween 17 and 21. Her i n i t i a l weight was 93.1 Kg at 168 cm and her goal weight was 77 Kg. She had been overweight s i n c e the age of 18 and had gained 30 pounds i n the f i r s t year of her marriage. While she a t t r i b u t e d t h i s gain to being very happy and l o v i n g to cook she s a i d that her most recent weight gain was due to l o n e l i n e s s and depression. One week a f t e r beginning a 1350 c a l o r i e p lan her weight was 90.7 Kg. She was extremely e n t h u s i a s t i c about the d i e t , i n f a c t at one month she claimed that she " l i v e s the d i e t " . She l i k e d the exchange p l a n because of i t s f l e x i b i l i t y . She had problems w i t h her arms which prevented much motion and t h i s made some e x e r c i s i n g impossible. At two months she weighed 87.5 Kg and reported that she was never over 1350 c a l o r i e s and was g e t t i n g d a i l y e x e r c i s e . She was pleased w i t h the manual and had been d i s c u s s i n g i t w i t h many of her f r i e n d s . At four months her weight was down to 86.3. At the f i n a l s i x month s e s s i o n she weighed 86.7 Kg and although she f e l t she hadn't l o s t much she was very happy w i t h how much b e t t e r and h e a l t h i e r she was f e e l i n g . Her biggest problem had been disappointment w i t h slow weight l o s s e s p e c i a l l y i n the l a s t p o r t i o n of the programme. She p r a i s e d the book and programme as the best she had seen. She a l s o commented on the p o s i t i v e a t t i t u d e of the experimenter as an important f a c t o r . She was disappointed however at not having been able to go through SD. 151 Subject NCNM-8 was a 33 year o l d housewife w i t h three c h i l d r e n between 5 and 15. Her i n i t i a l weight was 133.7 Kg at 165 cm and her d e s i r e d weight was 64 Kg. She became overweight w i t h her f i r s t preg-nancy at age 17 and gave as a reason overeating and no e x e r c i s e . She a l s o ate enormous q u a n t i t i e s of food i n the middle of the n i g h t . A f t e r one week on a 1200 c a l o r i e d i e t her weight was 132.4 Kg. She had d i f f i c u l t y w i t h her midnight e a t i n g and was given some technique to combat i t . At one month her weight was 131.3 Kg. She missed the two month session but came i n at four months. Her weight was up to 137.0 Kg at that time. She reported that her t y p i c a l p a t t e r n was to s t a r t out " a l l gung ho" i n the morning and by evening have given up. Her midnight e a t i n g was s t i l l a problem and she had given up working on t h a t . At the f i n a l s i x month session she weighed 138.2 Kg and i n s p i t e of t h i s g ain f e l t the programme was f a i r l y s u c c e s s f u l because of the things she had learned. When asked i f she had learned anything about h e r s e l f however she s a i d , "What's to l e a r n , I'm f a t , that's i t " . She was g e t t i n g a great deal of pressure from her doctors to l o s e weight but she s t i l l was unable to develop enough m o t i v a t i o n . She f e l t she might be able to do b e t t e r i f she were more c l o s e l y supervised. 152 Subj.ect NCNM-9 was a 46 year o l d woman w i t h three c h i l d r e n 11 to 21. She was separated from her husband and was studying some at U n i v e r s i t y . Her i n i t i a l weight was 74.8 Kg at 164.5 cm and her goal weight was 59 Kg. She had been overweight f o r the l a s t four years and a t t r i b u t e d the pro-blem to emotional problems. Her response to worry and ten s i o n was to eat. She also drank f r e q u e n t l y and u s u a l l y i t was beer. One week f o l l o w i n g the beginning of her 1500 c a l o r i e d i e t her weight was 73.25 Kg. She was s t i c k i n g to the d i e t and g e t t i n g o c c a s i o n a l exer-c i s e . At one month she weighed 73.0 Kg. Since her l i f e s t y l e i n v o l v e d going out f r e q u e n t l y , she had d i f f i c u l t y w i t h d i n i n g out andvwith d r i n k i n g . At two months her weight was 72.3 Kg. She reported that she belonged to a d i e t club that would give her support when she l o s t weight. She was walking or swimming about three times a week. A f t e r t h i s she became q u i t e depressed and couldn't get h e r s e l f to do anything. Consequently her weight at four months was up to 73.7 Kg. At the f i n a l s i x month se s s i o n she weighed 73.1 Kg and s a i d that the programme had made her f e e l worse than before. U s u a l l y able to do the things she set out to do, she found the f a i l u r e at t h i s d i e t attempt very f r u s t r a t i n g . She commented that because she was ea t i n g l e s s f r e q u e n t l y she was enjoying food more. However, she f e l t that the plan l e f t too much o r g a n i z i n g and r e s p o n s i b i l i t y to her. She f e l t both her eating and d r i n k i n g were due to the emotional upset that was caused by her being separated from her husband, a s t a t e she could not get used t o . She f e l t t h at she had no w i l l power. When she would eat the wrong things she would say to h e r s e l f "Oh you don't look too bad". This f a i l u r e had been hard on her s e l f esteem but she thought that i f she had attempted i t i n a hap-p i e r , more s t a b l e p e r i o d of her l i f e she would have been more s u c c e s s f u l . 153 Subject NCNM-10 was a 46 year o l d housewife w i t h f i v e c h i l d r e n be-tween 9 and 25. Her i n i t i a l weight was 87.5 Kg at 163 cm. and her goal weight was 59 Kg. She began to gain weight w i t h her f i r s t pregnancy and gained w i t h each subsequent one. She a l s o overate i n response to s t r e s s and a n x i e t y . One week f o l l o w i n g the d i e t i n s t r u c t i o n her weight was 87.7 Kg. A f t e r one month she weighed 87.9 Kg and reported that preparing food f o r her l a r g e f a m i l y presented a major snacking problem. Also she s t i l l used food as a reward f o r working hard around the house. At two months she weighed 86.9 Kg and reported being on a 1500 c a l o r i e d i e t about h a l f the time. She was not, however, graphing or keeping care-f u l t r a c k of what she ate. F o l l o w i n g t h i s she learned that her husband was to be t r a n s f e r r e d and she must s e l l t h e i r house and move. This upset i n l i f e s t y l e threw the d i e t r o u t i n e "out the window". At four months her weight was 90.8 Kg. By the s i x month session she was already s e t t l e d i n t o her new house. Her weight was 87.7 Kg. She f e l t the programme had f a i l e d f o r her. be-cause of unusual pressures on her during the programme p e r i o d . She thought the p l a n of d i e t and e x e r c i s e was e x c e l l e n t but that more emphasis should have been placed on the reasons f o r overeating. She had learned how much she rewarded h e r s e l f w i t h food f o r everything she d i d and was determined that food would no longer be her "best f r i e n d " . She was planning on j o i n i n g a group c a l l e d Overeaters Anonymous and using t h i s d i e t i n conjunc-t i o n w i t h t h e i r programme. She f e l t that s t i c k i n g .wiith the programme i n the face of f a i l u r e had forced her to examine her many motives f o r over-e a t i n g and that she was now 'better equipped to deal w i t h them. APPENDIX B Newspaper A r t i c l e s Used to R e c r u i t Subjects 155 Relax.. .and Ipse I some of that weight I-A University of B.C. grad student needs 48 ovenveight women.for, a research; proj-\,ect on obesity.'.. ' ]-.••'<' :]\ '>.[• •';/;;': ]••• Rod Borrie said several candidates will lie alone in a dark, padded, room for 24 hours and drink Metrical while relaxation instructions are piped through loudspeak-ers. "' • "Wliat we're vlooking at here," he said Tuesday, "is sensory deprivation' as a technique to improve relaxation'training-and as a booster in self-control." . . i •,;••>< . . . . . . . . . j Those given instruction in the padded; J room, 'and a control group taught the re-' j laxation' techniques in a more normal set-:  ;; ting, will be watched;for six months, 'r' ! 'The. idea of using "relaxation tech-' niques" to loose weight may seem stange ; to those accustomed to the idea that vigor- • j.ous exercise is necessary to burn off ex-. •' .cess calories. : " • ' Borrie wants to see whether sensory I deprivation aids in relaxation training by [ forcing concentration and providing an apr . ..,propriate setting...- ' • "The program: is based on a complete : change in lifestyle and regular eating and exercising," he said. "It's not a crash diet program. It's a long term thing:" Applicants must be women between 20 and 55 who are at least 25 per cent over-weight. • They also must be willing to submit to a medical checkup, introductory and follow-up interviews, and rigorous self control for thesix months.' ':• v ew diet based on persuasion • Weight reduction is usually fraught with, anxiety and suffering, real or imagined, but a University of B.C. graduate student is experimenting with a m^^e.laxed' method of dieting. l - i ' 1 - ' ' ' f» '• j.: Rod Borrie, a doctoral candidate in psy-chology, said in an interview Wednesday that gentle persuasidn rather than-harsh prohibition is the key to Ms-method.''