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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 t h e Department of Psychology  We a c c e p t t h i s t h e s i s as conforming t o the required standard  THE UNIVERSITY OF BRITISH COLUMBIA A u g u s t , 1977 ( c ) R o d e r i c k A l l e n B o r r i e , 1977  In p r e s e n t i n g t h i s  thesis  an advanced degree at  further  fulfilment  of  the  requirements  the U n i v e r s i t y of B r i t i s h Columbia, I agree  the L i b r a r y s h a l l make it I  in p a r t i a l  freely  available  for  this  thesis  f o r s c h o l a r l y purposes may be granted by the Head of my Department  of  this  thesis for  It  financial  or  i s understood that copying or p u b l i c a t i o n gain s h a l l not  w r i t t e n pe m i s s i o n .  Department  that  reference and study.  agree t h a t p e r m i s s i o n f o r e x t e n s i v e copying o f  by h i s r e p r e s e n t a t i v e s .  for  of  The U n i v e r s i t y o f B r i t i s h Columbia 2075 Wesbrook P l a c e V a n c o u v e r , Canada V6T 1W5  be allowed without my  ii ABSTRACT  Sensory d e p r i v a t i o n has been used i n a number o f c l i n i c a l  contexts  e i t h e r as a form o f t h e r a p y by i t s e l f o r i n c o n j u n c t i o n w i t h o t h e r 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 o f 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 t o t h e r a p e u t i c i n p u t make s e n s o r y 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 o f b e h a v i o u r change.  I n p a s t r e s e a r c h sensory de-  p r i v a t i o n has been used i n t h e treatment o f poor s e l f image, a u t i s m , p h o b i a s , and smoking.  T h i s s t u d y was designed t o extend p r e v i o u s r e s e a r c h  i n w h i c h s e n s o r y d e p r i v a t i o n was used t o s u c c e s s f u l l y moderate o r e l i m i n a t e h e a l t h endangering  behavior.  I n t h e r e s e a r c h on smoking t h e t e c h n i q u e was  used i n c o n j u n c t i o n w i t h a p p r o p r i a t e messages t o h e l p p s y c h o l o g i c a l l y a d d i c t e d smokers t o s t o p smoking ( S u e d f e l d , 1973).  The p r e s e n t p r o j e c t  a p p l i e d t h e s e n s o r y d e p r i v a t i o n t e c h n i q u e t o t h e problem o f o b e s i t y caused by o v e r e a t i n g . The d e s i g n was a 2 x 2 f a c t o r i a l w i t h t h e major v a r i a b l e s b e i n g (1) sens o r y d e p r i v a t i o n (SD) v e r s u s non-confinement (NC), and (2) t h e r a p e u t i c messages (M) v e r s u s no messages (NM). S u b j e c t s were 39 female v o l u n t e e r s between the ages o f 20 and 56 who responded t o announcements o f an e x p e r i m e n t a l l o s s programme.  weight  The s u b j e c t s were a s s i g n e d t o one o f t h e f o u r e x p e r i m e n t a l groups  w h i c h were equated f o r w e i g h t , 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 o f l y i n g i n a dark, q u i e t chamber f o r 24 h o u r s ; t h e messages c o n s i s t e d o f two s e t s o f communications c o n c e r n i n g weight was concerned  loss.  The f i r s t s e t o f messages  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 u r g e s ; t h e  second s e t 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 t e c h n i q u e s .  The group  w h i c h r e c e i v e d b o t h s e n s o r y d e p r i v a t i o n and messages heard t h e messages  iii  d u r i n g t h e i r s t a y i n sensory  deprivation.  F o l l o w i n g the e x p e r i m e n t a l  treat-  ment, a l l s u b j e c t s were g i v e n a s t a n d a r d d i e t manual and s t a n d a r d i z e d i n ^ s t r u c t i o n s i n i t s use.  S u b j e c t s were seen p e r i o d i c a l l y o v e r the f o l l o w i n g  s i x months. The w e i g h t l o s s d a t a a t 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 tween sensory 5.87  Kg) was  d e p r i v a t i o n and message.  combined treatment  (SDM mean =  s u p e r i o r to the o t h e r t h r e e groups (SDNM mean = 1.08  mean = .67 Kg, NCNM mean = 2.36 s k i n f o l d measurements.  Kg).  Kg f o r those who  d i d not.  NCM  There were no s i g n i f i c a n t changes i n  h e a r d the messages l o s i n g 3.14  Kg  versus  Weight l o s s over the f i n a l f o u r months showed  a c o n d i t i o n e f f e c t w i t h those who w h i l e the n o n c o n f i n e d  Kg,  The weight l o s s d a t a a t 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 1.23  The  be-  had sensory  subjects gained  .98 Kg.  d e p r i v a t i o n l o s i n g 1.58 These r e s u l t s a r e  Kg,  discussed  i n terms o f 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 o f sensory d e p r i v a t i o n . When v a r i o u s demographic and b e h a v i o u r a l d a t a were r e g r e s s e d on w e i g h t change, t h r e e 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 t h a t the more  d i f f i c u l t y the s u b j e c t a n t i c i p a t e d , the more w e i g h t she l o s t ; the  stronger  h e r m o t i v e t o p l e a s e h e r spouse, the l e s s w e i g h t 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 w e i g h t she l o s t .  The  d i s c u s s e d i n terms o f t h e i r i m p l i c a t i o n s f o r f u t u r e t r e a t m e n t s The p r e s e n t  r e s u l t s are  of o b e s i t y .  study i s a l s o d i s c u s s e d i n comparison w i t h o t h e r sensory  v a t i o n s t u d i e s and o t h e r o b e s i t y treatment  studies.  depri-  ±-'  iv  TABLE OF CONTENTS Page ABSTRACT  i i  TABLE OF CONTENTS  .  LIST OF TABLES AND FIGURES ACKNOWLEDGEMENT  v  INTRODUCTION The T h e r a p e u t i c  i  v  v  i  i  i  1 Use o f Sensory D e p r i v a t i o n  .....  Treatment o f Overweight  _ i f  Concepts o f O b e s i t y  20  Methodological  28  Considerations  R a t i o n a l e f o r t h e Treatment Used i n T h i s Study DESIGN OF THE STUDY  ..... .  32 35.  METHOD Subjects Procedure  35 .....  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 - U n c o n f i n e d w i t h Messages  40  Group Four - N o n c o n f i n e d w i t h no messages  41  Follow-up S e s s i o n s  41  Measures  42  W e i g h t , h e i g h t , and s k i n f o l d  42  Demographic d a t a  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 i n v o l v e m e n t  .....  46  Self 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  T a b l e o f Contents ( c o n t ' 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 t h e a n a l y s i s o f drop o u t s  ....  53  Weight change  ....  55  S k i n f o l d measurement change  ....  62  A n a l y s i s o f o t h e r dependent measures  ....  62  R e g r e s s i o n i n v o l v i n g w e i g h t change  ....  64  Unanalyzed d a t a  ....  65  DISCUSSION  67  Motivational effects  ....  69  Comparison w i t h o t h e r SD s t u d i e s  ....  71  Comparison w i t h o t h e r w e i g h t r e d u c t i o n s t u d i e s  ....  72  Treatment o f m e t h o d o l o g i c a l 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  S u b j e c t r e a c t i o n t o t h e programme  ....  80  Treatment format  ....  82  Relevance t o t h e o r i e s of o b e s i t y  ....  83  Individual differences  ....  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  APPENDIX B:  Newspaper a r t i c l e s used t o r e c r u i t subjects  105  ....  154  APPENDIX C:  Message t r a n s c r i p t s  156  APPENDIX D:  Forms used i n t h e s t u d y  174  vi  LIST OF TABLES AND FIGURE Page TABLE 1  Summary o f C o r r e l a t i o n s  ....  TABLE 2  Weight l o s s a t s i x months  57  TABLE 3  Weight l o s s a t two months  58  TABLE 4  Weight l o s s over l a s t f o u r months  ....  60  TABLE 5  S k i n f o l d measurement change s i x months  ....  61  studies....  74  TABLE 6  Summary o f w e i g h t r e d u c t i o n  FIGURE 1  Weight change o v e r s i x months  52  61  vii ACKNOWLEDGMENTS I w i s h t o express my g r a t i t u d e t o t h e 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 S u e d f e l d ,  my a d v i s o r f o r t h e p a s t f o u r y e a r s and my d i r e c t o r on t h i s  disserta-  t i o n , I w i s h t o 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 c i s m , p a t i e n c e , and o c c a s i o n a l , w e l l p l a c e d m o t i v a t i o n a l b o o s t s . My thanks go t o D r . Ralph H a k s t i a n f o r h i s sound s t a t i s t i c a l a d v i c e and h i s k i n d words throughout t h e p r o j e c t , and t o Dr. D e m i t r i o s Papageorgis-\  f o r h i s c l i n i c a l a d v i c e 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 s e e i n g s u b j e c t s .  I am g r a t e f u l t o Dr. R i c h a r d  S t u a r t f o r h i s a s s i s t a n c e and a d v i c e i n d e s i g n i n g t h e s t u d y , and t o D r s . L a r r y Ward and M e l v i n Lee of  f o r t h e i r help i n the planning stages  the p r o j e c t . I want t o thank Carmenza Ramirez f o r h e r a s s i s t a n c e i n t a k i n g t h e  s k i n f o l d measurements and Margaret Byrne f o r h e r h e l p i n s c h e d u l i n g subjects . S p e c i a l thanks a r e due t o C a r o l B o r r i e who n o t o n l y p r o v i d e d much encouragement and s u p p o r t b u t d i d much o f t h e t y p i n g and e d i t i n g o f e a r lier  drafts. To my f r i e n d s , n o t mentioned  s p e c i f i c a l l y h e r e , b u t who p r o v i d e d  much s u p p o r t through t h e 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 i m p o r t a n t , I w i s h t o thank each j e c t who p a r t i c i p a t e d i n t h e s t u d y , o f t e n i n s p i t e o f much  sub-  discouragement.  I hope t h a t I have taught y o u a t l e a s t a f r a c t i o n o f what y o u have taught to me.  INTRODUCTION  1  For many y e a r s r e s e a r c h e r s 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 o f reduced s e n s o r y s t i m u l a t i o n . h o u r s t o s e v e r a l days, t h i s p r o c e d u r e deprivation.  Over s h o r t p e r i o d s o f a  few  i s most commonly known as s e n s o r y  Research on human a d u l t s exposed t o temporary c o n d i t i o n s o f  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 b i o c h e m i s t r y , p e r s u a s i b i l i t y , EEG ego  s t r e n g t h (see Zubek, 1969).  promoted by the n a t u r e  activity,  and  This d i v e r s i t y of research p u r s u i t s i s  of s e n s o r y d e p r i v a t i o n , w h i c h , r a t h e r than b e i n g  a r e s e a r c h paradigm w i t h the mandates o f s p e c i f i c t h e o r i e s and i s a technique searcher's The  concepts,  o r method whose a p p l i c a b i l i t y i s l i m i t e d o n l y by the r e -  imagination.  c o n c e r n o f t h i s r e s e a r c h r e p o r t i s the a p p l i c a t i o n of s e n s o r y  - deprivation i n a therapeutic context.  S p e c i f i c a l l y t h i s r e p o r t i s an i n -  v e s t i g a t i o n of the use o f s e n s o r y 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 w e i g h t l o s s .  Sensory d e p r i v a t i o n i n t h i s programme  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 c o n j u n c t i o n w i t h more techniques 1972).  conventional  o f b e h a v i o r a l s e l f c o n t r o l f o r w e i g h t l o s s ( S t u a r t and  W h i l e s e n s o r y d e p r i v a t i o n was  the major e x p e r i m e n t a l  t h i s s t u d y , i n terms o f time i t a c t u a l l y was  was  Davis,  concern of  a s m a l l p o r t i o n of the  gramme; i n f a c t , the l e n g t h of t i m e t h a t each s u b j e c t f o l l o w e d the gramme was  was  propro-  s i x months whereas the s i n g l e s e s s i o n i n s e n s o r y d e p r i v a t i o n  o n l y 24 h o u r s . The p l a n of t h i s c h a p t e r i s t o b e g i n w i t h a r e v i e w of the  therapeutic  uses of s e n s o r y 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 o f the s e n s o r y d e p r i v a t i o n experience  which have p r o v i d e d  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 t h e treatment  of o b e s i t y w i l l be p r e s e n t e d w i t h a summary o f t h e r e l e v a n t t h e o r i e s o f o v e r w e i g h t and a d i s c u s s i o n o f treatment problems. for  N e x t , the r a t i o n a l e .  a p p l y i n g s e n s o r y d e p r i v a t i o n t o t h e p r o b l e m o f w e i g h t l o s s w i l l be  examined w i t h a f i n a l comment on t h e problems i n h e r e n t  i n obesity  research  and t h e d e s i g n o f t h i s s t u d y . The  T h e r a p e u t i c Use o f 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 o f sen-  s o r y d e p r i v a t i o n as a form o f o r a i d t o t h e r a p y , t h e number o f 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 t o t h e enormous body o f s e n s o r y d e p r i v a t i o n r e s e a r c h vation i s reported 1967)  i n general.  A type o f s e n s o r y d e p r i -  t o have been used as e a r l y as a n c i e n t Greece  ; however s y s t e m a t i c  research i n t o i t s c l i n i c a l  (Kouretas,  use began o n l y i n the  mid-1950's s h o r t l y a f t e r t h e f i r s t s e n s o r y d e p r i v a t i o n r e s e a r c h  o f any  k i n d began. Some o f t h e i n i t i a l s t u d i e s l o o k e d  a t t h e b e n e f i c i a l e f f e c t s o f 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 C a r r e r a , 1960; C l e v e l a n d  Reitman and B e n t i n c k ,  1963;  Reitman and C l e v e l a n d , 1964; Cooper, Adams, and Cohen, 1965).  s t u d i e s have combined s e n s o r y 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  Other  communications  d e s i g n e d t o t r e a t a s p e c i f i c p r o b l e m (Gibby and Adams, 1961; R o b e r t s o n , 1965;  Adams, R o b e r t s o n , and Cooper, 1966; S u e d f e l d ,  E p s t e i n , 1972; S u e d f e l d  Landon, Pargament and  and I k a r d , 1974; B a r n e s , 1976; Kammerman, •  >1977) o r w i t h some o t h e r t h e r a p y a i d s 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  S m i t h , 1973;  Suedfeld  and Buchanan, 1974).  I n a d d i t i o n some have used s e n s o r y d e p r i v a t i o n t o enhance the ness of a n o t h e r s e p a r a t e t h e r a p y method ( S c h e c h t e r , T o u s i e n g , 1969; and B e s t ,  M a i e r , 1970;  effective-  S h W l e y , Sexauer  M a r t i n , Roush, and N i c h o l s o n ,  1967;  and  Suedfeld  1977).  W h i l e we might c a t e g o r i z e the c l i n i c a l uses of s e n s o r y d e p r i v a t i o n according  t o whether i t i s used a l o n e , w i t h t h e r a p e u t i c  communications,  or w i t h o t h e r t h e r a p y methods, t h e r e i s a g r e a t d e a l o f o v e r l a p s t u d i e s i n the use of these methods.  between  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-experienced  s e n s o r y d e p r i v a t i o n w i t h o u t the communications.  In a d d i t i o n ,  communications have been i n c l u d e d w i t h s e n s o r y d e p r i v a t i o n i n s t u d i e s a c o m b i n a t i o n of t h e r a p y t e c h n i q u e s ( S u e d f e l d and B e s t , 1977).  using  Therefore,  i t w i l l be more u s e f u l t o d i s c u s s t h i s body of r e s e a r c h i n r e l a t i o n t o the e f f e c t s of the s e n s o r y d e p r i v a t i o n e x p e r i e n c e t h a t they were to  attempting  utilize. 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 t h a t used s e n s o r y d e p r i v a t i o n by  i t s e l f attempted t o examine the r e a c t i o n s o f p s y c h i a t r i c p a t i e n t s to r e duced s e n s o r y i n p u t .  An e a r l y s t u d y (Azima and Cramer-Azima, 1956)  14 p a t i e n t s i n t o f o u r days of s e n s o r y d e p r i v a t i o n and  reported  placed  such bene-  f i c i a l e f f e c t s as i n c r e a s e d r e s p o n s i v e n e s s 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 i n c r e a s e d  d e s i r e to s o c i a l i z e .  no b e h a v i o r a l improvements i n 12 s c h i z o p h r e n i c s  H a r r i s (1959) r e p o r t e d  following a short  session  w e a r i n g t r a n s l u c e n t goggles and l i s t e n i n g t o w h i t e n o i s e 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 n o r m a l s .  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  f o u r normal s u b j e c t s  who  4 experienced  one hour w i t h t r a n s l u s c e n t goggles and w h i t e n o i s e .  Again,  t h e r e were no r e p o r t s o f b e h a v i o r a l improvement. Gibbey e_t a l . (1960) r e p o r t e d symptom improvements i n 30 p s y c h i a t r i c p a t i e n t s w h i c h l a s t e d up t o a week a f t e r a s i x - h o u r 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 p l u g g e d .  These p a t i e n t s a l s o e x h i -  b i t e d an i n c r e a s e d d e s i r e f o r s o c i a l c o n t a c t and an i n c r e a s e d awareness o f the i n t e r n a l causes o f p e r s o n a l problems. study  (Cooper, Adams and Gibby, 1962)  f i c a n t i n c r e a s e i n ego  A n o t h e r r e p o r t f r o m the same  added t h a t p a t i e n t s showed a s i g n i -  s t r e n g t h on the R o r s c h a c h .  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  Reitman and B e n t i n c k , 1963) v a t i o n group and n o n c o n f i n e d t h a t sensory  found no d i f f e r e n c e between the sensory d e p r i group on p a t h o l o g y  ratings.  They  concluded  d e p r i v a t i o n o f f e r s " l i t t l e p r o m i s e " as a treatment  of  d i s o r d e r s but i n ;another .paper f romothe!:same, js.tudy "i(Reitman. and 1964)  (Cleveland,  behavior  Cleveland,  they do' r e p o r t improvements in.'^body image' and i n c r e a s e d - t a c t i l e '  sensitivity. These d i v e r g e n t r e s u l t s are most p r o b a b l y sensory  d e p r i v a t i o n techniques:  e x p l a i n e d by d i f f e r e n c e s i n  the Gibby e t a l . (1960) s t u d y used a  reduc-  t i o n o f a b s o l u t e s t i m u l a t i o n l e v e l by c o v e r i n g s u b j e c t s ' eyes w i t h c o t t o n and p l u g g i n g t h e i r e a r s , whereas the C l e v e l a n d e_t aT. used a r e d u c t i o n o f s t i m u l u s p a t t e r n i n g w i t h o u t Up  to t h i s p o i n t the term sensory  (1963) experiment  reducing stimulus  intensity.  d e p r i v a t i o n has been used t o d e s c r i b e  b o t h methods,,; however t h e r e i s a d i s t i n c t i o n to be made between the The  r e d u c t i o n of a b s o l u t e l e v e l o f s t i m u l a t i o n i s r e f e r r e d to as  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 o f s t i m u l u s p a t t e r n i n g w i t h o u t i n t e n s i t y i s known as p e r c e p t u a l d e p r i v a t i o n ( R o s s i , 1969).  two.  sensory  reducing  Unfortunately,  5 a c a r e f u l i n v e s t i g a t i o n o f t h e 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 o f the two p r o c e d u r e s has n e v e r been c a r r i e d o u t . In a r e c e n t r e v i e w o f the c l i n i c a l r e l e v a n c e o f s e n s o r y d e p r i v a t i o n , Suedfeld  (1975a) s u g g e s t s t h a t s e n s o r y d e p r i v a t i o n " d r a s t i c a l l y  many f a c t o r s which s h o u l d maximize t h e p a t i e n t ' s r e s p o n s i v e n e s s s e n s i t i v i t y t o one's own t h o u g h t s ,  magnifies to therapy:  memories, and e m o t i o n s ; dependence upon  the t h e r a p i s t , the d e s i r e f o r and reward v a l u e o f s o c i a l i n t e r a c t i o n ; r e ceptiveness  t o communications; a need f o r c o g n i t i v e s t r u c t u r e ; i n c r e a s e d  flow o f primary  process m a t e r i a l .  I t also f a c i l i t a t e s relaxation, mini-  mizes d i s t r a c t i o n , and e l i m i n a t e s cues t h a t i n normal environments undesired behavior"  elicit  (p. 9 8 ) . Some o f these f a c t o r s , such as t h e m i n i m i z a -  t i o n o f d i s t r a c t i o n and the i n c r e a s e i n r e c e p t i v e n e s s have l e d s e v e r a l r e s e a r c h e r s  t o study  t o communication  t h e p o s s i b i l i t y o f enhancing t h e  e f f e e t i v e n e s s , , o f t h e r a p e u t i c messages.  A c t u a l l y , the i d e a t h a t s e n s o r y  d e p r i v a t i o n might i n c r e a s e the e f f e c t i v e n e s s o f p e r s u a s i v e  or educational  m a t e r i a l s was p a r t o f t h e o r i g i n a l impetus b e h i n d s e n s o r y d e p r i v a t i o n r e search  ( S c o t t et_ a l . , 1959) .  I f s e n s o r y d e p r i v a t i o n would i n c r e a s e t h e  a t t e n t i v e n e s s o f the i n d i v i d u a l , i t would i n c r e a s e t h e impact o f t h e mat e r i a l presented.  P a r t o f t h i s i n c r e a s e d impact was p o s t u l a t e d t o r e s u l t  from a h e i g h t e n e d need f o r s t i m u l a t i o n caused by t h e s e v e r e r e d u c t i o n i n stimulus  level.  Notwithstanding,  some disagreement c o n c e r n i n g  the p r e c i s e d e f i n i t i o n  o f t h i s need f o r s t i m u l u s o r i n f o r m a t i o n , t h e r e i s g e n e r a l agreement t h a t s e n s o r y d e p r i v a t i o n does l e a d t o s t i m u l u s - s e e k i n g b e h a v i o r . e v i d e n c e i n s u p p o r t o f t h i s has been t h o r o u g h l y  Since the  reviewed by b o t h S c h u l t z  (1965) and Jones (1969) , a b r i e f s a m p l i n g o f t h i s e v i d e n c e w i l l  suffice  6 here.  The d o c t o r a l d i s s e r t a t i o n o f Bexton ( B e x t o n , Heron, and S c o t t ,  1954)  provided  t h e f i r s t i n d i c a t i o n t h a t sensory d e p r i v a t i o n c r e a t e d 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 a l l o w e d  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 w i s h e d , chose t o l i s t e n f a r more f r e q u e n t l y i n t h e l a t t e r h a l f o f t h e i r s t a y i n s e n s o r y d e p r i v a t i o n . Comparing s u b j e c t s i n s e n s o r y 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 ,  Scott,  B e x t o n , Heron, and Doane (1959) found t h a t t h e former chose t o l i s t e n t o r e c o r d e d t a l k s more o f t e n than t h e l a t t e r . I n a seven-day l o n g s e s s i o n , s u b j e c t s c o n f i n e d i n s e n s o r y d e p r i v a t i o n chose t o l i s t e n t o r a t h e r d u l l s t o c k market r e p o r t s s i g n i f i c a n t l y more o f t e n than d i d n o n s e n s o r a l l y 1967),  deprived  subjects  ( S m i t h , Myers and Johnson,  I n a d d i t i o n , as t h e d u r a t i o n o f t h e s e s s i o n i n c r e a s e d  so d i d t h e  d i f f e r e n c e between groups; those i n s e n s o r y d e p r i v a t i o n chose t o l i s t e n i n c r e a s i n g l y more t h e l o n g e r they s t a y e d . they chose t o l i s t e n , t h e most f r e q u e n t  When s u b j e c t s were asked why  response was a d e s i r e t o "hear a  v o i c e o r o t h e r m e a n i n g f u l sound" ( S m i t h , e t a l . , 1967).  These  researchers  s u g g e s t e d t h a t t h e i r f i n d i n g s s u p p o r t t h e concept o f a d r i v e f o r s e n s o r y v a r i a t i o n which increases w i t h l e n g t h o f d e p r i v a t i o n . I n g e n e r a l , t h e f i n d i n g s from o t h e r r e s e a r c h  i n t h i s area also  indi-  cate t h a t 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 i n c r e a s e d desire f o r s t i m u l a t i o n with a preference  f o r high information  (see J o n e s ,  1969), and t h a t t h i s d e s i r e w i l l v a r y among i n d i v i d u a l s depending on r e c e n t 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 e x p e r i e n c e o f t h e s u b j e c t who i s p l a c e d i n s e n s o r y d e p r i v a t i o n i s i n i t i a l l y pleasant lus  confusion  o r a t 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 t h e u s u a l  i n normal c o n d i t i o n s .  stimu-  When t h e 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 b e g i n s t o w i s h t h a t something w o u l d happen.  The  n a t u r e of the s t i m u l a t i o n comes t o m a t t e r l e s s so t h a t m a t e r i a l w h i c h n o r m a l l y might be a v o i d e d becomes sought a f t e r o r a t l e a s t more As S c o t t et_ a l . (1959) put i t ,  "the s u b j e c t becomes so b o r e d t h a t any  of s t i m u l a t i o n i s b e t t e r than n o t h i n g a t a l l " T h i s s t i m u l u s need may  acceptable.  (p.  form  208).  c o n t r i b u t e to the p a t i e n t ' s r e c e p t i v e n e s s  to  t h e r a p e u t i c messages t h a t are h e a r d i n c o n d i t i o n s of s e n s o r y d e p r i v a t i o n . A number of s t u d i e s have o b t a i n e d b e n e f i c i a l e f f e c t s u s i n g t h i s c o m b i n a t i o n f o r a v a r i e t y o f p r o b l e m s , one of the e a r l i e s t b e i n g a s t u d y by Gibby  and  Adams (1961).  14  They combined f o u r hours o f s e n s o r y d e p r i v a t i o n w i t h a  minute tape r e c o r d i n g d e s i g n e d to improve the p a t i e n t ' s s e l f c o n c e p t . T h i s s t u d y was  a 2 x 2 f a c t o r design which included 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.  M e a s u r i n g 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  Adams (1961) found t h a t combined sensory d e p r i v a t i o n and  and  tape produced a  f a r g r e a t e r 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 c o n d i tions.  Combining t h r e e hours of s e n s o r y 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  pre-  p a r e d tapes o r i e n t e d t o the unique problems o f each p a t i e n t , Adams, R o b e r t son and Cooper (1966) found the c o m b i n a t i o n s u p e r i o r t o s e n s o r y d e p r i v a t i o n a l o n e o r no treatment i n p r o d u c i n g b e h a v i o r a l improvements. reportedpalsod.included  i n c r e a s e s i n dominance, ego  tance, and sense o f p e r s o n a l adequacy, (Robertson, was  1965)  The  improvements  strength, self-accep-  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  r e p o r t e d t h a t sensory d e p r i v a t i o n w i t h a taped message  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 s e l f - a c c e p t a n c e  p r i v a t i o n or the message by i t s e l f .  than e i t h e r s e n s o r y  A r e a s o n f o r the l a c k of d i f f e r e n c e  between c o n d i t i o n s ..." i n t h i s study may  have been the d e l a y of a week be-  de-  8 tween treatment and p o s t - t r e a t m e n t  testing.  I n a r e c e n t s t u d y t h a t 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 t h a t t h e ^ c o m b i n a t i o n o f sensoryd e p r i v a t i o n and a s t a n d a r d i z e d tape r e c o r d i n g produced  changes i n MMPI  s c o r e s t h a t d i d n o t o c c u r i n sensory d e p r i v a t i o n o n l y o r no t r e a t m e n t groups.  Kammerman f e e l s t h a t t h i s method o f s e n s o r y d e p r i v a t i o n " p r o v i d e s  f o r maximum c o n t a c t w i t h t h e u n c o n s c i o u s . " ( E a r l y , 1975).  W h i l e t h e sen-  s o r y d e p r i v a t i o n o n l y group e v i d e n c e d i n c r e a s e d ego s t r e n g t h and d e f e n s i v e n e s s , t h e group t h a t h e a r d t h e 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 r e a s e d i n s i g h t , decreased i m p u l s i v i t y , and more e m o t i o n a l 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 o f s t u d i e s o f t h i s type t h a t emerged more from work on i n c r e a s e d s u g g e s t i b i l i t y i n d u c e d by s e n s o r y d e p r i v a t i o n ( S u e d f e l d , 1965; S u e d f e l d and V e r n o n , 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 a r e those by S u e d f e l d and h i s c o l l e a g u e s .  Based on t h e s i z e a b l e body o f e v i d e n c e t h a t  sensory d e p r i v a t i o n i n c r e a s e s s u s c e p t i b i l i t y t o p e r s u a s i o n attempts ( f o r r e v i e w see S u e d f e l d , 1969), an experiment was designed aimed a t g o i n g b e yond merely changing s u b j e c t i v e r e p o r t s o f a t t i t u d e t o change a c t u a l b e h a v i o r p a t t e r n s on an i s s u e o f p e r s o n a l i m p o r t a n c e , i n d u c i n g t h e i n d i v i d u a l to s t o p smoking ( S u e d f e l d , 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 t o change smoking behav i o r i n a study by P a t r i c k (1965).  However h i s treatment o f one hour o f  p e r c e p t u a l d e p r i v a t i o n f o l l o w e d by an a n t i - s m o k i n g f i l m was n o t s i g n i f i c a n t l y b e t t e r than t h e f i l m alone i n r e d u c i n g smoking b e h a v i o r over a t h r e e hour f o l l o w - u p p e r i o d .  F o r t h e S u e d f e l d ejr a_L. (1972) s t u d y s u b j e c t s were  r e c r u i t e d w i t h o u t r e f e r e n c e t o any attempt t o 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 d a t a were o b t a i n e d from an i n i t i a l r e c r u i t i n g v i e w ; a l l s u b j e c t s were heavy smokers.  The s t u d y was  inter-  a f a c t o r i a l design  i n v e s t i g a t i n g s e n s o r y d e p r i v a t i o n v e r s u s no sensory d e p r i v a t i o n and a b r i e f a n t i s m o k i n g message v v s ; no message. of  Sensory d e p r i v a t i o n c o n s i s t e d  l y i n g i n a c o m p l e t e l y d a r k , sound^attenuated  chamber f o r a p e r i o d o f  24 h o u r s , and the a n t i s m o k i n g message d i s c u s s e d t h e h e a l t h h a z a r d s o f smoking and l a s t e d l e s s than t h r e e m i n u t e s .  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 b j e c t s 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 c o n d i t i o n s were smoking s l i g h t l y l e s s .  S u b j e c t s who  went s e n s o r y d e p r i v a t i o n , e i t h e r w i t h o r w i t h o u t the message, had t h e i r r a t e of smoking by 38%.  underdecreased  T h i s 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 s i n c e sub-  j e c t s i n the sensory d e p r i v a t i o n o n l y group had r e c e i v e d no mention  of  cigarettes. P u r s u i n g these i n t r i g u i n g r e s u l t s , S u e d f e l d and I k a r d (1974) t e s t e d the h y p o t h e s i s t h a t the l a c k o f e f f e c t of the a n t i - s m o k i n g message was to  i t s brevity.  They t h e r e f o r e expanded the message to a dozen a n t i s m o k i n g  communications and spaced them a t d i f f e r e n t i n t e r v a l s throughout deprivation.  due  The a d d i t i o n a l f a c t o r o f i n i t i a l m o t i v a t i o n was  sensory  used by r e -  c r u i t i n g s u b j e c t s s p e c i f i c a l l y f o r an e x p e r i m e n t a l method t o 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 Q u e s t i o n n a i r e , were a s s i g n e d to one o f f o u r  groups s e t up as i n t h e p r e v i o u s study ( S u e d f e l d e_t al_. , 1972) . t h r e e month f o l l o w - u p , the sensory d e p r i v a t i o n — m e s s a g e  group had  At the reduced  t h e i r smoking r a t e by 70% and the sensory d e p r i v a t i o n o n l y group was ing  about 50% l e s s .  smok-  The message o n l y 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 y e a r , the combined s e n s o r y 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 s m a l l e r 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 s u b j e c t s were smoking o n l y 16% l e s s than t h e i r o r i g i n a l r a t e . r e s u l t s to be q u i t e s t a b l e . were c o m p l e t e l y  Follow-up a f t e r two y e a r s showed t h e s e  Of the s e n s o r y d e p r i v a t i o n s u b j e c t s ,  25%  a b s t i n e n t and many o t h e r s were smoking c o n s i d e r a b l y  t h e i r pretreatment l e v e l (Suedfeld,  below  1976).  These s t u d i e s do demonstrate the p o w e r f u l i n f l u e n c e o f sensory d e p r i v a t i o n i n changing b e h a v i o r . the h y p o t h e s i s influence.  However, they do n o t n e c e s s a r i l y support  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  I n one  s t u d y ( S u e d f e l d et_ a l _ . , 1972)  outside  both sensory d e p r i v a t i o n  groups e v i d e n c e d e q u a l amounts of smoking r e d u c t i o n r e g a r d l e s s of whether the message was was  heard.  In:.the o t h e r s t u d y ( S u e d f e l d and  I k a r d , 1974)  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 s e n s o r y d e p r i -  v a t i o n groups w i t h and w i t h o u t a n t i - s m o k i n g messages, but ' a t t h r e e months was c o u r s e of the n e x t y e a r .  s m a l l and l e s s e n e d  the d i f f e r e n c e  considerably  Sensory d e p r i v a t i o n a l o n e was  s t u d i e s to reduce smoking b e h a v i o r s i g n i f i c a n t l y .  o v e r the  s u f f i c i e n t i n both  T h i s 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 o f i n f o r m a t i o n need, enhanced i n f o r m a t i o n and i n c r e a s e d  value,  suggestibility.  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  the e f f e c t s of mere exposure t o sensory d e p r i v a t i o n . ges, s e n s o r y d e p r i v a t i o n was ing,  there  s e l f - a c c e p t i n g , and  r e s u l t of i n n e r c o n f l i c t  reported  Even w i t h o u t messa-  t o make p a t i e n t s more  a l s o more aware t h a t t h e i r own (Gibby e t a l . , 1960).  e x t e r n a l s t i m u l i , s e n s o r y d e p r i v a t i o n f o r c e s one  on  self-understand-  problems were the  By removing d i s t r a c t i n g to f o c u s 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 .  A t t h e time  of t h e smoking s t u d i e s by S u e d f e l d and h i s c o l l e a g u e s , t h e p u b l i c was being inundated w i t h antismoking  propaganda w h i c h may have c r e a t e d a  g e n e r a l low l e v e l d e s i r e i n many smokers t o q u i t . w i t h the p e r s o n a l e x p e r i e n c e  When t h i s i s combined  o f spending 24 h o u r s w i t h o u t  c i g a r e t t e s and  i n most cases n o t m i s s i n g them ( S u e d f e l d & I k a r d , 1974) a v e r y  therapeutic  e x p e r i e n c e 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  deprivation  technique  ( S u e d f e l d and I k a r d , 1974) has been compared t o t h a t o f t h e F i v e Day P l a n to q u i t smoking (McFarland by Barnes (1976) .  and F o l k e n b e r y ,  1964) i n a c o m p a r a t i v e  Except f o r s l i g h t l y m o d i f i e d sensory  study  deprivation 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 t o t h e 24 hour p r o c e d u r e o f S u e d f e l d & I k a r d (1975).  S u b j e c t s i n the F i v e Day P l a n c o n d i -  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 s e s s i o n s on f i v e evenings.  S i x months f o l l o w i n g treatment  reported abstinence Although  consecutive  53% o f the F i v e Day P l a n group  as compared t o 58% o f t h e Sensory D e p r i v a t i o n group.  t h i s d i f f e r e n c e between t r e a t m e n t s  i s not s t a t i s t i c a l l y  c a n t , the /§u,ccess r a t e o f b o t h smoking treatment  signifi-  programmes i s q u i t e i m -  pressive. I n s e v e r a l o t h e r s t u d i e s S u e d f e l d and h i s c o l l e a g u e s  ( S u e d f e l d and  S m i t h , 1973; S u e d f e l d and Buchanan, 1974; S u e d f e l d and H a r e , 1977) attempted t o u t i l i z e a combination  o f s e v e r a l e f f e c t s o f sensory  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 p h o b i c s .  deprivation to  I t was reasoned t h a t  i f p h o b i c s were g i v e n an o p p o r t u n i t y a f t e r a p e r i o d o f sensory  deprivation  to l o o k a t s l i d e s o f the o b j e c t o f t h e i r f e a r , i n t h i s case s n a k e s , t h e i n c r e a s e d s t i m u l u s need would cause them t o r e q u e s t t o see t h e 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 o f them.  I n 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 i n d u c e d by s e n s o r y d e p r i v a t i o n which would c r e a t e a form of d e s e n s i t i z a t i o n t o the s l i d e s .  U s i n g 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 o f f e a r the most r e c e n t study ( S u e d f e l d and H a r e , 1977)  compared a group o f p h o b i c s who  chose to v i e w snake s l i d e s  a f t e r f i v e hours o f s e n s o r y d e p r i v a t i o n , w i t h two c o n t r o l groups o f 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 a l s u b j e c t s showed s i g n i f i c a n t l y l e s s f e a r . denced on the p h y s i o l o g i c a l t e s t s .  t e s t s , the  experimen-  However, t h i s w a s n o t e v i ;  Not o n l y do t h e s e s t u d i e s s u p p o r t the  use o f sensory d e p r i v a t i o n i n the r e d u c t i o n of phobias but they a l s o r e p r e s e n t an i n g e n i o u s attempt t o u t i l i z e some o f 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 t h a t a t e c h n i q u e 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 i n c o r p o r a t e d i n t o more areas o f t h e r a p y as an a d j u n c t to o t h e r techniques.  U n f o r t u n a t e l y , the use o f s e n s o r y d e p r i v a t i o n as a f a c i l i t a -  t o r o f o t h e r t h e r a p e u t i c t e c h n i q u e s has not been examined v e r y f u l l y .  As  S u e d f e l d (1975a) s u g g e s t s , the poor exchange o f r e s e a r c h f i n d i n g s between s p e c i a l i z e d a r e a s may  be the reason b e h i n d t h i s l a c k o f r e s e a r c h .  Another  p o s s i b i l i t y f o r i t s n e g l e c t i s the n e g a t i v e aura which has t y p i c a l l y s u r rounded sensory d e p r i v a t i o n i n the p o p u l a r l i t e r a t u r e .  However, i t appears  t h a t t h e r e i s a r e n e w a l o f i n t e r e s t i n t h e - a r e a e v i d e n c e d i n the s c i e n t i f i c ( S u e d f e l d , 1975a, V; 1976; Kammerman, ..'1.9JZ-)iss) and p o p u l a r p r e s s e s ( S m i t h , 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 ( S u e d f e l d , 1975a, b)  and  t o the d i s p e l l i n g o f some of the n e g a t i v e i d e a s which have been a s s o c i a t e d w i t h the t e c h n i q u e ( e . g . , Heron, 1957).  13 One o f the e a r l i e r uses o f s e n s o r y 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 o f e s o p h o r i a , a d i s o r d e r i n which the  eyes -tend t o d e v i a t e i n w a r d .  M a r t i n , Roush, and N i c h o l s o n (1967) used  a form o f 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 s e n s o r y d e p r i v a tion.  S u b j e c t s 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 ment.  had o t h e r c o m b i n a t i o n s of t r e a t -  Another use has been the i n c o r p o r a t i o n o f a reduced s t i m u l u s en-  v i r o n m e n t i n t o the t r e a t m e n t o f a u t i s t i c c h i l d r e n ( S c h e c h t e r , S h i r l e y , Sexauer, and T o u s s i e n g , 1969; M a i e r , 1970). l i v e d i n a low s t i m u l u s l e v e l environment therapist.  I t was  I n t h e s e s t u d i e s the p a t i e n t  and was v i s i t e d d a i l y by a  f e l t t h a t l i v i n g i n a room w i t h a minimum amount o f  l i g h t , c o n s t a n t low sound l e v e l , a minimum o f i n a n i m a t e o b j e c t s , and m i n i mum  p e r s o n a l c o n t a c t e x c l u s i v e o f 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 d e f e n s i v e and much more r e c e p t i v e t o human c o n t a c t .  One  child,  t r e a t e d w i t h t h i s t e c h n i q u e f o r 76 days, showed remarkable improvement i n h i s c o n d i t i o n ( M a i e r , 1970). I n an e x t e n s i o n of the e a r l i e r r e s e a r c h on smoking ( S u e d f e l d , 1973), S u e d f e l d and B e s t (1977) have combined the t e c h n i q u e s 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 s e n s o r y d e p r i v a t i o n and a n t i s m o k i n g messages. T h i s c o m b i n a t i o n has n o t o n l y had a remarkable s u c c e s s 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 w e i g h t  loss  programme and b e i n g b e t t e r a b l e t o cope w i t h v e r y s t r e s s f u l The advantages  o f the c o m b i n a t i o n o f t e c h n i q u e s a r e s e v e r a l .  situations. Monitoring  o f smoking b e h a v i o r and s a t i a t i o n smoking b r i n g the p a t i e n t t o the s e n s o r y d e p r i v a t i o n s e s s i o n w i t h b o t h an i n c r e a s e d u n d e r s t a n d i n g o f h i s own smoki n g b e h a v i o r and a v e r y n e g a t i v e f e e l i n g about smoking more.  A f t e r a day  14 o f s a t i a t i o n smoking the d e s i r e t o smoke has been t e m p o r a r i l y reduced t o almost n o t h i n g .  The sensory d e p r i v a t i o n p r o v i d e s n o t o n l y a 24 hour  time out from smoking but a l s o 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 r e g a r d i n g smoking and one's d e s i r e t o q u i t .  The  antismoking  messages s e r v e to d i r e c t the p a t i e n t ' s thoughts to t h i s problem and t o p r o v i d e 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 smoking.  of q u i t t i n g  I n a d d i t i o n t o b o l s t e r i n g the p a t i e n t ' s m o t i v a t i o n 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 a l s o becomes a d i s t i n c t p o i n t f o r the i n d i v i d u a l .  starting  The 24 hours o f s e n s o r y d e p r i v a t i o n i s a n a l o -  gous to a r i t e o f passage a f t e r which the p e r s o n emerges i n t o h i s new  role  as nonsmoker. A f t e r an e x t r e m e l y a u s p i c i o u s p i l o t study u s i n g t h i s ( S u e d f e l d and B e s t , 1977)  technique  a larger scale investigation currently i n pro-  gress i s p r o d u c i n g even more p r o m i s i n g r e s u l t s (Suedfeld^,& B e s t ; i n p r e s s ) , 15 s u b j e c t s p e r c o n d i t i o n t h i s study i s a comparison of t h e s e n s o r y d e p r i v a t i o n smoking t r e a t m e n t , s a t i a t i o n smoking, and a c o m b i n a t i o n o f the techniques.  At the time o f t h i s w r i t i n g , f o l l o w - u p a t 6 months shows 73%  a b s t i n e n c e f o r the group w i t h combined s e n s o r y d e p r i v a t i o n and treatments.  