??':' Overweight subjects will lie alone in a quiet, dark room and drink Metrecal while relaxation instructions, are piped/from tape recorders. He said subjects who are isolated from distractions should be able to concentrate on the problem at hand — cutting excess pounds. •;•'* ;'' >To test his theory, Borrie said he needs ,.i48 women aged 20 to 55 who are at least 25 ^ per cent .overweight. They must agree to a ' ' f | medical checkup, follow-up interviews, 0and rigorous self-control for six months. . ai" Borrie said his subjects, for the sake of ^consistency, have to be of the same sex. ! Women were chosen because they usually *,4;are more available than men, he said. Only'' half of the volunteers will be ex-. posed, to his "sensory deprivation" tech- f nique. Others will be taught relaxation \ techniques in a more normal setting. ', . Borrie said the program is based on a j change of attitude and better eating and '< exercising habits, rather than a crash diet. Instead of attempting to cut 20 pounds in -!.. a month, subjects should be able to reduce their weight by one pound a week, be said. 156 APPENDIX C Message T r a n s c r i p t s 157 SET I 1. One of the most frequent mistakes that people make when they t r y to lose weight i s to put the emphasis on not e a t i n g . For example, they say to themselves, " I must not eat. I should not eat. I won't ea t . " This k i n d of t h i n k i n g i s dead wrong. I t makes about as much sense as concen-t r a t i n g on not having an i t c h i n g sensation on your nose. What happens i f you concentrate on not having an i t c h ? R i g h t : you have i t ! The same t h i n g happens w i t h l o s i n g weight. I f you concentrate on not e a t i n g , you end up more preoccupied, than ever w i t h e a t i n g . Free people resent being t o l d what not to do on a permanent b a s i s , even i f you t e l l i t to your-s e l f , but a free person i s able to change on the b a s i s of something he i s f o r . So, i f you look at t h i s as a promise to pr o t e c t your body, t h i s can r e s u l t i n not ove r e a t i n g , but you experience i t as "yes" r a t h e r than "donttt"., By concentrating on t h i s new sense of p r o t e c t i o n f o r your body, the urge to eat more than you should i s ignored and e v e n t u a l l y i t d i s a p -pears . We know t h i s much about urges. I f you repeatedly deny s a t i s f a c t i o n to an urge, whether b i o l o g i c a l or p s y c h o l o g i c a l by i g n o r i n g i t , the urge e v e n t u a l l y w i t hers away. This i s true even w i t h something as strong as hunger. When Ghandi went on h i s hunger s t r i k e , he d i d not concentrate on not e a t i n g . He concentrated on arousing p u b l i c o p i n i o n f o r h i s cause. Not e a t i n g was an i n c i d e n t a l aspect of h i s s t r a t e g y . As a r e s u l t , days l a t e r , even though weak from s t a r v a t i o n , he observed that h i s a p p e t i t e was gone. His urge to eat disappeared. S i m i l a r l y , by concentrating on t h i s new sense of p r o t e c t i o n f o r your body the urge to eat when you shouldn't i s ignored and e v e n t u a l l y i t disappears. 2. You are your body's keeper. Your body i s your p h y s i c a l p l a n t . When you put too much food i n t o your body, i t can do nothing but accept i t and make the best of i t . When you r e a l i z e that you are the one p u t t i n g the e x t r a weight t h e r e , you have some questions to ask y o u r s e l f . Are you f o r your body or are you not? Are you f o r l i v i n g or are you not? I f the an-swer i s no, then keep on over e a t i n g . But, i f the answer i s yes, you have a b u i l t i n o b l i g a t i o n to give your body the respect and p r o t e c t i o n i t deserves. You see how d i f f e r e n t that i s from saying, " I w i l l not eat"? In essence, t h i s i s an a r t form, the a r t of c o n t r o l l i n g an urge. I f you mean to c o n t r o l an urge, don't f i g h t i t , the more you f i g h t i t , the s t r o n g -er i t w i l l become. Instead, l e a r n to ignore i t . Here i s a way to do i t . When an urge to eat occurs, admit i t , but at the same time acknowledge that you have t h i s commitment to respect your body. Thus, you have two urges at the same time; the urge to eat and the urge to respect your body. Lock them together. By emphasizing respect f o r your body, you w i l l be able to keep your i n t a k e at a s e n s i b l e l e v e l . I f you l o c k together two c o n t r a d i c t o r y urges and focus on one, you must, at the same time, ignore the other. I would l i k e to teach you an e x e r c i s e which you may f i n d h e l p f u l whenever you f e e l the urge to eat or when you are s i t t i n g down to a meal. 158 Set I (cont'd) The e x e r c i s e i s as f o l l o w s : You s i t or l i e down, c l o s e your eyes, r e l a x your body, and take three slow deep breat h s . When you do t h i s you are i n e f f e c t e n t e r i n g i n t o a b r i e f p e r i o d of meditation or increased concentration. In t h i s s t a t e you concentrate on three c r i t i c a l p o i n t s : f i r s t : f o r your body, overeating i s a poison second: you cannot l i v e without your body t h i r d : I f .you want to l i v e , you owe your body respect and p r o t e c t i o n Repeating these three p o i n t s i s your way of acknowledging the f r a g i l e , precious nature of your.body, and, at the same time, your way of seeing y o u r s e l f as your body's keeper. You are i n t r u t h your body's keeper. When you make t h i s commitment to respect your body, you have w i t h i n your power to g r a d u a l l y l o s e a l l those e x t r a pounds. Notice how t h i s s t r a t e g y puts the emphasis on what you are f o r , r a t h e r than what you are against. I t i s true that overeating i s a poison and you are against i t , but the emphasis i s upon the p o s i t i v e commitment to respect your body. As a con-sequence of your commitment, i t becomes n a t u r a l f o r you to p r o t e c t your body against the poison of f u r t h e r overeating. Now, I would l i k e you to do the e x e r c i s e I have j u s t described. Let your body r e l a x , c l o s e your eyes and take three deep breaths. Now repeat a f t e r me. 1. For my body;, overeating i s a poison (pause) 2. 1 need my body to l i v e (pause) 3. 1 owe my body respect and p r o t e c t i o n You may want to t r y t h i s e x e r c i s e again, from time to time, while you are here. 3. States of D e p r i v a t i o n When you are t r y i n g to l o s e weight you are d e p r i v i n g y o u r s e l f of some of the food you would normally be e a t i n g . But a c t u a l l y there are three types of d e p r i v a t i o n which are l i n k e d to l o s i n g weight. The f i r s t i s food d e p r i v a t i o n . When you s k i p a meal you are i n a s t a t e of d e p r i v a -t i o n which a u t o m a t i c a l l y increases the p o s i t i v e value of food. This also makes you f e e l indebted to y o u r s e l f f o r a d d i t i o n a l e a t i n g and you are more l i k e l y to overeat at your next meal or snack. This can be avoided by simply planning meals f o r r e g u l a r hours and making sure you eat every planned meal. The second type of d e p r i v a t i o n i s energy d e p r i v a t i o n . I t has been found that overeaters o f t e n a s s o c i a t e great amounts of o v e r e a t i n g w i t h times when they are f a t i g u e d , g e n e r a l l y due to l a c k of s l e e p . Whether the energy store i s comehow depleted by sleep d e p r i v a t i o n or whether f a -t i g u e merely becomes a s i g n a l to eat, i t i s very important that the over-e a t e r take pains to avoid f a t i g u e due to l a c k of sleep. C a r e f u l monitor-i n g of sleep p a t t e r n s i s e s s e n t i a l i n the c o n t r o l of o v e r e a t i n g , second i n importance only to a t t e n t i o n to food i n t a k e and e x e r c i s e . The t h i r d type of d e p r i v a t i o n encountered by the overweight person t r y i n g to d i e t i s the stimulus d e p r i v a t i o n experienced as boredom. Many overeaters eat because they are bored and have nothing e l s e to do, how-ever there i s good c l i n i c a l evidence which supports the i d e a that e a t i n g 159 i s not the p r e f e r r e d pastime f o r overweight persons. E a t i n g , t h e r e f o r e , can be d i s p l a c e d by any number of other a c t i v i t i e s which w i l l keep your a t t e n t i o n and provide g r a t i f i c a t i o n s Since i t appears to be important that boredom be avoided i f at a l l p o s s i b l e , i t i s a good i d e a f o r you to keep a number of nonfood a c t i v i t i e s a v a i l a b l e at a l l times. Perhaps you might keep your sewing machine up a l l the time, or keep i n t e r e s t i n g books, r e c o r d s , or magazines i n c l e a r view, or t o o l s f o r gardening or other hobbies kept a v a i l a b l e . However, even i f you should f i n d y o u r s e l f w i t h nothing to do your experience here i n t h i s room has shown you that you can deal w i t h such a s i t u a t i o n without overeating. 4. I n t r o d u c t i o n to R e l a x a t i o n T r a i n i n g A great number of people today, e s p e c i a l l y i n our Canadian s o c i e t y , do not pay much a t t e n t i o n to t h e i r bodies. By t h i s I don't mean the way we dress or how clean we are or anything about the way we look. The body that most of us ignore i s our i n t e r n a l body which c o n s t a n t l y sends us s i g -n a l s concerning i t s f u n c t i o n i n g . Of course we are aware of the l a r g e r and louder s i g n a l s , such as, f a t i g u e , t o i l e t needs, extreme nervousness and hunger. However we are not r e a l l y f i n e l y tuned to the q u i e t e r s i g -n a l s such as muscle tone, heart beat, m i l d t e n s i o n , and blood pressure. Often even hunger i s not a very c l e a r s i g n a l e s p e c i a l l y w i t h overweight persons: Frequently overweight people ignore or j u s t don't recognize the body s i g n a l s f o r hunger and i n s t e a d they eat or overeat because of the s i g n a l s they see around them such as the. c l o c k saying i t s time to. eat or the mere presence of food. You can c o n t r o l these e x t e r n a l s i g n a l s by doing things l i k e keeping food out of s i g h t and never g e t t i n g out more than you should eat. But i t i s a l s o a good i d e a to t r y to get to know your body a l o t b e t t e r and l e a r n the p h y s i c a l s i g n a l s that i t i s sending. Right now I'm going to take you through an e x e r c i s e designed to teach you to r e l a x and become b e t t e r tuned to your body. F i r s t , l i e w i t h your hand at your s i d e and be comfortable and j u s t r e l a x . Now I want you to d i r e c t your a t t e n t i o n to the l a r g e toe on your l e f t f o o t . I want you to f e e l that toe; f e e l the muscle wrapped around the bone underneath i t . . Concentrate on r e l a x i n g that toe. As you r e l a x that toe, f e e l the muscle sagging o f f the bone. Fee l the muscle loosen-i n g . The toe becomes more.and more r e l a x e d . Let that r e l a x e d f e e l i n g spread to the next t o e , to the next near your b i g toe. Again, f e e l the bone,with the muscle wrapped around i t . Concentrate on that toe. Concen-t r a t e on l e t t i n g the muscle on that toe r e l a x . F e e l i t get l o o s e r ; f e e l g r a v i t y p u l l the muscle. No more tensi o n . And l e t that r e l a x e d f e e l i n g spread again to the next toe. Same procedure: concentrate on the toe, f e e l the bone wrapped around w i t h muscle, and r e l a x that toe. F e e l the muscle unwrapping from the bone underneath i t . Now move to your next toe. Again, f e e l the muscle t i g h t l y wrapped around the bone underneath. F e e l that muscle loosen, g e t t i n g l o o s e r and l o o s e r , s o r t of drooping o f f the bone. Four of your toes are now r e l a x e d . Let that r e l a x e d f e e l i n g move on to the next toe, the small toe on your l e f t f o o t . F e e l the small bone i n that toe and the muscle wrapped around that bone. Let that muscle 160 loosen and r e l a x , becoming l o o s e r , sagging o f f that toe, g r a v i t y p u l l i n g i t down. Now a l l f i v e toes on that foot are r e l a x e d . Let that relaxed f e e l i n g spread from the toes i n t o the b a l l of the f o o t . There's a l o t more bones there. F e e l the muscle around and between those bones loose n -i n g , r e l a x i n g . P a r t of your foot i s g e t t i n g h e a v i e r , p u l l i n g down, r e -l a x i n g , loosening. Now that l o o s e , r e l a x e d f e e l i n g i s spreading through the arch of your f o o t . Muscles loosening. No tension there. Feels very n i c e . This r e l a x e d f e e l i n g continues on to the h e e l of your f o o t . Concentrate on the muscle wrapped around the bones there. F e e l i t loosen. F e e l i t p u l l i n t o the bed. Your whole foo t now i s very r e l a x e d . Feels loose and heavy. Now move your concentration up to your ankle. There's a l o t of bone, a l o t of tendon there. F e e l the way i t a l l p u l l s together and l e t i t r e l a x . F e e l those tendons loosening, and the muscles that are attached to those tendons begin to loosen. You can s t a r t to f e e l your c a l f muscle l o o s e n i n g , sagging; the long bone of your lower l e g , and the muscles that are wrapped around i t a l l s t a r t i n g to r e l a x , u n t i l your l e g gets heaviers and h e a v i e r . F e e l those muscles loosen. Now move up to you knee. Concentration on the j o i n t t h ere, to your knee cap. F e e l a l l the tendons that meet here. Concentration on r e l a x i n g your knee. F e e l i t g e t t i n g heavy. Feels very r e l a x e d . Then move up. F e e l the long bone on your t h i g h . A l o t of muscles here, a l l wrapped t i g h t l y around that bone. Let them loosen, l e t them unwrap. F e e l them g e t t i n g heavy and sagging i n t o the bed. Concentrate on r e l a x i n g that t h i g h . Now your whole l e g , your whole l e f t l e g i s r e l a x e d now. Now I want you to t h i n k about how your l e f t l e g f e e l s compared to your r i g h t l e g . Does i t f e e l heavier? Perhaps i t t i n g l e s a b i t . Does i t f e e l more relaxed? Enjoy t h i s f e e l i n g of r e l a x a t i o n i n your l e f t l e g . While you are going through your body l i k e t h i s , c oncentrating on each part and l e t t i n g i t r e l a x , o c c a s i o n a l l y you f i n d an area which i s d i f f i c u l t to r e l a x . Very o f t e n t h i s occurs when you have s u f f e r e d some i n j u r y i n that p a r t . There i s a l o t of e x t r a ten-s i o n i n areas that have been i n j u r e d at one time' or another. Spend e x t r a concentration on those areas and get them to r e l a x j u s t as much as the r e s t of your body. Now we are going to move back down t h i s time to your r i g h t f o o t , s t a r t i n g again w i t h the b i g t o e , l e a v i n g your l e f t l e g a l l completely r e -l a x e d . Concentrate now on.the b i g toe of your r i g h t f o o t . Again, f e e l the muscle and the bone underneath that muscle. Let the muscle r e l a x . Let the muscle loosen. F e e l the t e n s i o n l e a v i n g . Now f e e l that r e l a x a t i o n spread to the next toe as the muscle there s t a r t s to loosen, and to the next toe. I t should be e a s i e r now: you've got the knack of i t . F e e l that t h i r d toe r e l a x i n g , the muscle lo o s e n i n g , g e t t i n g heavy, and move over to the next toe. F e e l the bone, f e e l the muscle; concentrate on i t , and concentrate on i t l o o s e n i n g , p u l l i n g down. And now move to your small toe, s t a r t i n g to t i n g l e , l o o s e n i n g , g e t t i n g heavy. Yau can f e e l g r a v i t y p u l l i n g down the muscle to s o r t of sagging o f f the bone. Now l e t that i n g l y r e l a x e d f e e l i n g move to the b a l l of your f o o t . F e e l i t loosen, f e e l i t get heavy. There's, a l o t of muscle i n between those bones too. Concentrate on t h a t , and l e t i t r e l a x . The relaxed f e e l i n g i s now moving to the arch of your f o o t . Has to go a b i t deeper here. There's a l o t of bone, a l o t of muscle, a l o t of tendon. F e e l i t a l l unwinding. Feels very good. S t a r t i n g to r e l a x . G e t t i n g heavy, l o o s e n i n g , and now spread-i n g down to your h e e l . Concentrate on your h e e l . Feel the bone there 161 and the muscle, and f e e l them r e l a x i n g , s i n k i n g i n t o the bed, g e t t i n g heavy. Your whole foot now s t a r t i n g to t i n g l e , f e e l i n g good. I t ' s very r e l a x e d , and a l l those muscles which are attached to your ankle. Spread the r e l a x a t i o n up to your ankle. Concentrate now on your ankle. A l o t of bones j o i n together at your ankle. A l o t of tendons a l l con-nected to muscles. F e e l them a l l r e l a x e d , l o o s e n i n g ; the whole j o i n t unwinding, g e t t i n g heavy. Feels good. That relaxed f e e l i n g i s spread-i n g up to your lower l e g . F e e l that b i g muscle of your c a l f , the t i g h t muscle, and you f e e l i t r e l a x i n g , unwinding. F e e l i t as i t sags o f f the bone there. Becomes heavy, becomes very r e l a x e d . Spread that r e -l a x a t i o n up to'your knee. Often knees are problem areas. We f r e q u e n t l y I n j u r e our knees. Fe e l the j o i n t there. F e e l how the bones j o i n toge-ther w i t h a l l the tendons h o l d i n g i t t i g h t i n your knee cap. F e e l i t a l l r e l a x . Maybe i t ' s the f i r s t time you'.ve ever re l a x e d your knee i n t h i s way. Enjoy the f e e l i n g , u n t i l i t gets heavier. F e e l that t i n g l y , r e -laxed f e e l i n g spread up from your lower l e g , and l e t that looseness con-tin u e up to your t h i g h . A l a r g e bone here, and a l o t of muscles wrapped around i t . F