two  satiation  T h i s i s f a r s u p e r i o r t o e i t h e r t e c h n i q u e s e p a r a t e l y : 25%  a b s t i n e n c e f o r s a t i a t i o n o n l y and 27% f o r s e n s o r y d e p r i v a t i o n .  Preliminary  d a t a from a 12 month f o l l o w - u p o f t h i s s t u d y show the combined s e n s o r y 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 t o be h o l d i n g a t 75% a b s t i n e n c e . e f f e c t i v e n e s s of these two t r e a t m e n t s appears  The  to be a d d i t i v e when the  t e c h n i q u e s are used t o g e t h e r . I t i s the s u c c e s s o f t h i s r e s e a r c h which l e d t o the p r e s e n t s t u d y . I t was  reasoned t h a t 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 t o the s u c c e s s -  Using  15 f u l t r e a t m e n t o f smoking i t might a l s o enhance t h e e f f e c t i v e n e s s o f t r e a t m e n t of a n o t h e r d i f f i c u l t p e r s o n a l problem — o b e s i t y .  Treatment  o f t h e Overweight  The s i t u a t i o n f a c i n g t h e o v e r w e i g h t i n d i v i d u a l s e e k i n g t o l o s e w e i g h t i s a complex and c o n f u s i n g one. to  Having made t h e i n i t i a l  decision  l o s e w e i g h t , t h e c h o i c e o f a s u i t a b l e t e c h n i q u e must be made from an  enormous s u p p l y o f a v a i l a b l e methods.  The s i m p l e d e c i s i o n t o go on a  d i e t t o l o s e w e i g h t i s c o m p l i c a t e d by t h e extreme overabundance o f spec i a l d i e t s each making s p e c i a l c l a i m s t o w e i g h t r e d u c t i o n ; a r e c e n t guide . l i s t s o v e r 60 d i f f e r e n t a v a i l a b l e w e i g h t l o s s d i e t s ( B e r l a n d , 1974).  If  one chooses t o p u t t h e burden o f d e c i s i o n on h i s p h y s i c i a n t h e number o f alternatives multiplies. simple.  Even g o i n g t h e r o u t e o f t h e d i e t p i l l i s n o t  A r e c e n t r e v i e w o f m e d i c a l t r e a t m e n t s (Samuel and B u r l a n d , 1974)  d e s c r i b e s t e n d i f f e r e n t amphetamines and numerous o t h e r v a r i e t i e s o f drugs used i n w e i g h t r e d u c t i o n .  There a l s o e x i s t a number o f more extreme and  more q u e s t i o n a b l e a l t e r n a t i v e s , such as the use o f l e v o d o p a t o i n d u c e v o 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 a r e a , and t h e i n c r e a s e o f c a l o r i c o u t p u t by means o f c h o l e s t y r a m e n e . W h i l e none o f t h e s e m e d i c a l t e c h n i q u e s has proven t o be e f f e c t i v e i n p r o d u c i n g l o n g - l a s t i n g r e s u l t s , t h e more d r a s t i c i n t e s t i n a l bypass has become a viable alternative notwithstanding the considerable r i s k  involved  (Quaade, 1974). In for of  s p i t e o f t h i s tremendous d i v e r s i t y o f t e c h n i q u e s , t h e p r o g n o s i s  s u c c e s s f u l w e i g h t l o s s and maintenance  o f that l o s s i n the treatment  o b e s i t y has t r a d i t i o n a l l y been e x t r e m e l y poor ( S t u n k a r d and McLaren-  16 Hume, 1959).  S t u n k a r d (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 o f b e h a v i o u r a l t e c h n i q u e s w i t h f i v e p r o p o s i t i o n s : (1) Most obese p e o p l e do not e n t e r treatment f o r o b e s i t y . (2) Of those who do e n t e r t r e a t m e n t , most w i l l n o t remain .... (3) Of t h o s e who r e m a i n , most w i l l n o t l o s e much w e i g h t .... (4) Of t h o s e who l o s e w e i g h t , most w i l l r e g a i n 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 . "  S i n c e the i n t r o d u c t i o n o f b e h a v i o u r m o d i f i c a t i o n , r e p o r t s o f s u c c e s s f u l t r e a t m e n t f o r o v e r w e i g h t 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 i n c r e a s e d ( S t u n k a r d , 1974). The p r o m i s i n g s u c c e s s o f b e h a v i o u r a l t e c h n i q u e s f o r w e i g h t l o s s has c r e a t e d a s i z e a b l e amassment o f r e s e a r c h 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 y e a r s have seen a number o f e x c e l l e n t r e v i e w s of the a r e a  (Stuart,  1973; Abramson, 1973; H a l l and H a l l , 1974; S t u n k a r d , 1974; Leon, 1976). In  a d d i t i o n most r e c e n t c o l l e c t i o n s o f r e a d i n g s i n the f i e l d o f b e h a v i o u r  m o d i f i c a t i o n c o n t a i n a t l e a s t a few papers on the t r e a t m e n t o f o b e s i t y (Patterson et  alii.,  1974; Y a t e s , 1975; L e i t e n b e r g , 1975).  As one r e s e a r c h e r  i n the a r e a has put i t , the body o f l i t e r a t u r e on the t r e a t m e n t o f o b e s i t y has become obese i t s e l f  ( R i c h a r d B. S t u a r t , p e r s o n a l communication).  For  t h i s r e a s o n the r e v i e w p r e s e n t e d h e r e w i l l be somewhat s e l e c t i v e , e x t r a c t ing  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 o f 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  t r e a t m e n t o f o b e s i t y was who  a study by F e r s t e r , Nurnberger and L e v i t t  r e p o r t e d a w e i g h t l o s s o f 15 pounds i n 15 weeks o f t r e a t m e n t .  (1962) They  reasoned t h a t l e n g t h e n i n g the c h a i n o f responses r e q u i r e d o f the i n d i v i d u a l - b e f o r e engaging i n 'eatlng:jV''ithe" 'desi"rie.;(toi'. eat-wdul'd^be-uweakened. 1  17 The  f i r s t l o n g - t e r m s u c c e s s i n the f i e l d i s a s t u d y by S t u a r t  (1967)  w h i c h S t u n k a r d (1974) r e f e r s to as a "landmark i n the t r e a t m e n t of o b e s i t y " . S t u a r t ' s treatment was  a 12-week comprehensive s e l f - c o n t r o l package w i t h  followup  H i s e i g h t s u b j e c t s l o s t from 26 to 47 pounds w i t h  a t one y e a r .  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 s t u d y t h a t i n c l u d e d a d e l a y e d t r e a t m e n t c o n t r o l group, which d i d not l o s e w e i g h t over the t r e a t m e n t p e r i o d . These s t u d i e s p r o v i d e d  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  t r o l programme ( S t u a r t & D a v i s , 1972). behavioural  self-con-  T h i s programme c o n t a i n s  specific  recommendations d e s i g n e d t o h e l p 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 o v e r f o o d i n t a k e and energy I n a d d i t i o n to c o n c e n t r a t i n g  expenditure. 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) s t u d y , the S t u a r t (1971) p l a n a l s o f o c u s e d on trolling ling  the a n t e c e d e n t s and  consequences of e a t i n g .  con-  An example of c o n t r o l -  the a n t e c e d e n t s o f 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 w h i c h  eating i s permitted. l a r room, i n one  The  i n d i v i d u a l i s allowed  to eat o n l y i n one p a r t i c u -  s e a t a t the t a b l e , and u s i n g a s p e c i f i c p l a c e m a t .  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 m a i n t e n ance of d a i l y r e c o r d s was  of c a l o r i e s consumed and w e i g h t change.  a l s o " extended-toathe:'control  This'technique  o f energy consumption by h a v i n g the  v i d u a l keep a d a i l y r e c o r d of c a l o r i e s expended on e x e r c i s e . programme i n c l u d e s 18 such b e h a v i o u r a l  s t e p s w h i c h can be  t a i l o r e d t o a c h i e v e c o n t r o l of e a t i n g and  The  indi-  entire  individually  exercise.  S i n c e the i n i t i a l s u c c e s s f u l s t u d y of S t u a r t (1967), a number o f  other  s t u d i e s have shown b e h a v i o u r m o d i f i c a t i o n to produce more w e i g h t 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 t e c h n i q u e and a n o n - s p e c i f i c t h e r a p y ( W o l l e r s h e i m , 1970); w i l l power ( J e f f r e y and C h r i s t e n s e n , 1972); and more t r a d i t i o n a l group ( P e n i c k , F i l i o n , Fox and S t u n k a r d , 1971).  therapy  These s t u d i e s used t r e a t m e n t  p e r i o d s r a n g i n g from 9 to 12 weeks';"' the s t a n d a r d procedure b e i n g a v i s i t w i t h the t h e r a p i s t a t l e a s t once a week.  Hagen (1974) s u g g e s t e d  t h i s f r e q u e n t c o n t a c t w i t h the t h e r a p i s t was  that  unnecessary and t h a t the a c -  t u a l t h e r a p e u t i c c o n t e n t o f the b e h a v i o r a l t e c h n i q u e s was p o w e r f u l enough. He t e s t e d the i d e a t h a t the w r i t t e n p r e s e n t a t i o n o f the b e h a v i o r a l s t e p s i n a manual form c o u l d be as e f f e c t i v e w i t h o u t v i s i t s w i t h a t h e r a p i s t , by comparing  t h r e e treatment c o n d i t i o n s — c o n t a c t o n l y , manual o n l y , and  manual p l u s c o n t a c t - — w i t h a no t r e a t m e n t c o n t r o l group. t r e a t m e n t p e r i o d and four-week  A f t e r a 10-week  f o l l o w u p a l l t h r e e t r e a t m e n t groups  had  s i g n i f i c a n t l y more w e i g h t l o s s than the no treatment c o n t r o l group  and  t h e r e 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 t r e a t m e n t groups.  The manual  o n l y t e c h n i q u e o r " 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 t r e a t m e n t s with therapist contact. A l t h o u g h 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 t r e a t m e n t , i t d i d i n c l u d e weekly  correspondence  and homework assignments w h i c h c o n s t i t u t e d a form o f t h e r a p i s t c o n t a c t . a t h e s i s by Fernan  In  (1973, c i t e d i n S t u n k a r d , 1974) Hagen's s t u d y 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 w i t h o u t even these forms o f t h e r a p i s t contact.  T h i s group r e c e i v e d the manual but had no f u r t h e r c o n t a c t of any  k i n d e x c e p t f o r p o s t - t r e a t m e n t and f o l l o w u p w e i g h - i n s .  W h i l e 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) s t u d y , the manual/no c o n t a c t group l o s t l e s s weight than the c o n t r o l w i t h no t r e a t m e n t .  group  The m i n i m a l w r i t t e n c o n t a c t appears to be a n e c e s s a r y  19 f a c t o r i n the s u c c e s s of the b i b l i o t h e r a p y t e c h n i q u e .  There seems t o be  some a s p e c t of t h e r a p i s t c o n t a c t , perhaps m o t i v a t i o n a l , t h a t i s needed i n a d d i t i o n t o the c o n t e n t of the b e h a v i o u r a l  s e l f - c o n t r o l programme.  S i n c e the i n i t i a l s u c c e s s ( S t u a r t , 1967) of the e f f e c t i v e n e s s of b e h a v i o u r a l e a t i n g ( H a r r i s , 1969; and S t u n k a r d , 1971;  and subsequent a f f i r m a t i o n  t e c h n i q u e s i n the t r e a t m e n t of o v e r -  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 ,  Abrahms and A l l e n , 1974), r e s e a r c h e r s  have  turned  t h e i r a t t e n t i o n t o s p e c i f i c elements of the programme c o n t e n t o t h e r therapist contact.  The k e e p i n g o f r e c o r d s  w e i g h t , or s e l f - m o n i t o r i n g , has p r o a c h (Romanczyk, 1974).  on one's own  Fox  than  c a l o r i e intake  proven t o be an i m p o r t a n t p a r t o f the  and ap-  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 o c c u r s  p r i o r t o 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 S c h w a r t z , 1974). 1973;  Mahoney, 1974)  Mahoney and h i s a s s o c i a t e s  (Mahoney, Moura, and Wade,  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 w e i g h t l o s s programme.  Self-reward  proved to  be more e f f e c t i v e i n p r o d u c i n g w e i g h t l o s s than s e l f - m o n i t o r i n g o r punishment (Mahoney e_t a l . , 1973)  and i t was  self-  b e t t e r when s e l f - r e w a r d  was  f o r h a b i t change r a t h e r than w e i g h t l o s s (Mahoney, 1974). Other forms of b e h a v i o u r m o d i f i c a t i o n t h a t have been used i n the t r e a t m e n t o f the o v e r w e i g h t are a v e r s i v e c o n d i t i o n i n g (Kennedy and 1968;  F o r e y t and Kennedy, 1971), c o v e r t s e n s i t i z a t i o n ( C a u t e l a ,  Meynen, 1970;  Janda and Rimm, 1972), and e x p e r i m e n t e r - c o n t r o l l e d  ment ( A y l l o n , 1963;  Harmatz and Lapuc, 1968;  H a l l , 1972).  Foreyt,  1967; reinforce-  These t e c h n i q u e s  have been found to be e f f e c t i v e a t l e a s t d u r i n g the course o f t r e a t m e n t but have not produced as c o n s i s t e n t l o n g - t e r m maintenance of w e i g h t l o s s as  20 s i t u a t i o n management t e c h n i q u e s where t h e i n d i v i d u a l c o n t r o l s h i s own e a t i n g s e t t i n g and b e h a v i o r (Abramson, 1973; Leon, 1976).  In addition  t o b e i n g l e s s e f f e c t i v e i n t h e l o n g r u n , each o f t h e s e o t h e r has more s p e c i f i c problems.  techniques  Both a v e r s i v e c o n d i t i o n i n g , w h i c h i s the  p a i r i n g o f d e s i r e d food cues w i t h n o x i o u s s t i m u l i , and c o v e r t  sensitization,  a t e c h n i q u e where t h e 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 t o some t a r g e t f o o d , have the d i s a d v a n t a g e o f b e i n g d i r e c t e d toward a few s p e c i f i c blem foods and n o t t o a b r o a d range o f e a t i n g .  pro-  R e i n f o r c e m e n t by t h e ex-  p e r i m e n t e r l i k e w i s e does n o t t y p i c a l l y m o d i f y g e n e r a l e a t i n g b e h a v i o u r b u t rewards l o s s e s i n w e i g h t a c h i e v e d by any means.  As Mahoney (1974) has  shown i n h i s s t u d y o f s e l f - r e w a r d , r e i n f o r c e m e n t  o f 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 m a i n t a i n i n g  continued  weight l o s s than i s r e i n -  forcement o f w e i g h t l o s s i t s e l f . Concepts o f O b e s i t y The  s u p e r i o r i t y o f t r e a t m e n t t e c h n i q u e s f o r o v e r w e i g h t t h a t 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 u n d e r s t o o d by e x a m i n i n g some o f t h e c u r r e n t c o n c e p t u a l i z a t i o n s o f o b e s i t y and i t s causes.  Human o b 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 : h y p o t h a l a m i c ,  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 ( B r a y , 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 p a t t e r n s a r e r e s p o n s i b l e f o r t h e m a j o r i t y o f o v e r w e i g h t p r o b l e m s ; t h e o t h e r e t i o l o g i c a l forms a r e comparatively  r a r e ( B r a y , 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 e x p e n d i t u r e and e x c e s s i v e problems w h i c h r e q u i r e b e h a v i o u r a l The  i n t a k e o f c a l o r i e s , two  r a t h e r than m e d i c a l s o l u t i o n s .  problem o f 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 t h e l i f e  s t y l e and a t t i t u d e s o f o u r c u l t u r e .  The m a j o r i t y o f t h e p o 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 e a r n a l i v i n g , and has l a r g e p o r t i o n of l e i s u r e time.  a  Combine t h i s w i t h a h i g h v a l u e on l a b o u r  s a v i n g , s t e p - r e d u c i n g conveniences  and a preponderance o f  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 o f v e r y i n a c t i v e  people.  I n 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 n e c e s s a r y t o go out o f h i s way  t o get i t .  I n 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  re-  q u i r e the a v a i l a b i l i t y o f s p e c i a l f a c i l i t i e s o r the a b i l i t y to a f f o r d p r o p e r equipment, o r i f n o t h i n g e l s e , a good d e a l o f p e r s o n a l 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 , t r e a t m e n t o f t h i s problem r e q u i r e s t h a t the i n d i v i d u a l ' s environment be manipulated  t o f a c i l i t a t e and encourage i n c r e a s e d energy  ( S t u a r t and D a v i s , 1972;  Jeffrey, i n press).  On an i n d i v i d u a l l e v e l  can i n c l u d e such s t e p s as d a i l y g r a p h i n g o f one's energy ( S t u a r t and D a v i s , 1972)  this  expenditure  o r p e r s o n a l p r o g r e s s on a p a r t i c u l a r e x e r c i s e p r o -  gramme ( e . g . , Cooper, 1975) v a t o r s and e s c a l a t o r s .  expenditure  and a v o i d i n g such e n e r g y - s a v i n g  d e v i c e s as e l e -  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 t h e e s -  t a b l i s h m e n t of n a t i o n a l s t a n d a r d s 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 - activity  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 t h a t encourage p h y s i c a l ( J e f f r e y , 1976).  The problem r e c e i v i n g the g r e a t e s t a t t e n t i o n has been t h a t of d i e t a r y habits, s p e c i f i c a l l y overeating.  Once r e s e a r c h e r s were a b l e t o l o o k 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 t h a t the obese were s i m p l y g l u t t o n o u s , they began to s e a r c h 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 o t h e r than eating habits.  The  t h e o r e t i c a l q u e s t i o n o f whether p e r s o n a l i t y f a c t o r s  e x i s t w h i c h p r e c i p i t a t e o b e s i t y i s o f t e n s i m p l i f i e d to why o v e r e a t and o t h e r s do n o t .  One  some p e o p l e  r e a s o n f o r the p o p u l a r n o t i o n t h a t obese  22 p e r s o n s were m e r e l y v e r y h e d o n i s t i c was t h e common b e l i e f t h a t p e o p l e s h o u l d e a t when they a r e hungry and t h a t everyone s h o u l d be hungry o n l y when h i s stomach i s empty.  I t was Cannon (Cannon and Washburn, 1912)  who c l a i m e d  t h a t t h e p e r c e p t i o n o f stomach c o n t r a c t i o n s was t h e e x p e r i e n c e  of hunger.  However, s i n c e s t u d i e s such as one i n w h i c h 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 ,  1 9 4 7 ) , the r e l a t i o n s h i p between stomach c o n t r a c t i o n s and hunger i s thought to be l e s s a b s o l u t e .  F u r t h e r i n v e s t i g a t i o n s o f 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 t o the obese have demonstrated t h a t w h i l e stomach  contrac-  t i o n s have o n l y a weak i n f l u e n c e on hunger, obese persons have a p o o r e r 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 B r u c h , 1970; S t u n k a r d and F o x , 1971).  These d i f f e r e n c e s , however, a r e n o t  enough t o account f o r t h e d i f f e r e n c e s i n food i n t a k e between obese and nonobese p e r s o n s ( S t u n k a r d  and F o x , 1971).  Bruch (1973) has i n c o r p o r a t e d into her psychoanalytic  explanation  t h e concept o f poor hunger awareness 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 s u g g e s t s , l e a d s t o the m i s i n t e r p r e t a t i o n o f v a r i o u s s t a t e s as hunger.  emotional  E s s e n t i a l l y a developmental p s 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  s u g g e s t s t h a t by c o 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" own f e e l i n g s , o v e r b e a r i n g s  p a r e n t s cause the c h i l d  t o m i s t r u s t h i s own s e n s a t i o n s  and n e v e r l e a r n t o l a b e l them a p p r o p r i a t e l y .  S i n c e the c h i l d i s not a l l o w e d  t o f e e l "unhappy"'! t h e a l t e r n a t i v e i s t h a t  he "must" be f e e l i n g hungry.  Most o f t h e s u p p o r t i n g  e v i d e n c e t h a t Bruch  (1973) o f f e r s i s i n the form o f i n d i v i d u a l case s t u d i e s , b u t i t i s i n t e r e s t i n g t o n o t e the c o n t r a s t s between h e r concept o f m i s l a b e l l i n g and t h e c o g n i t i v e - a r o u s a l t h e o r y o f S c h a c h t e r (1971) .  23 S c h a c h t e r ' s t h e o r y i s b a s i c a l l y a m o d i f i c a t i o n o f W i l l i a m James' - e a r l i e r t h e o r y o f emotion ( 1 8 9 0 ) w h i c h s t a t e s t h a t a f e e l i n g o r emotion i s produced by a c o m b i n a t i o n o f a s t a t e o f 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 . as a p e r s o n a l  The s t a t e o f a r o u s a l makes one aware o f t h e f e e l i n g  e x p e r i e n c e , b u t t h e a c t u a l l a b e l i n g o f t h e s p e c i f i c emotion  i s the r e s u l t o f t h e c o g n i t i v e assessment o f t h e s i t u a t i o n ( S c h a c h t e r , 1964).  Obese i n d i v i d u a l s , a c c o r d i n g  t o S c h a c h t e r , a r e 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 e m o t i o n s , b u t a r e o v e r l y - enced by e x t e r n a l f o o d - r e l a t e d while  cues.  influ-  -Slochower (1976) has p o s i t e d  t h e p o s i t i o n s o f S c h a c h t e r and B r u c h appear t o be c o n f l i c t i n g  that points  of v i e w , they a r e a c t u a l l y r e l a t e d . S i n c e the i n t e r n a l l y g e n e r a t e d v i s c e r a l responses o f d i f f e r e n t emot i o n s a r e 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 t o " m i s l a b e l " a f e e l i n g by m i s j u d g i n g 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  instance,  to m i s t a k e t h e f e e l i n g o f " a n x i e t y " f o r t h e f e e l i n g o f "hunger.' ! ! F o r the 1  -  obese then i t might be t h a t "hunger" i s the l a b e l i n a p p r o p r i a t e l y t o any number o f e m o t i o n a l r e s p o n s e s .  applied  The p r o b l e m w i t h t h i s argument i s  t h a t t h e 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 b e i n g 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  ( L a c e y , 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  reported  t o suppress g a s t r i c c o n t r a c t i o n s  In fact, fear i s  (Cannon, 1929).  S c h a c h t e r ' s s o l u t i o n t o t h i s problem i s a h y p o t h e s i z e d d i f f e r e n c e b e tween obese and normal-weight p e r s o n s on t h e d i m e n s i o n o f 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 ( S c h a c h t e r , 1971).  He s u g g e s t s t h a t obese i n d i v i d u a l s a r e  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 c o u n t e r parts.  T h i s p a r t i c u l a r o r i e n t a t i o n o f t h e obese p r e d i s p o s e s them t o be  24 l e s s aware o r l e s s d i s c e r n i n g o f i n t e r n a l hunger cues and more r e a d i l y aware o f e x t e r n a l cues i n t h e i r immediate enviornment.  Instead of  e a t i n g when the f e e l i n g o f hunger d i c t a t e s , t h e e x t e r n a l l y o r i e n t e d p e r son e a t s when the a p p r o p r i a t e cues f o r e a t i n g a r e p r e s e n t — e . g . , t h e presence o f food o r o t h e r s e a t i n g , t h e time o f 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 o f 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 c u r r e n t p r e v a l e n c e o f o b e s i t y . S c h a c h t e r and h i s a s s o c i a t e s ( e . g . , S c h a c h t e r , 1971; S c h a c h t e r and R o d i n , 1974) have amassed c o n s i d e r a b l e e x p e r i m e n t a l e v i d e n c e i n s u p p o r t of  the h y p o t h e s i s t h a t obese persons a r e more e x t e r n a l l y o r i e n t e d t h a n  nonobese p e r s o n s . of  As a d e m o n s t r a t i o n o f t h e poor hunger d i s c r i m i n a t i o n  the obese, S c h a c h t e r , Goldman, and Gordon (1968) found t h a t the obese  eat j u s t as much when t h e i r stomachs a r e f u l l as when they a r e empty, and t h a t f e a r does n o t a f f e c t t h e i r i n t a k e . ate  Normal-weight c o n t r o l s u b j e c t s  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 . E v i d e n c e f o r t h e obese b e i n g more dependent on e x t e r n a l cues than  nonobese comes from a s t u d y by S c h a c h t e r and Gross  (1968) .  Utilizing a  t r i c k c l o c k t h a t e i t h e r slowed down o r speeded up i n r e l a t i o n t o a c t u a l t i m e , they found t h a t obese persons a t e more when time was speeded up and l e s s when time was slowed down t h a n d i d nonobese i n t h e same s i t u a t i o n . When o t h e r p l e a s a n t 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 a r e e l i m i n a t e d from t h e e a t i n g s i t u a t i o n , t h e obese e a t f a r l e s s than do normal w e i g h t 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 p r o v i d e d e v i d e n c e t h a t the obese a r e more a f f e c t e d by the t a s t e o f f o o d .  The h e a v i e r s u b j e c t s were, the more they a t e when  25 the f o o d was good t a s t i n g .  When the f o o d had q u i n i n e added t h e r e was  no  d i f f e r e n c e i n consumption among o v e r w e i g h t , normal w e i g h t , and underweight groups. A v e r y i n t e r e s t i n g d e m o n s t r a t i o n o f the e f f e c t o f the presence o f food on the e a t i n g p a t t e r n s o f the o v e r w e i g h t i s a n o t h e r s t u d y by N e s b i t t (1968).  He p r e s e n t e d o v e r w e i g h t , u n d e r w e i g h t , and normal w e i g h t s u b j e c t s  w i t h a l u n c h which c o n s i s t e d o f e i t h e r one O;K t h r e e sandwiches w i t h "dozens 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 t o w h i c h s u b j e c t s were i n v i ted to h e l p themselves.  The underweight and normal w e i g h t s u b j e c t s a t e  about the same number o f sandwiches i n b o t h the one sandwich and the t h r e e sandwich c o n d i t i o n s .  The o v e r w e i g h t s u b j e c t s , on the o t h e r hand, were  a f f e c t e d c o n s i d e r a b l y by the m a n i p u l a t i o n . I n the one sandwich they a t e l e s s than e i t h e r o f the o t h e r groups (M = 1.48 M's  o f 1.5 and 1.96  condition,  sandwiches v e r s u s  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 t h r e e sandwich c o n d i t i o n t h e y a t e c o n s i d e r a b l y more t h a n the o t h e r two groups (M = 2.32 v e r s u s M's  o f 1.62  and  1.88).  A number o f 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 h y p o t h e s i s have been performed comparing o v e r w e i g h t and normal w e i g h t s u b j e c t s on g e n e r a l t a s k s o t h e r than e a t i n g b e h a v i o u r (see S c h a c h t e r and R o d i n , 1974).  Pliner  (1973) found obese s u b j e c t s t o be more r e s p o n s i v e 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 c u e s , b u t l e s s r e s p o n s i v e when cues were o f low s a l i e n c e .  Obese s u b j e c t s have a l s o been found t o be more d i s t r a c t a b l e  than normals when p e r f o r m i n g a p r o o f r e a d i n g t a s k , 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 o f an e m o t i o n a l n a t u r e ( R o d i n , 1974).  I n a number o f 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 s u b j e c t s d i d b e t t e r than normal  26 w e i g h t s u b j e c t s ( R o d i n , Herman, and S c h a c h t e r , 1974): they had 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 a s k ; they had more complete  faster recall  o f 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 o f t a c h i s t o s c o p i c a l l y p r e s e n t e d words. I n a more r e c e n t s t u d y , Rodin and Slochower  (1976) used some o f these  measures o f 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 t o p r e d i c t changes i n w e i g h t and e a t i n g b e h a v i o u r .  A t a summer camp, they t e s t e d normal-weight  chil-  dren f o r e x t e r n a l i t y and then measured t h e i r w e i g h t s b i - w e e k l y o v e r a two month p e r i o d .  S i n c e meals were s e r v e d i n such a way  t h a t the c h i l d r e n  had f r e e a c c e s s to food t h a t was p l e n t i f u l and v i s i b l e , i t was t h a t the more e x t e r n a l l y o r i e n t e d would g a i n more w e i g h t . was  predicted  This hypothesis  g e n e r a l l y s u p p o r t e d s i n c e the more e x t e r n a l l y r e s p o n s i v e c h i l d r e n  g a i n e d more w e i g h t than c h i l d r e n l o w e r 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 s u p p o r t i v e o f S c h a c h t e r ' s hypothesis.  U s i n g R o t t e r ' s (1966) t e s t to measure i n t e r n a l v e r s u s e x t e r -  n a l l o c u s of c o n t r o l ( I - E ) , Gormanous and Lowe (1975) found no  differences  i n the l o c u s of c o n t r o l s c o r e s o f normal w e i g h t and obese s u b j e c t s . h i s b r i e f n o t e c o n c e r n i n g f a l s e assumptions  In  about the obese, Mahoney (1975)  s t a t e s t h a t the e v i d e n c e f o r the e x t e r n a l i t y i s e q u i v o c a l and c i t e s a r e v i e w o f Wooley and Wooley (1975) to support t h i s .  Slochower  (1976) has  suggested t h a t the e x t e r n a l i t y i s by no means a g e n e r a l c h a r a c t e r i s t i c o f the obese and she p r o v i d e s e v i d e n c e t h a t o v e r e a t i n g 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 o t h e r than e x t e r n a l food cues.  I n h e r s t u d y , she found s u p p o r t  f o r the " m i s l a b e l l e d emotion" h y p o t h e s i s .  Her obese s u b j e c t s a t e much more  when they c o u l d n o t i d e n t i f y the cause o f t h e i r own h i g h a r o u s a l (manipul a t e d by means of f a l s e b i o f e e d b a c k ) than when they were g i v e n a r e a s o n  27 f o r i t s occurrence.  Slochower a l s o found t h a t obese s u b j e c t s r e p o r t e d  s i g n i f i c a n t l y more a r o u 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 subjects.  These f i n d i n g s suggest t h a t t h e obese e i t h e r m i s i n -  t e r p r e t a r o u s a l as b e i n g hunger o r they e a t as a means t o reduce a r o u s a l . I t i s a l s o p o s s i b l e t h a t b o t h o f these mechanisms a r e w o r k i n g t o some extent simultaneously. The c o n f l i c t i n g e v i d e n c e on t h e i s s u e o f i n t e r n a l v e r s u s e x t e r n a l o r i e n t a t i o n does n o t negate the importance o f t h e t h e o r y ; on t h e c o n t r a r y , i t emphasizes  the c o m p l e x i t y o f the e x t e r n a l i t y concept.  The i d e a o f  e x t e r n a l i t y i s n o t a new one; i t has been used f o r many y e a r s under such terms as f i e l d dependence-independence  ( W i t k i n e_t a l _ . , 1954), l o c u s o f  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 c o n c e p t i o n s o f p e r s o n a l o r i e n t a t i o n has v a r -  i o u s measurement t e c h n i q u e s a s s o c i a t e d w i t h i t .  The f a c t t h a t t h e r e a r e  so many d i f f e r e n t c o n s t r u c t s and measuring d e v i c e s o f t h e i n t e r n a l - e x t e r n a l d i m e n s i o n suggests t h a t i t i s a many f a c e t e d concept c o n t a i n i n g more than one dimension o r sub-dimension.  Even w i t h i n the s i n g l e concept o f  p e r c e i v e d l o c u s o f c o n t r o l ( R o t t e r , 1966) , a number o f dimensions have been found t o e x i s t .  R e i d and Ware (1974), f o r example, have f a c t o r  a n a l y z e d t h r e e s e p a r a t e s u b s c a l e s from t h e Locus o f 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 tentative solution to  be drawn from t h i s s i t u a t i o n i s t h a t a multi-method approach i s n e c e s s a r y i n any attempt t o 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 R e g a r d l e s s o f the t h e o r e t i c a l background  o f any t r e a t m e n t f o r the  obese, t h e i s s u e o f p r i m a r y importance i s t h e s u c c e s s o f t h e t r e a t m e n t . The problem o f measuring  t h e s u c c e s s o f a programme o r t h e r e l a t i v e  s u c c e s s of one type o f treatment o v e r another has been t h e f o c u s o f s e v e r a l r e c e n t papers i n the a r e a ( 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 o f s p e c i f i c problem areas t h a t v a r y a c r o s s s t u d i e s .  Some o f 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 o f d i f f e r e n t treatment methods, w h i l e o t h e r 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 o f results. A number o f t h e problems  a r e concerned w i t h the s u b j e c t s themselves.  Methods o f s u b j e c t s e l e c t i o n have c r e a t e d a l i t e r a t u r e on t h e t r e a t m e n t o f o b e s i t y w h i c h i s based l a r g e l y on s l i g h t l y o v e r w e i g h t c o l l e g e s t u d e n t s ( S t u a r t , 1973; F r a n z i n i and Grimes, 1976).  There i s a need t o r e c r u i t  s u b j e c t s from w i d e r ranges o f s o c i a l s t a t u s and age t o i n s u r e g r e a t e r g e n e r a l i z a b i l i t y of r e s u l t s .  I n 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) t h a t more i n d i v i d u a l d a t a be r e p o r t e d than t h e u s u a l m i n i m a l i n c l u s i o n o f age and weight.  A l s o more a t t e n t i o n s h o u l d be p a i d t o the r e l a t i o n s h i p between  t r e a t m e n t s u c c e s s and demographic v a r i a b l e s r a t h e r than merely p e r s o n 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 o f d a t a from s u b j e c t s who t e r m i n a t e b e f o r e c o m p l e t i n g the programme ( S t u a r t , 1973; J e f f r e y 1975; Baekelund and L u n d w a l l , 1975). I t i s i m p o r t a n t t h a t t h e p r o c e d u r e s used t o h a n d l e drop-outs be d e s c r i b e d  29 i n r e s e a r c h r e p o r t s , and attempts s h o u l d be made t o m i n i m i z e s u b j e c t 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 r e d u c i n g the  drop-out r a t e i s t o r e q u i r e the s u b j e c t t o p u t 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 a r e a i n the t r e a t m e n t 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 d a t a .  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 d a t a o t h e r than age and w e i g h t has been s u g g e s t e d ; a f r e q u e n t s h o r t c o m i n g c i t e d i s the use o f w e i g h t and h e i g h t as the s o l e measures of o b e s i t y . the  I t has been argued t h a t u s i n g w e i g h t and w e i g h t change as  s o l e measures o f o b e s i t y and o f t r e a t m e n t success does not n e c e s s a r i -  l y p r o v i d e complete and r e l i a b l e r e s u l t s s i n c e w e i g h t i s not always a - good measure o f body f a t ( S t u a r t , 1973; H a l l and H a l l , 1974; 1975).  Jeffrey,  To p r o v i d e a more complete i n d i c a t i o n o f o b e s i t y , i t has been  proposed t h a t s k i n f o l d measurements be taken i n a d d i t i o n t o w e i g h t measurements  ( 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 d a t a has been l i s t e d as a common problem ( S t u a r t , 1973; F r a n z i n i and Grimes, 1976).  S i n c e i t has been  found t h a t d a t a r e g a r d i n g e a t i n g p a t t e r n s and w e i g h t w h i c h i s p r o v i d e d by the o v e r w e i g h t s u b j e c t s themselves i s v e r y u n r e l i a b l e ( S t u a r t and D a v i s , 1972; Leon and C h a m b e r l a i n , 1973), i t i s recommended t h a t e x p e r i menter c o l l e c t e d d a t a 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 r e g a r d t o d a t a c o l l e c t i o n , S t u a r t (1973) has a l s o s t r e s s e d the  importance' o f e v a l u a t i n g s u b j e c t response to the p r o c e d u r e  itself.  T h i s i s i n a d d i t i o n t o the w e i g h t and s k i n f o l d changes used t o judge treatment success.  The s u b j e c t s ' e v a l u a t i o n o f the programme and s u g -  g e s t i o n s f o r improvements  can g i v e the r e s e a r c h e r needed i n s i g h t s  into  30 reasons f o r the s u c c e s s or f a i l u r e o f a t r e a t m e n t .  A l s o S t u a r t (1973)  s u g g e s t s t h a t o t h e r e f f e c t s o f the t r e a t m e n t on the s u b j e c t need t o be evaluated.  P o s s i b l e problems may  w e i g h t changes.  o c c u r due to the i n d u c e d b e h a v i o u r o r  F o r t h i s reason measurements o f 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 t o be  included.  The t h i r d and f i n a l s o u r c e of problems  i n the comparison o f t r e a t -  ment programmes l i e s i n the d e s i g n o f the t r e a t m e n t s t h e m s e l v e s .  There  has been no s e t format r e g a r d i n g the l e n g t h o f treatment o r o f f o l l o w - u p 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 t r e a t m e n t comparison J e f f r e y , 1975).  ( S t u a r t , 1973; H a l l and H a l l ,  1974;  B e h a v i o u r a l t r e a t m e n t s o f o b e s i t y have ranged from p e r i -  ods o f f o u r weeks to f o u r and one h a l f months w i t h the mode b e i n g 10 t o 15 weeks; f o l l o w - u p s a f t e r treatment f o r these same s t u d i e s have ranged from none a t a l l t o one y e a r (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 t h a t s u b j e c t s be f o l l o w e d f o r a t l e a s t s i x months. A n o t h e r 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 p r o grammes when the type o f d i e t p l a n i s n o t the a c t u a l f o c u s o f the r e search attention.  S t u a r t (1973) has encouraged  the use o f s t a n d a r d i z e d  treatment p l a n s ( e . g . , S t u a r t and D a v i s , 1972) when i n v e s t i g a t i n g v a r i a b l e s o t h e r than the d i e t program i t s e l f .  Of even g r 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 o f s e r v i c e a c r o s s t r e a t m e n t c o n d i t i o n s w i t h i n a given study.  I t i s i m p o r t a n t t h a t s u b j e c t s r e c e i v e the same  a t t e n t i o n i n a l l a s p e c t s o t h e r than the e x p e r i m e n t a l v a r i a b l e . such as i n t e r v i e w s , w e i g h - i n s , and d i e t s , s h o u l d a l l be  Services  carefully  31 standardized  f o r a l l subjects across  conditions  ( S t u a r t , 1973).  Simi-  l a r l y , t h e use o f d i f f e r e n t t h e r a p i s t s s h o u l d be b a l a n c e d a c r o s s ( S t u a r t , 1973) and t h e r a p i s t e x p e c t a n c i e s  groups  s h o u l d be equated ( P a u l , 1969).  Much o f t h e p r o b l e m o f 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 o f i n t e r v i e w p r o c e d u r e s across conditions  (Stuart, personal  One a d d i t i o n a l s u g g e s t i o n  communication).  f o r improved e v a l u a t i o n o f v a r i o u s  ment t e c h n i q u e s i s t h e i n c l u s i o n o f an i n d e x o f c o s t ( J e f f r e y , 1975).  effectiveness  T h i s i n d e x might be a r a t i o o f t h e mean t r e a t m e n t time  o r c o s t p e r s u b j e c t over t h e mean w e i g h t r e d u c t i o n . suggestion  treat-  T h i s i s an e x c e l l e n t  b u t 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 .  F o r example Barnes (1976) a s s e s s e d c o s t e f f e c t i v e n e s s i n h e r comparison of s e n s o r y d e p r i v a t i o n treatment and t h e F i v e Day P l a n f o r smoking. D i v i d i n g t h e t o t a l c o s t o f t r e a t m e n t by an i n d e x o f smoking r e d u c t i o n p e r s u b j e c t she found t h e F i v e Day P l a n t o be more e f f e c t i v e r e l a t i v e t o i t s c o s t than was s e n s o r y d e p r i v a t i o n .  T h i s comparison was u n f a i r and d i s t o r -  ted s i n c e the cost o f h e r sensory d e p r i v a t i o n treatment i n c l u d e d the four s e n s o r y d e p r i v a t i o n rooms. ber o f subjects.  T h i s c o s t was s p r e a d o v e r h e r v e r y s m a l l num-  I n t h e s h o r t r u n sensory d e p r i v a t i o n t r e a t m e n t was more  c o s t l y than the Jp'ive Day P l a n ; however, s i n c e t h e c o s t o f such equipment i s a one time expense, t h e c o s t e f f e c t i v e n e s s i n d e x f o r s e n s o r y t i o n treatment would decrease w i t h t h e number o f s u b j e c t s t h a t o f t h e F i v e Day P l a n remains c o n s t a n t .  depriva-  treated while  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 p e r s o n n e l were donated f o r t h e purposes o f h e r s t u d y .  32  R a t i o n a l e f o r t h e treatment used i n t h i s study The  d e s i g n o f t h e w e i g h t c o n t r o l programme t h a t comprises t h i s  s t u d y i s based on c o n s i d e r a t i o n s o f t h e c h a r a c t e r i s t i c s b o t h o f s e n s o r y d e p r i v a t i o n and o f " t h e 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 t h e e a r l i e r d i s c u s s i o n o f t h e c l i n i c a l a p p l i c a t i o n o f s e n s o r y d e p r i v a t i o n , s e n s o r y d e p r i v a t i o n appears t o make i n d i v i d u a l s more r e s p o n s i v e  t o t h e r a p y ( S u e d f e l d , 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 r e c e p t i v e n e s s  t o communication, and  a t the same time making one's own c o g n i t i o n s more s a l i e n t .  Individuals  have been found t o be b o t h more p e r s u a s i b l e and b e t t e r a b l e t o r e c a l l m a t e r i a l h e a r d d u r i n g s e n s o r y d e p r i v a t i o n ( S u e d f e l d , 1969). valuable  f e a t u r e s f o r the treatment, o f any problem.  These a r e  I t was d e c i d e d t o  i n v e s t i g a t e t h i s r o l e o f s e n s o r y d e p r i v a t i o n as an e d u c a t o r t o f a c i l i t a t e the l e a r n i n g o f m a t e r i a l geared toward changing e a t i n g h a b i t s . c i f i c h a b i t s t o be l e a r n e d were those b e h a v i o u r a l d e s c r i b e d by S t u a r t and D a v i s  The spe-  s e l f - c o n t r o l techniques ,  (1972).  By i n c r e a s i n g s i m u l t a n e o u s l y  r e c e p t i v i t y t o e x t e r n a l i n p u t and t h e  s a l i e n c e o f 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 o f f o r c e d 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 b e i n g p a i d t o therapist-generated  a d v i c e i n t h i s endeavour.  obese p e r s o n , t h i s i n c r e a s e d peutic.  