e e l that muscle loosen. I t ' s a long muscle, and i t j u s t sags o f f the bone.,- getting, very heavy, g r a v i t y p u l l i n g those, muscles away from the bone. F e e l i n g r e l a x e d . Feels good. . Both of your legs are now very r e l a x e d . F e e l that r e l a x a t i o n spreading up to your buttocks. These, are the two l a r g e s t muscles of your body. F e e l them r e l a x , g e t t i n g heavy, s i n k i n g i n t o the bed, g e t t i n g very loos e . Now I want you to con-c e n t r a t e on your g e n i t a l area. This i s o f t e n a p o i n t of much te n s i o n . Spend some time and r e l a x . F e e l the tension going away. I want you to continue up to your stomach. F e e l the muscles that cover your stomach. Fee l them r e l a x , g e t t i n g l o o s e r , a l l the t e n s i o n l e a v i n g . And you can f e e l the organs underneath those muscles; your stomach, your i n t e s t i n e s . F e e l them a l l r e l a x e d . A l l the tension there s u b s i d i n g . Feels very com-f o r t a b l e . Now go a l l the way through and f e e l the muscles of your back. F e e l your backbone, each v e r t e b r a w i t h muscles attached to i t . These muscles are o f t e n extremely t i g h t . I want you to go up f e e l i n g each v e r -t e b r a and the muscle on e i t h e r side of i t , and r e l a x i t s l o w l y , f e e l i n g that muscle loosen. Feels good. There's a f e e l i n g of r e l a x a t i o n spread-i n g from your lower back and t r a v e l l i n g up towards your head. At each v e r t e b r a , the muscle near i t loosens, f e e l s heavy, begins to t i n g l e , spreading up your back towards your head. This wonderful sensation of being very r e l a x e d . Now concentrate on your chest. F e e l your r i b s . Be-tween each of your r i b s i s muscle. Take a deep breath. F e e l those r i b s spread apart. The muscle between them i s s t r e t c h i n g . F e e l that muscle get loo s e . F e e l i t r e l a x e d . Gets heavy. Your whole chest i s r e l a x i n g . S t i l l moving as you breathe, but i t i s very rela x e d . A l l the organs i n -side your chest. Concentrate on them. F e e l them r e l a x . This can be an extremely e x h i l a r a t i n g experience. R e l a x a t i o n here i n your chest s t a r t s shooting up your neck. That t i n g l y loosness - you can f e e l i t i n your neck. B i g muscles i n your neck - they're unwinding. G e t t i n g heavy, sag-ging i n t o the bed. Those muscles that a t t a c h to the back of your head -they're g e t t i n g l o o s e , g e t t i n g heavy. That relaxed f e e l i n g i s spreading r i g h t over the top of your head. You can f e e l your s c a l p r e l a x i n g , l o o s e n i n g , sagging r i g h t o f f your s k u l l . Feels very good. A r e l a x a t i o n comes over the top of your head and down to your forehead. Your forehead i s o f t e n the seat of a great deal of t e n s i o n . Whenever you are concerned about something, worried about something, d i s t r e s s e d , t e n s i o n r e s i d e s i n your forehead. F e e l your forehead r e l a x , and as i t does t h i s i s a very wonderful f e e l i n g ; one of complete r e l a x a t i o n . F e e l the muscles of your 162 whole face now rel a x i n g ; the muscles around your mouth, the muscles i n your cheeks, the muscles around your eyes. Your eyes are relaxing. Feel the muscles of your eyebrows relax. I t ' s a very nice f e e l i n g . Enjoy i t . Your whole body i s now relaxed. This relaxation procedure i s one you can pr a c t i c e on your own. For best r e s u l t s d a i l y p r a c t i c e i s desira b l e . Now while you are i n th i s deeply relaxed state I want to l i s t e n to some of the quiet signals from your body. F i r s t , t r y to f e e l your heart beat. Direct your attention to the center of your chest and f e e l the constant, quiet throbbing of your own heart, (pause) I f you have d i f f i -c u l t y f e e l i n g your beating heart take a few rapid deep breaths, then re-lax again and l i s t e n (pause) Each pulsation of your heart i s pushing your blood further through the body. I f you are relaxed enough you might be able to f e e l this pulsing i n d i f f e r e n t parts of your body. Your hands and e s p e c i a l l y your fi n g e r t i p s are often very s e n s i t i v e to t h i s . I f you want to a c t u a l l y l i s t e n to your heart beat cup your hands over your ears, relax, and l i s t e n , (pause). If you don't hear i t cup your hands s l i g h t l y t i g h t e r , (pause) Put your hands at your side once more and this time I want you to di r e c t your attention to your stomach. I want you to take three deep breaths but before you do I'm going to explain exactly how to do i t . Wait u n t i l I say breath. Instead of expanding your chest to take those deep breaths, I want you to expend your stomach By p u l l i n g your diaphragm down you w i l l be extending your stomach while you p u l l a i r into your lungs. With each breath take i n as much a i r as possible and push your stomach out as f a r as i t w i l l go. When you have a l l the a i r you can manage the slowly exhale by p u l l i n g your stomach back i n . Try to push out a l l of the a i r i n your lungs as you suck i n your stomach as f a r as i t w i l l go. Then repeat the whole procedure. Do not breath r a p i d l y . Breath i n and out slowly and you w i l l f i n d your s e l f becoming more and more relaxed with each breath. As you rela x d i r e c t your attention to i n -side your stomach and t r y to fefel i t as you expand and contract. O.K. now I want you to take three deep breaths as I have j u s t described them. Ready. Breathe, (pause) Becoming more relaxed with each breath Feeling your stomach... This exercise i s one that you should use often. I t i s a means to quick relaxation and to awareness of your stomach. I t i s an exercise which can be done anywhere; you don't have to be l y i n g down. In fac t i t i s a good idea to do th i s three-deep-breath exercises each time you s i t down at the table before you have anything to eat. While you are taking your three deep breaths and relaxin g you can remind yourself of your new commitment to protect your body and your health. I want you to do the following exercise using your imagination. I am going to read o f f a series of emotions. I would l i k e you to think back to the l a s t time you experienced the emotion and r e l i v e i t i n your mind the whole experience as best you can. When I f e l l you that time i s up, you w i l l cease thinking about the emotion and go on to the next one 163 which I w i l l give you. The f i r s t o n e . i s , t h i n k about the l a s t time you were very happy. Ready, s t a r t 3 minutes (MONITOR: DO NOT STOP TAPE RECORDER BETWEEN ITEMS) O.K. next: I want you to t h i n k about the l a s t time you were very disappointed. 1-1/2 minutes O.K. Nnext:I want you to t h i n k about the l a s t time you f e l t very gguilty.. 1-1/2 minutes O.K. next: I want you to t h i n k about the l a s t time you f e l t you were a f a i l u r e . 1-1/2 minutes O.K. next: I want you to t h i n k about the l a s t time you were very anxious. 1-1/2 minutes O.K. next: I want you to t h i n k about the l a s t time you were very disgusted w i t h your s e l f . 1-1/2 minutes This concludes the e x e r c i s e . The purpose of the e x e r c i s e was to -show you that you could experience emotions, even very negative ones and not have to eat. Think about t h i s and remember i t when you leave here. I t i s a myth that you cannot cope w i t h emotions unless you have something to eat. 5. From time to time most of us f e e l negative emotions such as f e a r , t e n s i o n , anger or sadness. For many people e a t i n g becomes a way to cope w i t h these negative emotions. In f a c t , some overweight people come to b e l i e v e that e a t i n g i s the only way they can cope w i t h these unplea-sant f e e l i n g s . However, t h i s i s a f a l s e b e l i e f . A good s u b s t i t u t e which many people f i n d works j u s t as w e l l or even b e t t e r than e a t i n g i s to take three deep breaths and r e l a x j u s t as you were taught i n the l a s t message. 