For the e x t e r n a l l y o r i e n t e d  f o c u s on i n t e r n a l s t i m u l i may be v e r y  thera-  W i t h p r o p e r guidance t h e obese i n d i v i d u a l may be a b l e t o become  b e t t e r attuned  t o the i n t e r n a l cues o f hunger.  T h i s assumes t h a t i f t h e  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 , t h e r e w i l l be l e s s dependence on t h e 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 a l s o been found to f a c i l i t a t e ( S u e d f e l d , 1975a), obese p e r s o n s .  T h i s q u a l i t y s h o u l d be v e r y u s e f u l i n d e a l i n g w i t h  As Bruch (1973) has s u g g e s t e d , much o f the obese p e r -  son's o v e r e a t i n g i s i n s t i g a t e d by a n x i e t i e s . to  I f g i v e n an a l t e r n a t i v e  e a t i n g f o r the r e d u c t i o n o f a n x i e t y , the obese p e r s o n may  a b l e to a v o i d o v e r e a t i n g i n e m o t i o n a l s i t u a t i o n s . was  relaxation  be b e t t e r  For these reasons i t  d e c i d e d t o 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 progressive relaxation exercise.  The i n i t i a l success o f 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 s h o u l d encourage the i n d i v i d u a l t o p r a c t i c e the e x e r c i s e a g a i n under normal  circumstances.  Another q u a l i t y o f s e n s o r y d e p r i v a t i o n i s t h a t i t " e l i m i n a t e s cues t h a t i n the normal environment 1975a, p. 9 8 ) .  e l i c i t undesired behavior" (Suedfeld,  T h i s i s p a r t i c u l a r l y a p p r o p r i a t e because i t s h o u l d p r o -  v i d e the obese p e r s o n w i t h an i m p r e s s i v e d e m o n s t r a t i o n t h a t h i s hunger i s e x t e r n a l l y generated.  I n t h e absence o f food cues the e x t e r n a l l y  o r i e n t e d obese p e r s o n s h o u l d e x p e r i e n c e v e r y l i t t l e hunger d u r i n g 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 g o i n g  24 hours w i t h o u t h a v i n g o r w a n t i n g a c i g a r e t t e was ence ( S u e d f e l d e t a l . , 1972; of  an i m p r e s s i v e e x p e r i -  S u e d f e l d and I k a r d , 1974), the e x p e r i e n c e  24 hours w i t h l i t t l e o r no hunger s h o u l d be a d r a m a t i c As mentioned  one.  p r e v i o u s l y , t h i s study planned t o use b e h a v i o r a l s e l f -  c o n t r o l t e c h n i q u e s a l o n g w i t h the s e s s i o n o f sensory d e p r i v a t i o n . ing  Judg-  from the s u p e r i o r success r a t e of the combined t e c h n i q u e s o f S u e d f e l d  and B e s t ( i n p r e p . , 1977)  o v e r e i t h e r t e c h n i q u e s i n g l y , i t was  f e l t that  by p a i r i n g a w e i g h t c o n t r o l method a l r e a d y proven to be e f f e c t i v e  (such  as t h a t o f S t u a r t and D a v i s , \ 1 9 7 2 ) , 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 s h o u l d be g r e a t l y i n c r e a s e d .  Not  s p e c i f i c a l l y designed  t o t e s t the e f f e c t i v e n e s s o f s e l f - c o n t r o l t e c h n i q u e s ,  t h i s study i s a  t e s t o f the added e f f e c t i v e n e s s of the components of s e n s o r y d e p r i v a t i o n treatment.  The  s e p a r a t e components-—the s e n s o r y d e p r i v a t i o n s e s s i o n  the t h e r a p e u t i c c o m m u n i c a t i o n s — w e r e examined b o t h s e p a r a t e l y and combination.  and  in  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 b e h a v i o u r -  a l s e l f - c o n t r o l methods of w e i g h t r e d u c t i o n , . c o n t r o l o f the many problems inherent i n research  of the b e h a v i o u r a l  t r e a t m e n t of o b e s i t y i s  important.  As t h e s e problems have a l r e a d y been l i s t e d i t i s not n e c e s s a r y to d e t a i l them h e r e .  However some of the f e a t u r e s o f t h i s s t u d y d e s i g n e d  t o h a n d l e t h e s e problems are as f o l l o w s : u s i n g s u b j e c t s sampled from a b r o a d range of s o c i a l s t a t u s and age;  u s i n g s k i n f o l d as w e l l as w e i g h t  measurements;using e x p e r i m e n t e r c o l l e c t e d d a t a ; 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 p r o c e d u r e s ; r e p o r t i n g handling  of and  d a t a on d r o p - o u t s ; e v a l u a t i n g s u b j e c t responses to  f e e l i n g s about the programme; and subjects.  r e p o r t i n g more t h o r o u g h l y  and  on i n d i v i d u a l  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) s e n s o r y d e p r i v a t i o n (SD) v e r s u s  nonconfinement (NC)  p r i o r t o i n d i v i d u a l i n s t r u c t i o n i n t h e 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) v e r s u s non p r e s e n t a t i o n  (NM) o f t h e r a p e u t i c  communications d u r i n g t h e 24 hour p e r i o d p r i o r t o p e r s o n a l i n s t r u c t i o n i n t h e programme.  The f o u r t r e a t m e n t groups i n t h i s d e s i g n a r e 1) sen-  s o r y d e p r i v a t i o n w i t h messages (SD-M), 2) s e n s o r y d e p r i v a t i o n w i t h no messages (SD-NM), 3) n o n c o n f i n e d w i t h messages (NC-M), and 4) n o n c o n f i n e d w i t h o u t messages (NC-NM).  S u b j e c t s i n a l l f o u r groups were g i v e n t h e  same programme i n s t r u c t i o n s and f o l l o w - u p  i n t e r v i e w s o v e r a s i x month  period. D a t a were a n a l y z e d  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 o f 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 d a t a f o r t h e f o u r treatment groups and f o r t h e e x p e r i m e n t a l 2x2  groups p l u s a group o f d r o p - o u t s ; (2) a  a n a l y s i s o f v a r i a n c e o f w e i g h t and s k i n f o l d changes i n t h e f o u r  t r e a t m e n t groups; (3) a 2 x 2 x 7 repeated-measures a n a l y s i s o f v a r i a n c e on w e i g h t o v e r t h e s i x month p e r i o d ; and (4) r e g r e s s i o n a n a l y s e s o f w e i g h t changes on demographic and b e h a v i o r a l measurements.  In addition  a l a r g e amount o f i n d i v i d u a l d a t a i s r e p o r t e d 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 t o two a r t i c l e s p u b l i s h e d i n major l o c a l newspapers and a l i v e b r o a d c a s t r a d i o i n t e r v i e w , a l a r g e number o f women v o l u n t e e r e d t o  36 p a r t i c i p a t e i n an e x p e r i m e n t a l w e i g h t l o s s programme.  The newspaper  a r t i c l e s ireqiujested women between t h e ages o f 20 and 55 y e a r s who were at  l e a s t 25% o v e r w e i g h t t o p a r t i c i p a t e i n a s i x month programme t h a t  c o u l d i n c l u d e a 24 hour s e s s i o n o f s e n s o r y 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  t e l e p h o n e 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 p e r c e n t a g e o v e r w e i g h t . The upper end o f t h e recommended w e i g h t range f o r medium framed women was  used t o c a l c u l a t e p e r c e n t a g e o v e r w e i g h t f o r a l l s u b j e c t s  tan  L i f e T a b l e s , 1958).  or  (Metropoli-  S u b j e c t s who i n d i c a t e d t h a t t h e y were d i a b e t i c  h y p o g l y c e m i c were e x c l u d e d .  From t h e s e matched groups, s u b j e c t s were  a s s i g n e d randomly t o t h e f o u r t r e a t m e n t groups.  S u b j e c t s ' ages ranged  from 21 t o 57 y e a r s w i t h a mean age o f a p p r o x i m a t e l y 41. The p e r c e n t a ges o f e x c e s s w e i g h t ranged from 25% t o 130%. The i n i t i a l  d e s i g n c a l l e d f o r 12 s u b j e c t s i n each o f t h e f o u r groups.  An attempt was made i n t h e e a r l y s t a g e s o f t h e s t u d y t o keep t h e numbers b a l a n c e d among t h e groups; t h e r e f o r e , e a r l y drop-outs were r e p l a c e d from the  l i s t of volunteers.  No attempt was made t o r e p l a c e s u b j e c t s who  terminated during the l a t e r stages of the study.  S u b j e c t s were seen i n -  d i v i d u a l l y throughout t h e programme. Procedure S u b j e c t s s e l e c t e d from t h e l i s t o f v o l u n t e e r s were t e l e p h o n e d t o 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 .  S c h e d u l i n g o f s p e c i f i c times f o r  i n t e r v i e w s was a t t h e s u b j e c t ' s convenience throughout t h e s t u d y . the  At  f i r s t i n t e r v i e w t h e s u b j e c t was b r i e f e d about t h e p r o c e d u r e f o r t h e  e n t i r e s i x month s t u d y and demographic  and p e r s o n a l i t y d a t a were c o l l e c t e d .  37  A t t h i s time t h e s u b j e c t was a l s o r e q u e s t e d  to leave a deposit i n the  form o f a $25.00 check made p a y a b l e t o t h e Canadian H e a r t Fund. s u b j e c t s i g n e d an agreement s t a t i n g  Each  t h a t she would f o r f e i t h e r d e p o s i t  i f she f a i l e d t o a t t e n d a l l scheduled  sessions.  I n a c t u a l f a c t , the  d e p o s i t was r e t u r n e d t o a l l those who completed t h e f i n a l s i x month follow-up regardless o f 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  history,  w e i g h t , and h e i g h t , s u b j e c t s a l s o completed a M o t i v e C h e c k l i s t designed f o r t h i s s t u d y , t h e Locus o f C o n t r o l q u e s t i o n n a i r e ( R e i d and Ware, 1974) , a p o r t a b l e v e r s i o n o f t h e Rod and Frame Test and  ( W i t k i n e_t al_. , 1954) ,  S e l f - M o n i t o r i n g S c a l e (Snyder, 1974), t h e Autonomic P e r c e p t i o n  (Mandler, M a n d l e r , and U v i l l e r , 1958), t h e B a r b e r S u g g e s t i b i l i t y ( B a r b e r , 1965), and t h e P e r s o n a l C a u s a l i t y Q u e s t i o n n a i r e B l a s c o v i c h , and S e c o r d , 1974). were t o p r o c u r e programme.  Scale  (Peevers,  S u b j e c t s were g i v e n a form on w h i c h  t h e i r physician's approval  Scale  for their participation  they i n the  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 o f t h e programme  was sent home t o t h e s u b j e c t s ' spouse o r roommate a l o n g w i t h a form s o liciting  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 o t h e r p e r s o n by a s k i n g 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 t h e s u b j e c t ' s e a t i n g h a b i t s . During  t h e f i r s t i n t e r v i e w s u b j e c t s were i n s t r u c t e d t o r e c o r d 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 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.  altering  Each s u b j e c t was g i v e n  a s e l f - m o n i t o r i n g b o o k l e t 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 . c o n c e r n i n g each e a t i n g s i t u a t i o n .  I n a d d i t i o n t o r e c o r d i n g foods and  q u a n t i t i e s , s u b j e c t s were t o note t h e d a t e , p l a c e , t i m e , o t h e r p e o p l e  38 p r e s e n t , whether o t h e r s were e a t i n g , whether food was p r e s e n t b e f o r e 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-  d u l e d f o r the n e x t i n t e r v i e w t o be h e l d one week l a t e r . was b r i e f e d as t o the p r o c e d u r e  Each s u b j e c t  f o r the next sessions appropriate f o r  the group t o which she had been a s s i g n e d .  The e n t i r e p r o c e d u r e  f i r s t s e s s i o n took between one and o n e - h a l f t o two and o n e - h a l f depending  hours  on the i n d i v i d u a l s u b j e c t ' s speed.  The second s e s s i o n comprised procedure  f o r the  the experimental manipulation.  The  f o r a l l s e s s i o n s except t h i s one was i d e n t i c a l f o r s u b j e c t s  i n a l l groups.  A t the b e g i n n i n g o f t h e second s e s s i o n t h e s u b j e c t ' 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 app r o v a l forms were c o l l e c t e d .  A female r e s e a r c h a s s i s t a n t took measure-  ments o f 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 u s i n g a Lange S k i n f o l d Caliper.  The t r e a t m e n t p r o c e d u r e s 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)  S u b j e c t s r e p o r t e d t o t h e l a b o r a t o r y a t 12 noon, were b r i e f e d a g a i n about t h e p r o c e d u r e and were g i v e n a form t o s i g n s t a t i n g t h a t they understood D) .  the procedure  and were w i l l i n g t o p a r t i c i p a t e (see Appendix  A f t e r an o r i e n t a t i o n t o the sensory deprivation^ffha^%rr:aricl..^!tta. f o o d  and t o i l e t f a c i l i t i e s ,  s u b j e c t s were g i v e n a few minutes  chamber t o change i n t o c o m f o r t a b l e c l o t h i n g . to  a l o n e i n the  S u b j e c t s were r e q u e s t e d  l e a v e watches and any o t h e r d i s t r a c t i n g ^ o t f j e c t s s o u ^  When the s u b j e c t s i g n a l l e d t h a t she was c o m f o r t a b l e the l i g h t was t u r n e d off  and s e n s o r y 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 o f l y i n g on a f i r m bed i n a d a r k ,  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  (vanilla  39  Metrecal)  and w a t e r were i n thermos b o t t l e s n e x t t o t h e bed and were  a v a i l a b l e ad l i b t h r o u g h p l a s t i c t u b e s p i n n e d near the head o f t h e b e d . A c h e m i c a l t o i l e t was l o c a t e d i n t h e chamber a t t h e f o o t o f t h e b e d . I n s t r u c t i o n s were g i v e n r e q u e s t i n g make unnecessary n o i s e .  t h e s u b j e c t n o t t o move around o r  She was a l s o Informed t h a t a m o n i t o r would be  on duty i n an a d j a c e n t room f o r t h e e n t i r e 24 hours and t h a t t h e s u b j e c t c o u l d l e a v e t h e chamber a t any time should  she become t o o u n c o m f o r t a b l e .  T h i s , she was t o l d , would end h e r p a r t i n t h e e x p e r i m e n t .  A f t e r one  hour and 45 minutes each s e n s o r y d e p r i v a t i o n s u b j e c t was asked t o e s t i mate t h e amount o f time t h a t had passed and h e r response was r e c o r d e d . At t h r e e hours ( a p p r o x i m a t e l y and  3:00 p.m.) t h e s u b j e c t was wakened  i n f o r m e d t h a t she would be h e a r i n g  f i r s t s e t o f messages was p l a y e d  a tape r e c o r d e d message.  a t t h i s time.  A t 20 h o u r s  The  (approxi-  m a t e l y 9:00 a.m.) t h e s u b j e c t was awakened a g a i n and t h e second s e t o f messages was p l a y e d .  A t 24 hours t h e s u b j e c t was reawakened and i n f o r m e d  t h a t she had completed t h e f u l l 24 hour s e s s i o n and t h a t t h e l i g h t would be t u r n e d on. The two s e t s o f messages were one hour l o n g and 45 minutes l o n g , respectively.  The f i r s t s e t c o n t a i n e d  a d i s c u s s i o n o f t h e problems o f  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 e m o t i o n a l s i t u a t i o n s without eating.  The second s e t c o n t a i n e d  nutritional  informa-  t i o n , f a c t s about d i e t i n g , s u g g e s t i o n s f o r c o n t r o l l i n g e a t i n g b e h a v i o u r s , and  s u g g e s t i o n s f o r i n c r e a s i n g energy e x p e n d i t u r e (See Appendix C f o r  the complete t r a n s c r i p t s o f t h e r e c o r d e d messages).  40  Immediately f o l l o w i n g t h e s e n s o r y  d e p r i v a t i o n s e s s i o n the subject  was i n t e r v i e w e d about h e r r e a c t i o n s t o t h e e x p e r i e n c e 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 ) .  she had j u s t com-  Next t h e s u b j e c t was  p r o v i d e d w i t h a copy o f the d i e t manual ( S t u a r t and D a v i s , 1972) and t h e s p e c i f i c s o f t h i s p l a n were reviewed w i t h h e r .  S p e c i a l a t t e n t i o n was  p a i d t o the mechanics o f the d i e t ; r e c o r d i n g and g r a p h i n g  calorie intake  and o u t p u t , and the b e h a v i o r a l s t e p s s p e l l e d out i n the S t u a r t and D a v i s (1972) manual.  T h i s p a r t o f the procedure was i d e n t i c a l f o r a l l s u b j e c t s  i n a l l f o u r groups.  S u b j e c t s 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 p r o c e d u r e f o r s u b j e c t s i n t h i s group was i d e n t i c a l t o t h a t used w i t h Group One e x c e p t no mention was made o f t h e messages and t h e tapes were n o t p l a y e d .  The s u b j e c t was t o l d , as were a l l s e n s o r y d e p r i -  v a t i o n s u b j e c t s , t h a t she s h o u l d use t h e s e s s i o n t o c o n c e n t r a t e on h e r s e l f and h e r p r o b l e m o f l o s i n g w e i g h t .  Except f o r the absence o f t h e  messages and b e i n g awakened a t those t i m e s , t h e p r o c e d u r e b e f o r e , and a f t e r sensory  during  d e p r i v a t i o n was t h e same as f o r Group One.  Group Three - N o n c o n f i n e d w i t h messages (NC-M) The s u b j e c t s who r e c e i v e d o n l y t h e message p o r t i o n o f t h e treatment r e p o r t e d t o t h e l a b o r a t o r y on two c o n s e c u t i v e days. for  the t i m i n g and s p a c i n g o f t h e message p r e s e n t a t i o n , these  were s c h e d u l e d  subjects  t o h e a r the f i r s t s e t a t 3:00 p.m. on one day and 9:00 a.m.  on t h e f o l l o w i n g morning. day,  I n order to c o n t r o l  On r e p o r t i n g t o t h e l a b o r a t o r y on t h e f i r s t  the s u b j e c t ' s forms and o t h e r d a t a were c o l l e c t e d and she was l e d t o  a room where she would hear t h e f i r s t s e t o f messages.  The s u b j e c t 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  b u t not t u r n e d o f f c o m p l e t e l y . s a g e s , the s u b j e c t was  On c o m p l e t i o n o f the f i r s t s e t o f mes-  reminded o f the n e x t day's appointment and  ex-  cused t o r e t u r n home. On the f o l l o w i n g day  the s u b j e c t h e a r d the second s e t o f messages  under the same c i r c u m s t a n c e s  as on the p r e v i o u s day.  of the t a p e , the s u b j e c t was  g i v e n p e r s o n a l i n s t r u c t i o n i n the p l a n  p r e s e n t e d w i t h the d i e t manual as mentioned above. was  A t the  completion and  A t h i r d appointment  made f o r one week l a t e r . Group Four - N o n c o n f i n e d w i t h o u t messages (NC-NM) T h i s group of s u b j e c t s 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 s e n s o r y  deprivation.  A f t e r w e i g h i n g i n and h a n d i n g i n the  r e q u i r e d m a t e r i a l s , these s u b j e c t s were g i v e n p e r s o n 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 programme, and g i v e n the d i e t manual, as o u t l i n e d above.  A n o t h e r 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 f o l l o w - u p s e s s i o n s were arranged  two months, f o u r months, and was  the treatment  session.  s i x months a f t e r the second s e s s i o n , w h i c h I n g e n e r a l , t h i s t i m e t a b l e was  some i n d i v i d u a l v a r i a t i o n s due flicts. recorded.  t o be one week, one month,  to p e r s o n a l s c h e d u l i n g problems and  At each f o l l o w - u p s e s s i o n , the s u b j e c t ' s w e i g h t was The  s u b j e c t ' s own  followed with con-  measured and  p e r s o n a l r e c o r d s of c a l o r i e i n t a k e , o u t p u t ,  and w e i g h t were d i s c u s s e d b u t n o t 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 l e n g t h . The one week, one month, and c a l l y reviews o  f o u r month f o l l o w - u p s e s s i o n s were b a s i -  o f 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 ,  42 S u b j e c t s were asked about t h e i r own i m p l e m e n t a t i o n  o f and r e a c t i o n s t o  the e l e v e n b e h a v i o r a l s t e p s o u t l i n e d i n t h e S t u a r t and D a v i s gramme.  Suggestions  (1972) p r o -  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 s t e p s w i t h s p e c i a l focus on problems b r o u g h t up by t h e s u b j e c t . Other than reviex^ing these b e h a v i o r a l s t e p s and n o t i n g i n d i v i d u a l g r e s s , t h e r e were no o t h e r s t a n d a r d i z e d p r o c e d u r e s f o r these The  pro-  sessions.  two month and s i x month f o l l o w - u p s e s s i o n s proceded i n b a s i c a l l y  the same manner b u t were more s t a n d a r d i z e d .  These i n t e r v i e w s f o l l o w e d a  s p e c i f i c set of information gathering questions. up q u e s t i o n s . w e r e designed  The two month f o l l o w -  t o measure t h e e x t e n t t o w h i c h t h e s u b j e c t was  c a r r y i n g o u t each s t e p o f t h e programme and t h e r e a c t i o n s o f t h e s u b j e c t t o t h e programme and h e r p r o g r e s s v i e w was d e s i g n e d suggestions  up t o t h a t p o i n t .  The s i x month i n t e r -  t o t a p r e a c t i o n s t o t h e e n t i r e programme and t o g a t h e r  on t h e s t r o n g and weak p o i n t s o f t h e p r o c e d u r e .  Skinfold  measurements were taken a g a i n by t h e same female r e s e a r c h a s s i s t a n t a t this f i n a l session.  A l s o a t t h i s follow-up s e s s i o n the s u b j e c t ' s  data  d e p o s i t check was r e t u r n e d .  Measures W e i g h t , h e i g h t , and s k i n f o l d .  Weight and h e i g h t were measured on  a Health-O-Meter b a l a n c e  s c a l e with metric readings.  Therefore, weight  i s reported i n kilograms  (1 K i l o g r a m = 2.2 l b s . ) and h e i g h t i n c e n t i m e t e r s .  Weight measurements were taken w i t h t h e s u b j e c t d r e s s e d b u t w i t h o u t An attempt was made t o schedule  shoes.  t h e s u b j e c t a t t h e same t i m e o f day f o r  each s e s s i o n t o c o n t r o l f o r f l u c t u a t i o n i n w e i g h t over t h e course of t h e day.  However, t h i s was n o t always p o s s i b l e due t o i n d i v i d u a l  problems.  scheduling  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 a t 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 o f t h r e e measurements  t a k e n a t each s i t e was used t o account f o r s l i g h t v a r i a t i o n s i n measurement.  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 o f o v e r a l l body f a t and as b e i n g c l e a r l y measureable s e v e r e l y obese cases (Tanner. & Whitehouse,  1975).  i n a l l but  These measurements  were made by a female r e s e a r c h a s s i s t a n t . Demographic d a t a .  I n a d d i t i o n t o name, age, and m a r i t a l s t a t u s ,  the s u b j e c t was asked about e d u c a t i o n l e v e l , number o f c h i l d r e n , and occupation.  I n f o r m a t i o n r e l e v a n t s p e c i f i c a l l y t o w e i g h t was d e s i r e d  w e i g h t , age a t onset o f o v e r w e i g h t , p e r c e i v e d cause o f o v e r w e i g h t , p r e v i o u s d i e t attempts and amounts l o s t as a r e s u l t o f those a t t e m p t s .  The  s u b j e c t ' 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 a s k i n g t h e k i n d s and f r e q u e n c i e s o f s p o r t s , h o b b i e s , and e x e r c i s e she engaged i n . E s t i m a t e s o f smoking and a l c o h o l consumption were made through s e l f r e p o r t s .  Finally  the s u b j e c t was asked h e r m o t i v e s f o r e n r o l l i n g i n t h e programme and t h e amount o f 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 o u t t h e programme. F o r the l a t t e r measure t h e s u b j e c t e s t i m a t e d d i f f i c u l t y on a s c a l e o f z e r o (minimum) t o 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 M o t i v e C h e c k l i s t was d e s i g n e d f o r t h i s s t u d y  to measure t h e importance t o t h e s u b j e c t , o f each o f a number o f m o t i v e s for l o s i n g weight.  The l i s t i n c l u d e d i m p r o v i n g 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 , imp r o v i n g employment o p p o r t u n i t i e s , p r e p a r i n g f o r an upcoming e v e n t , and p l e a s i n g one's spouse o r f r i e n d s .  A c c o r d i n g t o S t u a r t ( p e r s o n a l communi-  c a t i o n ) t h e s e a r e the most commonly c i t e d m o t i v e s 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 m o t i v e t h e s u b j e c t  from one (not a t a l l i m p o r t a n t ) t o f i v e ( v e r y P e r s o n a l i t y measures.  c i r c l e d a number  important).  The v a r i o u s p e r s o n a l i t y t e s t s used i n t h i s  s t u d y were s e l e c t e d f o r t h e i r r e l e v a n c e t o 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 t o be m u l t i d i m e n s i o n a l and i t was hoped t h a t a more complete u n d e r s t a n d i n g would be g a i n e d by u s i n g 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 a t t e m p t i n g t o mea-  s u r e t h i s o r i e n t a t i o n i s b a s e d o n t h e t h e o r y o f S c h a c h t e r (1971).  The  i n t e n t i o n was t o a n a l y z e t h e 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 measures and s u c c e s s a t l o s i n g w e i g h t a t t h e c o n c l u s i o n  o f t h e programme.  F i e l d dependence-independence ( W i t k i n e t a l . , 1954) was measured w i t h a p o r t a b l e Rod-and-Frame T e s t . t o t a l absolute The  judgment e r r o r summed o v e r e i g h t  construct  trials.  o f i n t e r n a l v e r s u s e x t e r n a l c o n t r o l ( R o t t e r , 1966) was  a n o t h e r r e l e v a n t measure. was  The s c o r e from t h i s t e s t was t h e  The R e i d and Ware (1974) v e r s i o n o f t h i s  scale  used s i n c e i t has been d i v i d e d i n t o t h r e e s e p a r a t e d i m e n s i o n s : 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 d i m e n s i o n measures the e x t e n t t o w h i c h p e o p l e b e l i e v e t h a t l u c k , f a t e , o r f o r t u n e personal  achievements o r outcomes.  govern  The s o c i a l systems c o n t r o l d i m e n s i o n  r e f l e c t s t h e amount o f c o n t r o l p e o p l e f e e l they have o v e r s o c i a l and pol i t i c a l f o r c e s and e v e n t s . the p e r c e i v e d  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  amount o f c o n t r o l o v e r one's own d e s i r e s , i m p u l s e s and emo-  t i o n s ( R e i d and Ware, 1974).  T h i s s c a l e c o n s i s t s o f 45 f o r c e d  choice  items. A n o t h e r s c a l e r e l a t e d t o t h e Locus o f C o n t r o l s c a l e i s t h e P e r s o n a l C a u s a l i t y Scale  ( P e e v e r s , B l a s c o v i c h , and S e c o r d , 1974).  This  question-  45 n a i r e i s d e s i g n e d to c a t e g o r i z e regarding i d e a and  the i n d i v i d u a l . a s p e r s o n a l  the l o c u s of c a u s a l i t y .  The  or  external  major d i f f e r e n c e between t h i s  the Locus of C o n t r o l i s t h a t the P e r s o n a l  C a u s a l i t y S c a l e mea-  sures perceived  causality i n interpersonal relationships.  c o n s i s t s of "35  q u e s t i o n s 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  w h i c h p a r t i c i p a n t s respond i n t h e i r own p. 1 ) .  The  scale  words" (Peevers et a l . ,  1974,  I n a d d i t i o n t o c a t e g o r i z i n g i n d i v i d u a l s on l o c u s 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 s c o r e t h a t i n d i c a t e s the degree o f p e r c e i v e d  in-  t e n t i o n a l i t y t h a t o t h e r s have i n t h e i r a c t i o n s toward t h e i n d i v i d u a l . One  s u g g e s t i o n from the h y p o t h e s i s t h a t the obese are more e x t e r n a l -  •~ l y o r i e n t e d i s t h a t the obese are u n a b l e ' l t p a d a s c r i m i n a t e t i n i t e r n a l cues. To tap t h i s a s p e c t 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 P e r ception Scale T h i s s c a l e was  ( M a n d l e r , M a n d l e r , and U v i l l e r , 1958)  was  administered.  d e s i g n e d to measure the e x t e n t 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 t h a t the s c a l e i s a c t u a l l y measuring  the  degree t o w h i c h i n d i v i d u a l s tend t o be concerned about autonomic a c t i v i t y ( M c F a r l a n d , 1975).  T h i s 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 p r o b l e m 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 s c o r e i s p r e d i c t i v e of weight l o s s . Another v a r i a b l e t h a t 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  e x t e n t to w h i c h i n d i v i d u a l s are r e c e p t i v e t o  t e r n a l suggestions v a r i e s considerably  and might be an added d i m e n s i o n  t o the concept o f i n t e r n a l i t y - e x t e r n a l i t y . S c a l e was  The  Barber S u g g e s t i b i l i t y  used t o 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 h y p n o t i c i z e d and  ex-  r e q u i r e s no h y p n o t i c  s u g g e s t i b i l i t y , the t e s t i s s t a n d a r d -  induction  (Barber,  1965).  The  test  was  46 a d m i n i s t e r e d i n tape r e c o r d e d form t o i n s u r e a s t a n d a r d p r o c e d u r e .  The  o n l y 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 g o i n g to p l a y a tape recording.  I would l i k e you to c l o s e your e y e s , r e l a x and l i s t e n t o the  i n s t r u c t i o n s on the t a p e . "  The t e x t and s c o r i n g procedure f o l l o w e d  d i r e c t l y from B a r b e r (1965).  The t e s t y i e l d s two s e p a r a t e s c o r e s : an  o b j e c t i v e s u g g e s t i b i l i t y s c o r e which i s the amount o f 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 s c o r e w h i c h r e f l e c t s the e x t e n t to w h i c h the s u b j e c t f e l t the suggested e f f e c t as opposed t o m e r e l y g o i n g a l o n g w i t h the i n s t r u c t i o n s to p l e a s e the e x p e r i menter. S i n c e the i m p o r t a n c e o f t h e s e l f i n c o n t r o l l i n g w e i g h t l o s s has been demonstrated  t o be g r e a t e r 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  M o n i t o r i n g S c a l e was  self-control  d e s i g n e d to measure s e l f - o b s e r v a t i o n and  o f e x p r e s s i v e b e h a v i o r and s e l f p r e s e n t a t i o n (Snyder, 1974).  The  z a t i o n from how-aware one i s o f e x p r e s s i n g h i s own a t t i t u d e s o r to how able  aware he i s o f h i s own  Self-  generaliemotions  e a t i n g b e h a v i o r i s not a l a r g e o r unreason-  one. Spouse Involvement.  The s o c i a l n a t u r e o f t h e p r o b l e m of any  diet  and e x e r c i s e p l a n makes s o c i a l s u p p o r t e x t r e m e l y n e c e s s a r y , p a r t i c u l a r l y s u p p o r t from one's f a m i l y and spouse.  Although t h i s study d i d not d e a l  d i r e c t l y w i t h the f a m i l i e s o f 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 s u p p o r t by s e n d i n g some m a t e r i a l home f o r p e r u s a l and c o m p l e t i o n .  T h i s t e c h n i q u e has been suggested by S t u a r t ( p e r s o n a l  communication).  The m a t e r i a l p r o v i d e d 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 t h a t the spouse r e a d the d i e t manual.  I n a d d i t i o n the  spouse was  asked t o complete a q u e s t i o n n a i r e  e a t i n g h a b i t s (See Appendix D).  I t was  c o n c e r n i n g the  subject's  f e l t t h a t t h i s would a t l e a s t  s e r v e as a p u b l i c statement by the s u b j e c t t h a t she was  n:  to l o s e weight.  a spouse o r  M o s t , but not a l l , of the s u b j e c t s had  attempting  o t h e r w i t h whom they were l i v i n g . Self Monitoring.  Recent r e s e a r c h on the e f f e c t s o f  self-monitoring  has  shown i t t o 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  his  own  eating patterns  ( S t u a r t and D a v i s , 1972)  b u t i n g t o w e i g h t l o s s (Mahoney, 1974). ing  and i n a c t u a l l y c o n t r i -  This l a t t e r r o l e of s e l f monitor-  has been found t o be l e s s l o n g l a s t i n g and i s l i m i t e d t o  t h a t precedes the e a t i n g b e h a v i o u r (Romanczyk, 1974). s e n t s t u d y t h i s measure was  intended  monitoring  S i n c e i n the  to i n c r e a s e awareness and  pre-  provide  the e x p e r i m e n t e r 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 ' n o r m a l e a t i n g h a b i t s , post monitoring,  or s e l f monitoring  duce r e a c t i v i t y t o the m o n i t o r i n g Each s u b j e c t was  a f t e r h a v i n g e a t e n , was  used t o r e -  procedure.  given a small s e l f monitoring  booklet  and i n s t r u c -  t e d t o f i l l out one page f o r each i n c i d e n t o f e a t i n g whether i t was  a  f u l l meal o r a v e r y small, snack.  the  s e l f monitoring  booklet  The  monitoring Two  i n s t r u c t e d t o use  f o r one week s t a r t i n g i m m e d i a t e l y a f t e r the  t i a l i n t e r v i e w u n t i l the n e x t s e s s i o n . s u b j e c t was  s u b j e c t was  I t was  a l s o made c l e a r t h a t  not to change h e r e a t i n g h a b i t s s i n c e the purpose of was  the  self  to g a i n , i n s i g h t about h e r p r e s e n t p a t t e r n .  month i n t e r v i e w .  The  t h i r d follow-up  session occurred,  e i g h t weeks had p a s s e d s i n c e the i n s t r u c t i o n s e s s i o n . i n t e r v i e w : was  ini-  A  standardized  used t o a s s e s s the s u b j e c t s ' p r o g r e s s up to t h a t  (see Appendix D).  S u b j e c t s were asked to e s t i m a t e  after  point  the p e r c e n t a g e o f 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 . S i n c e 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 g r a p h i n g as i n s t r u c t e d . To a s s e s s the e x t e n t to w h i c h s u b j e c t s were f o l l o w i n g the b e h a v i o r a l s t e p s , they were asked to e s t i m a t e they engaged i n t h o s e s t e p s .  specific  p e r c e n t a g e of p o s s i b l e time  The h a b i t s measured i n t h i s way  (when home); not d o i n g a n y t h i n g  were: e a t -  ing  i n one p l a c e  e l s e when e a t i n g ; keep-  ing  p r o b l e m foods out o f s i g h t and r e a c h ; w o r k i n g on s p e c i f i c p r o b l e m  t i m e s j g e t t i n g h e l p from o t h e r s ; u s i n g a s m a l l e r p l a t e ; measuring p o r t i o n s ; k e e p i n g 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  plan. The she  s u b j e c t was  asked i f h e r a t t i t u d e toward e a t i n g had  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 .  were answered on a f i v e p o i n t s c a l e .  t o t h a t p o i n t and how  the n e x t f o u r months. o f the manual and  I n q u i r y was  These  questions  U s i n g the same s c a l e "of 0 t o  as i n the i n i t i a l i n t e r v i e w , s u b j e c t s e s t i m a t e d they had had  changed,if  the amount o f  much d i f f i c u l t y  difficulty  they a n t i c i p a t e d o v e r  a l s o made i n t o the s u b j e c t ' s  the number of times she had  100  read i t .  Finally  opinion 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 f e a t u r e s o f the programmes w h i c h d i f f e r e d between groups, i . e . , s e n s o r y d e p r i v a t i o n and messages. S u b j e c t s were o n l y asked about the f e a t u r e s they had S i x month i n t e r v i e w . signed  (See A p p e n d i x D).  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  received.  T h i s i n t e r v i e w was to get i d e a s and  desuggest-  i o n s from s u b j e c t s on the s t r o n g and weak p o i n t s o f 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 q u e s t i o n s  of how  or unsuccessful  much t h e i r a t t i t u d e  they f e l t the programme had been, how  successful  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 had changed, whether they f e l t b e t t e r about themselves, they f e l t h e a l t h i e r .  their health  and whether  S u b j e c t s a l s o responded o r a l l y t o s e v e r a l open  ended q u e s t i o n s about t h e programme's most i m p o r t a n t a s p e c t s , w o r s t a s p e c t s and how t h e programme c o u l d be improved.  Subjects also described  t h e i r g r e a t e s t problems and what they had l e a r n e d about Questions  themselves.  c o n c e r n i n g i n t e n t i o n s t o c o n t i n u e u s i n g t h e 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 o f a c h i e v i n g g o a l weight were a l s o i n c l u ded.  F i n a l l y , t h e s u b j e c t was a l l o w e d any g e n e r a l comments and asked i f  she would be w i l l i n g t o r e t u r n a g a i n i n the f u t u r e 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 .  I n a d d i t i o n t o t h e i n i t i a l e f f o r t t o equate  groups f o r w e i g h t , age, and m a r i t a l s t a t u s , a check was made t o e v a l u a t e the e q u i v a l e n c e o f t h e groups on the p e r s o n a l i t y measures and o t h e r demographic v a r i a b l e s .  One-way m u l t i v a r i a t e a n a l y s e s o f v a r i a n c e (MANOVAs)  were performed on th;ese dependent v a r i a b l e s u s i n g b l o c k s o f s i x o r e i g h t v a r i a b l e s a t a time.  S i n c e the s m a l l e s t number o f s u b j e c t s i n any o f  the t r e a t m e n t groups was n i n e , no more than n i n e v a r i a b l e s c o u l d be anal y z e d a t one time..  V a r i a b l e s were a n a l y z e d on groupings w h i c h . l o g i c a l l y  'seemed- -to Belong together-. 1  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 t h e groups on any o f t h e d a t a 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 w e i g h t , number o f y e a r s o v e r w e i g h t ,  tricep skinfold, infrascapular  s k i n f o l d , number o f c h i l d r e n , and y e a r s o f e d u c a t i o n 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 d f ) o f .495  = .675,  p_ >.50 j). 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 j  and Frame T e s t , t h e S e l f M o n i t o r i n g S c a l e , t h e t o t a l Locus o f C o n t r o l s c o r e , Autonomic p e r c e p t i o n , t h e s u b j e c t i v e and o b j e c t i v e Barber S u g g e s t i b i l i t y S c a l e s c o r e s , and t h e l o c u s and i n i t i a t i o n s c o r e s from the P e r s o n a l C a u s a l i t y Q u e s t i o n n a i r e 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 t h e r e s i g n i f i c a n t d i f f e r e n c e s b e tween amounts o f d r i n k i n g o r smoking, a n t i c i p a t e d d i f f i c u l t y , o r on t h e t h r e e s e p a r a t e s c a l e s o f the Locus o f 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 t h e i t e m s 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 e v e n t , o r 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 g r e a t e s t c h a r a c t e r i s t i c r o o t were found  ( g c r = .4048, S_ = 3, M = 1.5,  the f o u r e x p e r i m e n t a l sonality  ( 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 N = 13.5,  p_ >.05).  I n summary,  groups were e q u i v a l e n t on the demographic and  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 d a t a were t e s t 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 who  completed the s t u d y .  q u i t e l a r g e , the  subjects  S i n c e the number o f c o r r e l a t i o n s i n v o l v e d i s  .01 s i g n i f i c a n c e l e v e l was  as might be e x p e c t e d , was .55)  per-  u s e d , (see T a b l e 1 ) .  Age,  p o s i t i v e l y r e l a t e d to y e a r s o v e r w e i g h t Cr =  and n e g a t i v e l y r e l a t e d to the i m p o r t a n c e of i m p r o v i n g s o c i a l oppor-  t u n i t i e s (r_ = - . 4 8 ) .  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  t i v e s c o r e on B a r b e r ' s S u g g e s t i b i l i t y S c a l e  (_r = - . 4 4 ) .  Older  objec-  subjects  were l e s s s u g g e s t i b l e . H e i g h t and i n i t i a l w e i g h t 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 a t a s u r p r i s i n g l y low r_ = .40.  I n i t i a l w e i g h t was  w i t h the two s k i n f o l d measures: w e i g h t and .62,  and w e i g h t and  also p o s i t i v e l y correlated  t r i c e p s k i n f o l d w i t h an _r of  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 o f .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 o t h e r than w i t h i n i t i a l w e i g h t (r_ = .85).  Weight and  l a t e d w i t h v e r y few o t h e r v a r i a b l e s . low c o r r e l a t i o n between w e i g h t and  s k i n f o l d s were s i g n i f i c a n t l y There was  corre-  a s i g n i f i c a n t though  t o t a l Locus of C o n t r o l s c o r e  (r =  .41),  d e m o n s t r a t i n g a tendency f o r the h e a v i e r s u b j e c t s t o be more e x t e r n a l l y oriented.  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  conclusive.  Summary of. C o r r e l a t i o n s  Age Weight Height Y e a r s Overweight Tricep Skinfold Infrascapular Skinfold Y e a r s o f Education M o t i v e t o Improve S o c i a l Opportunity M o t i v e t o Improve Employment Opportunity Motive to Please Spouse B. S u g g e s t i b i l i t y Sc. O b j e c t . Suggestibility Sc. Sub.  Cojpela t i ^ n s  3  8  10  9  11  12  1  2  1 2 3 4 5  .04 .09 .55 .38  .40 .12 .62  -.10 .22  .25  6  .31  .63  .16  .21  .85  7  -.27  -.24  -.24  -.36  -.26  8  -.48  .21  -.04  -.32  05  .03  .05  9  -.09  .08  -.38  -.13  .02  .03  -.06  .46  10  .27  .12  -.04  .02  .15  .15  -.10  .007  11  -.44  .25  .25  -.34  .19  .18  -.16  .27  -.06  -.06  12  -.30  .24  .01  -.17  .41  .35  -.24  .20  .02  .04  .63  .17  .19  .17  .02  .05  13  14  15  .13  LOC  Total  13  .01  •41  .16  .08  .28  .38  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  .26  .09  -.08  .12  .26  -.01  .32  .19  -.05 -.18 -.18  .75  .47  .15  .44  .38  .36  -.19  -.05  .04  .33  .04  .21  .33  .18  .43  -.05  .11  .15  -.04  .04  .03  .40  .08 -.10 -.03 -.08  LOC S e l f  Control  16  -U7  Autonomic P e r c e p tion  17  .24  .47  .15  Weight Change 6 months  18  .07  .09  .004  16 17  .06  .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 y e a r s o f e d u c a t i o n  more h i g h l y educated s u b j e c t s tended to be l i g h t e r . Autonomic P e r c e p t i o n s c a l e was ( r = .47)  The  (r_ =  -.47)  s c o r e on  the  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 e f l e c t i n g a tendency f o r h e a v i e r s u b j e c t s t o r e p o r t more  awareness o r concern f o r autonomic a c t i v i t y .  T h e r e was  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 . s k i n f o l d was  a l s o one  Infrascapular  p o s i t i v e l y r e l a t e d t o the S u b j e c t i v e s c a l e on  S u g g e s t i b i l i t y S c a l e (r_ = .41).  other  Barber's  S u b j e c t s w i t h more f a t tended to be more  suggestible. There were a number o f 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  o f 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 themselves,  S e v e r a l o f the m o t i v e s f o r j o i n i n g the progamme on the m o t i v e  c h e c k l i s t were r e l a t e d .  The m o t i v e to improve s o c i a l o p p o r t u n i t y  was  p o s i t i v e l y r e l a t e d t o the m o t i v e t o improve employment o p p o r t u n i t y (r_ = .46), and  the m o t i v e to p r e p a r e f o r some upcoming event was  (_: = ,51) w i t h the importance of p l e a s i n g one's spouse.  correlated  On the Locus o f  C o n t r o l q u e s t i o n n a i r e the s u b s c a l e s 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 O b j e c t i v e and S u b j e c t i v e s u b s c a l e s of the  B a r b e r S u g g e s t i b i l i t y S c a l e 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  P e r s o n a l C a u s a l i t y s c o r e 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  s u b j e c t c l a i m e d to smoke (_r = .41). who  T h i s r e f l e c t s a tendency f o r those  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 t o a g r e a t e r  degree.  E x t e r n a l i t y on t h i s measure i s the amount one p e r c e i v e s  others  (as opposed t o s e l f ) as b e i n g r e s p o n s i b l e f o r i n t e r p e r s o n a l e v e n t s . F i n a l l y , the Autonomic P e r c e p t i o n s c o r e was  p o s i t i v e l y r e l a t e d t o the  S o c i a l Systems C o n t r o l s u b s c a l e o f the Locus o f C o n t r o l s c a l e ( r =  .43);  54 the more aware t h e s u b j e c t was o f h e r own p h y s i o l o g i c a l a c t i v i t y t h e more she f e l t s o c i a l systems t o be out o f h e r c o n t r o l . Group S i z e and A n a l y s i s o f Drop Outs. for  The i n i t i a l d e s i g n  12 s u b j e c t s i n each o f the f o u r groups.  were seen c o m p l e t e l y  called  However, s i n c e s u b j e c t s  on an i n d i v i d u a l b a s i s they d i d n o t a l l b e g i n t h e  programme a t t h e same time.  A number o f s u b j e c t s t e r m i n a t e d  a t v a r i o u s p o i n t s i n the p r o g r e s s o f t h e study.  the programme  I n the i n i t i a l  stages  an attempt was made t o r e p l a c e these s u b j e c t s w i t h o t h e r s from t h e 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 t h r e e months  from the b e g i n n i n g o f t h e f i r s t s u b j e c t . p o i n t ^ a w e r e not replaced.  S u b j e c t s who t e r m i n a t e d a f t e r t h a t  As a r e s u l t t h e d e s i r e d c e l l s i z e s were n o t  a c h i e v e d , n e i t h e r were t h e f i n a l number o f s u b j e c t s i n each group e q u a l . The SD-M group had 11 s u b j e c t s , t h e 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 a v o i d  dis-  t o r t i o n s i n t h e r e s u l t s caused by a n a l y s i s o f unequal c e l l d e s i g n s , two s u b j e c t s from the SD-M group and one s u b j e c t 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 a n a l y s e s o f v a r i a n c e and  t h e r e p e a t e d measures a n a l y s i s . ^  other  Their data are i n c l u d e d i n a l l  analyses. There was a t o t a l o f 15 s u b j e c t s who t e r m i n a t e d b e f o r e the p r o -  gramme's c o n c l u s i o n .  Of t h e s e , s i x t e r m i n a t e d  a f t e r the i n i t i a l  inter-  v i e w and t h e r e f o r e were n o t p r e s e n t e d w i t h any.of t h e treatments'. Three s u b j e c t s l e f t t h e sensory  deprivation session early.  one i n t h e SD-M group and one i n t h e SD-NM group, t e r m i n a t e d a f t e r f i v e hours o f sensory d e p r i v a t i o n .  Two o f t h e s e , the s e s s i o n  The t h i r d s u b j e c t , who had been  55  a s s i g n e d t o the SD-M group, l e f t a f t e r 45 minutes o f s e n s o r y d e p r i v a t i o n . I n accordance w i t h a p r e v i o u s u n d e r s t a n d i n g programme a t t h i s t i m e .  these s u b j e c t s t e r m i n a t e d t h e  One, however,was a l l o w e d t o c o n t i n u e  and she i s d i s c u s s e d i n the n e x t c h a p t e r .  unofficially  The r e m a i n i n g dropouts  from  the study were as f o l l o w s : two s u b j e c t s (one NC-M, one NC-NM) t e r m i n a t e d 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 s u b j e c t s (one SD-NM, one NC-NM) t e r minated a f t e r t h e one week f o l l o w up; o n e ' s u b j e c t s  (NC-M) t e r m i n a t e d  a f t e r the one month f o l l o w up; and two s u b j e c t s (one NC-M, one NC-NM) t e r m i n a t e d a f t e r the two month f o l l o w up.  Several other subjects ex-  p r e s s e d a d e s i r e t o q u i t when t h e y were d i s c o u r a g e d by p o o r p r o g r e s s . These s u b j e c t s were encouraged t o c o n t i n u e and responded t o t h i s  encour-  agement by r e m a i n i n g ihtsthe programme. I n o r d e r t o t e s t f o r s y s t e m a t i c d i f f e r e n c e s i n demographic and p e r s o n a l i t y v a r i a b l e s w h i c h d i s t i n g u i s h e d t h e drop-outs  from the o t h e r  groups o f s u b j e c t s , a f u r t h e r s e r i e s o f m u l t i v a r i a t e a n a l y s e s o f v a r i a n c e was p e r f o r m e d .  These a n a l y s e s i n c l u d e t h e s u b j e c t s who. dropped o u t as  a s e p a r a t e group compared t o the e x p e r i m e n t a l groups.  The o v e r a l l  o f the m u l t i v a r i a t e n u l l h y p o t h e s i s by the l i k e l i h o o d r a t i o  test  criterion  r e v e a l 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 f o r the v a r i a b l e s age, h e i g h t , y e a r s 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 o f education, -  o r number o f c h i l d r e n (A = .658, F —  = .704, p >.50); n o r f o r s c o r e s  O D  —_,o,J_oU  on the Rod and Frame t e s t , Locus o f C o n t r o l t e s t , Autonomic P e r c e p t i o n , the O b j e c t i v e and S u b j e c t i v e s c a l e s o f the B a r b e r S u g g e s t i b i l i t y S c a l e , and the l o c u s and i n i t i a t i o n s c a l e s o f the P e r s o n a l C a u s a l i t y S c a l e (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 n i t o r i n g S c a l e , and t h e F a t e , SSC, and S e l f C o n t r o l  subscales  o f t h e Locus o f C o n t r o l were a l s o n o t s i g n i f i c a n t (;_v = .652, ,860,  p_ >.50).  =  As i n t h e a n a l y s i s o f t h e f o u r e x p e r i m e n t a l groups, t h e  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 m o t i v e 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 t u n i t y , employment opport u n i t y , upcoming e v e n t , and p l e a s e spouse (A = .399, F„_ —  p_ <,05),  However, u s i n g t h e g r e a t e s t  = 1.66,  —zo,±oU  c h a r a c t e r i s t i c r o o t approach t h i s  t e s t was n o t s i g n i f i c a n t ( g c r = .301, S_ = 4, M = 1, N = 21, p_>.05). The  o v e r a l l f i n d i n g o f t h e s e a n a l y s e s i s t h a t the dropouts were n o t s y s -  t e m a t i c a l l y d i f f e r e n t on t h e p e r s o n a l i t y and demographic measures t a k e n from those who d i d n o t drop out.  T h i s r e s u l t i s d i s c o u r a g i n g i n t h a t no  good p r e d i c t o r o f e a r l y t e r m i n a t o r s emerged. Weight Change.  The dependent v a r i a b l e o f most i n t e r e s t i s t h e t o t a l  w e i g h t change over t h e 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 o f v a r i a n c e  (ANOVA) o f w e i g h t change a t the end o f t h e 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  However t h e r e 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 ^ ^ tween environment type and message.  =  3 2  = 1.70, p_ >.20)  7.43, p_ <.01) be-  The l a r g e s t w e i g h t change o c c u r r e d  i n t h e 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 o c c u r r e d i n t h e NC-NM group w h i c h had a mean l o s s o f 2.36 kg. . M u l t i p l e comparisons u s i n g , vkthe Neuman-Reujis';;^  *.  mean w e i g h t l o s s o f SD-M group t o be s i g n i f i c a n t l y (p_ <.05) g r e a t e r than the mean l o s s o f each o f t h e o t h e r t h r e e groups (Table 2 ) . In a d d i t i o n t o o v e r a l l w e i g h t l o s s f o r t h e s i x month p e r i o d , t h e pattern two  o f w e i g h t change over time was a l s o examined.  d i f f e r e n t ways.  T h i s was done i n  The f i r s t was t o a n a l y z e w e i g h t 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 Deprivation  Nonconfined  Messages  5.87 Kg*  .67 Kg*  3.27 Kg  No Messages  1.08 Kg*  2.36 Kg*  1.72 Kg  Condition 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 a t p <.01  Message Means  58  TABLE 3  Weight Loss Means Over F i r s t Two Months  Sensory Deprivation  NonConfiried  3,67 Kg  2.61 Kg  3.14 Kg  No Messages  .11 Kg  2.35 Kg  1.23 Kg  Condition , Means  1.89 Kg  2.48 Kg  Messages  S i g n i f i c a n t main e f f e c t a t p_ <.05  Message Means  59  periods.  ANOVA o f w e i g h t change over t h e 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) b u t a s i g n i f i c a n t message e f f e c t (F_^ 22  4.00, p_ =  =  . 0 5 ) . Those who had heard t h e messages  l o s t an average o f 3.13 k g v e r s u s 1.23 kg. f o r those who had n o t 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  n i f i c a n t a t two months ( F ^ ^  =  l o s s a r e p r e s e n t e d i n T a b l e 3. p e r i o d was a l s o a n a l y z e d .  3.00, p_<.10).  Q?l 22 in  =  Means f o r 2 month w e i g h t  Weight change d u r i n g t h e l a s t f o u r month  Here ANOVA r e v e a l e d t h e message e f f e c t  to be n o n s i g n i f i c a n t and t h e i n t e r a c t i o n ( F ^ ^ marginally s i g n i f i c a n t .  sig-  =  (F_<1)  '2.88, p < .10) t o be  There was a s i g n i f i c a n t environment main e f f e c t  7.60, p < .01) f o r change d u r i n g t h i s p e r i o d .  The mean change  t h e l a s t f o u r months f o r those who had spent 24 hours i n s e n s o r y de-  p r i v a t i o n was a l o s s o f 1.58 k g v e r s u s a g a i n o f .98 k g f o r those who were nonconfined.  Table 4 c o n t a i n s mean w e i g h t l o s s e s f o r t h e l a s t f o u r month  period. To examine the p a t t e r n o f w e i g h t change f u r t h e r a r e p e a t e d measures ANOVA was performed on a l l o f t h e w e i g h t measurements o v e r t h e s i x month period.  I f a s u b j e c t had missed a s e s s i o n and c o n s e q u e n t l y had a m i s s i n g  data c e l l , used. effect  t h e average o f t h e two a d j a c e n t s e s s i o n s f o r t h a t s u b j e c t was  T h i s 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 ^<J2  =  interaction  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).  e f f e c t was o f b o r d e r l i n e s i g n i f i c a n c e ( F ^ a c t u a l t r e n d s o f t h i s d a t a see F i g u r e 1.  =  The t r i a l by message 2.06, p_=.06).  For the  These f i n d i n g s r e f l e c t t h e  e a r l i e r f i n d i n g s from t h e ANOVA on t h e d i f f e r e n t time p e r i o d s , t h e groups w i t h messages l o s i n g most i n t h e f i r s t  2 months and t h e s e n s o r y d e p r i v a -  t i o n groups l o s i n g most w e i g h t o v e r t h e l a s t f o u r months.  This combination  TABLE 4  Weight Loss Means Over the L a s t Four Months ( n e g a t i v e numbers = w e i g h t g a i n )  Sensory Deprivation Messages  No Messages  Condition Means  NonConfined  Message Means  2.20 Kg  -1.93 Kg  .13 Kg  .97 Kg  -.02 Kg  .48 Kg  1.58 Kg  -.98 Kg  * S i g n i f i c a n t main e f f e c t a t 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 )  Trlcep Sensory Deprivation  NonConfined  Message Means  Message  1.93 mm  2.71 mm  2.32 mm  No Message  2.04 mm  .64 mm  1.34 mm  Condition Means  1.99 mm  1.68 mm  Infrascapular Sensory Deprivation .  NonConfined  Message Means  Message  2.36 mm  2.61 mm  2.48 mm  No Message  3.82 mm  1.21 mm  2.52 mm  Condition Means  3.09 mm  1.91 mm  produces  t h e i n t e r a c t i o n e f f e c t w i t h t h e SD-M group l o s i n g most w e i g h t  o v e r t h e 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  skinfold  measurements were t a k e n a t t h e b e g i n n i n g o f t h e programme and a g a i n a t the f i n a l s i x month s e s s i o n . variables  ANOVA o f change i n each o f these dependent  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 .  one w i t h t h e e x c e p t i o n o f t h e environment infrascapular  measure ( F ^ ^  =  (see T a b l e 5) ,  than  x message i n t e r a c t i o n f o r t h e  1-38, p_ <.10).  a l 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  A l l F r a t i o s were l e s s  A r e p e a t e d measures ANOVA  between groups on t h e s e  variables  T h i s complete l a c k o f s i g n i f i c a n t f i n d i n g s w i t h t h e 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 v i e w o f t h e r e l a t i o n between w e i g h t change and s k i n f o l d change. cantly  correlated  with infrascapular  S i x month w e i g h t change was s i g n i f i s k i n f o l d change (r_ = .50, p_ <.002,  and t o 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 t h e two s k i n f o l d measures was .67 (p_ <.0001). A n a l y s e s o f o t h e r dependent v a r i a b l e s .  1  ANOVA's were c a r r i e d out on  the o t h e r d a t a w h i c h were c o l l e c t e d a t t h e two and s i x month s e s s i o n s . Significant differences  between s e n s o r y d e p r i v a t i o n  versus nonconfined  sub-  j e c t s were found on t h e number o f c a l o r i e s o f e x e r c i s e they c l a i m e d t o average d a i l y ( F ^  3 2  = 4.54, p_< .05; SD mean = 271 v s . NC mean = 1 4 9 ) .  These two groups a l s o d i f f e r e d i n t h e p e r c e n t a g e o f time they r e p o r t e d they were t r y i n g t o s l o w down t h e i r e a t i n g (F_^ ^  = 8.13, p_ <.01; SD  mean = 69% v s . NC mean = 4 0 % ) . These were t h e o n l y s i g n i f i c a n t r e s u l t s from t h e d a t a c o l l e c t e d a t two months. A t s i x months, t h e r e was a s u r p r i s i n g f i n d i n g t h a t those who had t h e messages r e p o r t e d 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) t h a n those who d i d n o t have t h e messages (NM mean = 3 . 7 2 ) (__., ^  0  =  64 - 4.61,  p_ .05). <  I n a d d i t i o n t h e r e 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 t h e amount t h e s u b j e c t s r e p o r t e d f e e l i n g b e t t e r about themselves (F^ ^  ~ 6*93, p_ = < .01).  The e x t e n t t o w h i c h the  subject  f e l t b e t t e r about h e r s e l f seemed t o c o r r e s p o n d w i t h t h e amount o f w e i g h t l o s t (SD-M mean = 3 . 5 6 , SD-NM mean = 2 . 3 3 , NC-M mean = 2.22, = 3.22).  NC-NM mean  These were t h e o n l y 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 d a t a  a s i d e from the w e i g h t d a t a . Regressions  i n v o l v i n g w e i g h t change.  To f u r t h e r e x p l o r e t h e f a c -  t o r s w h i c h c o n t r i b u t e t o s u c c e s s f u l w e i g h t l o s s a s i d e from the  manipulated  e x p e r i m e n t a l v a r i a b l e s , m u l t i p l e r e g r e s s i o n s were performed w i t h t h e i n i t i a l demographic d a t a and w i t h t h e two month b e h a v i o u r a l d a t a as p r e d i c t o r s o f w e i g h t change.i  I n t h e 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, y e a r s o v e r w e i g h t ,  drinking pattern, anticipated dif-  f i c u l t y , m o t i v e t o p l e a s e spouse, Rod and Frame T e s t , S e l f - M o n i t o r i n g s c o r e , Autonomic P e r c e p t i o n , i n i t i a l w e i g h t , and number o f c h i l d r e n .  Most  o f 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 o f t h e i r h i g h e r c o r r e l a t i o n s w i t h w e i g h t change a t s i x months.  A stepwise m u l t i p l e r e g r e s s i o n  o f s i x month w e i g h t change on these v a r i a b l e s produced o n l y 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 o f 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 s t a n d a r d i z e d 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 ) o f .38 ( p_< .01, b i v a r i a t e r_ between s i x month w e i g h t change and t h i s p r e d i c t o r = .40)  and m o t i v e t o p l e a s e spouse w i t h a s t a n d a r d i z e d r e g r e s s i o n c o e f f i c i e n t  o f -.38 (p_< .01, b i v a r i a t e r_= - . 4 0 ) .  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 t h e s u b j e c t e x p e c t e d i n c a r r y i n g out the d i e t the more w e i g h t she l o s t .  M o t i v e t o p l e a s e spouse was a  n e g a t i v e p r e d i c t o r , i . e . , the more i m p o r t a n t  l o s i n g weight i n order to  65 p l e a s e h e r spouse was,  the l e s s w e i g h t the s u b j e c t l o s t .  This w i l l  be  d i s c u s s e d more t h o r o u g h l y 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 u s i n g the b e h a v i o u r  r e p o r t d a t a 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 w e i g h t 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 l a n b e i n g used, p e r c e n t a g e of the  stick-  i n g t o d i e t , average d a i l y c a l o r i e s o f e x e r c i s e , p e r c e n t a g e o f time the s u b j e c t a t e i n one p l a c e , p e r c e n t a g e o f time she a v o i d e d o t h e r  activities  w h i l e e a t i n g , amount o f r e p o r t e d h e l p from o t h e r s , p e r c e n t a g e o f time she used a s m a l l e r p l a t e , and more s l o w l y . change and  the p e r c e n t a g e o f time she  t r i e d to e a t  Stepwise m u l t i p l e r e g r e s s i o n s o f (a) two month w e i g h t  (b) s i x month w e i g h t change on these v a r i a b l e s y i e l d e d almost  identical results.  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  age o f time the s u b j e c t r e p o r t e d t o be a t t e m p t i n g t o e a t s l o w l y .  percent For  s i x month w e i g h t change the s t a n d a r d i z e d r e g r e s s i o n c o e f f i c i e n t was L  (p_ <.005-.,bivariate _r = .46) and (p_ < . 0 1 ^ b i v a r i a t e  r_ = .42).  t i o n to be a d e q u a t e l y  Two  The  .42  T h i s r e s u l t i n d i c a t e s t h a t the more the sublost.  o t h e r measures d i d not p r o v i d e enough i n f o r m a -  analyzed s t a t i s t i c a l l y .  These were the e s t i m a t e  time d u r i n g sensory d e p r i v a t i o n and the p r e - t r e a t m e n t eating.  .46  f o r the two month w e i g h t change i t was  j e c t r e p o r t e d b e i n g concerned w i t h e a t i n g s l o w l y the more w e i g h t she Unanalyzed d a t a .  the  time e s t i m a t e was  s e l f monitoring  of of  i n c l u d e d because of i t s p o s s i b l e v a l u e i n  p r e d i c t i n g d r o p - o u t s from SD i n a p o p u l a t i o n w h i c h had been  hypothesized  t o have a h i g h l e v e l o f s t r e s s i n a low s t i m u l u s environment. 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 o f 13%  than the normal r a t e of 5% r e p o r t e d by S u e d f e l d  W h i l e the  (3/23) i s h i g h e r  (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 a n a l y z e the d i f f e r e n c e s i n time e s t i m a -  t i o n between those who  l e f t e a r l y and those who  d a t a a r e -reduced even f u r t h e r s i n c e one drop-out  didn't.  The  available  l e f t sensory d e p r i v a t i o n  a f t e r 45 m i n u t e s , b e f o r e 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 s u b j e c t s who  the s e n s o r y  p r i v a t i o n s e s s i o n was  s u c c e s s f u l l y completed  .61 hour o f f t h e 1.75  hours o f a c t u a l t i m e .  e r r o r s i n e s t i m a t e f o r d r o p - o u t s were .75 and 1.75  hours  (mean =  deThe  1.25  hours). The d a t a from s e l f m o n i t o r i n g were b o t h i n c o m p l e t e and p o o r l y r e p o r t e d . W h i l e most s u b j e c t s d i d hand i n t h e i r forms a f t e r t h e f i r s t week, few handed i n t h e i r m o n i t o r i n g forms f o r t h e f i n a l week.  I n the i n i t i a l moni-  t o r i n g many s u b j e c t s had n o t m o n i t o r e d f o r a complete week and some k e p t 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 r e p o r t e d d a t a were  the amount and t y p e o f food consumed, a l t h o u g h the amount was corded q u i t e v a g u e l y .  often re-  W i t h t h e s e d a t a an attempt was made to e s t i m a t e  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 e s t i m a t e  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 did  demonstrate t h e u n r e l i a b i l i t y o f s u b j e c t r e p o r t e d d a t a .  r e p o r t e d c a l o r i e consumption was of  the d i e t .  T h i s was  1047  The mean  c a l o r i e s p e r day b e f o r e the b e g i n n i n g  lower than the l o w e s t c a l o r i e p l a n w h i c h was  g e s t e d f o r the s u b j e c t s , i . e . , a 1200  calorie diet.  Due  i n c o n s i s t e n c i e s i n these d a t a , no f u r t h e r a n a l y s e s were  sug-  to the g e n e r a l performed.  Some o f the o t h e r d a t a from the s i x month i n t e r v i e w were not anal y z e d due t o t h e i r n o n - q u a n t i t a t i v e n a t u r e .  These d a t a were c h i e f l y  cerned w i t h the s u b j e c t s ' f i n a l i m p r e s s i o n s o f the programme and i o n s f o r i t s improvement. next  section.  con-  suggest-  These d a t a are r e p o r t e d and d i s c u s s e d i n the  DISCUSSION  The  f i n d i n g s s u p p o r t e d the p r e d i c t i o n t h a t 24 hours o f s e n s o r y  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 i v e n e s s of a s t a n d a r d b e h a v i o r a l w e i g h t l o s s programme.  The  effect-  s i x month  w e i g h t change r e s u l t s show the group r e c e i v i n g t h i s t r e a t m e n t t o have been c l e a r l y more s u c c e s s f u l than the o t h e r t h r e e groups. w e i g h t l o s s o f t h i s group was group.  The  average  t w i c e t h a t of the n e x t most s u c c e s s f u l  S i n c e each i n d i v i d u a l r e c e i v e d i d e n t i c a l treatment a s i d e from  t h i s i n i t i a l manipulation,  i t may  be concluded t h a t s e n s o r y 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 w e i g h t 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 w e i g h t change among the o t h e r groups i s c o n s i d e r e d .  The  s i x month  follow-up  showed n e i t h e r an e n v i r o n m e n t a l nor a message e f f e c t on w e i g h t l o s s . s t e a d i t was cant.  the i n t e r a c t i o n between t h e s e two v a r i a b l e s t h a t was  An u n d e r s t a n d i n g  o f t h i s c o n f i g u r a t i o n can be g a i n e d by  the p a t t e r n of l o s s o v e r t i m e . t h e r a p e u t i c messages had  At two months those who  l o s t more w e i g h t than those who  them, r e g a r d l e s s of e n v i r o n m e n t a l c o n d i t i o n .  In-  signifi-  examining  had heard  the  had not heard  T h i s 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 w h i c h i n c l u d e d 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 exercise information.  Many of the s u b j e c t s who  heard the messages com-  mented f a v o u r a b l y on the m a t e r i a l and s e v e r a l r e q u e s t e d tape.  t r a n s c r i p t s of  (For s t a n d a r d i z a t i o n purposes these r e q u e s t s were p o l i t e l y  These p o s i t i v e r e a c t i o n s came from b o t h groups who  the  refused!'.)  had h e a r d the messages,  68 but more f r e q u e n t l y from those i n the n o n c o n f i n e d group.  In fact  s e v e r a l s e n s o r y d e p r i v a t i o n s u b j e c t s r e p o r t e d t h a t they d i d n o t r e a l l y remember t h e s p e c i f i c messages.  The u s e f u l c o n t e n t o f the messages com-  b i n e d w i t h the f a v o u r a b l e 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  effect.  The message e f f e c t , however, was no l o n g e r p r e s e n t a t s i x months. T h i s reduced e f f e c t i v e n e s s was p r o b a b l y due t o the l o s s o f r* impact as a r e s u l t o f g r a d u a l l y f o r g e t t i n g the message c o n t e n t .  Most of the r e -  q u e s t s t o hear the tape a g a i n and f o r c o p i e s o f the tape were l a t e r i n the programme; some s u b j e c t s s t a t e d they needed a b o o s t by h e a r i n g t h e tapes a g a i n . An i m p o r t a n t f a c t o r i n the p o o r e r p r o g r e s s l a t e r i n t h e study was i n f r e q u e n t c o n t a c t w i t h the e x p e r i m e n t e r .  I n f a c t , i n the f i n a l  interview,  the most common s u g g e s t i o n for. i m p r o v i n g the programme was t o have more frequent v i s i t s .  I n the H a t e r p o r t i o n o f t h e s t u d y , f o l l o w - u p s e s s i o n s  were one o r two months a p a r t and a p p a r e n t l y t h i s was n o t f r e q u e n t enough. Having t o r e p o r t t o be weighed p r o v i d e d a s t r o n g 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 o f s u b j e c t s r e g a r d l e s s o f treatment group,  s i n c e most sub-  j e c t s l o s t more w e i g h t i n t h e f i r s t two months t h a n o v e r t h e l a s t f o u r months. of  The w e i g h t change curve f o r t h e combined groups shows a l e v e l i n g  the l o s s curve t h a t resembles the u s u a l r e t e n t i o n c u r v e i n l e a r n i n g .  However, t h e r e 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 w e i g h t change d u r i n g t h i s p e r i o d . at  The s i g n i f i c a n t main e f f e c t f o r environment  t h i s time was due t o c o n t i n u e d w e i g h t l o s s a t 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 o r w i t h o u t messages, w h i l e the n o n c o n f i n e d  group e i t h e r g a i n e d w e i g h t o r remained the same. t i o n w i t h message group c o n t i n u e d  The s e n s o r y  depriva-  t o l o s e a t t h e same r a t e up u n t i l t h e  l a s t two months when t h e r e was some s l o w i n g o f t h e l o s s r a t e .  The s e n -  s o r y d e p r i v a t i o n group w i t h o u t messages d i d n o t r e a l l y b e g i n l o s i n g w e i g h t u n t i l a f t e r the two month f o l l o w up (See F i g u r e 1 ) . The c o m b i n a t i o n o f messages which were more e f f e c t i v e o v e r the f i r s t two months w i t h sensory d e p r i v a t i o n w h i c h was more e f f e c t i v e over t h e l a s t f o u r months makes t h e f i n a l s i x month r e s u l t s more u n d e r s t a n d a b l e . The combined e a r l y e f f e c t i v e n e s s o f t h e messages w i t h t h e l a t e r e f f e c t i v e ness o f s e n s o r y d e p r i v a t i o n e x p l a i n s why t h e s e n s o r y d e p r i v a t i o n w i t h messages was t h e most e f f e c t i v e t r e a t m e n t . MotivationaTlEffects The f i n d i n g t h a t those who had s e n s o r y d e p r i v a t i o n l o s t more w e i g h t d u r i n g t h e l a s t f o u r months s u g g e s t s t h a t s e n s o r y d e p r i v a t i o n may some s o r t o f m o t i v a t i o n a l b o o s t o r i n c r e a s e i n r e s o l v e .  provide  I n t h e group  w h i c h had sensory d e p r i v a t i o n w i t h o u t messages t h i s was something o f a " s l e e p e r e f f e c t " i n t h a t they had l o s t v e r y l i t t l e w e i g h t d u r i n g t h e f i r s t two months.  Another f i n d i n g which supports the i d e a o f a m o t i v a t i o n a l  b o o s t i s the d i f f e r e n t i a l dropout r a t e between the groups.  A f t e r t h e be-  g i n n i n g o f 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  containing  i n s t r u c t i o n s i n t h e d i e t and e x e r c i s e p l a n , t h e r e was o n l y one dropout from the combined s e n s o r y d e p r i v a t i o n groups and t h a t one was i n t h e no message t r e a t m e n t . t h r e e i n each group.  The n o n c o n f i n e d groups had a t o t a l o f s i x d r o p o u t s , Not o n l y d i d t h e s e n s o r y d e p r i v a t i o n groups l o s e  more w e i g h t i n t h e l a s t f o u r months, b u t they had f a r fewer dropouts  70 d u r i n g the e n t i r e programme.  T h i s i s s t r o n g evidence f o r a m o t i v a t i o n a l  e f f e c t o f sensory d e p r i v a t i o n . There were a l s o t h r e e s u b j e c t s who t e r m i n a t e d the s e n s o r y 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 f o r c e d t o drop out of the programme. However, the reasons f o r d r o p p i n g o u t of s e n s o r y d e p r i v a t i o n a r e q u i t e d i f f e r e n t from those f o r d r o p p i n g o u t o f an ongoing d i e t regimen.  Sub-  j e c t s t e r m i n a t e t h e 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 t o o b o r i n g o r too u p s e t t i n g t o c o n t i n u e ; s u b j e c t s drop out o f a d i e t  programme  c h i e f l y because they a r e n o t l o s i n g w e i g h t and a r e d i s c o u r a g e d .  Neverthe-  l e s s , even w i t h these d i f f e r e n t m o t i v e s , i t i s c o n c e i v a b l e t h a t the sens o r y d e p r i v a t i o n e x p e r i e n c e s e r v e d t o s c r e e n out those who were p o o r l y m o t i v a t e d and hence t o reduce the l a t e r dropout  rate.  The case o f one s u b j e c t speaks a g a i n s t t h i s p o s s i b l e  interpretation.  The s u b j e c t who t e r m i n a t e d s e n s o r y d e p r i v a t i o n a f t e r 45 minutes was ext r e m e l y upset a t the time and a l s o a n x i o u s n o t t o be e x c l u d e d from the r e s t o f the programme.  I n o r d e r t o comfort h e r a t t h e t i m e , she was  she would n o t be e x c l u d e d .  told  She was, i n f a c t , put through the r e s t o f the  s i x months r e c e i v i n g the same t r e a t m e n t as a l l o t h e r 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 h e r weight l o s s was n o t l a r g e . W h i l e h e r d a t a were n o t i n c l u d e d i n any group, she does p r o v i d e e v i d e n c e t h a t the m o t i v e s f o r r e m a i n i n g i n s e n s o r y d e p r i v a t i o n and f o r r e m a i n i n g 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 t h a t s u b j e c t s dropped out o f the programme because they were d i s a p p o i n t e d w i t h t h e i r own p r o g r e s s has o t h e r i m p l i c a t i o n s f o r the results.  The d a t a o f dropouts were e x c l u d e d from a l l a n a l y s e s except the  i n i t i a l a n a l y s e s o f demographic v a r i a b l e s .  Had i t been p o s s i b l e t o  71 i n c l u d e t h e i r w e i g h t s a t s i x months, the o v e r a l l r e s u l t s w o u l d most p r o b a b l y have been q u i t e d i f f e r e n t .  The f a c t t h a t dropouts l o s t  less  w e i g h t 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 o f dropouts among the groups suggest t h a t the r e s u l t s as they s t a n d are on the c o n s e r v a t i v e side.'  If  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 c o u l d have been i n c l u d e d i n the f i n a l a n a l y s e s , the o t h e r groups, e s p e c i a l l y the n o n c o n f i n e d  groups,  would have had s i g n i f i c a n t l y l e s s w e i g h t l o s s e s than the s e n s o r y d e p r i v a t i o n w i t h message group which had no d r o p o u t s .  T h i s may  account a t  l e a s t i n p a r t f o r the r e l a t i v e success o f the n o n c o n f i n e d - no message group which had t h r e e s u b j e c t s who  dropped out of the s t u d y .  Comparison w i t h o t h e r SD S t u d i e s I t i s i n t e r e s t i n g to compare t h e p r o c e d u r e i n t h i s s t u d y 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 . I k a r d experiment  I n the S u e d f e l d and  (1974) the s e n s o r y d e p r i v a t i o n and message v a r i a b l e s  were m a n i p u l a t e d i n the same way  as i n the p r e s e n t s t u d y .  As  mentioned  p r e v i o u s l y , sensory d e p r i v a t i o n t r e a t m e n t s w i t h and w i t h o u t messages were of  comparable e f f e c t i v e n e s s .  I n t h e p r e s e n t study the s e n s o r y d e p r i v a -  t i o n group w i t h o u t messages d i d v e r y p o o r l y 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 n a t u r e s of the problems b e i n g d e a l t l w i t h . nonerc type o f problem w h i l e o v e r e a t i n g i s n o t .  Smoking i s an a l l o r  O b e s i t y i s a problem t h a t  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 q u i r e s more e x t e r n a l i n f l u e n c e t o modify b e h a v i o r than does smoking. F o r these;;reasons the messages may s t u d y than i n the smoking s t u d y .  have been more i n f l u e n t i a l i n t h i s I n the smoking s t u d y ( S u e d f e l d and  72 I k a r d , 1974), however, s e n s o r y d e p r i v a t i o n was  not w o r k i n g as an a d j u n c t  to some o t h e r t r e a t m e n t ; i t and the messages r e p r e s e n t e d the e n t i r e treatment. A more r e c e n t study by S u e d f e l d and Best ( i n p r e p a r a t i o n ) 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 o f the smoking problem.  treatment  The c o m b i n a t i o n o f 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 p l u s 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 fact,  e f f e c t i v e n e s s o f the two t e c h n i q u e s appeared to be a d d i t i v e .  the  T h i s smoking  s t u d y i n v o l v i n g a c o m b i n a t i o n o f t e c h n i q u e s , has more i n common w i t h the p r e s e n t s t u d y , w h i c h combined s e n s o r y d e p r i v a t i o n W i t h a weight  plan  ( S t u a r t and D a v i s , 1972). Comparison With Other Weight R e d u c t i o n  Studies  A n o t h e r i m p o r t a n t comparison f o r t h i s s t u d y . i s w i t h o t h e r t i o n s o f weight programmes. out i t s problems.  investiga-  U n f o r t u n a t e l y such a comparison i s not w i t h -  T h i s s t u d y was  designed  t o t e s t whether s e n s o r y  v a t i o n and messages a i d e d an a l r e a d y t e s t e d weight p l a n .  The  depri-  treatment  p e r i o d c o n s i s t e d c h i e f l y o f 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 a f t e r w a r d s .  The  f i v e follow-up sessions  o v e r t h e next 24 weeks cannot, however, be s a i d to be t o t a l l y therapeutic effect.  Not o n l y was  f r e e of  t h e r e some r e i t e r a t i o n o f p o i n t s i n the  p l a n , but the c o n t a c t i t s e l f and t h e n e c e s s i t y o f w e i g h i n g o n e s e l f have been shown t o have t h e r a p e u t i c e f f e c t s (Hagen, 1974).  One  f o r e 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 l e n g t h o f f o l l o w - u p i n the p r e s e n t s t u d y . to say t h a t treatment  problem t h e r e from the  While i t i s probably  incorrect  c o n s i s t e d o n l y o f the s e n s o r y 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 t h a t treatment A n o t h e r method o f a s s e s s i n g treatment w i t h the e x p e r i m e n t e r .  l a s t e d f o r s i x months.  l e n g t h i s the amount o f  Measured i n t h i s way,  treatment  c o n s i s t e d o f s i x t h e r a p i s t s e s s i o n s each o f which was The  24-hour s e n s o r y  i n this  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 c o n t a c t .  the l e n g t h o f treatment  subjects,  v a r i e d between f o u r weeks and e i g h t e e n weeks w i t h  f o l l o w - u p s r a n g i n g from none a t a l l t o one y e a r .  G e n e r a l l y treatment  study  one hour l o n g .  I n o t h e r o b e s i t y s t u d i e s t h a t used more than one o r two  the e x p e r i m e n t e r was  contact  T y p i c a l l y , contact with  on a weekly b a s i s throughout the treatment  period.  s e s s i o n s 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 o f o t h e r s t u d i e s w h i c h used behaviour  management t e c h n i q u e s  i s presented  i n T a b l e 6.  This t a b l e i s  adapted from Leon (1976) and i n c l u d e s o n l y s t u d i e s w i t h more than two jects. for  The  r e s u l t s of the p r e s e n t  more d i r e c t comparison.  sub-  study have been t r a n s l a t e d i n t o pounds  For t h i s t a b l e , treatment  i n the  present  study i s c o n s i d e r e d the f i r s t two-month p e r i o d and the f o l l o w - u p i s the s i x month d a t a .  T h i s 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 o f treatment sensory  l e n g t h i s d i f f i c u l t i n t h i s study.  The  d e p r i v a t i o n s e s s i o n and enough o f the e x p e r i m e n t e r c o n t a c t d i d  o c c u r d u r i n g the f i r s t two months to w a r r a n t t h i s d e l i n e a t i o n i n the table. An o v e r a l l comparison o f the r e s u l t s of the c u r r e n t study w i t h  the  r e s u l t s o f the o t h e r s t u d i e s i n T a b l e 6 show the p r e s e n t p r o c e d u r e t o be on a p a r w i t h most of the o t h e r s .  The  r e s u l t s at 2 months f o r the  d e p r i v a t i o n w i t h message treatment  i s comparable to e l e v e n weeks o f  sensory  TABLE 6 (Adapted from Leon, 1976) Study  No. o f S's  P r e s e n t Study  Treatment Period , , v (wks)  Weight L o s s ( l b s ) ; Follow-up _ _ , _ Period PreEnd o f . ^ treatment treatment SD-M SD-NM NC-M NC-NM  39  8.07 .23 5.73 5.17 12.0  Stuart  (1967)  8  12  Stuart  (1971)  6  15  treatment delayed t r e a t ,  15.0 +5.0  H a r r i s (1969)  21  9-11  A v e r s i v e cond,  8.1 6.9  Control S o c i a l P r e s s u r e 5.4 Nonspecific 6.9 Learning 10.33 Control +2.39  W o l l e r s h e i m (1970)  79  12  Hagen (1974)  89  10  P e n i c k , F i l i o n , Fox & S t u n k a r d (1971)  32  12  Contact Manual & Contact Manual Control Behav. Mod. Group Therapy  11.94  4 mos.  12 mo.  > > > >  20 30 40 20  12.91 2.39 1.48 5.19 37.7  3-6 mos.  35.0 21.0  1 mo.  11.1 9.9 +3.6  2 mo.  3.54 6.52 8.61  1 mo.  12.27 13.34 10.50 .11  15.00 12.00 1.80 53% 33% 13% 24%  Weight l o s s pretreatment^- -i i follow-up  l b . 3 mo. lb. lb. lb.  53% 40% 27% 29% 18% 12%  20 30 40 20 30 40  lb. lb. lb. lb. lb. lb.  T a b l e 6 (cont'd) Monetary Behavioral Soc. R e i n f . Control  11.67 12.19 8.09 +1.70  10  Experimenter Controlled Self Controlled  10.1 5.6  21  6  Diet Group Therapy B e h a v i o r . Mod.  32  12  Abrahms and A l l e n (1974)  49  9  H a l l (1972)  14  Harmatz & Lapuc (1963)  Harris  & B r u n e r (1971)  J e f f r e y <? C h r i s t i a n (1972)  43  18  Mahoney, Mowra & Wade (1973)  53  4  0 4.90 7.8  Self Control Contract AttentionPlacebo  +1.5  Behav. Ther. W i l l Power Control  16.31 5.09 1.70  S e l f Reward S e l f Punishment Both Self Monitoring I n f o r m a t i o n Con.  7.4 13,4  6.4 3.7 5.2 .8 1.4  2 mo.  11.17 12.2811.25 +1.16  1 mo.  0 2.94 13.66  10 mo.  .6 +11.3 +9.4  4-1/2 mo.  4 mo.  16.31  11.5 7.3 12.0 4.5 3.2  75 a v e r s i v e c o n d i t i o n i n g ( H a r r i s , 1969), n i n e weeks o f s o c i a l r e i n f o r c e m e n t (Abrahms and A l l e n , 1974), s i x weeks o f b e h a v i o u r m o d i f i c a t i o n (Harmatz and Lapuc, 1968), o r 12 weeks o f a s e l f - c o n t r o l t r e a t m e n t ( H a r r i s and B r u n e r , 1971), t o name a few.  The p r e s e n t s t u d y compares f a v o r a b l y w i t h  the o t h e r s i n t h e p e r i o d between treatment and f i n a l  follow-up.  The ma-  j o r i t y o f o t h e r t r e a t m e n t s showed e i t h e r maintenance o f t h e weight or  a c t u a l w e i g h t g a i n d u r i n g t h e f o l l o w up p e r i o d .  lost  By c o n t r a s t , b o t h o f  our s e n s o r y d e p r i v a t i o n groups l o s t w e i g h t d u r i n g t h e f o l l o w - u p p e r i o d . • O v e r a l l , t h e p r e s e n t p r o c e d u r e appears no l e s s e f f e c t i v e t h a n o t h e r - t e c h n i q u e s and c o n s i d e r i n g t h e amount o f t h e r a p i s t time i n v o l v e d i s - genera l l y more c o s t - e f f i c i e n t .  The n e x t s t e p 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 t o  combine s e n s o r y d e p r i v a t i o n and t h e r a p e u t i c messages w i t h a r e g u l a r weekly contact schedule.  T h i s treatment procedure i s c u r r e n t l y b e i n g s t u d i e d  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 p r o g r e s s ) .  Treatment o f M e t h o d o l o g i c a l Problems A d d i t i o n a l comparative e v a l u a t i o n o f t h e p r e s e n t s t u d y can be made r e g a r d i n g t h e h a n d l i n g o f m e t h o d o l o g i c a l problems common i n o b e s i t y r e search.  These problems were s p e l l e d o u t i n d e t a i l i n t h e f i r s t c h a p t e r .  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 n o t be made h e r e ; i n s t e a d an e x a m i n a t i o n w i l l be made o f t h e manner i n w h i c h t h e p r e s e n t study for  accounted  t h e s e 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  s t e p t a k e n t o meet t h e o b j e c t i o n s r a i s e d about s u b j e c t p o p u l a -  t i o n s was t h e r e c r u i t m e n t o f s u b j e c t s from a more g e n e r a l p o p u l a t i o n than university students. background  T h i s a s s u r e d a w i d e r age range and b r o a d e r  i n t h e e x p e r i m e n t a l sample.  social  The age range was between 21 and  76 57 y e a r s .  W h i l e no d i r e c t measure o f s o c i a l s t a t u s was t a k e n , t h e l e v e l  o f e d u c a t i o n ranged  from grade 9 t o p o s t g r a d u a t e degrees.  