164 SET I I * This weight program has been designed s p e c i f i c a l l y to a i d you i n your e f f o r t s _ t o r e g u l a t e your weight. Since you are the one who wants to l o s e and keep o f f those e x t r a pounds, t h i s program emphasized i d e n t i -f y i n g your e a t i n g problems and changing your e a t i n g h a b i t s . We w i l l provide you w i t h i n f o r m a t i o n and suggestions f o r l o s i n g weight but we cannot c o n t r o l your weight f o r you, only you can do t h a t . Though many would l i k e i t , there i s no magic p i l l which w i l l solve your overweight problem f o r you. The s o l u t i o n must come from w i t h i n you. Thus, the primary focus of t h i s program i s you; your w i l l i n g n e s s now to to' a l l y commit y o u r s e l f to c o n t r o l l i n g your weight, your w i l l i n g n e s s to take r e s p o n s i b i l i t y f o r the causes and cures of your overweight, your w i l l i n g -ness to work hard at changing those aspects of your environment and those aspects of your l i f e which a f f e c t adversely your e a t i n g h a b i t s , your mo-t i v a t i o n to see the program through to the end, even when the going might be a l i t t l e rough. As was mentioned b e f o r e , to e f f e c t i v e l y c o n t r o l your weight you must take the i n i t i a t i v e to s y s t e m a t i c a l l y change your e a t i n g h a b i t s . No spe-c i a l d i e t i s r e q u i r e d because the i n t e n t i o n i s to produce l o n g - l a s t i n g changes i n e a t i n g p a t t e r n s . Most people could l o s e weight by e a t i n g nothing f o r a month or going on a s p e c i a l g r a p e f r u i t d i e t or some other crash d i e t . However, few would be w i l l i n g to remain on such a d i e t f o r the r e s t of t h e i r l i v e s . Thus, a f t e r weight i s l o s t on a s p e c i a l d i e t , people u s u a l l y resume t h e i r o l d e a t i n g h a b i t s — t h e very behaviors which caused the weight problem i n the f i r s t p l a c e ! For e f f e c t i v e weight con  t r o l , the i n d i v i d u a l must a l t e r h i s e a t i n g p a t t e r n s i n such a way that he  can l i v e w i t h them comfortably f o r the r e s t of h i s l i f e and s t i l l main- t a i n a d e s i r a b l e weight! "Crash" s t a r v a t i o n d i e t s have no l a s t i n g v a l u e . Rather, an attempt should be made to f i n d a reasonable balance between f a t t e n i n g and u n f a t t e n i n g f o o d s — a balance that can be maintained f o r l i f e . You must l e a r n to break the o l d h a b i t p a t t e r n s of e a t i n g snacks w h i l e pre-p a r i n g meals, e a t i n g w h i l e watching t e l e v i s i o n , e a t i n g e v e r y t h i n g that i s placed before you i n a r e s t a u r a n t , and so on. A c a r d i n a l r u l e . i n weight c o n t r o l i s make haste s l o w l y . That i s , don't t r y to l o s e weight too r a p i d l y . You are probably anxious to see the pounds drop o f f (and r i g h t f u l l y s o ) , but your s t r a t e g y of weight con-t r o l i s aimed at modifying longstanding e a t i n g p a t t e r n s . Those h a b i t s have been " i n power" f o r many years and may take a l i t t l e time to dethrone. A l s o , i f you set you r . s i g h t s f o r dramatic and r a p i d weight l o s s you may become prematurely discouraged w i t h gradual but s i g n i f i c a n t r e d u c t i o n s . Take i t one pound at a time. A one or two pound weight l o s s per week i s recommended as a healthy weight l o s s g o a l . In ten short weeks t h i s adds Large p o r t i o n s of these messages were adopted from Mahoney, M.J., & J e f f r e y , D.B. A manual of s e l f - c o n t r o l procedures f o r the overweight. Abstracted i n the JSAS Catalog of Selected Documents i n Psychology, 1974, 4, 129. 165 up to a 10-20 pound weight l o s s . In a d d i t i o n to having a proper a t t i t u d e and commitment to l o s i n g weight, i t i s a l s o very important to have s p e c i f i c i n f o r m a t i o n about weight management and to know how to implement t h i s i n f o r m a t i o n i n your d a i l y weight c o n t r o l program. We w i l l be t a l k i n g l a t e r about methods to help you become aware of your d a i l y weight f l u c t u a t i o n s and problema-t i c e a t i n g s i t u a t i o n s . We w i l l a l s o be p r o v i d i n g you w i t h i n f o r m a t i o n about d i e t i n g so you w i l l be able topplan your own e a t i n g program which w i l l i n c l u d e a balanced d i e t but which w i l l a l s o cut out those e x t r a c a l o r i e s so you can los e weight. F i n a l l y , we w i l l d i s c u s s s p e c i f i c t e ch-niques to change those nasty, gluttonous e a t i n g h a b i t s . 166 SOME BASIC FACTS ABOUT NUTRITION A b a s i c understanding of the human body and the food which nourishes i t can be very h e l p f u l to you i n your weight l o s s attempt. Our body uses food i n two ways: (1) as a source of f u e l to provide the energy to keep i t running, and (2) as a source of n u t r i e n t s f o r the c o n t i n u a l r e -p a i r and maintenance of a l l t i s s u e s . A l l foods can serve as f u e l f o r energy but no one food provides a l l the e s s e n t i a l n u t r i e n t s . We there-fore need a balanced d i e t of d i f f e r e n t foods. Most foods are a mixture of p r o t e i n , carbohydrate, and f a t (along w i t h v a r y i n g amounts of vitamins and m i n e r a l s ) . P r o t e i n s occur i n a l l l i v i n g matter and are e s s e n t i a l f o r the upkeep of every t i s s u e of our bodies. Becasue p r o t e i n i s not sto r e d i n the body i t must be su p p l i e d by our d a i l y d i e t . Good b a s i c sources of p r o t e i n are i n the m i l k group and the meat group of foods, and c e r t a i n of the vegeta-b l e group. Because some of these foods do not provide a l l the p r o t e i n that we need, our d i e t should c o n t a i n a v a r i e t y of these sources of p r o t e i n . Carbohydrates are second to f a t s as the main f u e l source s u p p l i e d i n the d i e t . The c h i e f f u n c t i o n of carbohydrate i s to supply sugar as f u e l f o r the b r a i n and nervous t i s s u e . By l i m i t i n g our i n t a k e of carbohydrate, we draw upon st o r e d f a t f o r our f u e l requirement. But some carbohydrate' i s r e q u i r e d i n a balanced d i e t . Otherwise, the body has to convert pro-t e i n i n t o sugar needed by the b r a i n . Food sources of carbohydrate are not d i f f i c u l t to f i n d . Cereals and vegetables are p r e f e r a b l e to p a s t r i e s and sweets as a source of carbohydrates. Any excess carbohydrate i n our d a i l y d i e t i s converted to f a t and stored as such i n the body. This i s a l s o true of excess p r o t e i n and excess f a t . Fats are b u i l t i n t o the s t r u c t u r e of a l l t i s s u e s as are p r o t e i n s . But f a t s are the most concentrated form of energy and serve p r i m a r i l y as a f u e l storage m a t e r i a l . Overweight occurs when there i s an excess amount of f a t storage caused by more food input than energy output. Food sources of f a t , l i k e carbohydrates, are not hard to f i n d . The problem i s to con-t r o l the amount of f a t - r i c h foods we eat such as f a t t y meats and whip cream d e s s e r t s . As we mature, we begin to need l e s s and l e s s food than we needed dur-i n g our a c t i v e growing years. With every year past 25 our food needs drop by about 1% but most of us continue e a t i n g as much as we d i d during our youth. E x t r a weight then begins to creep up. To maintain a constant l e v e l of bodyweight the food energy i n a d i e t must balance the d a i l y ener-gy requirements of the body. In order to l o s e weight, you must take i n fewer c a l o r i e s than you need. The most p r a c t i c a l way to do t h i s i s by a l t e r i n g longstanding e a t i n g p a t t e r n s which have caused the weight gain. Since overweight does not happen suddenly, you should not expect reducing to be an overnight a f f a i r . I t w i l l take some time to remedy the imbalance between food input and b o d i l y requirements. A l s o , do not expect your weight l o s s to be uniform and c o n s i s t e n t . I n d i v i d u a l s l o s e weight at d i f -f e r e n t r a t e s . The average weight l o s s curve i s one which contains many b r i e f "plateaus" and a few b r i e f 1 or 2 pound weight gains. 167 A Few P o i n t e r s to Remember About D i e t i n g 1. Your d a i l y d i e t should be a well-balanced one, high i n p r o t e i n and low i n carbohydrates and f a t s . However, do not e l i m i n a t e a l l carbo-hydrates and f a t s . Avoid crash s t a r v a t i o n d i e t s . 2. S u b s t i t u t e lower c a l o r i e foods and d i e t e t i c forms of food pre-p a r a t i o n f o r your present ones. F a m i l i a r i z e y o u r s e l f i n a general way w i t h the " c a l o r i e c o s t " of d i f f e r e n t food c a t e g o r i e s . 3. Make room f o r an o c c a s i o n a l snack or sweet by c u t t i n g down e l s e -where i n your food i n t a k e , Do not f o r b i d y o u r s e l f c e r t a i n food categor-i e s - — t h i s only makes them more tempting and increases the chances that you w i l l simply give up once you have "blown your d i e t " by e a t i n g a forbidden f r u i t . 4. Don't s k i p m e a l s ' — i t i s e a s i e r to avoid overeating i f you are not overhungry. 5. I f you f i n d that you are too hungry at mealtime, c o n t r o l your a p p e t i t e w i t h a s m a l l dose of carbohydrate h a l f an hour before mealtime, (e.g., 1 or 2 soda crackers or a small glass of vegetable j u i c e ) . 6. I f you overeat at l u n c h , or midmorning snacking i s a problem, make an e f f o r t to eat a h i g h - p r o t e i n b r e a k f a s t . 