Other  evidence  i n f a v o u r o f t h i s sample b e i n g v e r y g e n e r a l i z a b l e t o t h e p o p u l a t i o n o f obese women i s t h a t a l a r g e p r o p o r t i o n o f t h e sample had p r e v i o u s l y t r i e d such commercial w e i g h t programmes as Weight Watchers and TOPS. degree o f w e i g h t problems covered a broad  Also the  range.  C o m p l a i n t s h'ave been made a g a i n s t t h e poor r e p o r t i n g o f 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 p r e s e n t study r e c o r d e d a l a r g e amount o f p e r -  s o n a l d a t a , b o t h demographic and p e r s o n a l i t y , and these d a t a were anal y z e d b o t h i n c h e c k i n g f o r group d i f f e r e n c e s and t o attempt t o d i s c o v e r p r e d i c t o r s o f success.  Not o n l y were t h e e x p e r i m e n t a l groups e q u i v a l e n t  on t h e s e demographic and p e r s o n a l i t y v a r i a b l e s , b u t t h e r e were no d i f f e r ences between t h e s u b j e c t s who remained i n t h e programme and those who t e r minated  early.  More d e t a i l e d r e p o r t i n g o f t h e v a r i o u s i n d i v i d u a l d a t a can  be found i n Appendix A. Toward s o l v i n g t h e problem o f d r o p o u t s , . s t e p s were t a k e n t o l o w e r a t t r i t i o n r a t e s b y r e q u i r i n g a 25 d o l l a r d e p o s i t t h a t would be r e t u r n e d a t the c o m p l e t i o n o f t h e programme.  W h i l e t h i s may have reduced t h e dropout  r a t e somewhat, t h e f a c t t h a t t h e d e p o s i t was t o go t o a worthy c h a r i t y , t h e Canadian Heart Fund, made f o r f e i t u r e l e s s u n p l e a s a n t .  In fact several  s u b j e c t s p r e f e r r e d t o donate t h e i r d e p o s i t even a f t e r s u c c e s s f u l l y comp l e t i n g t h e programme.  P r e d i c t o r s o f Weight Loss The s e a r c h 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 o f s u c c e s s y i e l d e d o n l y t h r e e 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 e x p e c t a -  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  tance o f p l e a s i n g one's spouse. s u c c e s s f u l the s u b j e c t was t h a t when one  The  s t r o n g e r t h i s m o t i v e was,  i n the programme.  i s t r y i n g t o l o s e w e i g h t f o r someone e l s e , even a v e r y c l o s e  to have the g r e a t e s t l i k e l i h o o d o f success must want to do i t f o r h e r s e l f .  I n o r d e r f o r the p e r s o n  i n l o s i n g weight that person  T h i s f i n d i n g i s p a r a l l e l e d by one  i n the S u e d f e l d & I k a r d (1973) smoking study i n w h i c h one subject admitted  The  the programme. than those who  t h a t she r e a l l y o n l y j o i n e d the study i n o r d e r t o p l a c a t e  wanted h e r t o q u i t smoking. the amount  t h a t the s u b j e c t 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 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 w e i g h t  thought i t would be e a s i e r .  r e a l i s t i c v i e w o f the h a r d s h i p factor.  case  unsuccessful  e x p e c t a t i o n v a r i a b l e t h a t p r e d i c t e d w e i g h t l o s s was  of d i f f i c u l t y  the l e s s  The i m p l i c a t i o n h e r e i s  o t h e r , t h e r e i s a p o o r e r chance o f s u c c e e d i n g .  h e r f a m i l y who  the impor-  This f i n d i n g i m p l i e s that a  i n v o l v e d i n l o s i n g w e i g h t i s an  important  L o s i n g weight i s hard work and a t times d i s a p p o i n t i n g , and  e a r l y r e a l i z a t i o n o f t h i s f a c t h e l p s one  to deal w i t h i t .  On the  an  other  hand, u n r e a l e x p e c t a t i o n s o f an easy o r " m a g i c a l " s o l u t i o n l e a d t o poor progress. The  f i n a l p r e d i c t o r was  f o r t the s u b j e c t was  the b e h a v i o u r a l s e l f - r e p o r t o f how  making t o slow down her e a t i n g .  Those who  much e f reported  e a t i n g s l o w l y a g r e a t e r p e r c e n t a g e o f the time l o s t g r e a t e r amounts o f w e i g h t than those who  r e p o r t e d e a t i n g s l o w l y l e s s o f the time.  the o n l y b e h a v i o u r a l f a c t o r t h a t d i d p r e d i c t w e i g h t l o s s . the b e h a v i o u r o f food.  This  was  This i s also  step t h a t 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  I t i s q u i t e probable', t h a t more c o n c e r n w i t h t h i s s t e p . i s an  78 expression  of i n c r e a s e d awareness o f the e a t i n g p r o c e s s .  e a t i n g i s the major cause of o v e r w e i g h t , i n c r e a s e d  Since  over-  a t t e n t i o n to the a c t u a l  performance of the a c t of e a t i n g i s one v e r y 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 t h a t t h e s e p a r t i c u l a r v a r i a b l e s were the o n l y  p r e d i c t o r s of w e i g h t l o s s has ment of o b e s i t y . one  significant  some f o r t u n a t e i m p l i c a t i o n s f o r the t r e a t -  W h i l e these t h r e e 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  a n o t h e r , they do have the common f e a t u r e of b e i n g  changeable  t r a i n a b l e v a r i a b l e s r a t h e r t h a n permanent s u b j e c t v a r i a b l e s . 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 possible alternative predictors.  and  One  way  to  consider  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 o f 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 b e s t p r e d i c t o r o f s u c c e s s ,  then those not p o s s e s s i n g  " r i g h t q u a l i t y " on t h e s e f a c t o r s would have a poor p r o g n o s i s i s l i t t l e hope of changing t h a t q u a l i t y .  the  since  But as i t i s , each of the  a b l e s found to be a good p r e d i c t o r i s m a n i p u l a b l e .  there vari-  T h i s 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 t o a t t i t u d e s t h a t 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 i n c r e a s e d emphasis on the import a n c e of e x p e c t i n g  d i f f i c u l t y , o f l o s i n g w e i g h t f o r y o u r s e l f and not  o t h e r s , and o f e a t i n g s l o w l y at a l l t i m e s .  Considering  this,  i t i s pro-  b a b l e t h a t 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 d e p r i v a t i o n and messages c o n t r i b u t e d t o i t s g r e a t e r s u c c e s s . t h e r e were no s i g n i f i c a n t i n t e r g r o u p to s u p p o r t t h i s  for  sensory  However,  d i f f e r e n c e s on these t h r e e v a r i a b l e 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 d a t a  79 were c o l l e c t e d and r e p o r t e d .  Moreover, c r u c i a l d a t a such as w e i g h t were  c o l l e c t e d by the e x p e r i m e n t e r r a t h e r than r e l y i n g on s u b j e c t r e p o r t .  A  g r e a t d e a l has been s a i d a g a i n s t u s i n g a b s o l u t e w e i g h t change as the s o l e c r i t e r i o n of success.  F o r t h i s r e a s o n , measurements o f s k i n f o l d s  i n c l u d e d i n the p r e s e n t s t u d y .  were  W h i l e t h e r e 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 w e i g h t change and  s k i n f o l d change, t h e r e were no s i g n i f i c a n t treatment e f f e c t s on t h e  skinfold variable. the e f f e c t i v e n e s s  T h i s r e s u l t might be viewed as a statement a g a i n s t o f the t r e a t m e n t ; however, i t i s more p r o b a b l y 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 o f s k i n f o l d measures. trained  and p r a c t i c e d  Even f o r a w e l l  i n d i v i d u a l , i t i s d i f f i c u l t t o get the e x a c t same  r e a d i n g s w i t h r e p e a t e d measurements (Mayer, 1968; Grimes & F r a n z i n i , 1976) .  F o r t h i s r e a s o n an average o f t h r e e s e p a r a t e measurements a t each  s i t e was used i n t h i s s t u d y . A more c r i t i c a l problem i s the f a c t t h a t t h e c o r r e l a t i o n s w e i g h t 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 between w e i g h t change and i n f r a s c a p u l a r  between  small.  The h i g h e s t ,  s k i n f o l d , was o n l y .50 w h i c h  l e a v e s much room f o r v a r i a t i o n . A c t u a l l y many s u b j e c t s showed w e i g h t 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 o t h e r , o r w e i g h t change and no s k i n f o l d change, o r v i c e v e r s a .  Many o f t h e s u b j e c t s showed  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 . f o l d measurements may be much more i n f l u e n c e d and  differen-  I t seems t h e n , t h a t by such f a c t o r s  skin-  as type  q u a n t i t y o f e x e r c i s e (Grimes & F r a n z i n i , 1976), and t h e r e f o r e a r e n o t  especially reliable c r i t e r i a for overall fat loss.  I t i s probable that  i n the case o f l a r g e r weight l o s s e s s k i n f o l d measures might be a more v a l u a b l e criterion variable.  I t i s also possible  t h a t by i n c l u d i n g  a l a r g e r number  80 o f 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 i n c r e a s e d . t h i s s t u d y the two  However, i n  s i t e s r e p o r t e d t o be most i n d i c a t i v e o f 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  A n o t h e r f e a t u r e i n c l u d e d i n t h i s study was  a s u g g e s t i o n by  (1973) t o r e c o r d s u b j e c t s ' responses t o the programme i t s e l f .  Stuart 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-  t h e r she  f e l t b e t t e r i n g e n e r a l 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. of programme s u c c e s s ,  f e e l i n g b e t t e r about o n e s e l f , and  Opinions  feeling healthier  were a l l i n t e r e o r r e l a t e d but more i m p o r t a n t l y they were each r e l a t e d to w e i g h t change. success. she  T h i s was  most pronounced w i t h the f e e l i n g of the programme's  L o g i c a l l y , the more w e i g h t the s u b j e c t l o s t the more s u c c e s s f u l  f e l t the programme The most f r e q u e n t  was. responses t o the q u e s t i o n c o n c e r n i n g  the programme's  b e s t a s p e c t s were: the book (28% o f the s u b j e c t s mentioned t h i s ) , diet i t s e l f  (28%) , and  the e x e r c i s e ( 3 3 % ) .  A l t h o u g h e x e r c i s e was  the men-  t i o n e d the most f r e q u e n t l y many s u b j e c t s a l s o commented t h a t i t would have been good i f they had been a b l e to s t i c k t o i t . t o n o t e t h a t n i n e of the 11 who  l i s t e d the book as the b e s t f e a t u r e  not heard the tape r e c o r d e d messages. tape was  one  I t i s also interesting  However o n l y two  o f the b e s t a s p e c t s o f the programme.  had  s u b j e c t s s a i d the  Others; o f t e n mentioned  " b e s t " f e a t u r e s 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 p l a c e  (18%).  The  mentioned as a " b e s t " a s p e c t by o n l y t h r e e  sensory d e p r i v a t i o n s e s s i o n (15%) of the 20 s u b j e c t s  who  was  81 experienced  i t but a n o t h e r 15% r e p o r t e d t h a t they d i d not know whether  i t had been b e n e f i c i a l o r n o t . On the o t h e r hand 20% o f the sensory sensory  deprivation subjects  d e p r i v a t i o n as the programme's w o r s t a s p e c t .  listed  The most f r e q u e n t l y  mentioned " w o r s t " f e a t u r e s were the i n f r e q u e n c y o f f o l l o w - u p v i s i t s having  to keep r e c o r d s  gramme ( 1 3 % ) . was  ( 1 8 % ) , and the i n c o n v e n i e n t l o c a t i o n o f the  With suggestions  much more consensus.  (28%) pro-  f o r improvement o f the programme t h e r e  T w e n t y - s i x (66%) s u b j e c t s suggested t h a t more  c o n t a c t would be h e l p f u l and 11 (28%) thought t h a t m e e t i n g i n groups would be an improvement. t h r e e s u b j e c t s was  The  o n l y o t h e r improvement mentioned by more than  t o h e a r the taped messages a g a i n ( 1 5 % ) .  these s u b j e c t s were i n the message o n l y group.  A l l s i x of  Three o f the sensory  p r i v a t i o n s u b j e c t s s a i d they would have l i k e d another s e s s i o n o f  de-  sensory  deprivation. S e v e r a l o t h e r improvement s u g g e s t i o n s were made by o n l y one o r s u b j e c t s but seem w o r t h m e n t i o n i n g because o f t h e i r p o t e n t i a l to o t h e r programmes.  I t was  suggested t h a t the book d i d not  two  usefulness 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 t h a t more d i r e c t i o n s h o u l d 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 o f group e x e r c i s e s e s s i o n s .  One  s u b j e c t suggested t h a t i t would be of b e n e f i t b o t h to the i n d i v i d u a l  and  t o the programme i f p a r t i c i p a n t s had f o r the programme.  the o p t i o n t o v o l u n t e e r time t o work  A s s i s t a n c e p r o v i d e d i n t h i s way  t o meet some o f the o t h e r s u g g e s t i o n s ,  might be a good  such as. more l i t e r a t u r e  way  available,  more c o n t a c t w i t h f a m i l i e s to g a i n t h e i r s u p p o r t , and a l o n g e r programme in  general.  82 Treatment Format The  t h i r d major a r e a o f m e t h o l o g i c a l o b j e c t i o n s i s t h a t o f t h e a c -  t u a l treatment format.  The s t e p s t a k e n i n t h i s s t u d y t o meet t h e s e p r o -  blems were t o use a s t a n d a r d d i e t form, t o use s t a n d a r d i z e d i n t e r v i e w and f o l l o w - u p p r o c e d u r e s , and t o f o l l o w s u b j e c t s f o r a t l e a s t s i x months. The s t a n d a r d d i e t and e x e r c i s e p l a n used was t h a t i n t h e b o o k l e t S l i m Chance i n a F a t World  ( S t u a r t and D a v i s , 1972) which had t h e advantage o f  being a tested,commercially a v a i l a b l e product.  Standardized handling o f  s u b j e c t s was a c h i e v e d by u s i n g p r e p a r e d d a t a c o l l e c t i o n forms which r e quired s p e c i f i c interview questions.  Differences i n experimenter-subject  c o n t a c t o c c u r r e d o n l y when s u b j e c t s asked q u e s t i o n s about s p e c i f i c a l problems.  person-  Response t o t h e s e q u e s t i o n s was made as s t a n d a r d as p o s s i b l e  by u s i n g t h e t e x t and t h e taped message c o n t e n t as g u i d e l i n e s .  Neverthe-  l e s s i t cannot be s a i d t h a t each s u b j e c t r e c e i v e d 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 d o u b t f u l though t h a t such minor d i s c r e p a n c i e s  i n s u b j e c t h a n d l i n g would have had any n o t i c e a b l e e f f e c t on t h e o v e r a l l results.  T h i s i s so e s p e c i a l l y s i n c e t h e r e i s no reason t o suspect any  s y s t e m a t i c between-group d i f f e r e n c e s i n t r e a t m e n t . R e l e v a n t t o t h i s l a s t p o i n t i s an i s s u e w h i c h remained a problem i n t h i s s t u d y as w e l l .  Throughout t h e s t u d y s u b j e c t s were seen by o n l y one  e x p e r i m e n t e r who knew t h e r e l e v a n t hypotheses  and p r e d i c t i o n s o f t h e s t u d y .  D u r i n g the r u n n i n g o f t h e s t u d y , however, t h e e x p e r i m e n t e r was  concerned  o n l y w i t h the w e l f a r e and p r o g r e s s o f each s u b j e c t 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 t o i g n o r e 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 t h a t t h e r e was no group p a t t e r n t o t h e s c h e -  83 d u l i n g of i n t e r v i e w s and  follow-ups.  I n most r e s p e c t s , t h e n , the metho-  d o l o g i c a l problems seem t o 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  i m p o r t a n t c o n s i d e r a t i o n y e t t o be d i s c u s s e d  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 .  i s how  the p r e s e n t  W h i l e 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 t h e o r y o f o b e s i t y , the s t u d y d i d i n c l u d e d a t a r e l e v a n t t o S c h a c h t e r ' s s u g g e s t i o n s 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 s u b j e c t s were t e s t e d  on a b a t t e r y o f 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 t h e s e 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 w e i g h t , though t h e r e were e x c e p t i o n s .  Heavier subjects did e x h i b i t higher e x t e r n a l i t y  s c o r e s on the Locus of C o n t r o l t e s t .  T h i s was  t r u e o n l y f o r the  total  Locus of C o n t r o l s c o r e and not f o r the i n d i v i d u a l s u b s c a l e s , w h i c h sugg e s t s t h a t perhaps e x t e r n a l i t y i n o v e r w e i g h t i n d i v i d u a l s i s a v e r y factor.  I f t h i s i s s o , i t may  be  general  t h a t the o t h e r 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 c o n t e n t t o tap the i n t e r n a l - e x t e r n a l dimension adequately.  On the o t h e r hand, the c o r r e l a t i o n between Locus o f C o n t r o l  i n i t i a l w e i g h t , a l t h o u g h 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 to d e s c r i b e a s l i g h t tendency. measure has  and  o n l y l a r g e enough  I t i s also i n t e r e s t i n g that this p a r t i c u l a r  f a i l e d t o d i s c r i m i n a t e w e i g h t groups i n o t h e r  studies  (Gormanous and Lowe, 1975). Another measure r e l a t e d to i n i t i a l w e i g h t was t i o n score. subjects.  the Autonomic P e r c e p -  More awareness o f autonomic a c t i v i t y was T h i s i s e x a c t l y the o p p o s i t e  r e p o r t e d by  to what S c h a c h t e r ' s  w o u l d p r e d i c t , w h i c h i s t h a t the h e a v i e r s u b j e c t s h o u l d  heavier  hypothesis  exhibit less  84 awareness o f i n t e r n a l cues. s e l f - r e p o r t s c a l e , may  T h i s p a r t i c u l a r measure, b e i n g a s u b j e c t i v e  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 .  M c F a r l a n d (1975) found t h i s  measure t o be a p o o r p r e d i c t o r of a s u b j e c t ' s actual heart a c t i v i t y .  a b i l i t y to perceive h i s  I n t e r p r e t e d as a measure of i n t e r n a l c o n c e r n , the  p r e s e n t f i n d i n g p r o v i d e s some s u p p o r t f o r the m i s l a b e l e d sis.  emotion hypothe-  Overweight p e r s o n s are more f o c u s e d on i n t e r n a l f u n c t i o n s but  not a b l e t o c l e a r l y p e r c e i v e One  are  and d i f f e r e n t i a t e those f u n c t i o n s .  of the major reasons f o r i n c l u d i n g the v a r i o u s measures o f  t e r n a l i t y was  own  ex-  to t e s t the p o s s i b i l i t y t h a t some a s p e c t 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 c o u l d p r e d i c t i n d i v i d u a l s u c c e s s i n a programme based l a r g e l y on m a n i p u l a t i n g e x t e r n a l cues.  The  key  t o the S t u a r t and D a v i s (1972)  p l a n i s t o c o n t r o l one's environment i n o r d e r t o encourage d e s i r a b l e behav 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 ' s c o r e s f o r a l l . of the measures!-)' however, none of the measures proved to be a t a l l r e l a t e d t o s u c c e s s .  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 t h e tireatmentjiPiff o b e s i t y , but  c o u l d be d e l e t e r i o u s t o an o b e s i t y  Tor  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 w e i g h t persons i n o r i e n t a t i o n measures (a h y p o t h e s i s not t e s t e d i n t h i s the u s e f u l n e s s  of such d i f f e r e n c e s i s l e s s e n e d  p r e d i c t success i n weight l o s s attempts. Slotfhowerl  study),  i f they cannot be used t o  I t i s true that Rodin  and  (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 t o p r e d i c t w e i g h t  g a i n i n c h i l d r e n who  were l i v i n g i n a n o v e l environment.  However, these  85 r e s e a r c h e r s a l s o found t h a t those who  l o s t w e i g h t i n the same s i t u a t i o n  s c o r e d h i g h e r e x t e r n a l i t y than those whose w e i g h t remained c o n s t a n t . A l t h o u g h R o d i n and Slochower (1976) used e x t e r n a l i t y measures w h i c h  dif-  f e r e d from those used i n the p r e s e n t s t u d y , 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 p r e s e n t l a c k o f s u c c e s s a t p r e d i c t i o n i s p r o b a b l y b e t t e r e x p l a i n e d by the change o f 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 l e the s u b j e c t s i n t h i s s t u d y (and i n most o t h e r t r e a t m e n t 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 p a t t e r n s l i n k e d t o e a t i n g cues i n the s e t t i n g e x c e p t 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 s e t o f e a t i n g h a b i t s t i e d f i r m l y t o the s t i m u l u s p a t t e r n s o f a f a m i l i a r environment. I t may be t h a t e x t e r n a l i t y does p l a y a p a r t i n e s t a b l i s h i n g h a b i t s i n a n o v e l 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 w e i g h t l o s s a t tempts i n a f a m i l i a r environment. o f e x t e r n a l i t y used i n t h i s s t u d y .  At l e a s t t h i s i s t r u e w i t h the measures I n a f a m i l i a r s i t u a t i o n an i m p o r t a n t  f a c t o r would be t h e ease w i t h w h i c h 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 o f t h i s would make a b e t t e r p r e d i c t o r  o f s u c c e s s than measures o f e x t e r n a l i t y .  Singh (1973) has suggested t h a t  o v e r e a t i n g can be b e t t e r u n d e r s t o o d as an i n a b i l i t y t o i n h i b i t a w e l l l e a r n e d 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 o f e x t i n c t i o n , S i n g h d i d f i n d t h a t obese subj e c t s were l e s s a b l e than normal w e i g h t s u b j e c t s t o suppress response t e n d e n c i e s when s i t u a t i o n a l demands were changed.  T h i s i n a b i l i t y t o suppress  an ongoing response would seem t o be r e l a t e d t o ease o f e x t i n c t i o n and relearning.  86 A measure o f t h i s r e l e a r n i n g would be easy t o e s t a b l i s h ; t h e subj e c t c o u l d o v e r l e a r n some s i m p l e response and then go t h r o u g h e x t i n c t i o n o f t h a t response w i t h t h e s i m u l t a n e o u s l e a r n i n g o f an a l t e r n a t i v e r e sponse.  The number o f t r i a l s t o e x t i n c t i o n as w e l l as t r i a l s t o l e a r n i n g  the new response might then p r o v i d e v a l u a b l e i n f o r m a t i o n on t h e s u b j e c t ' s prognosis  i n t h i s s o r t o f programme.  Individual Differences R e c e n t l y Leon  Roth ( 1977) a f t e r .a.gfchorough r e v i e w o f the t h e o r e t i c a l i s T  sues i n o b e s i t y has c o n c l u d e d t h a t t h e " s e a r c h  for a unitary  explanation  of o b e s i t y does n o t , a t p r e s e n t , appear t o be a f r u i t f u l avenue o f e x p l o r a t i o n , and the e v i d e n c e s t r o n g l y s u g g e s t s t h a t o b e s i t y i s n o t a u n i t a r y syndrome" (1977, p. 138).  The s e a r c h f o r i n d i v i d u a l d i f f e r e n c e s t h a t can  e x p l a i n o b e s i t y and p r e d i c t s u c c e s s o f t r e a t m e n t has l a r g e l y been d i s a p pointing.  Leon & ; Ro"th .(1977)'-concluded, t h a t ^ f e w ^ p e r s o n a l i t y c h a r a c t e r i s t i c s ;  Nv  common t o obese persons can be c o n s i d e r e d  causative f a c t o r s .  Even a v a r i -  a b l e such as i n i t i a l w e i g h t w h i c h 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 w e i g h t l o s s (Murray, 1975), was n o t a s i g n i f i c a n t f a c t o r i n the present  study.  F o r a measure t o be a good p r e d i c t o r o f  t r e a t m e n t s u c c e s s i t s h o u l d be s p e c i f i c as t o the manner o f t h e treatment f o r w h i c h i t i s p r e d i c t i v e ( J e f f r e y , 1972;  Leon, 1976).  S i n c e the most  s u c c e s s f u l b e h a v i o u r a l methods o f d e a l i n g w i t h o b e s i t y are those t h a t r e q u i r e a r e l e a r n i n g o f e a t i n g h a b i t s (Leon, 1976) , a measure o f t h e a b i l i ty t o u n l e a r n and r e l e a r n a response would be r e l e v a n t i n f o r m a t i o n . e v e r , i t would n o t be by any means complete. tary i s o l a t e d behaviours; person's l i f e .  How-  E a t i n g h a b i t s are n o t s o l i -  they a r e i n t e r w o v e n i n t o e v e r y a s p e c t o f t h e  F o r t h e 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 o f 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 t o o t h e r h a b i t s and cues i n t h e p e r son's l i f e s h o u l d be t h e main concern o f t h e b e h a v i o u r a l  programme.  T h i s c o n s t e l l a t i o n o f i n t e r r e l a t e d h a b i t s i s where t h e i m p o r t a n t i n d i v i dual differences l i e .  I t i s a l s o where t h e key t o s u c c e s s f u l treatment  of w e i g h t 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 quantity of personal d a t a t h a t were a n a l y z e d  o r r e p o r t e d i n Appendix A, d i d n o t i n c o r p o r a t e  fchese d a t a i n t o t h e treatment programme f o r the i n d i v i d u a l s u b j e c t . t r u l y success-oriented  treatment would have t o do t h i s ; however, t h e r e -  s t r i c t i o n s imposed by r e s e a r c h i n weight s t u d i e s .  c o n s i d e r a t i o n s make t h i s a r a r e i n c l u s i o n  K e e p i n g t h i s i n mind, t h e p r e s e n t study was n o t i n -  tended t o be a " b e s t " t r e a t m e n t method. d e p r i v a t i o n as a . t h e r a p e u t i c gramme.  I t was r a t h e r a t e s t o f s e n s o r y  f a c i l i t a t o r i n a minimal-contact weight  pro-  The f i n d i n g s o f f e r s t r o n g e v i d e n c e t h a t s e n s o r y d e p r i v a t i o n w i t h  messages i n c r e a s e s programme e f f e c t i v e n e s s . s o r y d e p r i v a t i o n appeared t o p r o v i d e jects'  A  Even w i t h o u t messages, sen-  some l o n g - t e r m e f f e c t s t o t h e sub-  motivation.  I t i s i m p o r t a n t t o keep i n mind the r e l a t i o n o f s e n s o r y d e p r i v a t i o n t o the r e s t o f the p r o c e d u r e .  The a c t u a l exposure t o s e n s o r y 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 t o b e i n g i n s t r u c t e d i n t h e a c t u a l d i e t programme t o be used. ly  The f o l l o w i n g s i x months o f f o l l o w - u p were b a s i c a l -  d a t a c o l l e c t i n g t i m e s , a l t h o u g h i f t h e s u b j e c t b r o u g h t up s p e c i f i c  problems they were d i s c u s s e d .  Hence, t h e f o l l o w - u p  sessions d i d include  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 o f r e i t e r a t i n g p o i n t s  contained  88 i n t h e programme a l r e a d y o u t l i n e d .  However c o n t a c t over s i x months was  m i n i m a l and, as mentioned e a r l i e r , seen as i n a d e q u a t e by most s u b j e c t s . Thus t h e r o l e o f s e n s o r y d e p r i v a t i o n was d e s i g n e d t o be an a d j u n c t t o a complete w e i g h t c o n t r o l programme. P a r t of the explanation  f o r t h e i n c r e a s e d e f f e c t i v e n e s s o f t h e sen-  s o r y d e p r i v a t i o n treatment may l i e i n t h e 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 s t a n d a r d i z e d experience.  programme, a f f e c t t h e s e n s o r y d e p r i v a t i o n  I t has been w e l l documented (e.g., J o n e s , 1969) t h a t 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, t h e i n d i v i d u a l seeks t o r a i s e h i s l e v e l o f i n p u t .  W i t h no ready means t o i n c r e a s e e x -  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 t h o u g h t s , f a n t a s i e s , r e v e r i e s , dreams, e t c . — to a c h i e v e a more d e s i r a b l e i n p u t l e v e l .  This experience of increased a t -  t e n t i o n t o i n t e r n a l s t i m u l i w i l l be a c o m p l e t e l y  unique i n d i v i d u a l one,  d i f f e r e n t from t h a t o f any o t h e r p e r s o n (see S u e d f e l d press).  and B o r r i e , i n  Thus, s e n s o r y d e p r i v a t i o n , by f o r c i n g t h e i n d i v i d u a l t o f o c u s  a t t e n t i o n oh h i m s e l f and t o 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 t h a t accommodates i n d i v i d u a l d i f f e r e n c e s  not o n l y i n p e r s o n a l i t y b u t a l s o i n h a b i t p a t t e r n s and i n t e r r e l a t i o n s h i p s . S i n c e i n d i v i d u a l r e a c t i o n s t o s e n s o r y 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 a c c o u n t i n g  w i l l n o t be made h e r e .  However, t h e  t h e r a p e u t i c power o f t h i s e x p e r i e n c e i s e x e m p l i f i e d by case #SDNM-9. T h i s woman r e p o r t e d  t h a t d u r i n g s e n s o r y d e p r i v a t i o n she f e l t  dependent upon t h e m o n i t o r who was o u t s i d e t h e chamber.  extremely  She d i d n o t l i k e  t o f e e l t h i s . d e p e n d e n t , and t h e u n p l e a s a n t n e s s o f t h e f e e l i n g h e l p e d h e r to r e a l i z e t h a t i n most a s p e c t s o f h e r l i f e she was a v e r y dependent  89 p e r s o n who She  r a r e l y r e l i e d s o l e l y on her own  a l s o found she n e v e r d i d a n y t h i n g  d e c i s i o n about  t h a t was  Other p e r s o n s were always the m o t i v a t i n g  anything.  o n l y f o r h e r own  benefit.  forces behind her a c t i o n s .  r e p o r t e d t h a t h e r e x p e r i e n c e i n s e n s o r y d e p r i v a t i o n had made h e r l y aware of t h i s and she was  s u l t was  initial-  g r a d u a l l y t a k i n g s t e p s t o r e s o l v e the  blem and become master o f h e r own  life.  She  pro-  I n c i d e n t a l l y she f e l t t h i s r e -  o f g r e a t e r p e r s o n a l s i g n i f i c a n c e than her p r o g r e s s i n the w e i g h t  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 o f s e n s o r y d e p r i v a t i o n have been  r e p o r t e d by S u e d f e l d  and B e s t (1977) i n a r e c e n t smoking s t u d y .  Conclusion I n c o n c l u s i o n , . t h i s s t u d y has  demonstrated t h a t s e n s o r y d e p r i v a t i o n  can a c t 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 p e u t i c communications.  S u b j e c t s 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 a b l e t o c a r r y out a s t a n d a r d w e i g h t r e d u c t i o n than those who tion.  b e h a v i o u r a l programme of  o n l y p o r t i o n s o r none of t h i s combina-  I n a d d i t i o n , t h i s treatment seemed t o p r o v i d e a m o t i v a t i o n a l b o o s t  as e v i d e n c e d by c o n t i n u e d for  had  thera-  w e i g h t l o s s and  l o w e r dropout r a t e .  The  the e f f e c t i v e n e s s of t h i s combined t r e a t m e n t are l e s s c l e a r .  reasons The i n -  d i v i d u a l n a t u r e of the s e n s o r y d e p r i v a t i o n e x p e r i e n c e a l l o w s f o r s e v e r a l simultaneous explanations.  AmongTfchese e x p l a n a t i o n s  p r i v a t i o n promotes i n t r o s p e c t i o n , a l l o w s one helps  are t h a t s e n s o r y  de-  t o r e f l e c t on c u r r e n t p r o b l e m s ,  the i n d i v i d u a l i n c r e a s e h i s awareness of i n t e r n a l cues, s e r v e s 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 p r o v i d e s 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 . none of t h e s e may  a preliminary  W i t h each i n d i v i d u a l any,  be p a r t of the s e n s o r y d e p r i v a t i o n  experience.  a l l or  90 F u r t h e r , the f i n d i n g s o f t h i s s t u d y support the h y p o t h e s i s t h a t t h e r a p e u t i c communication i s made more e f f e c t i v e when i t i s h e a r d i n sensory d e p r i v a t i o n . .  I t i s i m p o r t a n t to note t h a t t h i s f i n d i n g i s d i f -  f e r e n t from the p r e v i o u s smoking s t u d i e s where t h e r 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 t r e a t m e n t .  This difference  can be a t t r i b u t e d t o 1) the d i f f e r e n c e s i n the problems b e i n g t r e a t e d and 2) the d i f f e r e n c e s i n message l e n g t h and c o n t e n t . 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 s t u d y are t w o f o l d .  In the a r e a o f the t r e a t m e n t o f o v e r w e i g h t i n d i v i d u a l s , the  f i n d i n g s suggest t h a t s e n s o r y d e p r i v a t i o n can be a v a l u a b l e a d j u n c t to t h e r a p y , e s p e c i a l l y when combined w i t h a more p o w e r f u l i n d i v i d u a l l y o r i e n t e d w e i g h t - l o s s programme.  I n the a r e a of s e n s o r y d e p r i v a t i o n  research,  t h i s s t u d y suggests t h a t s e n s o r y d e p r i v a t i o n as a t h e r a p y t e c h n i q u e needs to be e x p l o r e d f u r t h e r and a p p l i e d to a w i d e r v a r i e t y o f problems.  Also,  more a t t e n t i o n s h o u l d be p a i d t o t h e v a r i a b l e s o f s u b j e c t i v e e x p e r i e n c e that occur i n sensory d e p r i v a t i o n . suggest new  G r e a t e r knowledge o f t h i s f a c t o r may  areas t o w h i c h the method might be  applied.  90a  FOOTNOTE  ''"To c r e a t e groups o f e q u a l s i z e f o r t h e MANOVA's and ANOVA's, s u b j e c t s SDM-2 SDM-5, and SDNC-5 were randomly s e l e c t e d t o be o m i t t e d from these a n a l y s e s . S i n c e s u b j e c t SDNC-5 d i d v e r y w e l l i n t h e programme, a second s e t o f a n a l y s e s was  performed o m i t t i n g a d i f f e r e n t s u b j e c t from t h e SD-NC group.  The r e s u l t s  from these a n a l y s e s d i f f e r e d v e r y l i t t l e from t h e f i r s t a n a l y s e s and d i d n o t change w h i c h e f f e c t s were s t a t i s t i c a l l y  significant.  The r e s u l t s r e p o r t e d  a r e those o f t h e f i r s t a n a l y s e s w i t h t h e o r i g i n a l randomly s e l e c t e d s u b j e c t s 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 p a y - o f f s and group p r e s s u r e ' i n w e i g h t r e duction. Abramson, E.A.  B e h a v i o r Therapy, 1974, 5_, 391-400. A r e v i e w o f b e h a v i o r a l approaches  to weight  control.  B e h a v i o r Research and Therapy, 1973, __, 547-556. Adams, H.B.,  R o b e r t s o n , M.H,,  p e r s o n a l i t y change,  & Cooper, G.D.  Sensory d e p r i v a t i o n  and  J o u r n a l o f Nervous and M e n t a l D i s o r d e r s ,  1966, 143, 256-265. 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York:  N.Y.:  Sensory  Appleton-Century-  105  APPENDIX A  106 Subject c h i l d , who Her  SDM-1  was  a 37 y e a r o l d m a r r i e d woman w i t h a 13 y e a r o l d  worked managing the apartment b u i l d i n g i n w h i c h she a l s o r e s i d e d .  s t a r t i n g weight was  92.4  Kg a t 158  cm and her d e s i r e d w e i g h t was  She began t o g a i n w e i g h t a f t e r the b i r t h o f h e r c h i l d and  61  Kg.  attributed this  g a i n t o not enough a c t i v i t y and e a t i n g too much of the wrong, f o o d s .  She  had p r e v i o u s l y t r i e d an a l l s t e a k d i e t when she l o s t 9 pounds i n 9 days Weight Watchers when she l o s t 20 pounds i n s i x weeks. ing  the s t u d y was  t h a t she f e l t she had  Her  and  reason f o r j o i n -  t r i e d e v e r y t h i n g 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 t o conquer h e r w e i g h t problem. A f t e r SD she had v e r y few comments on the e x p e r i e n c e except t h a t i t was hot and  stuffy.  she s a i d she  I n the f i r s t week a f t e r SD she l o s t 1.3  f e l t v e r y determined and v o l u n t e e r e d  t h a t p s y c h o l o g y was was  SD had h e l p e d i n h e r p r o g r e s s she s a i d , "Yes,  i n SD.  t h a t she  W h i l e she  a t t i t u d e toward e a t i n g had  100%".  She had become so  T h e r e f o r e she  Kg and s t i l l was  she was  f e l t i t was She  slept  so e f f e c t i v e t h a t she "must have been f e l t that having  v e r y determined.  t h i n k i n g about  The most d i f f i c u l t o b s t a c l e t o her p r o g r e s s was  when she made p r o g r e s s . learned  At two months when asked i f  changed i n t h a t she was  saw n o t h i n g wrong w i t h the way  she  impression.  At s i x months she had l o s t 8.6  tance.  t h a t she."used to t h i n k  f e l t the messages had h e l p e d she  h e a r d them i n SD made the b i g g e s t  she a t e .  month  f e l t t h a t t h i n g s must have been s a i d w h i l e she  I n f a c t she f e l t t h a t i t was  brainwashed".  At one  a l o s t of bunk" but because of the ease w i t h w h i c h  l o s i n g w e i g h t she no l o n g e r thought t h a t .  conscientious  Kg.  everything  h e r husband  who  and t h e r e f o r e n e v e r gave h e r a s s i s -  e n t i r e l y up to her and  s a i d a t the end  t h i s was  rewarding  of the programme t h a t she  to be p a t i e n t w i t h h e r s e l f and not become d i s g u s t e d w i t h l a p s e s  cause she i n t e n d s  Her  t o be on the d i e t f o r the r e s t of her  life.  had be-  107 S u b j e c t SDM-2 was time as a c l e r k . w e i g h t was  59 Kg.  a 55 y e a r o l d m a r r i e d woman who was  employed p a r t  She began t h e programme a t 76.4 Kg a t 152 cm.  Her d e s i r e d  She began g a i n i n g w e i g h t a f t e r the b i r t h of the l a s t of  h e r t h r e e c h i l d r e n , aged 32, 31, and 25.  However she d i d not f e e l t h a t she  o v e r a t e and c l a i m e d t o be q u i t e a c t i v e .  She j o i n e d the s t u d y p a r t l y because  she was  c u r i o u s about the "new  experience".  A f t e r e i g h t hours i n SD  she  spoke to the m o n i t o r over the i n t e r c o m and e x p r e s s e d doubts about the u s e f u l ness o f the e x p e r i e n c e .  The m o n i t o r gave h e r r e a s s u r a n c e and she  the 24 hours a l t h o u g h she complained One week a f t e r SD she suggested her r e s o l v e .  She had l o s t 1.4  of the chamber's s t u f f i n e s s . t h a t the SD e x p e r i e n c e had  Kg, had q u i t d r i n k i n g and was  A t two months a l t h o u g h she had l o s t o n l y a n o t h e r helped.  strengthened  e a t i n g much s l o w e r .  .4 Kg, she s t i l l  f e l t SD  had  The thought of t h a t e x p e r i e n c e made her f e e l she c o u l d a c c o m p l i s h  the t h i n g s she s e t out to do. ment.  completed  The 24 hours of SD had been q u i t e an  The message t h a t had made the most i m p r e s s i o n on her was  accomplish-  t h a t she  was  responsible to h e r s e l f . At f o u r months t h i s s u b j e c t wanted t o q u i t the programme. .8 Kg and f e l t v e r y d i s c o u r a g e d and embarrassed. a l e t t e r e x p r e s s i n g her d e s i r e t o q u i t . importance  She was  She had  gained  Rather than c a l l , she sent t e l e p h o n e d and t o l d o f the  of her s t a y i n g i n the programme even i f she gained w e i g h t .  She  remained i n the programme and r e t u r n e d a t t h e s i x month f o l l o w up when she g a i n e d a n o t h e r 1.6  had  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 . a l o n e and found t h i s t o be when she a t e , and t h i s was r a t h e r than boredom.  She spent a l o t of time l a r g e l y out of h a b i t  At the end of the programme she^ s t i l l f e l t t h a t SD  had  b o o s t e d h e r m o t i v a t i o n but t h a t i t hadn't l a s t e d and t h a t perhaps a r e p e a t s e s s i o n would h e l p .  W h i l e she c l a i m e d to n o r m a l l y be " q u i t e a s t r o n g p e r s o n "  the i n a b i l i t y to l o s e w e i g h t was bothersome. a l o n e was  the o n l y one who  c o u l d do i t .  S t i l l she r e a l i z e d t h a t she  108  S u b j e c t SDM-3 was a 24 y e a r o l d f i r s t year u n i v e r s i t y s t u d e n t . s i n g l e and weighed75".3 Kg a t 168.5 cm.  She was  Her d e s i r e d weight was 59 Kg.  She.  had been overweight s i n c e the age o f t e n and c o u l d n o t r e a l l y say what the cause o f h e r overweight was a l t h o u g h she d i d c o n f e s s t h a t she p r o b a b l y a t e 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 p a c k o f c i g a r e t t e s a day. t i o n f o r j o i n i n g the s t u d y was t o l o s e w e i g h t .  Her o n l y s t a t e d m o t i v a -  D u r i n g SD she had s e v e r a l  dreams about b e i n g i n the chamber and t h i n g s happening t o h e r t h e r e .  The  f o l l o w i n g day o u t s i d e the chamber she s a i d she f e l t v e r y d i s o r i e n t e d and antisocial. A t one week she had l o s t 2,5 Kg but a t t h e n e x t one month s e s s i o n had gained back 2 o f those Kg. the Christmas h o l i d a y s . resolve.  T h i s was due t o much e a t i n g and d r i n k i n g o v e r ,  She r e t u r n e d t o the p l a n w i t h the u s u a l New  Year's  A t two months she c l a i m e d she was "gung ho" a g a i n and was down t o  71.7 Kg as p r o o f .  She s t i l l v i v i d l y r e c a l l e d t h e SD e x p e r i e n c e ,  the dreams she had t h e r e .  particularly  I n one o f t h e s e dreams the l i g h t went on and some  l a d y was s t a n d i n g t h e r e t e l l i n g h e r she c o u l d n ' t go t o the bathroom.  In  another dream t h e l i g h t was on a g a i n and she was l o o k i n g a t h e r s e l f i n a mirror.  She f e l t t h a t SD had made the messages h i t h a r d e r .  A t the end o f the s i x months h e r w e i g h t was back up t o 73.5 Kg and she a t t r i b u t e d t h i s to n o t f o l l o w i n g the p l a n .  The programme had made h e r much  more aware of h e r e a t i n g h a b i t s , o f h e a l t h y foods and o f t h e importance o f exercise.  