168 Some Misconceptions About Food and D i e t i n g There are a s u r p r i s i n g l y l a r g e number of people who have many mis-conceptions about food and d i e t i n g . These misconceptions may mean the d i f f e r e n c e between success and f a i l u r e i n l o s i n g weight, or may make weight r e d u c t i o n more of a chore and l e s s of a pleasure. The f o l l o w i n g are some of the more popular misconceptions. 1. Brown eggs have a higher food value than white eggs. F a l s e . 2. Toasting reduces the c a l o r i e s i n bread. F a l s e . 3. P r o t e i n i s the most important n u t r i t i o n a l need of the body. F a l s e . 4. One can eat and d r i n k whatever he pleases i f a v i t a m i n and mineral capsule i s taken each day to assure a supply of e s s e n t i a l n u t r i e n t s . F a l s e . 5. I t ' s n a t u r a l to get f a t t e r as you get o l d e r . F a l s e . 6. One can never eat too much p r o t e i n . F a l s e . 7. I f a person has been overweight f o r a long time (e.g., since h i l d -hood) , h i s problem i s probably "medical" or h e r e d i t a r y . F a l s e . 8. Food eaten before you go to bed i s more l i k e l y to cause weight gain than i f the same food were eaten f o r b r e a k f a s t . F a l s e . 9. Pork l i v e r has more n u t r i t i v e value than c a l f l i v e r . F a l s e . 10. A person can never d r i n k too much m i l k . F a l s e . 11. Overweight people are g e n e r a l l y happy, healthy people. F a l s e . 12. Because meat i s a high p r o t e i n food, i t does not cause weight gain. F a l s e . 13. Beer i s a good source of n u t r i e n t s . F a l s e . 14. I t makes no d i f f e r e n c e whether a person eats f a s t or slow. F a l s e . 15. I t i s b e t t e r to l o s e weight as r a p i d l y as p o s s i b l e r a t h e r than one pound at a time. F a l s e . 16. A l l f a t and carbohydrates should be el i m i n a t e d i n a reducing d i e t . F a l s e . 17. E x e r c i s e increases the a p p e t i t e . F a l s e . 18. One should d r i n k l e s s water, while d i e t i n g . F a l s e . 19. The stomach shr i n k s during d i e t i n g . F a l s e . 20. Meal-skipping helps reducing. F a l s e . 21. One should expect to f e e l weak and f a t i g u e d during weight reducing. F a l s e . 169 SPECIFIC WEIGHT CONTROL TECHNIQUES S p e c i f i c e a t i n g h a b i t s are somewhat i n d i v i d u a l i z e d . To cope w i t h t h i s v a r i e t y , we have compiled a l i s t of weight c o n t r o l techniques which vary i n t h e i r appropriateness f o r d i f f e r e n t e a t i n g s t y l e s . The tech-niques are d i v i d e d i n t o three types: Quantity C o n t r o l , Q u a l i t y C o n t r o l and S i t u a t i o n C o n t r o l . We recommend that you choose the e a s i e s t t e c h -nique to begin w i t h and use i t u n t i l i t becomes a new e a t i n g h a b i t which i s b e n e f i c i a l to you (a minimum of one to two weeks). Then choose the next e a s i e s t technique and see i t u n t i l i t becomes par t of your good eat-i n g h a b i t s . Continue employing e a t i n g c o n t r o l techniques i n t h i s manner as long as i t takes you to e l i m i n a t e your bad e a t i n g h a b i t s and develop new p o s i t i v e e a t i n g h a b i t s . Quantity C o n t r o l Techniques 1. Reduce the amount of food you serve y o u r s e l f . I t i s much more important f o r you to work on e a t i n g smaller p o r t i o n s of food than to worry about overcoming your l i f e l o n g peachant f o r strawberry shortcake. S t a r t now to cut down the t o t a l q u a n t i t y of food you eat. This can be accomplished by buying, f i x i n g and s e r v i n g smaller q u a n t i t i e s of food. For example, r a t h e r than s e r v i n g y o u r s e l f two, e x t r a l a r g e p o r t i o n s of potatoes only serve y o u r s e l f one moderate s i z e p o r t i o n of potatoes; One u s e f u l method to cut down servings i s to simply use a s m a l l s i z e d p l a t e . This may a s m a l l e r p o r t i o n doesn't appear q u i t e so s m a l l . You may have an o c c a s i o n a l event or other f a t t e n i n g food as long as you keep the quan-t i t i e s s m a l l and a l s o reduce q u a n t i t i e s of l e s s l i k e d foods. This tech-nique i s p a r t i c u l a r l y h e l p f u l i f you f e e l hemmed i n by s t r i c t d i e t s . There i s no "forbidden f r u i t " i n our weight c o n t r o l program; you simply have to cut down the t o t a l q u a n t i t i e s of food eaten. 2. Leave food on your p l a t e . S t a r t g e t t i n g i n the h a b i t of l e a v i n g a l i t t l e b i t of everything on your p l a t e when you f i n i s h . Many people f e e l compelled to f i n i s h everything even though they are s t u f f e d . C h i l d -hood t r a i n i n g and the d e s i r e not to waste money may l i e at the root of t h i s h a b i t . Think f o r a second about the money "wasted" on o b e s i t y (heart operations, useless c l o t h i n g , e t c . ) . Don't f i n i s h a c h i l d ' s food f o r him or force y o u r s e l f to p o l i s h o f f the remnants of a ham. Throw them out, feed them to the dog, or whatever and p l a n a smaller p o r t i o n next time. This technique i s e s p e c i a l l y appropriate f o r restaurant eat-i n g . Do not eat everything put before you simply because you have p a i d f o r i t . Y o u ' l l be paying a much steeper p r i c e i f you do. 3. Eat Slowly. I t takes q u i t e a w h i l e f o r your food i n t a k e to r e g i s -t e r w i t h the b r a i n , so i f you eat f a s t you may overshoot your body's needs. Begin by r e q u i r i n g y o u r s e l f to swallow one b i t e before p u t t i n g the next of the f o r k . A c t u a l l y , put your f o r k down between b i t e s . To-ward the end of the meal, i n t e r r u p t your e a t i n g f o r 2 to 5 minutes so that you can get i n the h a b i t of s t a r t i n g or stopping your e a t i n g at w i l l . I t i s important that you i n i t i a l l y t r y t h i s when you are moderately f u l l and then g r a d u a l l y work toward s i t u a t i o n s where you stop e a t i n g d e s p i t e moderate hunger. Require y o u r s e l f to delay second hel p i n g s by at l e a s t 10 minutes. 170 Q u a l i t y C o n t r o l Techniques 1. Keep a supply <£ d i e t e t i c o r un f a t t e n i n g foods on hand. Again, the temptation to snack or overeat i s great when you have an u n l i m i t e d supply of sweets on hand. You w i l l be l e s s tempted i f your l a t e n i g h t temptation r e q u i r e s a b r i s k walk to the store r a t h e r than to the r e f r i g e r -a t o r . Make i t e a s i e r to snack d i e t e t i c a l l y than f a t t e n i n g l y . That i s , do not keep sweets around the house. I f the c h i l d r e n need them f o r l u n -ches, buy only enough f o r them. Keep a supply of d i e t e t i c foods i n b r i g h t and shiny containers (e.g., always have c o l d d i e t pop on hand and a container of c e l e r y s t i c k s i n the r e f r i g e r a t o r ) . Do not keep c o l d beer i n the r e f r i g e r a t o r ( i f beer i s your d o w n f a l l ) . A l s o , rearranged your cupboards so that f a t t e n i n g snacks are i n strange, hard-to-reach places but d i e t e t i c ones are r i g h t up f r o n t . 2. Avoid high c a l o r i e snacks. I f your cupboards are f i l l e d w i t h ready-to-eat goodies, you are much more l i k e l y to give i n to that l a t e n i g h t snack temptation. Quick p r e p a r a t i o n foods are a l s o unadvisable. I f you have to have a snack, t r y to make i t a l e s s p r e f e r r e d one or some-t h i n g w i t h n u t r i t i o n a l value (e.g., a bowl of c e r e a l ) . S u b s t i t u t e pop-corn f o r potato c h i p s ; the former takes time to prepare and has fewer c a l o r i e s . 3. Do not adorn f a t t e n i n g foods. Avoid seasoning which makes some f a t t e n i n g food t a s t e b e t t e r . I f you have to have a soda or beer, e i t h e r have i t only moderately c o l d ( p r e f e r a b l y warm) or have a l e s s pre-f e r r e d brand. Do not use r e a l b u t t e r , n o n - d i e t e t i c jam, e t c . S i t u a t i o n C o n t r o l Techniques 1. E n l i s t the help of your f a m i l y and f r i e n d s . Your f a m i l y and f r i e n d s can be very h e l p f u l i n your e f f o r t s to l o s e weight. Now i s the time to a c t i v e l y e n l i s t t h e i r a s s i s t a n c e . S t a r t by making p u b l i c your commitment to l o s e weight. Research has i n d i c a t e d that t h i s i s important i n h e l p i n g you to see your weight l o s s program through to a s u c c e s s f u l completion. In a d d i t i o n ask your f a m i l y and f r i e n d s to do the f o l l o w i n g : (a) not to c r i t i c i z e your fatness but r a t h e r to p r a i s e you f o r your weight management progress; (b) to prepare and serve you small q u a n t i t i e s of low c a l o r i e foods; (3) not to o f f e r you a d d i t i o n a l food at r e g u l a r meals or at p a r t i e s ; (d) to engage i n nonfood a c t i v i t i e s such as t a k i n g a walk around the b l o c k r a t h e r than having an evening snack. 