She f e l t she had v e r y l i t t l e s e l f c o n t r o l and needed someone  s t a n d i n g o v e r h e r " w i t h a w h i p " t o keep h e r i n l i n e .  She d i d become aware  of the f a c t t h a t she e a t s most when she i s depressed and t h a t she l o o k s f o r excuses t o be a b l e t o d r i n k o r e a t .  She no l o n g e r f e l t i t was p o s s i b l e t o  r e a c h h e r i n i t i a l g o a l weight and had lowered h e r e x p e c t a t i o n s .  109 Subject and 27. 68 Kg.  SDM-4 was  a 53 y e a r o l d h o u s e w i f e w i t h two  Her i n i t i a l w e i g h t was  cm.  Her  goal weight  Her w e i g h t g a i n began s i x months a f t e r g e t t i n g m a r r i e d at age  She e x p l a i n e d  t h a t she a t e at t h i s time because she was  s e v e r a l times she v o l u n t e e r e d order  113.75 Kg at 165.5  c h i l d r e n aged 32  t h a t she  f e l t she may  so happy.  have g a i n e d w e i g h t i n  but f e l t she needed some guidance and someone who  h e r problem.  A l t h o u g h she f e l t SD was  The  many l e t t e r s to her f r i e n d s . out o f the chamber and  I n one  At one week she had being very cooperative. took h e r o f f a l l p r o t e i n .  the  Even though  only j u i c e a f t e r  she was  getting quite  hours. l o s t 2.6  Kg but complained t h a t h e r husband was  F o l l o w i n g t h i s she was She  not  i l l f o r 2 weeks and her  d i d not l o s e w e i g h t d u r i n g t h i s  doctor  period.  At two months she d i d not f e e l t h a t SD had h e l p e d ; i n f a c t s i n c e SD had n o t been a b l e to s l e e p w e l l and She  she blamed t h i s on the SD  d i d f e e l however t h a t the messages had  came back to h e r . she had  .  On r e c a l l i n g the SD e x p e r i e n c e she com-  p l a i n e d about the d i s i n f e c t a n t s m e l l and a l s o c l a i m e d confused i n the l a s t few  took h e r  s a t at  d o i n g so w e l l on the programme.  t o the chamber.  about  a l s o composed  of h e r dreams someone came and  e a t i n g a b i g meal and d r i n k i n g wine she had  w h i c h she r e t u r n e d  She  l e d h e r t o a banquet i n h e r honour. She  head o f the t a b l e because she was  cared  too s t u f f y she d i d do a l o t o f t h i n k -  darkness made her t h i n k about h e r b l i n d f a t h e r .  everyone was  were  She j o i n e d the study because she wanted t o l o s e w e i g h t i n  a h e a l t h y way  ing.  19.  However  t o 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  making advances.  was  At t h i s p o i n t she was  l o s t another 2 Kg and  f r i e n d so t h a t the f i r s t one  s a i d t h a t she had to get t o 160  experience.  d e f i n i t e l y h e l p e d h e r and  down to 107.0  Kg.  they  At f o u r months  s t a r t e d a contest with  l b s would get a r i n g w o r t h  At s i x months she had not l o s t f u r t h e r w e i g h t . the f a c t t h a t she had been away to I s r a e l and had  she  T h i s was  a $100.  a t t r i b u t e d to  g a i n e d 2 Kg w h i c h she  had  110  s i n c e l o s t and t h a t she had been i n t h e h o s p i t a l f o r two weeks where she c o u l d n ' t s t a y on h e r d i e t .  She f e l t t h a t 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 d u r i n g t h e programme t h a t she hadn't l o s t the w e i g h t t h a t she wanted t o . However she f e l t t h a t t h e programme had p r e v e n t e d h e r from g a i n i n g d u r i n g t h a t time and had made h e r much more a b l e t o cope w i t h problems w i t h o u t  u s i n g food.  She was s t i l l v e r y  mined a t t h e end o f t h e programme and was p l a n n i n g t o c o n t i n u e  deter-  i t s use.  Ill  S u b j e c t SDM-5 was occupation.,  49 years o l d , s i n g l e , and was  She weighed 86.7  kg a t 161 cm.  and had been o v e r w e i g h t s i n c e age 16. p e r c e i v e d cause of o v e r w e i g h t was  not employed a t  She had a grade 12  Her g o a l w e i g h t was  l o n e l i n e s s ; she o v e r a t e  education  61 Kg.  She j o i n e d t h i s study because h e r  had o r d e r e d her t o get h e r w e i g h t down. and was  bothered  Her  t o 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 had stopped s i x months e a r l i e r .  any  but doctor  She d i d not p a r t i c u l a r l y l i k e  by the h e a t w h i c h caused a headache.  A l s o she was  not  a b l e t o 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  SD  too u n c o m f o r t a b l e t o take much i n . One week a f t e r SD h e r w e i g h t was  down t o 86.5  p l e a s e d w i t h the S t u a r t and D a v i s p l a n and was c a l o r i e s , though she d i d not get much e x e r c i s e .  Kg.  She was  a b l e to s t i c k w i t h  84.7  A t s i x months she was 81.5  1200  By two months she had  through the book f o u r times p l u s r e f e r e n c e s to s p e c i f i c p a r t s . time h e r w e i g h t was  quite  By  read  this  Kg. q u i t e pleased w i t h her progress.  Kg and h e r b l o o d p r e s s u r e had gone down.  Her w e i g h t  was  The book, she e x p l a i n e d , p r o -  v i d e d h e r w i t h a sense o f communality o f the problem; she wasn't the o n l y one  fighting i t .  to e a t .  Her major problems were f i t s o f d e p r e s s i o n w h i c h l e d h e r  The programme had made h e r more aware of her own  feelings of i n -  f e r i o r i t y but a l s o o f the f a c t t h a t nobody c o u l d s o l v e t h i s problem but herself.  112  S u b j e c t SDM-6 was  a 44 y e a r 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. 110.25 Kg.  Her h e i g h t was  172 cm.  and her i n i t i a l w e i g h t  was  Her overweight began a t age 30 and the o n l y r e a s o n she c o u l d  g i v e f o r t h i s was because she was  t h a t she i s c o n s t a n t l y n i b b l i n g .  " t i r e d o f b e i n g f a t " , Her g o a l was  r e s t l e s s d u r i n g SD and was about nightmares  She j o i n e d t h i s  study  77 Kg.  very  p l e a s e d when the 24 hours was  about the a s s a s s i n a t i o n o f Gandhi.  up.  She was She  complained  This i s of i n t e r e s t  i n t h a t Gandhi's hunger s t r i k e s were used as an example i n one of the messages . Thoughout the e n t i r e s i x months her w e i g h t v a r i e d v e r y 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 c o n t a c t about her problem and j o i n e d a TOPS c l u b and got some s o r t o f c o n t e s t going w i t h them. SD as a " t e r r i b l y i n t e r e s t i n g " e x p e r i e n c e .  At two months she  She d i d n o t f e e l i t had  h e r w e i g h t but t h a t i t had h e l p e d h e r t o understand A t s i x months she weighed 111.3 h e r own  laziness.  L o s i n g w e i g h t was  busy w i t h h e r f a m i l y and was s t i c k i n g t o the d i e t .  recalled helped  herself.  and a t t r i b u t e d h e r l a c k o f s u c c e s s j u s t not i m p o r t a n t enough.  She was  very  not a b l e t o c o n c e n t r a t e the e x t r a energy to  She saw the major problem o f the programme as h e r  l a c k of s e l f d i s c i p l i n e .  to  She f e l t t h a t u n l e s s she got her head s t r a i g h t  she would n e v e r get to her g o a l weight o f 170 l b s .  own  113  S u b j e c t SDM-7 was  a s i n g l e 23 year.'-, o l d woman who worked w i t h m e n t a l -  l y r e t a r d e d i n d i v i d u a l s . She began the programme a t a w e i g h t o f 102.85 Kg and h e i g h t o f 163 cm.;  h e r g o a l w e i g h t was  57 Kg.  She had been o v e r w e i g h t  s i n c e the age of 15 and saw the cause of h e r overweight as b e i n g  insecure.  When she began t h i s programme she had a l r e a d y been w o r k i n g a t l o s i n g w e i g h t w i t h a regimen of d i e t and e x e r c i s e . o t h e r p e o p l e and i t was  She l i v e d i n a house w i t h a number o f  a c t u a l l y one of h e r g i r l f r i e n d s who  originally  s i g n e d h e r up f o r the programme. She d i d n o t l i k e the SD s e s s i o n and c l a i m e d a f t e r the f i r s t s e t o f messages.  A t one p o i n t she woke up and f e l t e x t r e m e l y  d i s o r i e n t e d and s e r i o u s l y c o n s i d e r e d g o t t e n where she was. siastically  t e r m i n a t i n g the s e s s i o n .  She had  She was m o t i v a t e d r i g h t from the b e g i n n i n g  took to the d i e t p l a n ; she was  exercise plan.  t o become " t e r r i b l y b o r e d "  for-  and e n t h u -  a l r e a d y c a r r y i n g out a r e g u l a r  A t the one week f o l l o w up h e r w e i g h t was  down t o 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 t h a t the s e s s i o n had made h e r more aware o f t h i n g s but hadn't r e a l l y reached h e r " s u b c o n s c i o u s " . 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 h e r body and  would t h i n k about i t when she f e l t l i k e c h e a t i n g . down t o 96.5 was  A l t h o u g h she had been  a t one month, a t two months h e r w e i g h t was back t o 98.5;  She  q u i t e depressed by t h i s s i n c e she had a wager w i t h one of h e r housemates  t h a t she would l o s t 50 l b o v e r a p a r t i c u l a r p e r i o d . A t f o u r months h e r w e i g h t was  s t i l l a t 98.5.  She e x p l a i n e d t h a t she  had been e a t i n g j u n k food as a r e s u l t o f d e p r e s s i o n . was  t h a t she was  terminated.  one month 'pregnant and was  The u n d e r l y i n g  about to have the  reason  pregnancy  114 A t the f i n a l s i x month s e s s i o n h e r 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 o f t h e p r o gramme b u t f e l t t h a t i t had n o t r e a l l y caught on w i t h h e r u n t i l t h e l a s t two months.  She f e l t t h a t she had gained c o n t r o l over h e r d e s i r e t o e a t  w h i l e s t i l l r e a l i z i n g she g r e a t p l e a s u r e she d e r i v e s from f o o d .  She l i k e d  the i n f r e q u e n c y o f the f o l l o w - u p s e s p e c i a l l y because she h a t e s t o be t o l d what t o do.  She planned  reach h e r g o a l w e i g h t .  t o c o n t i n u e the p l a n and f e l t i t was p o s s i b l e t o  115  S u b j e c t SDM-8 was  a 43 y e a r - ^ o l d h o u s e w i f e w i t h t h r e e c h i l d r e n the  youngest b e i n g 10 y e a r s o l d .  She a l s o worked p a r t - t i m e as a  stenographer.  Overweight s i n c e the age o f 12 she f e l t t h a t the major cause o f her w e i g h t was 77.7  t h a t she was  a compulsive eater.  over-  She began the programme at  Kg and gave her d e s i r e d w e i g h t as 57 Kg.  Her h e i g h t was  152 cm.  The  foods w h i c h were the b i g g e s t 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 y e a r 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 t o  have someone to r e p o r t 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 r e p o r t e d t h a t i t was  p l e a s a n t and she e n j o y e d i t as a v e r y r e s t f u l e x p e r i e n c e .  w e i g h t was  75.7  and she seemed q u i t e p l e a s e d w i t h her p r o g r e s s  A t one week h e r on 1200  calor-  ies . A t 2 months she was  down t o 73.0  Kg.  s u p p o r t i v e o f h e r d i e t p l a n and she was was  Her daughters had been q u i t e  getting daily light exercise.  She  v e r y p l e a s e d w i t h the book and found i t t o p r o v i d e a l o t o f m o t i v a t i o n . A t the f i n a l s i x month s e s s i o n , she was  she had been down t o 71.9  Kg a t 4 months.  a g a i n t o 73.7  Kg even though  She a t t r i b u t e d the l o s s a t 4  months t o h a v i n g been away i n Mexico and not b e i n g a b l e t o e a t the food The  g a i n i n the l a s t two months was  self. to eat.  due  t o not spending enough time on  there. her-  She had been worr'iedabout problems w i t h h e r f a m i l y and t h i s l e d h e r T h i s f a i l u r e a t the end o f the programme made h e r f e e l l i k e a t e r -  rible procrastinator.  She  f e l t the programme was  v e r y s e n s i b l e but t h a t  had done p o o r l y because she d i d n ' t take enough time f o r h e r s e l f .  she  116  S u b j e c t SDM-9 was a 43 y e a r o l d h o u s e w i f e w i t h f o u r c h i l d r e n between 11 and 23 y e a r s o l d . tall.  She began t h e programme w e i g h i n g 72.5 Kg a t 164 cm  Her g o a l w e i g h t was 60 Kg.  Her o n l y e x p r e s s e d m o t i v e f o r j o i n i n g  the programme was t o l o s e w e i g h t w h i c h had been a problem s i n c e h e r f i r s t c h i l d was b o r n . She found t h e f i r s t few hours o f SD v e r y f r u s t r a t i n g and had d i f f i c u l ty c o n c e n t r a t i n g on the content  of t h e messages once they were o v e r .  Her  comment on t h e messages was t h a t they a l l seemed v e r y s e n s i b l e . Her w e i g h t was down t o 71.8 Kg a f t e r one week on 1200 c a l o r i e s .  She  r e p o r t e d t h a t the n i g h t f o l l o w i n g SD e v e r y t h i n g from t h e messages she had heard k e p t r e t u r n i n g t o h e r a l l n i g h t  long.  At one month she was q u i t e d i s a p p o i n t e d w i t h t h e s m a l l w e i g h t l o s s she had had.  I n s p i t e o f a v i g o r o u s e x e r c i s e programme, a v e r a g i n g  400 c a l o r i e s  a day h e r w e i g h t was 71.6 Kg. At two months h e r w e i g h t was back up t o 72.3 Kg.  She had n o t been  k e e p i n g r e g u l a r t r a c k o f h e r d i e t and had slowed down i n h e r e x e r c i s e because she had begun t a k i n g a c c o u n t i n g  courses.  A f t e r t h i s she c u t h e r d i e t down between 800 and 900 c a l o r i e s and conc e n t r a t e d on v e g e t a b l e s  and meats i n e s s e n t i a l l y a low c a r b o h y d r a t e d i e t .  A t f o u r months she was down t o 68.5 Kg. 67,4 Kg.  She f e l t the most i m p o r t a n t  e x e r c i s e although  Her f i n a l w e i g h t a t s i x months was  p a r t o f t h e programme had been t h e  she knew she s h o u l d have done more.  not impress h e r and she d i d n ' t t h i n k i t h e l p e d . about p r o p e r h a b i t s was v e r y  important.  Her time i n SD d i d  She a l s o f e l t t h a t l e a r n i n g  117  S u b j e c t SDM-10 was  a 42 y e a r o l d mother of f o u r c h i l d r e n between the  ages o f 10 and 22 y e a r s .  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 s t u d e n t . ing  73.5  She j o i n e d the programme weigh-  Kg a t 154 cm t a l l and her g o a l was  55 Kg.  began a f t e r her second c h i l d around the age o f 25. f e e l s she uses i t as a She  Her overweight  problem  She e n j o y s e a t i n g but  comfort.  c l a i m e d to have spent most o f h e r 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 a s l e e p d u r i n g the r e l a x a t i o n message. A f t e r one week her w e i g h t had changed l i t t l e (73.9 Kg) however a t one month i t was  down to  69.3  supposed to  Kg.  She had not r e a l l y s t a r t e d the programme when she was  but had d e l a y e d a c o u p l e of weeks. A t two months she was week s p l u r g e a t C h r i s t m a s exercising.  back up t o 71.0  and a t t r i b u t e d t h i s g a i n to a 2  d u r i n g w h i c h time she a t e q u i t e a b i t and  I c e cream was  a p a r t i c u l a r problem w i t h h e r .  stopped  A t t h i s time when  asked to r e c a l l the SD e x p e r i e n c e she s a i d t h a t i t must have h e l p e d because i t had been e a s i e r f o r h e r t o d i e t t h i s time than i t e v e r had b e f o r e . was  the l o n g e s t she had e v e r been on a d i e t .  messages.  A f t e r Christmas  A t f o u r months she was progress.  She  She c o u l d no l o n g e r r e c a l l  she had no t r o u b l e g e t t i n g back on the down t o 66.0  Kg and was  diet.  q u i t e p l e a s e d w i t h her  Kg but was  not p a r t i c u l a r l y d i s c o u r a g e d  the g a i n w h i c h she a t t r i b u t e d t o some p e r s o n a l problems and t o h a v i n g  She  by final  Her b i g g e s t problems w i t h the p l a n had been t h a t she runs a  v e r y u n s t r u c t u r e d h o u s e h o l d and t h e r e f o r e had d i f f i c u l t y p l a n n i n g h e r dule.  the  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 o u t l o o k .  A t s i x months she weighed 67.4  examinations.  This  sche-  found the i n t e l l e c t u a l and p e r s o n a l a s p e c t s of the programme ap-  p e a l i n g and s t i l l c o u l d not say f o r sure t h a t SD had h e l p e d her m o t i v a t i o n .  118 S u b j e c t SDM-11 was  a 54 y e a r o l d m a r r i e d woman w i t h f i v e  between 18 and 32 y e a r s o l d . cretary.  children  She was w o r k i n g t h r e e days a week as a se-  Overweight became a problem a t the age o f 35 when the s t r e s s o f  r a i s i n g c h i l d r e n l e d her to eat. felt tired.  A t t h a t time she would o v e r e a t when she  O v e r e a t i n g howeverwas not a problem a t t h i s t i m e .  She began  the programme w e i g h i n g 82.75 Kg a t 169 cm t a l l w i t h a g o a l w e i g h t o f 64  Kg.  At the b e g i n n i n g o f t h e SD s e s s i o n she got p a n i c k y and t r i e d yoga breathing techniques.  T h i s e v i d e n t l y worked f o r d u r i n g the r e l a x a t i o n mes-  sage she f e l l a s l e e p .  O v e r a l l , she. s a i d she enjoyed the e x p e r i e n c e but  wouldn't want to r e p e a t i t , A t one week she had l o s t one k i l o g r a m and was programme. exercise. she was  She remained c o n s i s t e n t l y on 1500 A t two months h e r w e i g h t was  77 Kg.  q u i t e p l e a s e d w i t h the  c a l o r i e s w i t h a minimum o f She e x p l a i n e d t h a t everytime  about t o w a i v e r 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 g o i n g through t h a t i f I'm  She f e l t t h a t she was  g o i n g to eat t h i s " .  a d o p t i n g a h e a l t h i e r a t t i t u d e toward  food.  A t f o u r months she weighed 73.5 Kg and a t s i x months was She was  s t i l l v e r y determined  and now  c o n v i n c e d t h a t i t was  down t o 73 Kg.  something  she must do f o r h e r s e l f s i n c e o t h e r s can't be depended upon to h e l p . a t t i t u d e toward food and h e a l t h had changed so t h a t now  sabotaged by her husband who l a t e bars f o r her.  The  reason  t h a t she f e l t she had been  on one o c c a s i o n brought home f o u r huge choco-  Her daughter, who  had been q u i t e s u p p o r t i v e , thought  t h a t her husband d i d n o t r e a l l y want h e r t o l o s e w e i g h t . s i z e d the f a c t t h a t she must do i t on h e r own. r e a c h i n g h e r g o a l w e i g h t was  Her  i f she went " o v e r -  b o a r d " i t was more l i k e l y t o be on bananas than on c h o c o l a t e . f o r h e r p o o r e r p r o g r e s s i n the l a s t two months was  that  A l l o f t h i s empha-  When asked i f she  p o s s i b l e she s a i d " I t h i n k so - I'm  thought going t o " .  119  S u b j e c t SDNM-1 was a 41 y e a r o l d housewife w i t h f o u r c h i l d r e n between 21 and 10 y e a r s o l d . She "weighed 87.6 Kg a t 159 cm and had a g o a l weight of 61 Kg.  She f i r s t began t o g a i n w e i g h t a t t h e age o f 21 around t h e time  of h e r f i r s t two c h i l d r e n ' s b i r t h s and g a i n e d a g a i n a f t e r t h e b i r t h o f h e r last child. ate  She a t e when she was nervous o r u p s e t and was g e t t i n g d e s p a r -  about g e t t i n g t h e weight o f f .  She smoked a l i t t l e more t h a n 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 u n e v e n t f u l f o r h e r .  She commented t h a t  once she had a c r a v i n g f o r a c i g a r e t t e and a l s o t h a t she had had a dream about b e i n g on a d i e t . down t o 84.6 Kg,  D u r i n g t h e f i r s t month she d i d q u i t e w e l l d r o p p i n g  S h o r t l y a f t e r t h i s however, came t h e C h r i s t m a s h o l i d a y s  when she "dropped e v e r y t h i n g " . A t two months h e r w e i g h t was back up t o 87.1 Kg.  She d i d comment however t h a t e v e r y t i m e she a t e she thought o f t h e  dark room. Over t h e n e x t two months h e r whole f a m i l y went on a d i e t w h i c h added a l o t of support.  A t f o u r months h e r w e i g h t was back down t o 84.4 Kg.  the f i n a l s i x month f o l l o w - u p h e r w e i g h t was 86.0 Kg.  At  She f e l t she had  l e a r n e d how to e a t b u t n o t r e a l l y what t o e a t and thought t h a t a more  rigid  d i e t would be b e t t e r f o r h e r . H e r , b i g g e s t problem on t h e programme was " k e e p i n g h e r mouth s h u t " . a desire to repeat i t .  She f e l t v e r y p o s i t i v e l y about SD and e x p r e s s e d  120 S u b j e c t SDNM-2 was a 39 y e a r o l d m a r r i e d woman who worked i n t h e o f f i c e of  a f a m i l y run b u s i n e s s .  old.  She had t h r e e c h i l d r e n between 19 and 12 y e a r s  Her w e i g h t was 118.5 Kg a t a h e i g h t o f 161 cm.  Her g o a l w e i g h t was  70 Kg. She had been o v e r w e i g h t s i n c e t h e age o f 16 and f e l t t h a t t h e reason for  t h i s o n s e t was t h a t she became somewhat h y p o g l y c e m i c a t t h a t age.  Her  most immediate concern f o r g e t t i n g h e r w e i g h t o f f was w i t h problems i n h e r a n k l e s caused b y h a v i n g t o s u p p o r t such excess w e i g h t . She went t h r o u g h SD w i t h o u t a problem except f o r an o v e r r i d i n g concern f o r h e r p u r s e w h i c h had been l e f t o u t s i d e t h e chamber.  She a l s o thought  about why she c o u l d n ' t l o s e w e i g h t and about h e r 12 y e a r o l d c h i l d a t home. A t t h e one week f o l l o w up h e r w e i g h t was down t o 117.7 Kg. In  g e n e r a l s e s s i o n s w i t h t h i s s u b j e c t were l o n g e r t h a n u s u a l as she  would t a l k about h e r many problems w i t h h e r f a m i l y and p a r t i c u l a r l y w i t h h e r o l d e s t son who would g e t 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 g o i n g on about how m i s e r a b l e h e r l i f e was.  A t one  month h e r w e i g h t was up t o 119.25 Kg. , She e x p l a i n e d t h a t she was " r e t a i n ing  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 t o t h e d i e t ,  She was p l a n n i n g  to go t o C a l i f o r n i a f o r an e x t e n s i v e t e s t i n g o f h y p o g l y c e m i a . The n e x t time s h e was seen was a t t h r e e months when h e r w e i g h t was 123,5 Kg, S h e . r e p o r t e d h a v i n g been f a i t h f u l l y on 1200 c a l o r i e s b u t t h a t something was h a y w i r e i n h e r body.  Her t e s t s f o r h y p o g l y c e m i a had been  p o s i t i v e and she had been g i v e n a s p e c i a l l i s t o f foods t h a t she s h o u l d e a t . A t f o u r months h e r w e i g h t was up t o 126.3 Kg. She r e p o r t e d t h a t she was s t i l l on t h e d i e t and t h a t she was u s i n g the u r i n e t e s t f o r k e t o s i s . t e s t s showed t h a t she was i n k e t o s i s and s h o u l d thus be b u r n i n g f a t .  Her  121  At the f i n a l s i x month s e s s i o n she r e l a t e d t h a t she had been g i v e n p i l l s to r e l e a s e f l u i d .  Her w e i g h t a t t h i s time was back down to 121.4 Kg.  She f e l t t h a t t h i s was good b u t t h a t she s h o u l d have been l o s i n g a l l a l o n g . However she was n o t w o r r i e d about i t s i n c e she knew t h a t t h e r e was something p h y s i c a l l y wrong t h a t was c a u s i n g h e r t o r e t a i n f l u i d .  She  nevertheless  f e l t she had l e a r n e d 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 e x p r e s s e d some f r u s t r a t i o n t h a t the d o c t o r s c o u l d n o t seem t o d i s c o v e r what h e r p r o b l e m was.  She f e l t the SD s e s s i o n was o f no b e n e f i t t o h e r and  t h a t a l l she d i d was w o r r y about h e r p u r s e .  122 Subject  SDNM-3 was  the ages 23 and  7.  a 48 y e a r o l d h o u s e w i f e w i t h f o u r c h i l d r e n between  Her w e i g h t was  been o v e r w e i g h t s i n c e the age as two much food. little  food.  She  She  98.5  Kg and h e i g h t was  of e i g h t and  61  the cause o f h e r  She  had  overweight  Kg.  found SD v e r y t e d i o u s and was  not a b l e t o r e l a x c o m p l e t e l y .  23-1/2 hours she wanted t o l e a v e but was  At  persuaded to s t a y because o f  Most of her time i n SD was  the  spent l i s t e n i n g t o h e r b o d i l y  p r o c e s s e s and p l a y i n g "games w i t h the l i g h t i n my mind". a f t e r SD she was  cm.  f e l t she d i d not o v e r e a t but t h a t she needed v e r y  Her g o a l w e i g h t was  s h o r t time l e f t .  saw  162  For s e v e r a l days  d i s t u r b e d w i t h problems g e t t i n g t o s l e e p and w i t h poor  digestion, A t one week h e r w e i g h t was the d i e t regimen. as w e l l .  Her  down to 97 Kg and she was  quite pleased  A f t e r t h a t she q u i t smoking and d i d not  one month w e i g h t was  Her w e i g h t a t t h r e e months was  96.7  s t a y on the d i e t  Kg.  92.7  Kg, a l o s s t h a t she a t t r i b u t e d to  h a v i n g been away i n Mexico f o r s e v e r a l weeks around C h r i s t m a s . d i f f i c u l t y e a t i n g Mexican food and was revenge".  Her  She  a break to cleanse  had  sometimes i l l w i t h "Montezuma's  r e f l e c t i o n s on the SD e x p e r i e n c e were t h a t i t s e r v e d  f o c a l p o i n t ; i t was  with  as a  the system and b r e a k o l d h a b i t s .  A l s o when she thought o f the o r d e a l she f e l t " i f you can do t h a t you can  do  anything", At f o u r months h e r w e i g h t was - of e v e r y t h i n g  up t o 94.3  the programme i s w o r k i n g " .  and thought t h a t n o r m a l l y  Kg but she  She was  f e l t that " i n s p i t e  upset w i t h f a m i l y problems  she would have g a i n e d much more.  month f o l l o w up her w e i g h t was  much the same a t 94.9  programme had been s u c c e s s f u l s i n c e she n o r m a l l y  At the f i n a l s i x  Kg but she f e l t  the  gains 5 pounds a y e a r .  At  123  t h i s p o i n t she f e l t t h a t SD had been p r e t t y d e v a s t a t i n g . a l o n g h a r d l o o k a t h e r s e l f had made h e r d e p r e s s e d .  . H a v i n g t o take  She c l a i m e d  that since  SD she had f e l t entombed and a t t r i b u t e d t h i s t o t h e i s o l a t i o n o f SD, f e e l i n g b u r i e d f o r t h a t time.  She a l s o was concerned t h a t m e d i c a l  and p s y c h i a -  t r i c f a c t o r s c o u l d have been s t r e s s e d more.  She f e l t t h a t i n o r d e r t o  r e a c h h e r g o a l w e i g h t she would need m e d i c a l  help.  124 Subject  SDNM-4 was a m a r r i e d woman, 43 y e a r s o l d , w i t h s i x c h i l d r e n  between t h e ages o f 8 and 21 y e a r s . Relations Officer.  She was,employed as an I n d u s t r i a l  Her s t a r t i n g w e i g h t was 83.5 Kg a t 161.6 cm.  She had  g a i n e d w e i g h t a f t e r h e r f i r s t c h i l d b u t s a i d she d i d n ' t r e a l l y know why. Her major m o t i v e f o r l o s i n g weight,was t o appear s l i m m e r . determined and thought she would have no d i f f i c u l t y  She was v e r y  i n reaching her goal  o f 68 Kg. Sensory d e p r i v a t i o n was u n e v e n t f u l  except f o r some i n t e r e s t i n g dreams.  I n one she had l e f t t h e chamber and k e p t t r y i n g u n s u c c e s s f u l l y t o g e t back in.  A more a l a r m i n g  dream was t h a t t h e programme was b e i n g  who h a t e d f a t women and was g a s s i n g  r u n by someone  them i n t h e chamber.  A t one week her. w e i g h t was.down t o 82 K g , b u t a t one month i t was back up t o 84 Kg.  She had gone on an e a t i n g b i n g e t h a t l a s t e d a week.  months she had g a i n e d againnand was now 85.2 Kg.  A t two  She had r e c e n t l y found  t h a t she was h y p o g l y c e m i c and was g o i n g on a s p e c i a l d i e t p l a n f o r t h a t . A month a f t e r t h a t she w r o t e t o say t h a t she was d i s c o n t i n u i n g t h e programme and g o i n g back t o Weight Watchers where she had e x p e r i e n c e d p r i o r success.  She s t a t e d t h a t she needed the w e e k l y w e i g h - i n and t h e c o n s t a n t  reminder t o keep on t h e t r a c k . the programme was r e s e a r c h  On t h e phone i t was e x p l a i n e d t o h e r t h a t  and t h a t h e r d a t a were  important.  At t h e f i n a l s i x month meeting h e r w e i g h t was 84.2 Kg.  She f e l t t h e  programme was n o t s u c c e s s f u l b u t t h a t i t might have been had she f o l l o w e d i t . She  found t h e d e t a i l s o f t h e d i e t regimen bothersome and t o o time consuming.  She was p u z z l e d Her  as t o why she c o u l d n ' t  g e t s e r i o u s about l o s i n g w e i g h t .  f i n a l comment was t h a t she wondered what t h e 24 hours o f SD was f o r .  125 Subject old. She  SDNM-5 was  Her w e i g h t was  a 51 y e a r o l d h o u s e w i f e w i t h one  79.3  Kg at 166  cm t a l l and her g o a l w e i g h t was  f e l t t h a t h e r overweight w h i c h began a t age  e a t i n g and  30 was  due  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 .  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  o t h e r day. ing  l o s t s i x pounds.  dinner.  She was  to  Her  64  excessive  weeks p r i o r  c u t t i n g down on  also walking  Her major m o t i v e f o r j o i n i n g the programme was  every  t o a v o i d becom-  a " m i d d l e aged frump". She  found the bed  i n SD too h a r d and  t h e r e f o r e described her e x p e r i -  ence as u n c o m f o r t a b l e and she r e p o r t e d h a v i n g u n u s u a l dreams such as about a h u r r i c a n e , and  The week f o l l o w i n g SD h e r w e i g h t was  a t one month she was  down t o 77,1  Kg when she r e p o r t e d  A t the two month f o l l o w up a f t e r C h r i s t m a s she had (77.5  Kg) but r e p o r t e d  t h a t she was  going to e x e r c i s e c l a s s e s . t h i s was  t h a t she  The was  Her husband had  a t food and had  Kg.  She  difficulty  r e g u l a r check ups  was  life. slightly  reported  r e c e n t l y j o i n e d her on the  T h i s seemed to h e l p her s i n c e at  down to 75.0  f i n a l s i x month f o l l o w up was  back up t o 79.5  gained  Kg  s t e p p i n g up her e x e r c i s e programme by  good f o r h e r ^ m o t i v a t i o n .  f o u r month s e s s i o n she was  one  down t o 78.4  t r y i n g t o get i n t o h a b i t s t h a t would l a s t h e r the r e s t o f h e r  and  Kg.  d r i n k i n g con-  Two  t o j o i n i n g the programme she had begun a d i e t of her own sugars and s t a r c h e s and had  c h i l d 29 y e a r s  plan the  Kg. q u i t e s u r p r i s i n g i n that her weight  t h a t she had been c o n s t a n t l y p i c k i n g  l e a v i n g l i q u o r alone.  i n o r d e r t o keep on the p l a n .  She  f e l t she needed more  O t h e r w i s e she was  w i t h the programme but q u i t e d i s g u s t e d w i t h h e r s e l f .  pleased  126 S u b j e c t SDNM-6 was a 33 y e a r o l d m a r r i e d woman w i t h f o u r c h i l d r e n b e tween t h e ages s i x and 13. She was employed as a keypunch o p e r a t o r . weighed 69.4 Kg a t 156 cm and had a g o a l weight o f 54 Kg. overweight  She  She had been  f o r . 10 y e a r s s e e i n g t h e cause as "babies and s u r g e r i e s " . Three  months p r i o r t o j o i n i n g t h e programme she had l o s t 34 pounds on Weight Watchers and had k e p t t h a t weight o f f .  She had been r e f e r r e d t o t h i s p r o -  gramme by t h e Smoking C l i n i c a t UBC. She d i d n o t f i n d SD u n p l e a s a n t even though she was a b i t shaky a t f i r s t and was o c c a s i o n a l l y v e r y warm,  She spent h e r 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 t h i n g s done f o r C h r i s t m a s . f l i t t i n g " b u t she r e l a x e d and e n j o y e d i t .  A f t e r a w h i l e h e r "mind began  One week f o l l o w i n g SD h e r w e i g h t  was 70.6 Kg w h i c h was down from t h e 71.3 she had been a t t h e time o f SD. A t one month she was up t o 71.9 Kg a l t h o u g h she r e p o r t e d h a v i n g been down t o 68 Kg b e f o r e becoming i l l  around C h r i s t m a s .  d i d n ' t e a t much b u t was r e t a i n i n g a l o t o f f l u i d .  W h i l e she was s i c k she Her p h y s i c i a n had t o l d  h e r t h a t h e r k i d n e y s were n o t f u n c t i o n i n g p r o p e r l y . was up t o 73.8 Kg.  A t two months h e r weight  She f e l t t h a t she had approached t h e programme w i t h t o o  much o f an a t t i t u d e t h a t i t would be v e r y easy.  She was then s t a r t i n g t o  p l a n meals i n advance. A t t h e f o u r month f o l l o w up she weighed 74.8 Kg and r e p o r t e d g e t t i n g worse.  She was now s n e a k i n g f o o d and f e l t t h a t she needed group support t o  keep h e r m o t i v a t e d .  A t s i x months she was down some t o 72.7 Kg. T h i s l o s s  she a t t r i b u t e d t o t h e f a c t t h a t she had s t a r t e d smoking a g a i n a t t h e same l e v e l as b e f o r e g o i n g t o t h e Smoking C l i n i c .  She f e l t i f she had f o l l o w e d  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 h e r l a c k o f  w i l l power t o h a v i n g hunger urges w h i c h she had n e v e r r e a l l y e x p e r i e n c e d b e f o r e because she had always been smoking.  The urges began when she q u i t  127  smoking.  A t t h e same time she s a i d h e r e a t i n g p r o b l e m came m a i n l y from  s o c i a l pressure.  T h i s 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  S u b j e c t SDNM-7 was a 52 y e a r o l d m a r r i e d woman who worked as a R e g i s t e r e d Nurse a t a major h o s p i t a l . years o l d .  She had t h r e e c h i l d r e n between 23 and 28  Her i n i t i a l w e i g h t was 83.8 Kg a t 162 cm. and h e r d e s i r e d  w e i g h t was 61 Kg. She had been o v e r w e i g h t f o r the p a s t 10 y e a r s and a t t r i b u t e d h e r g a i n a t t h a t time t o have been t h e r e s u l t o f o v e r e a t i n g t r i g g e r e d by e m o t i o n a l  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 i n c e n o t h i n g e l s e had worked; on S t i l l m a n ' s q u i c k w e i g h t l o s s d i e t she had lost  .75 pounds and on a c o m p l e t e l y  l i q u i d d i e t had l o s t 1.5 pounds.  A t t h e time o f SD h e r w e i g h t was up t o 84.5 Kg. c u l t i e s w i t h SD; i t was n e i t h e r u n p l e a s a n t want t o r e p e a t i t .  She r e p o r t e d no d i f f i -  n o r u n c o m f o r t a b l e b u t she d i d n ' t  One week f o l l o w i n g SD h e r weight was down t o 82.6 Kg and  a t t h e one month f o l l o w up was 82.5 Kg. T h i s s l o w p r o g r e s s was d i s c o u r a g i n g and she r e p o r t e d t h a t she was p l a n n i n g on f a s t i n g 2 days a week. A t two months she was 84.1 Kg and was c o n s i d e r i n g f a s t i n g 3 days a week.  She r e p o r t e d f o l l o w i n g t h e 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 s n a c k i n g i n t h e e v e n i n g .  A t f o u r months  she r e p o r t e d t h a t she had ceased f a s t i n g because she was becoming d i z z y . Her w e i g h t was down t o 81.6 Kg. A t t h e f i n a l s i x month s e s s i o n h e r w e i g h t was 82.0 Kg. She found i t d i f f i c u l t t o keep t h e programme going w i t h such s l o w w e i g h t l o s s . 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 was  She d i d not f e e l t h a t she c o u l d even r e a c h  h e r g o a l w e i g h t b u t was p l a n n i n g t o s t i c k w i t h the programme t o a v o i d g a i n i n g any more.  129  Subject  SDNM-8 was  a 25 y e a r o l d woman who  Nurse.  Her i n i t i a l w e i g h t was  75.3  Kg a t 164  51 Kg.  She had been overweight s i n c e 18 and  worked as a  Registered  cm and her g o a l weight saw  the cause as b e i n g away  from home w h i c h 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 s t a r c h y f o o d s , beer.  was  She j o i n e d t h i s programme because she was  and  drinking  not f e e l i n g v e r y good about  h e r s e l f and her w e i g h t . She  reported  t h a t 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 laxing.  One  week f o l l o w i n g SD her w e i g h t was  73.5  Kg.  A f t e r one month  reported  t h a t SD had been a s t a r t i n g p o i n t f o r her good p r o g r e s s ,  although  she r e p o r t e d t h a t b e i n g s i c k around C h r i s t m a s time c o n t r i b u t e d t o h e r r e n t w e i g h t of 71.0  e v e r , had  on h e r 1500  500  changed v e r y l i t t l e  number of f a m i l y w o r r i e s o f what she was  c a l o r i e s o f e x e r c i s e a day  c a l o r i e d i e t about 60% of the time. (70.9  Kg)  a t t h a t time.  g r e s s a t f o u r months w i t h a w e i g h t of 70.6  records  Kg.  She  t h a t l e d h e r t o eat and eating.  She  At the f i n a l s e s s i o n h e r w e i g h t was  Her w e i g h t how-  showed l i t t l e  r e p o r t e d h a v i n g had  t h a t she had  stuck w i t h  back t o 70.9  needed to be pushed more t o keep up the p l a n .  p r o g r e s s to h e r own  proa  stopped k e e p i n g  Kg and  Nevertheless  her. she  felt  she  she f e l t she  g a i n e d a h e a l t h i e r a t t i t u d e about the k i n d s of foods to eat and was She was  and  On the o t h e r hand she s a i d t h a t the i d e a o f  not e a t i n g p i e and o t h e r such f a v o r i t e foods had  l e s s sweets.  cur-  Kg.  At two months she r e p o r t e d a v e r a g i n g t h a t she was  she  had  eating  i m p r e s s e d w i t h the whole p l a n but a t t r i b u t e d h e r poor  laziness.  130 S u b j e c t SDNM-9 was and 6.  a 40 y e a r o l d housewife w i t h two c h i l d r e n aged 4  She o c c a s i o n a l l y worked as a s o c i a l worker.  at 155 cm w i t h a g o a l weight of 55 Kg.  Her w e i g h t was  She had been overweight  Kg  s i n c e the  age o f 12 and a t t r i b u t e d her weight problem t o h e r b i n g e e a t i n g . a l l y she would go on b i n g e s and e a t h i g h c a r b o h y d r a t e  71.3  Occasion-  foods.  W h i l e she d i d not f i n d SD t o 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 joy  it.  She e x p r e s s e d a d e s i r e t o get up and do and see t h i n g s .  en-  Toward  the end of h e r s e s s i o n she r e p o r t e d " v i s u a l e x p e r i e n c e s w i t h shapes and lights".  She d i d n o t p a r t i c u l a r l y t h i n k about f o o d o r d i e t i n g but she d i d  get hungry.  F i n i s h i n g the a l l o t m e n t o f M e t r e c a l she r e p e a t e d l y  and r e c e i v e d more.  requested  She consumed a t o t a l of 10 cans o f M e t r e c a l and  f o r more j u s t p r i o r t o b e i n g l e t out a t the end o f 24  asked  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 w e i g h t ; weight  a t one week, one month and 2 months were 71.6  Kg r e s p e c t i v e l y ,  Kg., and  She r e p o r t e d h e r most d i f f i c u l t time b e i n g when she  p l e a s e d w i t h h e r s e l f and her p r o g r e s s . ing  Kg, 71.4  A t two months she r e l a t e d an  her 71.0  felt interest-  p e r s o n a l e x p e r i e n c e t h a t stemmed from the SD s e s s i o n . W h i l e i n SD she f e l t tense and was  t h a t t h i s t e n s i o n was people.  unable t o r e l a x however was  made aware  the r e s u l t of f e e l i n g e x t r e m e l y dependent on o t h e r  T h i s made h e r aware o f the e x t e n t t o w h i c h she l o o k e d to o t h e r s f o r  leadership.  Even h a v i n g to ask f o r more food i n SD made h e r aware o f t h i s  dependence and made her r e s e n t f u l o f i t .  She a l s o r e a l i z e d the' f.emotional :  r o l e t h a t 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 t o s t r e t c h out h e r stomach. A t f o u r months h e r weight was  down t o 68.5  Kg.  She r e p o r t e d she  had  been w o r k i n g 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 t h i n g s f o r herself.  A t the f i n a l s i x month s e s s i o n she was  down to 65.9  Kg but  said  131  t h a t she hadn't l o s t any weight  d u r i n g the l a s t month.  been s t i c k i n g c a r e f u l l y to the programme she was to withdraw from the programme.  Because she  d i s c o u r a g e d and had  had tried  She f e l t she had f i n a l l y been a b l e t o  f o c u s on the p r o b l e m w h i c h r e a l l y c e n t e r e d on h e r own m o t i v a t i o n and t h a t she had a much h e a l t h i e r a t t i t u d e about f o o d . She f e l t she had g a i n e d a g r e a t d e a l of i n s i g h t i n t o the reasons  f o r h e r e a t i n g and t h a t she was  now  a b l e t o be more  l o o k out f o r h e r s e l f and r e l y l e s s on the o p i n i o n s o f o t h e r s . p r o g r e s s she a t t r i b u t e d t o her one s e s s i o n o f  SD,  emotional independent, A l o t of t h i s  132  S u b j e c t NCM-1 t i a l w e i g h t was  was  a 33 y e a r o l d a r t i c l e d s t u d e n t of law.  Her  ini-  85.1 Kg a t 167 cm. t a l l and h e r d e s i r e d w e i g h t was 59 Kg.  She had been overweight since:" around t e n y e a r s o l d and saw the cause o f the problem as h e r mother's use o f food as a s i g n o f a f f e c t i o n . blem was  This pro-  a c o n t i n u i n g one i n t h a t she s t i l l l i v e d w i t h h e r mother who  t i n u e d to use food i n t h i s way.  con-  P i e s and p a s t r y were c o n s t a n t l y p r e s e n t  and h e r mother always made sure t h a t she was p o s s i b l e i n f l u e n c e on h e r w e i g h t was  e a t i n g "enough".  Another  t h a t she took b i r t h c o n t r o l  pills  c o n s t a n t l y t o a v o i d the u n p l e a s a n t n e s s o f m e n s t r u a t i o n . Because o f a h e c t i c s c h e d u l e and a number o f problems  a t home she  was  n o t a b l e to r e t u r n u n t i l one month a f t e r h e a r i n g the messages, a t w h i c h time h e r w e i g h t was  85.7 Kg.  Her b o y f r i e n d ' 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 p r e v e n t e d her from g e t t i n g s t a r t e d on the d i e t . months she was  down to 82.5 Kg.  She was  and g e t t i n g r e g u l a r moderate e x e r c i s e .  At  s t i c k i n g t o a d i e t o f 1350 She was  two calories  r e c e i v i n g no s u p p o r t from  h e r mother w h i c h p r e s e n t e d q u i t e a problem s i n c e h e r mother p r e p a r e d h e r food.  She e x p r e s s e d a d e s i r e t o become more independent  but complained t h a t t h i s was tiveness.  from her mother  i m p o s s i b l e because o f her mother's m a n i p u l a -  Even the p o s s i b i l i t y o f m a r r y i n g 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 o f i n h e r i t a n c e . T h i s s u b j e c t was not seen a g a i n u n t i l the f i n a l s i x month s e s s i o n when h e r w e i g h t was  up t o 90.0 Kg.  as the r e a s o n f o r h e r f a i l u r e .  Her complete l a c k of f a m i l y support was Her mother was  seen  c o n s t a n t l y t r y i n g to sabotage  h e r e f f o r t s and h e r 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 o r discomf o r t arose. had.  One  Food, she had found, was  t h e o n l y u n c o m p l i c a t e d p l e a s u r e she  t h i n g she f e l t she had gained was), a more thorough u n d e r s t a n d i n g o f  133 the c o m p l e x i t y of h e r 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 o f h e r environment,  134  S u b j e c t NCM-2 was  a 57 y e a r o l d housewife who  however, one had r e c e n t l y been k i l l e d .  had had two  Throughout the s i x months she  i n mourning and o c c a s i o n a l l y became q u i t e e m o t i o n a l . was  93.8  Kg a t 166 cm and h e r g o a l was  t o w e i g h t 68 Kg. The  down t o 90.2  the book n o r I was was  Her weight  had  reason f o r her  h e r use o f food as a comfort i n time o f s t r e s s .  One week f o l l o w i n g the messages h e r weight was month was  was  Her I n i t i a l weight  been g a i n e d a t t h r e e d i f f e r e n t ages: 14, 24 and 51. problem was  children  Kg.  92.8  Kg and a t  one  She r e p o r t e d t h a t she l i k e d t h e f a c t t h a t n e i t h e r  e v e r n e g a t i v e and s i n c e t h e r e were no f o r b i d d e n f r u i t i t  e a s i e r to not e a t t h i n g s .  She had been u s i n g the r e l a x a t i o n e x e r c i s e  to curb h e r e a t i n g u r g e s , A t two months h e r weight was the Christmas h o l i d a y s . was  following.  89.7  Kg and she had been o f f the d i e t  Her husband had been v e r y s u p p o r t i v e of the p l a n she  A t f o u r months h e r w e i g h t was  88.0 Kg and she r e p o r t e d hav-  i n g been o f f the programme a g a i n f o r about a month. t h a t she was  over  s u p p r e s s i n g h e r g r i e f too much.  Her d o c t o r  She was  suggested  s t i l l u s i n g the r e l a x a -  t i o n e x e r c i s e and found i t v e r y 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  p l e a s e d h e r as she d i d n ' t want t o t a k e drugs f o r i t . A t the f i n a l s i x month s e s s i o n her w e i g h t was concerned She was better.  about l o s i n g weight but was  87.1 Kg.  She was  not  s t i l l v e r y concerned w i t h h e r h e a l t h .  p l e a s e d w i t h the e f f e c t s h e r e x e r c i s e had had i n making h e r  feel  The major problem had been her g r i e f w h i c h had a l s o depressed  and l e d h e r t o eat f o r c o m f o r t . l o s i n g weight  She f e l t t h a t w h i l e she was  t h a t she c o u l d do i t .  as  her  v e r y l a z y about  135  S u b j e c t NCM-3 was a 41 y e a r o l d m a r r i e d woman who r a n a f l o r i s t shop.  She had f o u r c h i l d r e n between t h e ages o f 5 and 19. Her i n i t i a l  w e i g h t was 108.3 Kg a t 170 cm and h e r g o a l weight was.;70Kg. become overweight w i t h h e r l a s t pregnancy.  She s p e c u l a t e d  She had that since  she had been r e m a r r i e d perhaps she was more c o n t e n t , however, she a l s o o v e r a t e when she was u p s e t .  Her w e i g h t a t t h i s p o i n t was c a u s i n g h e r  problems w i t h h e r back and h e r d o c t o r had o r d e r e d  h e r t o reduce.  A f t e r t h e s e s s i o n w i t h t h e messages t h i s s u b j e c t h a d g r e a t i n making any o f t h e s c h e d u l e d appointments.  difficulty  The major c o n f l i c t was t h e  f a c t t h a t she was c h i e f l y r e s p o n s i b l e f o r h e r s t o r e j  The f i r s t f o l l o w  up f o r h e r was a f t e r two months when h e r weight was 107.5 Kg.  She f e l t  she was h a v i n g d i f f i c u l t y because she needed someone t o r e p o r t t o . she had gone o f f t h e d i e t a t C h r i s t m a s  time.  Because she went away f o r a h o l i d a y she was n o t seen a g a i n the f i n a l s i x month s e s s i o n when h e r w e i g h t was 106.9 Kg. she was more c o n s c i o u s  until  She f e l t  that  o f t a k i n g care o f h e r s e l f but that running h e r  s t o r e was a d r a i n on h e r and made h e r n e r v o u s . eat.  Also  T h i s made h e r want t o  She was n o t t h i n k i n g o f s e l l i n g h e r s t o r e and thought t h a t  a c t i o n would h e l p h e r l o s e w e i g h t .  this  She f e l t t h a t now she was a b l e t o  f o l l o w a d i e t w i t h o u t becoming depressed about d e p r i v i n g h e r s e l f .  136  S u b j e c t NCM-4 was a 44 y e a r o l d h o u s e w i f e w i t h s i x c h i l d r e n between -  11 and 23 y e a r s o l d .  Her i n i t i a l w e i g h t was 8i2'..l Kg a t 167 cm and h e r  g o a l w e i g h t was 68 Kg.  Her w e i g h t problem w h i c h she had had s i n c e the  age o f 15 was due m a i n l y t o poor e a t i n g h a b i t s . showing a p r e f e r e n c e Her m o t i v a t i o n  She was a f u s s y  f o r sweets and g e n e r a l l y a v o i d i n g many  f o r j o i n i n g the programme was  a g g r a v a t e d by h a v i n g r e c e n t l y g i v e n up  eater  vegetables.  t h a t her p r o b l e m had been  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 Kg and a f t e r one month was down t o 78.2.  o f messages h e r weight was  81.6  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, d u r i n g w h i c h she d i d n ' t f o l l o w the d i e t at a l l .  F o r t h i s r e a s o n h e r w e i g h t went up t o 79.1 Kg a t two months.  A f t e r the e l e c t i o n was o v e r she r e t u r n e d due t o 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 .  t o the d i e t o n l y  briefly  Problems between h e r husband  and h e r w h i c h r e s u l t e d i n t h e i r s e p a r a t i o n produced s t r e s s t h a t p r e v e n t e d h e r 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 . was  79.0  At f o u r months her w e i g h t  Kg.  A t the f i n a l s i x month s e s s i o n h e r weight was major d i f f i c u l t y as h e r i n a b i l i t y t o o r g a n i z e  76.9 Kg.  herself.  She saw the  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 from h e r husband.  A f t e r seeking  family counseling  were back t o g e t h e r  and g e t t i n g a l o n g much b e t t e r .  harassment  she and h e r husband She f e l t she had  l e a r n e d a l o t about h e r e a t i n g h a b i t s but s t i l l d i d n ' t u n d e r s t a n d her c r a v i n g f o r sweets. planning  She now r e a l i z e d the importance o f e x e r c i s e and  t o s t a r t o v e r on t h e programme.  was  137 S u b j e c t NCM-5 was a 44 y e a r 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 t h r e e c h i l d r e n between 15 and 19 from an e a r l i e r  m a r r i a g e b u t 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 . was  76.5 Kg a t 155 cm and h e r d e s i r e d w e i g h t was 57 Kg.  overweight  Her weight  She had been  s i n c e t h e age o f 13 and saw t h e cause o f t h e problem  being  t h a t e a t i n g was h e r response t o s t r e s s and she was a v e r y e m o t i o n a l p e r son w i t h a l o t o f s t r e s s .  Her motive f o r j o i n i n g the programme was t h a t  r e c e n t l y h e r o v e r w e i g h t was c a u s i n g h e r t o 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 t h e messages h e r w e i g h t was 76.8 Kg.  Because  of h e r busy s c h e d u l e she found v e r y l i t t l e time t o f o l l o w t h e d i e t o r do any e x e r c i s e . A t one month h e r weight was 78.0 Kg and she was wondering i f she r e a l l y d i d want t o be thin.anyway.  A t two months she was t h e same  w e i g h t a t 78 Kg and she r e p o r t e d a v e r a g i n g about 2000 c a l o r i e s a day.  Her  Common Law spouse seemed t o be s a b o t a g i n g h e r d i e t by b r i b i n g h e r w i t h f o o d because, she c l a i m e d , he l i k e d h e r t o be f a t .  She a l s o s a i d t h a t up  to t h a t p o i n t she had made no r e a l commitment t o t h e programme b u t i n t e n ded t o do so a t t h e b e g i n n i n g o f t h e y e a r . A t f o u r months she weighed 79.5 Kg and complained o f b e i n g v e r y depressed.  She had been o f f a n t i d e p r e s s a n t s f o r a y e a r b u t was now back  on them.  Her spouse was p r o v i d i n g no e m o t i o n a l support f o r h e r programme  and she f o u h d o h e r s e l f h a v i n g t o become more  independent.  A t t h e f i n a l s i x month s e s s i o n she weighed 77.7 Kg and a t t r i b u t e d t h i s l o s s t o h a v i n g j o i n e d TOPS programme i n t h e p r e v i o u s two weeks.  She  enjoyed t h e o t h e r women i n t h e programme and was on a h i g h p r o t e i n d i e t . She f e l t t h e p h i l o s o p h y b e h i n d t h i s programme had been good b u t was n o t r i g h t f o r h e r , as she had g r e a t d i f f i c u l t y f o l l o w i n g t h e s t r u c t u r e .  She  138  d i d n ' t l i k e b e i n g t o l d what t o do o r b e i n g t i e d t o a c h a r t . t h a t she now had a b e t t e r o r i e n t a t i o n about why she s h o u l d  She f e l t l o s e weight  but d i d n ' t f e e l t h i s a t t i t u d e change was t h e r e s u l t o f t h e programme.  139  S u b j e c t NCM-6 was 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 s a l e s p e r s o n .  i n i t i a l weight was ing  a 45 y e a r o l d h o u s e w i f e w i t h f o u r c h i l d r e n between  95.25 Kg a t 163  been overweight s i n c e the age o f 16 she saw  e x e r c i s e as the c h i e f causes. discovered her  cm and her g o a l w e i g h t was overeating  Hav-  l a c k of she  t h a t she d i d much s n a c k i n g w h i l e w o r k i n g the food c o u n t e r a t  job.  back up t o 95.1.  Her  snacking  at work was  93.7  Kg.  To f i g h t her s n a c k i n g  a t work she was  b l e s to h e r j o b and e a t i n g them i n s t e a d .  She  Kg but a f t e r one  s t i l l a p r o b l e m and  found i t d i f f i c u l t t o f i n d the time f o r e x e r c i s e . was  70 Kg.  D u r i n g her week o f s e l f m o n i t o r i n g  A week f o l l o w i n g the message she weightejd-u 94.5 was  and  Her  month she  At two months her w e i g h t b r i n g i n g raw  vegeta-  f e l t she had become much  more aware o f e a t i n g . At f o u r months h e r w e i g h t was t o 95.6  Kg.  of being  n e c e s s a r y and e a t i n g a t work.  surrounded by d e l i c a t e s s e n goodies was  h e r even though between meal e a t i n g was f e l t t h a t she was had  Kg and by s i x months was  weak w i l l e d and  The  the  constant  too much f o r  never a problem at home.  She  e a s i l y bored w i t h any programme.  l e a r n e d to slow down when she a t e but c o n t i n u e d  foods:  back up  The major problems were seen as never h a v i n g time t o do  e x e r c i s e t h a t she knew was temptation  94.7  t o eat the wrong  She  140  S u b j e c t NCM-7 was  a 43 y e a r o l d h o u s e w i f e w i t h f i v e c h i l d r e n be-  tween 9 and 19 y e a r s o l d . h e r g o a l w e i g h t was  64 Kg.  Her i n i t i a l weight was 91.2 Kg a t 156 cm  and  She had been o v e r w e i g h t s i n c e a f t e r the  b i r t h o f h e r 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 o v e r e a t t o cope w i t h boredom. One week a f t e r the messages h e r w e i g h t was  89.7 Kg and she showed  v e r y s l o w p r o g r e s s a f t e r t h a t w i t h one and two month w e i g h t s o f 89.4 and 88.4 Kg.  Kg  She had been t a k i n g i n d e r o l f o r h i g h b l o o d p r e s s u r e and  f e l t t h a t t h i s had slowed down h e r metabolism because she was  s t i c k i n g to  h e r 1350 c a l o r i e d i e t . A t f o u r months her w e i g h t was up t o 90.4 Kg and a t s i x months was f u r t h e r t o 92.9 Kg.  She f e l t she had been unable t o b r e a k h e r o l d h a b i t s  and l e a r n new ones and she was c o n f u s e d about h e r m o t i v a t i o n . to l o s e w e i g h t b u t wasn't w o r k i n g a t i t .  so slow.  She a l s o e x p r e s s e d  r e s i s t a n c e a g a i n s t t h e b e h a v i o u r a l a s p e c t s o f the programme. h a v i n g qualms about b e h a v i o u r t h e o r y s i n c e i t was  tion. power.  She v o i c e d  o u t s i d e r a t h e r than  She saw the taped messages as an attempt a t m a n i p u l a -  On the o t h e r hand she saw h e r s e l f as b e i n g w i s h y washy w i t h no w i l l She was b e g i n n i n g t o h a t e housework a n d t h i s made h e r eat a l o t  around the house. was  She wanted  She had s t a y e d on the d i e t f o r  two months but q u i t because h e r p r o g r e s s was  internal influence.  up  I n a d d i t i o n she was d e v e l o p i n g b u r s i t i s which she  a p s y c h o s o m a t i c symptom o f t h i s h a t r e d .  gramme i t s e l f was  s u c c e s s f u l b u t she was  not.  felt  She c o n c l u d e d t h a t the p r o -  141  S u b j e c t NCM-8. was a 30 y e a r o l d h o u s e w i f e w i t h two c h i l d r e n aged six  and e i g h t .  Her i n i t i a l w e i g h t was 111 Kg a t 167.5 cm and h e r g o a l  w e i g h t was 64 Kg. become e x t r e m e l y  She had been heavy s i n c e t h e age o f e i g h t b u t had  heavy a f t e r h e r second c h i l d .  h e r response t o d e p r e s s i o n and d i s a p p o i n t m e n t  Overeating  had become,  with herself.  She had p r e -  v i o u s l y l o s t w e i g h t on TOPS and Weight Watcher programmes b u t had always g a i n e d the w e i g h t back. One week a f t e r h e a r i n g t h e messages h e r w e i g h t was down t o 108.2 Kg. She was q u i t e p l e a s e d w i t h t h e 1700 c a l o r i e and t h e programme i n g e n e r a l . By one month she weighed 104.5 Kg and was s t i l l v e r y e n t h u s i a s t i c about h e r steady p r o g r e s s . and  Her e x e r c i s e c o n s i s t e d o f 5 minutes each morning  evening. A t two months h e r w e i g h t was 102.2 Kg and a l t h o u g h s t i l l p l e a s e d  with  the d i e t she r e p o r t e d t h a t she had been depressed f o r one week and had n e g l e c t e d p a r t s o f t h e p l a n l i k e w r i t i n g t h i n g s down.  She was a b l e t o s t a y  on t h e d i e t p l a n throughout the C h r i s t m a s h o l i d a y s b u t " f e l l a p a r t " a f t e r wards.  She stopped k e e p i n g  t r a c k and even took down h e r graphs.  At four  months h e r w e i g h t was 106.4 Kg. A f t e r t h a t she was n e v e r a b l e . t o g e t back on t h e p l a n .  She would s t a r t f o r a few days and then q u i t .  she s t i l l wanted t o do i t b u t c o u l d n ' t f o l l o w through.  She c l a i m e d  Her s i x month  w e i g h t was 107.9 Kg. W h i l e she washable t o 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 v e r y 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 h e r w e i g h t l o s s  she became o v e r c o n f i d e n t and then s t a r t e d t o s l i d e .  T h i s i s t u r n would  g i v e h e r t h e f e e l i n g she was l e t t i n g everyone down w h i c h would depress h e r . Then she would go back t o food f o r c o n s o l a t i o n .  She f e l t  particularly  142  f r u s t r a t e d knowing she c o u l d do i t b u t wasn't. of h e r w e i g h t .  She was much more aware  To succeed she f e l t i t would be n e c e s s a r y t o i s o l a t e  h e r s e l f from o t h e r s , t o shut o u t t h e comments o f o t h e r s .  143 S u b j e c t NCM-9 was  a 44 y e a r o l d housewife w i t h f i v e c h i l d r e n between  the ages o f 7 and 20.  Her i n i t i a l weight was  h e r d e s i r e d weight was  66 Kg.  94.5  Kg a t 166.5  an e m o t i o n a l response; e a t i n g when she was  subsequently  week her w e i g h t was  aspect.  94.4  Kg.  change over the s i x months.  her w e i g h t was  93.2  one  gained  A f t e r some p e r -  to c o n t i n u e and came i n a t the two month p e r i o d when Kg.  A l t h o u g h she had not been on the d i e t she  been v e r y busy and e a t i n g was She  At  and had p r o b a b l y  She wanted to q u i t the programme a t t h i s t i m e .  s u a s i o n she agreed  and  A t one month she r e f u s e d to come i n f o r her  appointment s a y i n g t h a t she had been v e r y depressed 5 pounds.  bored.  never a b l e t o f o l l o w the d i e t v e r y c a r e f u l l y  d i d not show much weight  age  Her o v e r e a t i n g  upset, tense, or  She f e l t t h i s programme might h e l p h e r w i t h t h i s T h i s s u b j e c t was  and  She c o u l d not remember any p a r t i c u l a r  when h e r w e i g h t problem began; she had always had i t . was  cm  n e v e r a problem when she was  had  " m e n t a l l y busy".  found t h a t h a v i n g t o c o n c e n t r a t e on the mechanics of the d i e t o n l y  — made h e r h u n g r i e r .  She was  d e s p e r a t e l y l o o k i n g f o r some i n c e n t i v e t h a t  would m o t i v a t e h e r t o do i t . A t f o u r months her weight was up to 96.6  Kg.  back t o 94.5 Kg and by s i x months was  She f e l t the programme s h o u l d work f o r o t h e r s but was  r i g h t f o r h e r ; i t hadn't d e a l t enough w i t h her e m o t i o n a l problems.  not  A  r e c e n t r e s i d e n t o f Vancouver she had no f r i e n d s and f e l t v e r y a l i e n a t e d and i s o l a t e d .  I n a d d i t i o n h e r 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 o r a c e n t r e where she might v o l u n t e e r time and f e e l usef u l would have been much b e t t e r f o r h e r .  144 S u b j e c t NCNM-1 was a 21 y e a r o l d woman who worked as a s e c r e t a r y . She had been o v e r w e i g h t s i n c e l e a v i n g h i g h s c h o o l when she began e a t i n g t o soo'tlv emotional, problems. tive.  A l s o a t t h a t time she became much l e s s a c -  Her i n i t i a l w e i g h t was 78 Kg a t 161 cm and h e r g o a l w e i g h t was 55  Kg. One week a f t e r . b e g i n n i n g t h e d i e t she weighed 76.7 Kg and was extremely  e n t h u s i a s t i c about t h e p l a n .  she s a i d she would have q u i t .  A t t h a t p o i n t i n any o t h e r programme  She was n o t a b l e t o come i n a g a i n  until  the two month s e s s i o n when h e r w e i g h t was 74.0 Kg. Her problem e a t i n g time had been a f t e r work i n t h e e a r l y e v e n i n g . t a k e n a second j o b .  To combat t h i s she had  She was s t i c k i n g t o 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 e v e r y day.  She was s t i l l p l e a s e d w i t h t h e  p l a n and found t h e manual v e r y u s e f u l . At f o u r months h e r w e i g h t was 71.7 Kg. She c l a i m e d  t h a t where she  used t o t h i n k o f 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 o f h e r l i f e around i t , now she d i d n o t t h i n k o f i t o f t e n . 71.1  Kg and was s t i l l enthused about the p l a n .  A t s i x months she weighed She was p l e a s e d w i t h t h e  c o n t i n u o u s w e i g h t l o s s and a l s o 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 b i g g e s t problems had been g o i n g p u t t o d i n n e r  o t h e r s and s n a c k i n g .  with  However she now f e l t she was n o t as l a z y as she  thought she was and t h a t l o s i n g w e i g h t was n o t so h a r d i f you go about i t i n t h e p r o p e r way.  145 S u b j e c t NCNM-2 was  a 32 year o l d h o u s e w i f e w i t h one  She a l s o worked, as a R e g i s t e r e d Nurse. a t 153.2  cm and her g o a l weight, was  a f t e r she was  m a r r i e d a t age 23.  happy and secure  c h i l d aged 5.  Her i n i t i a l w e i g h t was  50 Kg.  77.2  She became o v e r w e i g h t s h o r t l y  She thought t h a t because she  felt  she began to o v e r e a t and to eat the wrong f o o d s .  j o i n e d t h i s programme because i t was  Kg  She  r e s e a r c h , i t l a s t e d s i x months, and  someone would be v e r y i n t e r e s t e d i n h e r p r o g r e s s .  She was  also currently  a t t e n d i n g 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 s e s s i o n she weighed 77.1 a t one month was and  down a b i t to 76.3  f o r t h between h e r 1350  Watchers programme.  Kg.  She was  Kg  and  c o n s t a n t l y s h i f t i n g back  c a l o r i e p l a n w i t h t h i s programme and Weight  A t two months when h e r w e i g h t was  78.4  she  decided  t h a t she w o u l d s t i c k to the Weight Watcher d i e t and the e x e r c i s e p a r t o f t h i s programme. A t f o u r months h e r w e i g h t was some i n s i g h t i n t o h e r s e l f .  77.2  Kg and she f e l t t h a t she had  gained  She d i s c o v e r e d t h a t she f e l t g r e a t s e c u r i t y  I n h a v i n g l o t s o f food around the house, and always k e p t i t o v e r s t o c k e d . She  a l s o c l a i m e d t h a t she no l o n g e r c a r e d about l o s i n g w e i g h t anymore  because she was had  j u s t too l a z y .  However she was  p l e a s e d w i t h the book and  t o l d s e v e r a l people about i t and they had been d o i n g w e l l on i t . At the f i n a l s i x month s e s s i o n she was  programme.  Her w e i g h t was  the " d i e t to end d i e t s " .  75.0  quite disappointed with  Kg but she had i n t e n d e d  t h a t t h i s would be  On one hand she f e l t more c o n t a c t and  literature  would have b e n e f i t t e d her attempt but on the o t h e r hand she r e s e n t e d t o l d what t o do and knew i t must be s e l f i n s t i g a t e d .  the  She  f e l t she  being had  l e a r n e d the i m p o r t a n c e of the p r o p e r a t t i t u d e but f e l t she d i d n ' t have i t . She was  d i s a p p o i n t e d t h a t the programme hadn't done more f o r h e r .  146 S u b j e c t NCNM-3 was tween 5 and 12.  Her  w e i g h t o f 59 Kg. c h i l d and saw  a 36 year o l d h o u s e w i f e w i t h t h r e e c h i l d r e n be-  I n i t i a l w e i g h t was  80 Kg a t 168 cm w i t h a g o a l  She had been o v e r w e i g h t s i n c e t h e b i r t h of her  the cause as o v e r e a t i n g i n response t o boredom.  One week a f t e r b e g i n n i n g the d i e t her w e i g h t was one month was  last  77.3  Kg.  78.9  and  after  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 k e e p i n g t r a c k o f c a l o r i e s and wasn't e x e r c i s i n g . s t e a d she was  j u s t b e i n g c a r e f u l o f what she ate and f o l l o w i n g some of  behavioural steps. she was  In-  At two months she weighed 75.5  c o n c e n t r a t i n g on the l e a r n i n g o f new  Kg and r e p o r t e d  the  that  eating habits.  A t the f o u r month s e s s i o n she r e p o r t e d t h a t she had not been on a d i e t a t a l l . Her w e i g h t was  76.0  Kg.  She  suggested t h a t she would do  b e t t e r i f she had some one e l s e on the programme t h a t she c o u l d c a l l when she was  l o s i n g her motivation.  main p r o b l e m was  At s i x months she weighed 75.4  l a c k i n g the p r o p e r i n c e n t i v e .  Kg.  Her  Not b e i n g a c c o u n t a b l e to  anyone i n the l a t t e r p a r t of the p l a n had made i t easy t o f o r g e t about i t . She was  q u i t e d i s a p p o i n t e d w i t h h e r s e l f and f e l t the programme was  i n the g u i d e l i n e s i t s e t down. b a d l y enough i t would now  good  She knew t h a t i f she wanted t o l o s e w e i g h t  be p o s s i b l e .  147  S u b j e c t NCNM-4 was a 48 y e a r o l d h o u s e w i f e w i t h f i v e c h i l d r e n between 16 and.28. w e i g h t was 61 Kg.  Her i n i t i a l w e i g h t was 82.8 Kg a t 163 cm and h e r g o a l She had s t a r t e d t o g a i n w e i g h t w i t h the b i r t h o f h e r  f i r s t c h i l d b u t a t the age o f 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 w e i g h t 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 d i s a p p o i n t e d w i t h t h i s slow p r o g r e s s 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 t o  d i a b e t i c and was p u t on an exchange p l a n d i a b e t i c d i e t .  She remarked  on t h e s i m i l a r i t i e s between t h e d i a b e t i c d i e t and t h i s programme d i e t . A t two months h e r w e i g h t was 80.8 Kg. problem time.  Suppertime was h e r b i g g e s t  To combat t h i s she was e a t i n g ahead o f t h e r e s t o f t h e  f a m i l y t o she c o u l d t h e n s e r v e everyone e l s e . 81.8  Kg.  Her w e i g h t a t 4 months was  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 b u t  f e l t t h a t i t was t o o much so she was p l a n n i n g on r e d u c i n g i t t o 900 calories. A t t h e 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 a t e l e s s .  Also f o r the l a t e s t  t h r e e weeks she had been going t o TOPS m e e t i n g s .  One o f h e r major p r o -  blems had been t h e l a c k o f support  from h e r f a m i l y .  of h e r e f f o r t s a y i n g " Y o u ' l l never do i t " . to  They would make f u n  She f e l t t h a t she had l e a r n e d  c o n t r o l h e r e a t i n g h a b i t s much b e t t e r and had d i s c o v e r e d t h a t she  needed v e r y l i t t l e  food.  148 S u b j e c t NCNM-5 was as an a r t s t u d e n t . g o a l w e i g h t was and she saw  a 26 y e a r o l d m a r r i e d woman who  Her i n i t i a l weight was  53 Kg.  74.6  was  studying  Kg at 158 cm and  her  She had been o v e r w e i g h t s i n c e the age o f s i x  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 d e r i v e d a g r e a t  d e a l of comfort from f o o d . A f t e r one week she was and her w e i g h t was  71.9  Kg.  q u i t e p l e a s e d w i t h the mechanics of the p l a n She was  a s m a l l amount o f r e g u l a r e x e r c i s e . Her w e i g h t at two months was  f o l l o w i n g a 1200  calorie diet with  A t one month she weighed 70.5  down t o 68.3  Kg and she was  very  Kg. pleased  w i t h the s e n s i b i l i t y o f 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 b u t had been d i s a p p o i n t e d because  t h e i r emphasis was  s o l e l y on l o s i n g as much w e i g h t as p o s s i b l e .  A t t h i s p o i n t h e r w e i g h t l o s s was  beginning  and many o f h e r f r i e n d s would compliment h e r .  t o be p h y s i c a l l y v i s i b l e  T h i s f a c t p l u s the ease w i t h  w h i c h she had l o s t w e i g h t made h e r f e e l a b i t cocky and nibble.  she s t a r t e d to  However, t h i s got a b i t out o f hand so she got back onto the  programme s t r i c t l y .  At f o u r months her w e i g h t was  64.6  At the f i n a l s i x month s e s s i o n she weighed 62.0  Kg.  Kg but d i d not  feel  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 w h i c h she o c c a s i o n a l l y would s l i p back i n t o . to e a t had been h e r b i g g e s t problem. than she ever had b e f o r e and was was  O t h e r w i s e she was  p l a n n i n g t o s t a r t s t u d y i n g dance.  and was  used i n t h i s programme.  g o i n g to c o n t i n u e u s i n g the p l a n .  gramme was  h a v i n g t o pay  she s h o u l d have t o pay have been h e l p f u l .  She s t i l l  She  situational  f e l t v e r y committed  Her one o b j e c t i o n t o the  f o r the d i e t manual.  out  feeling healthier  more c o n f i d e n t i n h e r s e l f and p l e a s e d w i t h the i d e a o f  c o n t r o l t h a t was  may  This p l u s d e a l i n g w i t h going  pro-  She i n i t i a l l y d i d n ' t t h i n k  f o r i t b u t l a t e r thought t h a t owning i t h e r s e l f  149  S u b j e c t NCNM-6 was a 43 y e a r o l d m a r r i e d woman w i t h 4 c h i l d r e n between 11 and 16 and who worked as an o r t h o d o n t i c  technician.  Her  i n i t i a l w e i g h t was 89.2 Kg a t 167.5 cm and h e r d e s i r e d w e i g h t was 68 Kg.  She had been o v e r w e i g h t s i n c e t h e age o f 16 and h e r o n l y  perceived  cause was t h a t she j u s t l i k e d t o e a t . One Kg. and  week a f t e r s t a r t i n g h e r 1350 c a l o r i e d i e t h e r w e i g h t was 87.8  She a l s 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 , gardening.  jogging,  Her w e i g h t a t one month was 87.0 Kg.  At two months she weighed 85.6 Kg and f e l t v e r y good about t h e d i e t . She  f e l t t h a t she was e a t i n g more now than b e f o r e  the d i e t b u t t h a t now  she was e a t i n g t h e r i g h t foods.  Furthermore she was n o t hungry and no  l o n g e r c r a v e d sweets o r candy.  Her w e i g h t a t f o u r months was 83.5 and  she c l a i m e d ill  i t had been v e r y d i f f i c u l t .  and a t e t o f e e l b e t t e r .  D u r i n g t h a t p e r i o d she had been  She a l s o had been g e t t i n g no e x e r c i s e .  At t h e f i n a l s i x month s e s s i o n h e r weight was 86.6 Kg.  She d i d n ' t  know why she was d o i n g i t b u t 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 " . A l s o she had gone away t w i c e and b o t h times had p u t on w e i g h t . she hadn't been e x e r c i s i n g . c i s e was h e r b i g g e s t problem.  Also  She found t h a t managing t o g e t r e g u l a r  exer-  She f e l t she was no l o n g e r as s t r o n g  w i l l e d as she thought she had been.  R e c e n t l y h e r n e i g h b o r had d i e d and  i t made h e r t h i n k , "Why am I s u f f e r i n g ; I ' d r a t h e r d i e happy -• e a t i n g " . On t h e o t h e r hand she f e l t she was e a t i n g b e t t e r foods and was l e s s hungry than on o t h e r d i e t s .  150 S u b j e c t NCNM-7 was a 43 y e a r o l d h o u s e w i f e w i t h t h r e e c h i l d r e n between 17 and 21. Her i n i t i a l w e i g h t was 93.1 Kg a t 168 cm and h e r g o a l w e i g h t was 77 Kg.  She had been o v e r w e i g h t s i n c e t h e age o f 18 and had  gained 30 pounds i n t h e f i r s t y e a r o f h e r m a r r i a g e .  W h i l e she a t t r i b u t e d  t h i s g a i n t o b e i n g v e r y happy and l o v i n g t o cook she s a i d t h a t h e r most r e c e n t w e i g h t g a i n was due t o l o n e l i n e s s and d e p r e s s i o n . One week a f t e r b e g i n n i n g She was e x t r e m e l y  a 1350 c a l o r i e p l a n h e r w e i g h t was 90.7 Kg.  e n t h u s i a s t i c about t h e d i e t , i n f a c t a t one month she  c l a i m e d t h a t she " l i v e s the d i e t " . of i t s f l e x i b i l i t y .  She l i k e d t h e exchange p l a n because  She had problems w i t h h e r arms w h i c h p r e v e n t e d  much  m o t i o n and t h i s made some e x e r c i s i n g i m p o s s i b l e . At two months she weighed 87.5 Kg and r e p o r t e d t h a t she was never o v e r 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 p l e a s e d  the manual and had been d i s c u s s i n g i t w i t h many o f h e r f r i e n d s .  with  At four  months h e r w e i g h t was down t o 86.3. A t t h e f i n a l s i x month s e s s i o n she weighed 86.7 Kg and a l t h o u g h she f e l t she hadn't l o s t much she was v e r y 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 b i g g e s t problem had been  disappointment  w i t h s l o w w e i g h t 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 o f t h e programme. She p r a i s e d the book and programme as t h e b e s t 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 o f t h e e x p e r i m e n t e r as an i m p o r t a n t factor.  She was d i s a p p o i n t e d however a t n o t h a v i n g been a b l e t o go  through SD.  151  S u b j e c t NCNM-8 was  a 33 y e a r o l d h o u s e w i f e w i t h t h r e e c h i l d r e n  between 5 and 15.  Her i n i t i a l w e i g h t was  d e s i r e d w e i g h t was  64 Kg.  133.7  Kg a t 165  cm and  her  She became o v e r w e i g h t w i t h h e r f i r s t  preg-  nancy a t age 17 and gave as a r e a s o n o v e r e a t i n g and no e x e r c i s e .  She  a l s o a t e enormous q u a n t i t i e s o f food i n the m i d d l e o f 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 h e r w e i g h t was  She had d i f f i c u l t y w i t h her m i d n i g h t to  combat i t .  e a t i n g and was  A t one month h e r w e i g h t was  131.3  132.4  Kg.  g i v e n some  technique  Kg.  She m i s s e d the two month s e s s i o n b u t came i n at f o u r months. w e i g h t was p a t t e r n was  up t o 137.0  Kg a t t h a t t i m e .  She r e p o r t e d t h a t h e r  t o s t a r t out " a l l gung ho" i n the morning and by  have g i v e n up.  Her m i d n i g h t  e a t i n g was  Her  typical evening  s t i l l a problem and she had  given  up w o r k i n g on t h a t . A t the f i n a l s i x month s e s s i o n she weighed 138.2 t h i s g a i n f e l t the programme was she had  learned.  f a i r l y s u c c e s s f u l because of the  things  When asked i f she had l e a r n e d a n y t h i n g about h e r s e l f  however she s a i d , "What's t o l e a r n , I'm a g r e a t d e a l of p r e s s u r e was  Kg and i n s p i t e o f  f a t , that's i t " .  She was  from her d o c t o r s t o l o s e w e i g h t b u t she  unable to develop enough m o t i v a t i o n .  do b e t t e r i f she were more c l o s e l y  She  supervised.  getting still  f e l t she might be a b l e t o  152  Subj.ect NCNM-9 was a 46 y e a r o l d woman w i t h t h r e e c h i l d r e n 11 t o 2 1 . She was s e p a r a t e d Her  from h e r husband and was s t u d y i n g some a t U n i v e r s i t y .  i n i t i a l w e i g h t was 74.8 Kg a t 164.5 cm and h e r g o a l w e i g h t was 59 Kg.  She had been o v e r w e i g h t f o r t h e l a s t f o u r y e a r s and a t t r i b u t e d t h e p r o blem to emotional She  problems.  Her response t o w o r r y and t e n s i o n was t o e a t .  a l s o drank f r e q u e n t l y and u s u a l l y i t was b e e r . One week f o l l o w i n g t h e b e g i n n i n g  was  73.25 Kg.  cise.  o f h e r 1500 c a l o r i e d i e t h e r w e i g h t  She was s t i c k i n g t o t h e d i e t and g e t t i n g o c c a s i o n a l  A t one month she weighed 73.0 Kg.  g o i n g o u t f r e q u e n t l y , she had d i f f i c u l t y  Since h e r l i f e s t y l e  involved  w i t h d i n i n g out andvwith d r i n k i n g .  At two months h e r w e i g h t was 72.3 Kg.  She r e p o r t e d t h a t she b e l o n g e d  to a d i e t c l u b t h a t would g i v e h e r support when she l o s t w e i g h t . was  exer-  w a l k i n g o r swimming about t h r e e times a week.  She  A f t e r t h i s she became  q u i t e d e p r e s s e d and c o u l d n ' t g e t h e r s e l f t o do a n y t h i n g .  Consequently  her w e i g h t a t f o u r months was up t o 73.7 Kg. At t h e f i n a l s i x month s e s s i o n she weighed 73.1 Kg and s a i d t h a t t h e programme had made h e r f e e l worse than b e f o r e .  U s u a l l y a b l e t o do t h e  t h i n g s she s e t o u t t o do, she found t h e f a i l u r e a t t h i s d i e t attempt v e r y frustrating.  She commented t h a t because she was e a t i n g l e s s f r e q u e n t l y  she was e n j o y i n g food more.  However, she f e l t t h a t t h e p l a n l e f t t o o  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 t o h e r . d r i n k i n g were due t o t h e e m o t i o n a l separated  She f e l t b o t h h e r e a t i n g and  u p s e t t h a t was caused by h e r b e i n g  from h e r husband, a s t a t e she c o u l d n o t get used t o .  t h a t she had no w i l l power.  She f e l t  When she would e a t t h e wrong t h i n g s she would  say t o h e r s e l f "Oh you don't l o o k t o o bad".  T h i s f a i l u r e had been h a r d  on h e r s e l f esteem but she thought t h a t i f she had attempted i t i n a happ i e r , more s t a b l e p e r i o d o f h e r l i f e she would have been more s u c c e s s f u l .  153 S u b j e c t NCNM-10 was tween 9 and 25. w e i g h t was  a 46 year o l d h o u s e w i f e w i t h f i v e c h i l d r e n be-  Her i n i t i a l weight was  59 Kg.  Kg a t 163 cm.  and her  goal  She began t o g a i n w e i g h t w i t h her f i r s t pregnancy  gained w i t h each subsequent one. and  87.5  and  She a l s o o v e r a t e i n r e s p o n s e t o s t r e s s  anxiety. 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 w e i g h t was  one month she weighed 87.9 large family presented  87.7  Kg.  After  Kg and r e p o r t e d t h a t p r e p a r i n g food f o r her  a major s n a c k i n g problem.  A l s o she s t i l l  used  food as a reward f o r w o r k i n g h a r d around the house. A t two months she weighed 86.9 d i e t about h a l f the time.  She was  f u l t r a c k o f what she a t e . was  Kg and r e p o r t e d b e i n g on a 1500 n o t , however, g r a p h i n g  or k e e p i n g  w e i g h t was  threw the d i e t r o u t i n e "out the window".  90.8  This upset  At f o u r months her  Kg.  By the s i x month s e s s i o n she was Her w e i g h t was  care-  F o l l o w i n g t h i s she l e a r n e d t h a t h e r husband  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.  in lifestyle  calorie  87.7  Kg.  She  a l r e a d y s e t t l e d i n t o her new  f e l t the programme had  f a i l e d f o r her. be-  cause o f u n u s u a l p r e s s u r e s on her d u r i n g the programme p e r i o d . the p l a n of d i e t and e x e r c i s e was  She had  t h a t food would no l o n g e r be her "best f r i e n d " .  She  thought  l e a r n e d how  she rewarded h e r s e l f w i t h food f o r e v e r y t h i n g she d i d and was  t i o n w i t h t h e i r programme.  She  e x c e l l e n t but t h a t more emphasis s h o u l d  have been p l a c e d on the reasons f o r o v e r e a t i n g .  j o i n i n g a group c a l l e d O v e r e a t e r s  house.  She was  much  determined  planning  Anonymous and u s i n g t h i s d i e t i n  on conjunc-  f e l t t h a t s t i c k i n g .wiith the programme i n  the f a c e o f f a i l u r e had  f o r c e d h e r to examine h e r many m o t i v e s f o r o v e r -  e a t i n g and t h a t she was  now  'better equipped t o d e a l w i t h them.  APPENDIX B  Newspaper A r t i c l e s Used t o R e c r u i t S u b j e c t s  155  Relax.. .and Ipse I some of that weight . . .  . . . . . .  A University of B.C. grad student needs j Those given instruction in the padded; ..,propriate setting...- ' 48 ovenveight women.for, a research; proj- J room, 'and a control group taught the re-' • "The program: is based on a complete \,ect on obesity.'.. ' ]-.••'<' ]\ '>.[• •';/;;': j laxation' techniques in a more normal set: change in lifestyle and regular eating and ]••• Rod Borrie said several candidates will ; ting, will be watched;for six months, 'r' exercising," he said. "It's not a crash diet lie alone in a dark, padded, room for 24 ! ' T h e . idea of using "relaxation techprogram. It's a long term thing:" hours and drink Metrical while relaxation ' niques" to loose weight may seem stange instructions are piped through loudspeak- ; to those accustomed to the idea that vigor- • Applicants must be women between 20 and 55 who are at least 25 per cent overers. "' • j.ous exercise is necessary to burn off ex-. weight. • "Wliat we're vlooking at here," he said •' .cess calories. " • ' They also must be willing to submit to a Tuesday, "is sensory deprivation' as a Borrie wants to see whether sensory medical checkup, introductory and followtechnique to improve relaxation'training- I deprivation aids in relaxation training by up interviews, and rigorous self control for and as a booster in self-control." . . i •,;••>< [ forcing concentration and providing an apr . thesix months.' ':• v :  I-  :  ;  :  ew diet based on persuasion • Weight reduction is usually fraught with, ,.i48 women aged 20 to 55 who are at least 25 anxiety and suffering, real or imagined, ^ per cent .overweight. They must agree to a ' but a University of B.C. graduate student ' | medical checkup, follow-up interviews, is experimenting with a m^^e.laxed'0and rigorous self-control for six months. method of dieting. l - i ' 1 - ' ' ' f» '• j.:. ai" Borrie said his subjects, for the sake of Rod Borrie, a doctoral candidate in psy- ^consistency, have to be of the same sex. chology, said in an interview Wednesday ! Women were chosen because they usually that gentle persuasidn rather than-harsh *,4;are more available than men, he said. prohibition is the key to Ms-method.''