2. Eat only i f you are hungry. This may sound f o o l i s h , but many people eat at 8, 12, and 6 — n o t because they are hungry at the t i m e s — but because they are g e n e r a l l y considered the " r i g h t " times to eat. Let your stomach guide your e a t i n g ; not the c l o c k o r the stomachs of your f r i e n d s o r f a m i l y . Don't f e e l compelled to eat because of s o c i a l pres-sures, You can s i t at the f a m i l y dinner t a b l e and converse without eat-i n g . I f p o s s i b l e eat s e v e r a l balanced s m a l l meals each day r a t h e r than j u s t one l a r g e meal and much munching. 171 3. Delay your g r a t i f i c a t i o n . When tempted to n i b b l e , t r y to wait f o r p r o g r e s s i v e l y longer periods of time (5 min, 8 min., etc.) before i n d u l g i n g ( i f the l a t t e r can't be avoided). Set a timer f o r your delay p e r i o d and do not set u n t i l i t buzzes. By p r o g r e s s i v e l y lengthening the delay, you w i l l l e a r n to c o n t r o l on-the-spot urges. 4. R e s t r i c t y o u r s e l f before you eat. I f you are e a t i n g by your-s e l f , prepare the meal, f i x your p l a t e , and then put everything away be-for e you s i t down to eat. This w i l l i n s u r e that you don't continue ad-ding things to your p l a t e . I f the e n t i r e l o a f of bread i s l y i n g r i g h t there i n f r o n t of you, you are much more l i k e l y to reach f o r a few e x t r a p i e c e s . Get i n the h a b i t of s e t t i n g l i m i t s before you begin e a t i n g . 5. Buy and prepare food on a f u l l stomach. Never go shopping when you are hungry. You are much more l i k e l y to buy i n d i s c r i m i n a t e l y (both i n q u a n t i t y and i n type) when you are hungry. A l s o , i f e a t i n g w h i l e pre-p a r i n g a meal i s a problem, prepare the evening meal immediately a f t e r you have f i n i s h e d lunch. I t won't hurt i t to s i t f o r a few hours. This w i l l reduce your temptation to n i b b l e . 6. Separate e a t i n g from a l l other a c t i v i t i e s . When you e a t , devote your e n t i r e a t t e n t i o n to e a t i n g . Many weight problems r e s u l t from the type of e a t i n g that becomes almost unconscious; that I s , you may be munching on peanuts w h i l e watching the news without r e a l i z i n g what you are doing. I f you spend a l o t of time i n the k i t c h e n , you may f i n d your-s e l f h a b i t u a l l y consuming l e f t - o v e r s and sweets. Make sure that when you eat you do nothing e l s e — t h a t i s , no t e l e v i s i o n , no reading, no phone c a l l s , e t c . 172 E x e r c i s e to Weight Reduction The r o l e of p h y s i c a l e x e r c i s e i n weight re d u c t i o n has oft e n been b e l i t t l e d . I t has been s t a t e d , f o r example, that one must climb the s t a i r s to the top of the Empire State B u i l d i n g and down again repeatedly f o r f o u r hours i n order to l o s e one pound of body f a t . Such s t a t i s t i c s would dampen the enthusiasm o f the most ardent devotee of e x e r c i s e . How-ever, i t i s also true that i f that same i n d i v i d u a l climbed the s t a i r s to. h i s f o u r t h f l o o r o f f i c e and back down again four times a day, he would l o s e that pound of f a t i n t h i r t y days or s i x working weeks. This would r e s u l t i n a y e a r l y l o s s of approximately nine pounds. I t i s not necessary f o r e x e r c i s e to be prolonged and exhausting f o r i t to be e f f e c -t i v e . Short but re g u l a r periods of e x e r c i s e w i l l make the same c o n t r i b u -t i o n and can be a u s e f u l and enjoyable p a r t of your weight r e d u c t i o n pro-gram. I t has been c l e a r l y demonstrated that when d i e t and e x e r c i s e are combined, r e g u l a r e x e r c i s e increases the r a t e of weight l o s s . F u r t h e r -more, i t i s w e l l known that the overweight i n d i v i d u a l w i l l burn more c a l o r i e s per minute than h i s lean counterpart when c a r r y i n g out the same task. I t has been found t h a t , i n a d d i t i o n to increased weight l o s s , ex-e r c i s e helps d i e t e r s to r e t a i n needed body f l u i d s and mainta i n a b e t t e r , more p o s i t i v e a t t i t u d e . I n t e r e s t i n g l y e x e r c i s e i s most b e n e f i c i a l when r e s t r i c t i o n of c a l o r i e i n t a k e i s not excessive. When a d i e t i s too severe, the body's r a t e o f metabolism changes and reduces the e f f e c t i v e n e s s of e x e r c i s e . E x e r c i s e has yet another b e n e f i t to the d i e t e r : by i n c r e a s i n g energy expenditure i t i s not necessary to r e s t r i c t c a l o r i e i n t a k e severely i n order to y i e l d encouraging r e s u l t s . The d e p r i v a t i o n and hunger that o f t e n accompany d i e t i n g probably c o n t r i b u t e more to an i n a b i l i t y to adhere to a weight l o s s program than any other f a c t o r . By moderately decreasing i n -take and i n c r e a s i n g expenditure, such discomforts can be avoided. By i n c r e a s i n g e x e r c i s e , a more re l a x e d and more s a t i s f y i n g d i e t a r y program can be enjoyed. In a d d i t i o n , however, i t i s necessary to weave increased energy ex-penditure i n t o the n a t u r a l f a b r i c of d a i l y l i v i n g . Although not measur-a b l e , such increases w i l l undoubtedly i n f l u e n c e energy expenditure and have some e f f e c t on body weight. One should be as conscious of how she uses her body as she i s of what she puts i n t o i t and how fas h i o n a b l y i t i s bedecked, but i n a l a b o r s e r v i n g s o c i e t y l i k e ours t h i s would c a l l f o r a k i n d of d i u r n a l heresy. For example, w h i l e the telephone company ex t o l s the v i r t u e s of adding extension telephones to save 70 miles of walk i n g per yea r , t h i s should be seen by the weight conscious person as an expensive l e i s u r e c o s t i n g as much as 15 excess pounts of body f a t i n 10 years. In the same v e i n , department stores which provide convenient e l e v a t o r s and e s c a l a t o r s but po o r l y l i t s t a i r w e l l s c a t e r to the conven-ience but not the h e a l t h of t h e i r customers, as do the purveyors of g o l f c a r t s , power (and even r i d i n g ) lawn mowers, mechanical snow shovels, e l e c t r i c garage doors, c a r v i n g k n i v e s , i c e crushers, can openers, tooth brushes, and even parking l o t s which y i r t u a l l y e l i m i n a t e walking from 173 shopping tours. To surmount these many forces which would lea d to i n a c t i v i t y , one must make a d e l i b e r a t e d e c i s i o n to t h i n k before she saves even a s i n g l e c a l o r i e of energy and then act to expend that c a l o r i e . This i s done by walking u p s t a i r s every time i t i s appropriate i n s t e a d of w a i t i n g f o r things to accumulate on the bottom step or sending an otherwise q u i t e s u f f i c i e n t l y , a c t i v e c h i l d up, by s i t t i n g i n s t e a d of l y i n g down, standing i n s t e a d of s i t t i n g , and walking i n s t e a d of standing verytime i t i s p r a c t i c a b l e to choose the more energetic o p t i o n . F i n a l l y w h i l e these changes are o f t e n more r e a d i l y arranged i n the home, i t i s a l s o p o s s i b l e to make a number of adjustments i n work s i t u a -t i o n s . For example, j u s t u s i n g the coat rack and the coffee pot on another f l o o r , using the t o i l e t at the f a r end of the h a l l , or p a r k i n g at the extreme end of the l o t can a p p r e c i a b l y increase the amount of energy expended over the course of a year. But none of these adjustments w i l l be automatic; some w i l l be the subject of r i d i c u l e , and a l l w i l l r e q u i r e more e x e r t i o n . To be s u c c e s s f u l i n the face of these odds r e -q u i r e s a f i r m commitment to s t r o n g l y embracing e x e r t i o n as a b a s i c thread i n the f a b r i c of d a i l y l i v i n g . APPENDIX D Forms used i n the Study 175 CONSENT FORM As a volunteer f o r t h i s weight c o n t r o l study, we want you to know what t h i s part of the experiment i s going to be l i k e . You w i l l spend up to 24 hours l y i n g on a bed i n a dark, somewhat sound-reducing room, and you are i n s t r u c t e d to remain reasonably q u i e t while i n the room. That i s to say, you are not permitted to s i n g , w h i s t l e , t a l k to your-s e l f , e t c . ; a l s o , you are asked to r e f r a i n from moving around the room, s i t t i n g upon the bed, e t c . , except as d e t a i l e d below. Water and food ( l i q u i d d i e t food) w i l l be a v a i l a b l e at your bedside through p l a s t i c straws, and you are f r e e to take them at w i l l . From time to time, messages w i l l be presented to you over an intercommunica-t i o n system, and al s o you may be asked questions about how you are f e e l -i n g , and so on. At a l l times w h i l e you are i n the room, there w i l l be a monitor i n the room next door to you who w i l l l i s t e n p e r i o d i c a l l y through the intercom set to make sure that you are a l l r i g h t , and that you are obeying the i n s t r u c t i o n s to l i e s t i l l without moving around the room, t a l k i n g to y o u s e l f , or the l i k e . Several hundred subjects have p a r t i c i p a t e d i n experiments i n v o l v i n g e s s e n t i a l l y the same k i n d of s i t u a t i o n , and very few of them have found i t s t r e s s f u l or unpleasant, However,e±f2youashbuldpfindsthat y o u r - r e a c t i o n to the s i t u a t i o n i s negative, you may end the experiment simply be g e t t i n g • o f f the bed and walking out of the room. I f you decide to do t h i s , you should not f e e l that i t r e f l e c t s upon you i n any way; some people j u s t f i n d such a s i t u a t i o n unpleasant, and there i s no p a r t i c u l a r reason why they should force themselves to continue i n i t . You should f e e l assured that among these s e v e r a l hundred s u b j e c t s , none has ever experienced any extremely undesirable or l a s t i n g s ide e f f e c t s . I have read the above i n f o r m a t i o n , and agree to p a r t i c i p a t e i n the p r o j e c t as described. Peter Suedfeld, Ph.D P r o j e c t D i r e c t o r • > DATE SIGNATURE PRINTED NAME: AGE: ADDRESS TELEPHONE NO. SOCIAL INSURANCE NO. 176 MOTIVE CHECKLIST Below i s a l i s t of d i f f e r e n t reasons that people have f o r wanting to l o s e weight. Under each reason i s a s c a l e ranging from very impor-tant ( 5 ) , to not at a l l important ( 1 ) . C i r c l e the number which represents how important each of these reasons i s f o r you i n your d e c i s i o n to j o i n t h i s program. For example, i s improving your appearance very important to you? C i r c l e the 5 under that p a r t i c u l a r reason. 1. Improve my appearance 1 2 3 4 5 not at a l l not very somewhat f a i r l y very important important . important important important 2. Improve my h e a l t h 1 2 3 4 5 3. Demonstrate s e l f - c o n t r o l 1 2 3 3 4 5 4. Improve s o c i a l o p p o r t u n i t i e s 1 2 3 4 5 5. Improve employment o p p o r t u n i t i e s . 1 2 3 4 5 6. Prepare f o r some upcoming event 1 2 3 4 5 7. Please my spouse or f r i e n d s 1 2 3 4 5 I f you have other reasons f o r j o i n i n g the program please l i s t them here and put a number from 1 to 5 representing how important that reason i s to you. 177 Spouse Involvement Form has decided to p a r t i c i p a t i n a program designed to help her c o n t r o l over-eating and l o s e excess weight. A program of t h i s k i n d i s a b i g job and at times w i l l be very d i f f i c u l t . I t i s f o r t h i s reason that your support and a s s i s t a n c e are c r u c i a l to the suc-cess of the program. E s s e n t i a l l y the program i s a method of s e l f c o n t r o l . Various techniques have been developed to a i d the i n d i v i d u a l i n l e a r n i n g good e a t i n g h a b i t s and good e x e r c i s i n g h a b i t s . For example, i n order to avoid e a t i n g a l l the time wherever one might be, i t i s important to arrange f o r her to eat i n only one room, such as the d i n i n g room, and not do anything e l s e w h i l e e a t i n g . Your r o l e i n t h i s aspect would be to encourage your w i f e / f r i e n d to eat i n one place and o f f e r p o s i t i v e comments when she i s f u l f i l l i n g t h i s p a r t i c u l a r step. The techniques are many and i n s t e a d of l i s t i n g them a l l here, I would l i k e to request that you acquaint y o u r s e l f w i t h the program by reading the short booklet that we w i l l be supplying your w i f e / f r i e n d . I would l i k e to add that f o r the program to be e f f e c t i v e and long l a s t i n g , i t must be taken completely s e r i o u s l y and f o r an inde-f i n i t e p e r i o d of time. This i s not a crash d i e t w i t h a piece of choO c o l a t e cake at the end. I t i s a change i n l i v i n g s t y l e w i t h more emphasis on n u t r i t i o n a l h a b i t s and e x e r c i s e h a b i t s . I cannot empha-s i z e enough the importance of your support to the success of t h i s a t -tempt to lose and maintain a new low weight. 178 You can be of a s s i s t a n c e to the program by p r o v i d i n g us w i t h some info r m a t i o n about the current e a t i n g h a b i t s of your w i f e / f r i e n d . She has already given us i n f o r m a t i o n and w i l l continue to do t h i s , however, i n an experimental program l i k e t h i s , i t i s very important that we c o l -l e c t as much in f o r m a t i o n as p o s s i b l e about each p a r t i c i p a n t . Please answer as best as you can the f o l l o w i n g questions about your w i f e / f r i e n d ' s e a t i n g h a b i t s : 1. How many meals does she eat a day? Average number . A 2. How w e l l balanced are the.-meals she eats? check one: very p o o r l y balanced - not very n u t r i t i o u s ' ' not very balanced - some n u t r i t i o u s foods but mostly junk foods about average - some n u t r i t i o u s foods - some junk foods f a i r l y balanced - mostly n u t r i t i o u s foods very w e l l balanced - very n u t r i t i o u s 3. How appropriate f o r someone on a d i e t i s the food she eats? check one: very appropriate - very few f a t t e n i n g foods somewhat appropriate about average somewhat i n a p p r o p r i a t e not at a l l appropriate - mostly f a t t e n i n g foods 4. How w e l l do you think she has snacking under c o n t r o l ? check one: never snacks r a r e l y snacks sometimes snacks frequent snacking always snacking 5. Does she oft e n turn down f a t t e n i n g foods when they are offered? check one: __; always turns down f a t t e n i n g foods f r e q u e n t l y turns down f a t t e n i n g foods sometimes turns down f a t t e n i n g foods r a r e l y turns down f a t t e n i n g foods never turns down f a t t e n i n g foods 179 Two Month Interview NAME D A T E . I . C a l o r i e plan? % of days on % of days over % of days under Graphing yes J i o I I . E x e r c i s e average c a l o r i e s / d a . p a t t e r n : regular_ sporadic Graphing yes no I I I . Habits % of time E a t i n g i n one place (when home) Not doing anything e l s e '  Keeping problem foods out of s i g h t and reach Working on s p e c i f i c problem times G e t t i n g help from others ] Use smaller p l a t e ' Measure p o r t i o n s Keeping safe foods a v a i l a b l e E a t i n g s l o w l y ] . Payoff p l a n 1. Do you f e e l your a t t i t u d e toward e a t i n g has changed? 5 4 3 2 1 Completely A great deal Somewhat A l i t t l e b i t Not at a l l 2. Do you f e e l b e t t e r about y o u r s e l f ? 1 2 3 4 5 Not at a l l A l i t t l e b i t Somewhat A great deal Very much 3. Do you f e e l h e a l t h i e r and more p h y s i c a l l y f i t ? 5 4 3 2= 1 Extremely A great deal Somewhat A l i t t l e b i t Not at a l l how oft e n how o f t e n cont'd. 180 4. How much d i f f i c u l t y have you had thus f a r (0-100) 5. How much d i f f i c u l t y do you foresee having f o r the next four months (0-100) 6. How many times have, you read the book? 7. What i s your o p i n i o n of the book? 1 2 3 4 5 Worthless Of l i t t l e Value Somewhat u s e f u l Very u s e f u l Extremely U s e f u l S.D. Experience Has i t helped? Have you thought of that experience much? What was i t l i k e ? (Pleasant-Unpleasant) Message: Have they helped? Have you t r i e d r e l a x a t i o n s i n c e then? Have you thought of them? 181 S i x Month Interview NAME DATE 1. Do you f e e l that f o r you the progress has been s u c c e s s f u l or un-succ e s s f u l ? 1 2 21 4 5 _ completely f a i r l y n e i t h e r f a i r l y completely unsuccessful unsuccessful s u c c e s s f u l s u c c e s s f u l s u c c e s s f u l nor unsuccessful Comments: 2, Do you f e e l that your a t t i t u d e toward e a t i n g has changed si n c e the beginning of the program? 5 4 3 2 1 changed changed a changed changed not at a l l completely great deal somewhat a l i t t l e changed 3. Have your a t t i t u d e s toward your h e a l t h i n general changed? 5 4 3 2 1 changed changed a changed changed not at a l l completely great deal somewhat a l i t t l e changed 4. Do you f e e l b e t t e r about y o u r s e l f ? 1 2 3 4 5 not at a l l a l i t t l e somewhat a great deal very much 5. Do you f e e l h e a l t h i e r and more p h y s i c a l l y f i t ? 1 2 3 4 5 not at a l l a l i t t l e somewhat a great deal extremely 6. What do you t h i n k are the most important aspects of the program? 7. What are the worst aspects of the program? 8. How could the program be improved? cont'd.... S i x Month Interview. (cont'd) 9. What i s the greatest problem you had wh i l e on the program? 10. What have you learned about y o u r s e l f during the program? 11. Do you t h i n k you w i l l use t h i s program i n the future? 12. Do you f e e l i t i s p o s s i b l e f o r you to reach your goal weight? 13. General Comments 

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