??':' Only'' half of the volunteers will be exOverweight subjects will lie alone in a . posed, to his "sensory deprivation" tech- f quiet, dark room and drink Metrecal while nique. Others will be taught relaxation \ relaxation instructions, are piped/from techniques in a more normal setting. ', tape recorders. . Borrie said the program is based on a j ' He said subjects who are isolated from change of attitude and better eating and < distractions should be able to concentrate exercising habits, rather than a crash diet. Instead of attempting to cut 20 pounds in on the problem at hand — cutting excess !.. a month, subjects should be able to reduce pounds. •;•'* ;'' >To test his theory, Borrie said he needs their weight by one pound a week, be said. f  156  APPENDIX C Message T r a n s c r i p t s  157  SET I 1. One o f the most f r e q u e n t m i s t a k e s t h a t p e o p l e make when t h e y t r y t o l o s e w e i g h t i s t o put t h e emphasis on n o t e a t i n g . F o r example, they say to t h e m s e l v e s , " I must n o t e a t . I s h o u l d n o t e a t . I won't e a t . " T h i s k i n d o f t h i n k i n g i s dead wrong. I t makes about as much sense as concent r a t i n g on n o t h a v i n g an i t c h i n g s e n s a t i o n on your nose. What happens i f y o u c o n c e n t r a t e on n o t h a v i n g 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 w e i g h t . I f y o u c o n c e n t r a t e on n o t e a t i n g , you end up more p r e o c c u p i e d , than e v e r w i t h e a t i n g . Free p e o p l e r e s e n t b e i n g t o l d what n o t t o do on a permanent b a s i s , even i f y o u t e l l i t t o y o u r s e l f , b u t a f r e e p e r s o n i s a b l e t o change on t h e b a s i s o f something he i s for. So, i f y o u l o o k a t t h i s as a promise t o p r o t e c t y o u r body, t h i s can r e s u l t i n n o t o v e r e a t i n g , b u t y o u e x p e r i e n c e i t as " y e s " r a t h e r than "donttt"., By c o n c e n t r a t i n g on t h i s new sense o f p r o t e c t i o n f o r your body, the urge t o e a t more than y o u s h o u l d i s i g n o r e d 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 u r g e s . I f y o u r e p e a t e d l y deny s a t i s f a c t i o n to an u r g e , whether b i o l o g i c a l o r p s y c h o l o g i c a l by i g n o r i n g i t , t h e urge e v e n t u a l l y w i t h e r s away. T h i s i s t r u e even w i t h something as s t r o n g as hunger. When Ghandi went on h i s hunger s t r i k e , he d i d n o t c o n c e n t r a t e on n o t e a t i n g . He c o n c e n t r a t e d on a r o u s i n g 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 a s p e c t o f 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 t h a t h i s a p p e t i t e was gone. H i s urge t o e a t d i s a p p e a r e d . S i m i l a r l y , by c o n c e n t r a t i n g on t h i s new sense o f p r o t e c t i o n f o r your body t h e urge t o e a t when you s h o u l d n ' t i s i g n o r e d and e v e n t u a l l y i t d i s a p p e a r s . 2. You a r e your body's keeper. Your body i s your p h y s i c a l p l a n t . When you p u t t o o much f o o d i n t o your body, i t can do n o t h i n g b u t a c c e p t i t and make the b e s t o f i t . When y o u r e a l i z e t h a t y o u a r e t h e one p u t t i n g the e x t r a w e i g h t t h e r e , y o u have some q u e s t i o n s t o ask y o u r s e l f . A r e y o u f o r your body o r a r e y o u n o t ? A r e you f o r l i v i n g o r a r e y o u n o t ? I f the answer i s n o , then keep on over e a t i n g . B u t , i f t h e answer i s y e s , y o u have a b u i l t i n o b l i g a t i o n t o g i v e y o u r body the r e s p e c t and p r o t e c t i o n i t d e s e r v e s . You see how d i f f e r e n t t h a t i s from s a y i n g , " I w i l l n o t e a t " ? In e s s e n c e , t h i s i s an a r t form, the a r t o f c o n t r o l l i n g an urge. I f y o u mean t o c o n t r o l an u r g e , don't f i g h t i t , t h e more y o u f i g h t i t , the s t r o n g er i t w i l l become. I n s t e a d , l e a r n t o i g n o r e i t . Here i s a way t o do i t . When an urge t o e a t o c c u r s , admit i t , b u t a t t h e same time acknowledge t h a t you have t h i s commitment t o r e s p e c t your body. Thus, you have two urges a t the same t i m e ; t h e urge t o e a t and t h e urge t o r e s p e c t your body. Lock them t o g e t h e r . By e m p h a s i z i n g r e s p e c t f o r your body, you w i l l be a b l e t o keep your i n t a k e a t a s e n s i b l e l e v e l . I f you l o c k t o g e t h e r two c o n t r a d i c t o r y urges and f o c u s on one, you must, a t t h e same t i m e , i g n o r e the o t h e r . I would l i k e t o t e a c h you an e x e r c i s e w h i c h you may f i n d h e l p f u l whenever y o u f e e l t h e urge t o e a t o r when y o u a r e s i t t i n g down t o 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 o r l i e down, c l o s e your e y e s , r e l a x y o u r body, and t a k e t h r e e slow deep b r e a t 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 m e d i t a t i o n o r i n c r e a s e d concentration. I n t h i s s t a t e you c o n c e n t r a t e on t h r e e c r i t i c a l p o i n t s : first: f o r your body, o v e r e a t i n g i s a p o i s o n second: you cannot l i v e w i t h o u t your body third: I f .you want t o l i v e , you owe your body r e s p e c t and p r o t e c t i o n R e p e a t i n g t h e s e t h r e e p o i n t s i s your way o f acknowledging the f r a g i l e , p r e c i o u s n a t u r e o f your.body, and, a t the same t i m e , y o u r way of s e e i n g y o u r s e l f as y o u r body's k e e p e r . You are i n t r u t h your body's k e e p e r . When you make t h i s commitment t o r e s p e c t your body, you have w i t h i n your power t o g r a d u a l l y l o s e a l l those e x t r a pounds. N o t i c e how t h i s s t r a t e g y p u t s the emphasis on what you are f o r , r a t h e r than what you are a g a i n s t . I t i s t r u e t h a t o v e r e a t i n g i s a p o i s o n and you are a g a i n s t i t , but the emphasis i s upon the p o s i t i v e commitment t o r e s p e c t your body. As a consequence 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 a g a i n s t the p o i s o n of f u r t h e r o v e r e a t i n g . Now, I would l i k e you t o do the e x e r c i s e I have j u s t d e s c r i b e d . Let y o u r body r e l a x , c l o s e y o u r eyes and take t h r e e deep b r e a t h s . Now r e p e a t a f t e r me. 1. For my body;, o v e r e a t i n g i s a p o i s o n (pause) 2. 1 need my body to l i v e (pause) 3. 1 owe my body r e s p e c t and p r o t e c t i o n You may want t o t r y t h i s e x e r c i s e a g a i n , from time to t i m e , w h i l e you are here. 3.  S t a t e s of  Deprivation  When you are t r y i n g t o l o s e w e i g h t 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 n o r m a l l y be e a t i n g . But a c t u a l l y t h e r e are t h r e e types of d e p r i v a t i o n w h i c h are l i n k e d t o l o s i n g w e i g h t . 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 a r e i n a s t a t e o f d e p r i v a t i o n w h i c h a u t o m a t i c a l l y i n c r e a s e s the p o s i t i v e v a l u e o f food. This also makes you f e e l i n d e b t e d t o 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 o v e r e a t a t your n e x t meal o r snack. T h i s can be a v o i d e d by s i m p l y p l a n n i n g meals f o r r e g u l a r hours and making s u r e you eat every p l a n n e d 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 t h a t o v e r e a t e r s o f t e n a s s o c i a t e g r e a t amounts o f 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 o f s l e e p . Whether the energy s t o r e i s comehow d e p l e t e d by s l e e p d e p r i v a t i o n o r whether f a t i g u e m e r e l y becomes a s i g n a l to e a t , i t i s v e r y i m p o r t a n t t h a t the o v e r e a t e r take p a i n s t o a v o i d f a t i g u e due t o l a c k of s l e e p . C a r e f u l m o n i t o r i n g o f s l e e p 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 i m p o r t a n c e o n l y to a t t e n t i o n t o food i n t a k e and e x e r c i s e . The t h i r d type o f d e p r i v a t i o n encountered by the o v e r w e i g h t p e r s o n t r y i n g to d i e t i s the s t i m u l u s d e p r i v a t i o n e x p e r i e n c e d as boredom. Many o v e r e a t e r s eat because they are b o r e d and have n o t h i n g e l s e t o do, howe v e r t h e r e i s good c l i n i c a l e v i d e n c e w h i c h s u p p o r t s the i d e a t h a t e a t i n g  159  i s not the p r e f e r r e d p a s t i m e f o r overweight p e r s o n s . 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 o f o t h e r a c t i v i t i e s w h i c h w i l l keep your a t t e n t i o n and p r o v i d e g r a t i f i c a t i o n s S i n c e i t appears t o be i m p o r t a n t t h a t boredom be a v o i d e d i f a t 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 t o keep a number of nonfood a c t i v i t i e s a v a i l a b l e a t a l l t i m e s . Perhaps you might keep your sewing machine up a l l the t i m e , or keep i n t e r e s t i n g books, r e c o r d s , o r magazines i n c l e a r v i e w , o r t o o l s f o r g a r d e n i n g o r o t h e r h o b b i e s k e p t a v a i l a b l e . However, even i f you s h o u l d f i n d y o u r s e l f w i t h n o t h i n g t o do y o u r e x p e r i e n c e h e r e i n t h i s room has shown you t h a t you can d e a l w i t h such a s i t u a t i o n w i t h o u t o v e r e a t i n g . 4.  Introduction to Relaxation  Training  A g r e a t number o f p e o p l e t o d a y , e s p e c i a l l y i n our Canadian s o c i e t y , do n o t pay much a t t e n t i o n t o t h e i r b o d i e s . By t h i s I don't mean the way we d r e s s o r how c l e a n we a r e o r a n y t h i n g about the way we l o o k . The body t h a t most of us i g n o r e i s our i n t e r n a l body w h i c h c o n s t a n t l y sends us s i g n a l s c o n c e r n i n g i t s f u n c t i o n i n g . Of course we a r e aware of the l a r g e r and l o u d e r s i g n a l s , such a s , 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 t o the q u i e t e r s i g n a l s such as muscle t o n e , h e a r t b e a t , m i l d t e n s i o n , and b l o o d p r e s s u r e . O f t e n even hunger i s not a v e r y 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 o v e r w e i g h t p e r s o n s : F r e q u e n t l y o v e r w e i g h t p e o p l e i g n o r e o r j u s t don't r e c o g n i z e the body s i g n a l s f o r hunger and i n s t e a d t h e y e a t o r o v e r e a t because of the s i g n a l s t h e y see around them such as the. c l o c k s a y i n g i t s time to. e a t o r the mere p r e s e n c e o f f o o d . You can c o n t r o l t h e s e e x t e r n a l s i g n a l s by d o i n g t h i n g s l i k e k e e p i n g f o o d out o f s i g h t and n e v e r g e t t i n g out more than you s h o u l d e a t . But i t i s a l s o a good i d e a t o t r y t o get t o 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 t h a t i t i s s e n d i n g . R i g h t now I'm g o i n g t o t a k e you t h r o u g h an e x e r c i s e d e s i g n e d t o t e a c h you to r e l a x and become b e t t e r tuned t o your body. F i r s t , l i e w i t h your hand a t your s i d e and be c o m f o r t a b l e and j u s t r e l a x . Now I want you t o d i r e c t y o u r a t t e n t i o n to the l a r g e t o e on your l e f t f o o t . I want you t o f e e l t h a t t o e ; f e e l the muscle wrapped around the bone underneath i t . . C o n c e n t r a t e on r e l a x i n g t h a t t o e . As you r e l a x t h a t t o e , f e e l the muscle s a g g i n g o f f t h e bone. F e e l the muscle l o o s e n i n g . The t o e becomes more.and more r e l a x e d . L e t t h a t r e l a x e d f e e l i n g s p r e a d t o the n e x t t o e , t o the n e x t n e a r your b i g t o e . A g a i n , f e e l the b o n e , w i t h the muscle wrapped around i t . C o n c e n t r a t e on t h a t t o e . Concent r a t e on l e t t i n g t h e muscle on t h a t 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 t e n s i o n . And l e t t h a t r e l a x e d f e e l i n g s p r e a d a g a i n t o the n e x t t o e . Same p r o c e d u r e : c o n c e n t r a t e on the t o e , f e e l the bone wrapped around w i t h m u s c l e , and r e l a x t h a t t o e . F e e l the muscle unwrapping from t h e bone underneath i t . Now move t o your n e x t t o e . A g a i n , f e e l the muscle t i g h t l y wrapped around the bone underneath. Feel t h a t muscle l o o s e n , g e t t i n g l o o s e r and l o o s e r , s o r t o f d r o o p i n g o f f the bone. Four o f your t o e s a r e now r e l a x e d . L e t t h a t r e l a x e d f e e l i n g move on t o the n e x t t o e , the s m a l l toe on y o u r l e f t f o o t . F e e l the s m a l l bone i n t h a t toe and the muscle wrapped around t h a t bone. L e t t h a t muscle  160  l o o s e n and r e l a x , becoming l o o s e r , s a g g i n g o f f t h a t t o e , 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 t h a t f o o t are r e l a x e d . L e t t h a t r e l a x e d f e e l i n g s p r e a d from the toes i n t o the b a l l o f the f o o t . There's a l o t more bones t h e r e . F e e l the muscle around and between those bones l o o s e n i n g , r e l a x i n g . P a r t of your f o o t 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 , l o o s e n i n g . Now t h a t l o o s e , r e l a x e d f e e l i n g i s s p r e a d i n g through the arch of y o u r f o o t . M u s c l e s l o o s e n i n g . No t e n s i o n t h e r e . Feels v e r y n i c e . T h i s r e l a x e d f e e l i n g c o n t i n u e s on t o the h e e l of your f o o t . C o n c e n t r a t e on the muscle wrapped around the bones t h e r e . F e e l i t l o o s e n . F e e l i t p u l l i n t o t h e bed. Your whole f o o t now i s v e r y r e l a x e d . Feels l o o s e and heavy. Now move your c o n c e n t r a t i o n up t o y o u r a n k l e . There's a l o t of bone, a l o t of tendon t h e r e . F e e l the way i t a l l p u l l s t o g e t h e r and l e t i t r e l a x . F e e l those tendons l o o s e n i n g , and the muscles t h a t are a t t a c h e d to those tendons b e g i n t o l o o s e n . 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 , s a g g i n g ; the l o n g bone of y o u r l o w e r l e g , and the muscles t h a t 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 y o u r l e g gets h e a v i e r s and h e a v i e r . F e e l those muscles l o o s e n . Now move up t o you knee. C o n c e n t r a t i o n on the j o i n t t h e r e , t o your knee cap. F e e l a l l the tendons t h a t meet h e r e . C o n c e n t r a t i o n 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. F e e l s v e r y r e l a x e d . Then move up. F e e l the l o n g bone on y o u r t h i g h . A l o t o f muscles h e r e , a l l wrapped t i g h t l y around t h a t bone. L e t them l o o s e n , l e t them unwrap. F e e l them g e t t i n g heavy and s a g g i n g i n t o the bed. C o n c e n t r a t e on r e l a x i n g t h a t t h i g h . Now your whole l e g , y o u r 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 y o u r l e f t l e g f e e l s compared t o your r i g h t l e g . Does i t f e e l h e a v i e r ? Perhaps i t t i n g l e s a b i t . Does i t f e e l more r e l a x e d ? Enjoy t h i s f e e l i n g o f r e l a x a t i o n i n y o u r l e f t l e g . W h i l e you are g o i n g t h r o u g h y o u r body l i k e t h i s , c o n c e n t r a t i n g on each p a r t 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 a r e a which i s d i f f i c u l t t o r e l a x . Very o f t e n t h i s o c c u r s when you have s u f f e r e d some i n j u r y i n t h a t p a r t . There i s a l o t of e x t r a t e n s i o n i n a r e a s t h a t have been i n j u r e d a t one time' or a n o t h e r . Spend e x t r a c o n c e n t r a t i o n on those areas and get them t o r e l a x j u s t as much as the r e s t o f y o u r body. Now we are g o i n g t o move back down t h i s time t o your r i g h t f o o t , s t a r t i n g a g a i n 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 c o m p l e t e l y r e l a x e d . C o n c e n t r a t e now on.the b i g toe of your r i g h t f o o t . A g a i n , f e e l the muscle and the bone underneath t h a t muscle. L e t the muscle r e l a x . L e t the muscle l o o s e n . F e e l the t e n s i o n l e a v i n g . Now f e e l t h a t r e l a x a t i o n s p r e a d t o the n e x t toe as the muscle t h e r e s t a r t s t o l o o s e n , and to the n e x t t o e . I t s h o u l d be e a s i e r now: you've got the knack o f i t . F e e l t h a t t h i r d toe r e l a x i n g , the muscle l o o s e n i n g , g e t t i n g heavy, and move over t o the n e x t t o e . F e e l the bone, f e e l the m u s c l e ; c o n c e n t r a t e on i t , and c o n c e n t r a t e 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 s m a l l t o e , s t a r t i n g t o 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 s a g g i n g o f f the bone. Now l e t t h a t i n g l y r e l a x e d f e e l i n g move t o the b a l l of y o u r f o o t . F e e l i t l o o s e n , f e e l i t get heavy. There's, a l o t of muscle i n between t h o s e bones t o o . C o n c e n t r a t e on t h a t , and l e t i t r e l a x . The r e l a x e d f e e l i n g i s now moving t o the a r c h of y o u r f o o t . Has t o go a b i t deeper h e r e . There's a l o t o f bone, a l o t of muscle, a l o t of tendon. F e e l i t a l l u n w i n d i n g . Feels v e r y good. S t a r t i n g t o r e l a x . G e t t i n g heavy, l o o s e n i n g , and now spreadi n g down t o y o u r h e e l . C o n c e n t r a t e on your h e e l . F e e l the bone t h e r e  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 f o o t now s t a r t i n g t o t i n g l e , f e e l i n g good. I t ' s v e r y r e l a x e d , and a l l those muscles w h i c h are a t t a c h e d t o your a n k l e . Spread the r e l a x a t i o n up t o y o u r a n k l e . C o n c e n t r a t e now on your a n k l e . A l o t of bones j o i n t o g e t h e r a t your a n k l e . A l o t o f tendons a l l conn e c t e d to m u s c l e s . 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 u n w i n d i n g , g e t t i n g heavy. F e e l s good. That r e l a x e d f e e l i n g i s s p r e a d i n g up t o your l o w e r l e g . F e e l t h a t b i g muscle o f y o u r c a l f , the t i g h t m u s c l e , and you f e e l i t r e l a x i n g , u n w i n d i n g . F e e l i t as i t sags o f f the bone t h e r e . Becomes heavy, becomes v e r y r e l a x e d . Spread t h a t r e l a x a t i o n up t o ' y o u r knee. O f t e n knees a r e p r o b l e m a r e a s . We f r e q u e n t l y I n j u r e our knees. F e e l the j o i n t t h e r e . F e e l how the bones j o i n t o g e t h e r 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 e v e r r e l a x e d y o u r knee i n t h i s way. E n j o y the f e e l i n g , u n t i l i t g e t s h e a v i e r . F e e l t h a t t i n g l y , r e l a x e d f e e l i n g s p r e a d up from y o u r lower l e g , and l e t t h a t l o o s e n e s s cont i n u e up t o your t h i g h . A l a r g e bone h e r e , and a l o t o f muscles wrapped around i t . F e e l t h a t muscle l o o s e n . I t ' s a l o n g m u s c l e , and i t j u s t sags o f f the bone.,- g e t t i n g , v e r y 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 . F e e l s good. . Both of your l e g s are now v e r y r e l a x e d . F e e l t h a t r e l a x a t i o n s p r e a d i n g up t o your b u t t o c k s . These, a r e the two l a r g e s t muscles o f 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 v e r y l o o s e . Now I want you t o conc e n t r a t e on your g e n i t a l a r e a . T h i s i s o f t e n a p o i n t of much t e n s i o n . Spend some time and r e l a x . F e e l the t e n s i o n g o i n g away. I want you t o c o n t i n u e up t o your stomach. F e e l the muscles t h a t c o v e r your stomach. F e e 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 m u s c l e s ; y o u r 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 t e n s i o n t h e r e s u b s i d i n g . F e e l s v e r y comf o r t a b l e . Now go a l l the way through and f e e l the muscles o f your back. F e e l y o u r backbone, each v e r t e b r a w i t h muscles a t t a c h e d t o i t . These muscles a r e o f t e n e x t r e m e l y t i g h t . I want you t o 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 s i d e of i t , and r e l a x i t s l o w l y , f e e l i n g t h a t muscle l o o s e n . F e e l s good. There's a f e e l i n g o f r e l a x a t i o n s p r e a d i n g from y o u r l o w e r back and t r a v e l l i n g up towards your head. A t each v e r t e b r a , the muscle n e a r i t l o o s e n s , f e e l s heavy, b e g i n s t o t i n g l e , s p r e a d i n g up your back towards y o u r head. T h i s w o n d e r f u l s e n s a t i o n o f b e i n g v e r y r e l a x e d . Now c o n c e n t r a t e on your c h e s t . F e e l y o u r r i b s . Between each o f y o u r r i b s i s muscle. Take a deep b r e a t h . F e e l t h o s e 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 t h a t muscle get l o o s e . F e e l i t r e l a x e d . Gets heavy. Your whole c h e s t i s r e l a x i n g . S t i l l moving as you b r e a t h e , b u t i t i s v e r y r e l a x e d . A l l the organs i n s i d e your c h e s t . C o n c e n t r a t e on them. F e e l them r e l a x . T h i s can be an e x t r e m e l y e x h i l a r a t i n g e x p e r i e n c e . R e l a x a t i o n h e r e i n your c h e s t s t a r t s s h o o t i n g up your neck. That t i n g l y l o o s n e s s - you can f e e l i t i n y o u r neck. B i g muscles i n your neck - t h e y ' r e unwinding. G e t t i n g heavy, s a g g i n g i n t o the bed. Those muscles t h a t a t t a c h t o the back of your head t h e y ' r e g e t t i n g l o o s e , g e t t i n g heavy. That r e l a x e d f e e l i n g i s s p r e a d i n g r i g h t o v e r t h e top o f your head. You can f e e l y o u r 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 . F e e l s v e r y good. A r e l a x a t i o n comes over the top of your head and down t o your f o r e h e a d . Your f o r e h e a d i s o f t e n the s e a t o f a g r e a t d e a l o f t e n s i o n . Whenever you a r e concerned about something, w o r r i e d 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 f o r e h e a d . F e e l your f o r e h e a d r e l a x , and as i t does t h i s i s a v e r y w o n d e r f u l f e e l i n g ; one o f complete r e l a x a t i o n . F e e l the muscles o f your  162 whole f a c e now r e l a x i n g ; the muscles around your mouth, t h e muscles i n your cheeks, the muscles around your eyes. Your eyes a r e r e l a x i n g . F e e l the muscles o f your eyebrows r e l a x . I t ' s a very n i c e f e e l i n g . Enjoy i t . Your whole body i s now r e l a x e d . T h i s r e l a x a t i o n procedure i s one y o u can p r a c t i c e on your own. F o r best results d a i l y practice i s desirable. Now w h i l e you a r e i n t h i s deeply r e l a x e d s t a t e I want t o l i s t e n t o some o f the q u i e t s i g n a l s from your body. F i r s t , t r y to f e e l your h e a r t b e a t . D i r e c t your a t t e n t i o n t o the c e n t e r o f your c h e s t and f e e l the c o n s t a n t , q u i e t t h r o b b i n g o f your own h e a r t , (pause) I f you have d i f f i c u l t y f e e l i n g your b e a t i n g h e a r t take a few r a p i d deep b r e a t h s , then r e l a x a g a i n and l i s t e n (pause) Each p u l s a t i o n o f your h e a r t i s pushing your b l o o d f u r t h e r through the body. I f you a r e r e l a x e d enough you might be a b l e t o f e e l t h i s p u l s i n g i n d i f f e r e n t p a r t s o f your body. Your hands and e s p e c i a l l y your f i n g e r t i p s a r e o f t e n v e r y s e n s i t i v e t o t h i s . I f you want to a c t u a l l y l i s t e n t o your h e a r t beat cup your hands over your e a r s , r e l a x , and l i s t e n , (pause). I f 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 a t your s i d e once more and t h i s time I want you to d i r e c t your a t t e n t i o n to your stomach. I want you t o take t h r e e deep b r e a t h s but b e f o r e you do I'm g o i n g t o e x p l a i n e x a c t l y how to do i t . Wait u n t i l I say b r e a t h . I n s t e a d o f expanding your c h e s t to take those deep b r e a t h s , I want you t o expend your stomach By p u l l i n g your diaphragm down you w i l l be e x t e n d i n g your stomach w h i l e you p u l l a i r i n t o your l u n g s . With each b r e a t h take i n as much a i r as p o s s i b l e 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 s l o w l y exhale by p u l l i n g your stomach back i n . T r y 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 r e p e a t the whole p r o c e d u r e . Do not b r e a t h r a p i d l y . B r e a t h i n and o u t s l o w l y and y o u w i l l f i n d your s e l f becoming more and more r e l a x e d w i t h each b r e a t h . As you r e l a x d i r e c t your a t t e n t i o n t o i n s i d e your stomach and t r y t o fefel i t as you expand and c o n t r a c t . O.K. now I want you to take t h r e e deep b r e a t h s as I have j u s t d e s c r i b e d them. Ready. Breathe, (pause) Becoming more r e l a x e d w i t h each b r e a t h  F e e l i n g your  stomach...  T h i s e x e r c i s e i s one t h a t you s h o u l d use o f t e n . I t i s a means to q u i c k r e l a x a t i o n and t o awareness o f your stomach. I t i s an e x e r c i s e which can be done anywhere; you don't have t o be l y i n g down. I n f a c t i t i s a good i d e a t o do t h i s t h r e e - d e e p - b r e a t h e x e r c i s e s each time you s i t down a t the t a b l e b e f o r e you have a n y t h i n g t o e a t . While y o u a r e t a k i n g your t h r e e deep b r e a t h s and r e l a x i n g you can remind y o u r s e l f o f your new commitment to p r o t e c t your body and your h e a l t h . I want y o u t o do the f o l l o w i n g e x e r c i s e u s i n g your i m a g i n a t i o n . I am going t o r e a d o f f a s e r i e s o f emotions. I would l i k e you t o t h i n k back t o t h e l a s t time you e x p e r i e n c e d t h e emotion and r e l i v e i t i n your mind the whole e x p e r i e n c e as b e s t you can. When I f e l l you t h a t time i s up, you w i l l cease t h i n k i n g about the emotion and go on t o the next one  163 which I w i l l g i v e you. were v e r y happy.  The f i r s t o n e . i s , t h i n k about the l a s t time  Ready, s t a r t  3 minutes  (MONITOR: DO NOT  STOP TAPE RECORDER BETWEEN ITEMS)  O.K.  n e x t : I want you to t h i n k about the l a s t time you were v e r y disappointed. 1-1/2  O.K.  you  minutes  n e x t : I want you to t h i n k about the l a s t time you were v e r y anxious. 1-1/2  O.K.  minutes  n e x t : I want you to t h i n k about the l a s t time you f e l t were a f a i l u r e . 1-1/2  O.K.  minutes  Nnext:I want you t o t h i n k about the l a s t time you f e l t v e r y gguilty.. 1-1/2  O.K.  you  minutes  n e x t : I want you t o t h i n k about t h e l a s t time you were v e r y d i s g u s t e d w i t h your s e l f . 1-1/2  minutes  T h i s c o n c l u d e s the e x e r c i s e . The purpose o f the e x e r c i s e was to -show you t h a t you c o u l d e x p e r i e n c e emotions, even v e r y n e g a t i v e ones and n o t have t o e a t . Think about t h i s and remember i t when you l e a v e h e r e . I t i s a myth t h a t you cannot cope w i t h emotions u n l e s s you have something to eat. 5. From time t o time most o f us f e e l n e g a t i v e emotions such as f e a r , t e n s i o n , anger o r sadness. F o r many p e o p l e e a t i n g becomes a way t o cope w i t h these n e g a t i v e emotions. I n f a c t , some o v e r w e i g h t p e o p l e come to b e l i e v e t h a t e a t i n g i s the o n l y way they can cope w i t h these u n p l e a 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 o r even b e t t e r than e a t i n g i s t o take t h r e e deep b r e a t h s and r e l a x j u s t as you were t a u g h t i n the l a s t message.  164  SET I I * T h i s w e i g h t program has been d e s i g n e d s p e c i f i c a l l y t o a i d y o u i n your e f f o r t s _ t o r e g u l a t e y o u r w e i g h t . S i n c e you a r e t h e 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 y o u r e a t i n g problems and changing y o u r e a t i n g h a b i t s . We w i l l p r o v i d e y o u w i t h i n f o r m a t i o n and s u g g e s t i o n s f o r l o s i n g w e i g h t b u t we cannot c o n t r o l y o u r w e i g h t f o r y o u , o n l y you can do t h a t . Though many would l i k e i t , t h e r e i s no magic p i l l w h i c h w i l l s o l v e y o u r o v e r w e i g h t 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, t h e p r i m a r y f o c u s o f t h i s program i s you; y o u r w i l l i n g n e s s now t o to' a l l y commit y o u r s e l f t o c o n t r o l l i n g your w e i g h t , your w i l l i n g n e s s t o t a k e r e s p o n s i b i l i t y f o r t h e causes and c u r e s o f your o v e r w e i g h t , your w i l l i n g ness t o work h a r d a t changing those a s p e c t s o f y o u r environment and those a s p e c t s o f your l i f e which a f f e c t a d v e r s e l y your e a t i n g h a b i t s , your mot i v a t i o n t o see t h e program through t o t h e end, even when t h e g o i n g might be a l i t t l e rough. As was mentioned b e f o r e , t o e f f e c t i v e l y c o n t r o l y o u r w e i g h t you must take t h e i n i t i a t i v e t o s y s t e m a t i c a l l y change y o u r e a t i n g h a b i t s . No spec i a l d i e t i s r e q u i r e d because t h e i n t e n t i o n i s t o 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 p e o p l e c o u l d l o s e w e i g h t by e a t i n g n o t h i n g f o r a month o r g o i n g on a s p e c i a l g r a p e f r u i t d i e t o r some o t h e r c r a s h d i e t . However, few would be w i l l i n g t o remain on such a d i e t f o r the r e s t o f t h e i r l i v e s . Thus, a f t e r w e i g h t i s l o s t on a s p e c i a l d i e t , p e o p l e 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 v e r y b e h a v i o r s w h i c h caused t h e w e i g h t problem i n t h e f i r s t p l a c e ! F o r e f f e c t i v e w e i g h t con t r o l , t h e 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 t h a t he can l i v e w i t h them c o m f o r t a b l y f o r the r e s t o f h i s l i f e and s t i l l maint a i n a d e s i r a b l e w e i g h t ! " C r a s h " 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 . R a t h e r , an attempt s h o u l d be made t o f i n d a r e a s o n a b l e b a l a n c e 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 b a l a n c e t h a t can be m a i n t a i n e d f o r l i f e . You must l e a r n t o b r e a k t h e o l d h a b i t p a t t e r n s o f e a t i n g snacks w h i l e p r e p a r i n g meals, e a t i n g w h i l e w a t c h i n g 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 t h a t i s p l a c e d b e f o r e y o u 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 w e i g h t c o n t r o l i s make h a s t e s l o w l y . That i s , don't t r y t o l o s e w e i g h t t o o r a p i d l y . You a r e p r o b a b l y a n x i o u s t o see the pounds drop o f f (and r i g h t f u l l y s o ) , b u t y o u r s t r a t e g y o f w e i g h t cont r o l i s aimed a t m o d i f y i n g l o n g s t a n d i n g 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 y e a r s and may take a l i t t l e time t o d e t h r o n e . A l s o , i f y o u s e t y o u r . s i g h t s f o r d r a m a t i c and r a p i d w e i g h t l o s s y o u may become p r e m a t u r e l y d i s c o u r a g e d w i t h g r a d u a l b u t 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 a t a t i m e . A one o r two pound w e i g h t l o s s p e r week i s recommended as a h e a l t h y weight l o s s g o a l . I n t e n s h o r t weeks t h i s adds  Large p o r t i o n s o f t h e s e messages were adopted from Mahoney, M.J., & J e f f r e y , D.B. A manual o f s e l f - c o n t r o l p r o c e d u r e s f o r t h e o v e r w e i g h t . A b s t r a c t e d i n t h e JSAS C a t a l o g o f S e l e c t e d Documents i n P s y c h o l o g y , 1974, 4, 129.  165  up t o a 10-20 pound w e i g h t l o s s . I n a d d i t i o n t o h a v i n g a p r o p e r a t t i t u d e and commitment t o l o s i n g w e i g h t , i t i s a l s o v e r y i m p o r t a n t t o have s p e c i f i c i n f o r m a t i o n about w e i g h t management and t o know how t o implement t h i s i n f o r m a t i o n i n your d a i l y w e i g h t 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 h e l p y o u become aware o f your d a i l y weight f l u c t u a t i o n s and problemat 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 y o u w i l l be a b l e t o p p l a n your own e a t i n g program w h i c h w i l l i n c l u d e a b a l a n c e d d i e t b u t w h i c h w i l l a l s o c u t out those e x t r a c a l o r i e s so you can l o s e w e i g h t . 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 c h n i q u e s t o change those n a s t y , g l u t t o n o u s e a t i n g h a b i t s .  166  SOME BASIC FACTS ABOUT NUTRITION A b a s i c u n d e r s t a n d i n g o f t h e human body and t h e f o o d which n o u r i s h e s i t can be v e r y h e l p f u l t o y o u i n your w e i g h t l o s s a t t e m p t . Our body uses f o o d i n two ways: (1) as a source o f f u e l t o p r o v i d e t h e energy t o keep i t r u n n i n g , and (2) as a source o f n u t r i e n t s f o r t h e c o n t i n u a l r e p a i r and maintenance o f a l l t i s s u e s . A l l foods can s e r v e as f u e l f o r energy b u t no one food p r o v i d e s a l l t h e e s s e n t i a l n u t r i e n t s . We t h e r e f o r e need a b a l a n c e d d i e t o f d i f f e r e n t f o o d s . Most foods a r e a m i x t u r e o f p r o t e i n , c a r b o h y d r a t e , and f a t ( a l o n g w i t h v a r y i n g amounts o f v i t a m i n s and m i n e r a l s ) . P r o t e i n s o c c u r i n a l l l i v i n g m a t t e r and a r e e s s e n t i a l f o r t h e upkeep of e v e r y t i s s u e o f o u r b o d i e s . Becasue p r o t e i n i s n o t s t o r e d i n the body i t must be s u p p l i e d b y o u r d a i l y d i e t . Good b a s i c s o u r c e s o f p r o t e i n a r e i n the m i l k group and the meat group o f f o o d s , and c e r t a i n o f the v e g e t a b l e group. Because some o f t h e s e foods do n o t p r o v i d e a l l the p r o t e i n t h a t we need, o u r d i e t s h o u l d c o n t a i n a v a r i e t y o f these s o u r c e s o f p r o t e i n . C a r b o h y d r a t e s a r e second t o f a t s as the main f u e l s o u r c e 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 o f c a r b o h y d r a t e i s t o s u p p l y 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 o u r i n t a k e o f c a r b o h y d r a t e , we draw upon s t o r e d f a t f o r o u r f u e l r e q u i r e m e n t . But some c a r b o h y d r a t e ' i s r e q u i r e d i n a b a l a n c e d d i e t . O t h e r w i s e , the body has t o c o n v e r t p r o t e i n i n t o sugar needed by the b r a i n . Food s o u r c e s o f c a r b o h y d r a t e are n o t d i f f i c u l t to find. C e r e a l s and v e g e t a b l e s a r e p r e f e r a b l e t o p a s t r i e s and sweets as a s o u r c e o f c a r b o h y d r a t e s . Any excess c a r b o h y d r a t e i n o u r d a i l y d i e t i s c o n v e r t e d t o f a t and s t o r e d as such i n t h e body. T h i s i s a l s o t r u e o f excess p r o t e i n and excess f a t . F a t s a r e b u i l t i n t o t h e s t r u c t u r e o f a l l t i s s u e s as a r e p r o t e i n s . But f a t s a r e the most c o n c e n t r a t e d form o f energy and s e r v e p r i m a r i l y as a f u e l s t o r a g e m a t e r i a l . Overweight o c c u r s when t h e r e i s an excess amount of f a t s t o r a g e caused by more f o o d i n p u t than energy o u t p u t . Food s o u r c e s o f f a t , l i k e c a r b o h y d r a t e s , a r e n o t h a r d t o f i n d . The p r o b l e m i s t o cont r o l the amount o f f a t - r i c h foods we e a t such as f a t t y meats and whip cream d e s s e r t s . As we mature, we b e g i n t o need l e s s and l e s s f o o d than we needed d u r i n g our a c t i v e growing y e a r s . With e v e r y y e a r p a s t 25 o u r food needs drop by about 1% b u t most o f us c o n t i n u e e a t i n g as much as we d i d d u r i n g our y o u t h . E x t r a w e i g h t then b e g i n s t o creep up. To m a i n t a i n a c o n s t a n t l e v e l o f bodyweight t h e food energy i n a d i e t must b a l a n c e t h e d a i l y e n e r gy r e q u i r e m e n t s o f the body. I n o r d e r t o l o s e w e i g h t , y o u must t a k e 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 t o do t h i s i s by a l t e r i n g l o n g s t a n d i n g e a t i n g p a t t e r n s which have caused the w e i g h t g a i n . S i n c e overweight does n o t happen s u d d e n l y , you s h o u l d n o t expect r e d u c i n g t o be an o v e r n i g h t a f f a i r . I t w i l l t a k e some time t o remedy t h e imbalance between food i n p u t and b o d i l y r e q u i r e m e n t s . A l s o , do n o t expect y o u r w e i g h t l o s s t o be u n i f o r m 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 w e i g h t a t d i f f e r e n t r a t e s . The average w e i g h t l o s s c u r v e i s one w h i c h c o n t a i n s many b r i e f " p l a t e a u s " and a few b r i e f 1 o r 2 pound w e i g h t g a i n s .  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 s h o u l d be a w e l l - b a l a n c e d one, h i g h i n p r o t e i n and low i n c a r b o h y d r a t e s and f a t s . However, do not e l i m i n a t e a l l c a r b o h y d r a t e s and f a t s . A v o i d c r a s h 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 l o w e r c a l o r i e foods and d i e t e t i c forms o f food p a r a t i o n f o r y o u r p r e s e n t ones. F a m i l i a r i z e y o u r s e l f i n a g e n e r a l 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 .  preway  3. Make room f o r an o c c a s i o n a l snack o r sweet by c u t t i n g down e l s e where i n y o u r 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 c a t e g o r i e s - — t h i s o n l y makes them more t e m p t i n g and i n c r e a s e s the chances t h a t you w i l l s i m p l y g i v e up once you have "blown your d i e t " by e a t i n g a f o r b i d d e n fruit. 4. Don't s k i p m e a l s ' — i t i s e a s i e r to a v o i d o v e r e a t i n g overhungry.  i f you are  not  5. I f you f i n d t h a t you are too hungry at m e a l t i m e , 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 c a r b o h y d r a t e h a l f an hour b e f o r e mealtime, ( e . g . , 1 o r 2 soda c r a c k e r s or a s m a l l g l a s s of v e g e t a b l e j u i c e ) . 6. I f you o v e r e a t at l u n c h , o r midmorning s n a c k i n g make an e f f o r t t o eat a h i g h - p r o t e i n b r e a k f a s t .  i s a problem,  168  Some M i s c o n c e p t i o n s About Food and D i e t i n g There a r e a s u r p r i s i n g l y l a r g e number o f p e o p l e who have many m i s c o n c e p t i o n s about f o o d and d i e t i n g . These m i s c o n c e p t i o n s may mean t h e d i f f e r e n c e between s u c c e s s and f a i l u r e i n l o s i n g w e i g h t , o r may make w e i g h t r e d u c t i o n more o f a chore and l e s s o f a p l e a s u r e . The f o l l o w i n g are some o f the more p o p u l a r m i s c o n c e p t i o n s . 1. 2. 3. 4.  5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.  Brown eggs have a h i g h e r f o o d v a l u e than w h i t e eggs. False. T o a s t i n g reduces t h e c a l o r i e s i n b r e a d . False. P r o t e i n i s t h e most i m p o r t a n t n u t r i t i o n a l need o f t h e body. F a l s e . One can e a t and d r i n k whatever he p l e a s e s i f a v i t a m i n and m i n e r a l c a p s u l e i s t a k e n each day t o a s s u r e a s u p p l y o f e s s e n t i a l n u t r i e n t s . False. I t ' s n a t u r a l t o get f a t t e r as you get o l d e r . False. One can n e v e r e a t t o o much p r o t e i n . False. I f a p e r s o n has been o v e r w e i g h t f o r a l o n g time ( e . g . , s i n c e h i l d hood) , h i s p r o b l e m i s p r o b a b l y " m e d i c a l " o r h e r e d i t a r y . False. Food e a t e n b e f o r e you go t o bed i s more l i k e l y t o cause w e i g h t g a i n t h a n i f t h e same f o o d were e a t e n f o r b r e a k f a s t . False. P o r k l i v e r has more n u t r i t i v e v a l u e than c a l f l i v e r . False. A p e r s o n can n e v e r d r i n k too much m i l k . False. Overweight p e o p l e a r e g e n e r a l l y happy, h e a l t h y p e o p l e . False. Because meat i s a h i g h p r o t e i n f o o d , i t does n o t cause w e i g h t gain. False. Beer i s a good s o u r c e o f n u t r i e n t s . False. I t makes no d i f f e r e n c e whether a p e r s o n e a t s f a s t o r s l o w . False. I t i s b e t t e r t o l o s e w e i g h t 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 a t a t i m e . False. A l l f a t and c a r b o h y d r a t e s s h o u l d be e l i m i n a t e d i n a r e d u c i n g d i e t . False. Exercise increases the appetite. False. One s h o u l d d r i n k l e s s w a t e r , w h i l e d i e t i n g . False. The stomach s h r i n k s d u r i n g d i e t i n g . False. Meal-skipping helps reducing. False. One s h o u l d expect t o f e e l weak and f a t i g u e d d u r i n g w e i g h t r e d u c i n g . False.  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 c o m p i l e d a l i s t of w e i g h t c o n t r o l t e c h n i q u e s w h i c h v a r y i n t h e i r a p p r o p r i a t e n e s s 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 t e c h n i q u e s are d i v i d e d i n t o t h r e e t y p e s : Q u a n t i t y 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 t h a t you choose the e a s i e s t t e c h n i q u e t o b e g i n 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 w h i c h i s b e n e f i c i a l t o you (a minimum of one t o two weeks). Then choose the n e x t e a s i e s t t e c h n i q u e and see i t u n t i l i t becomes p a r t of your good e a t i n g h a b i t s . Continue employing e a t i n g c o n t r o l t e c h n i q u e s i n t h i s manner as l o n g as i t t a k e s you t o e l i m i n a t e y o u r 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 s e r v e y o u r s e l f . I t i s much more i m p o r t a n t f o r you to work on e a t i n g s m a l l e r p o r t i o n s of food than t o w o r r y about overcoming your l i f e l o n g peachant f o r s t r a w b e r r y shortcake. S t a r t now t o cut down the t o t a l q u a n t i t y of food you e a t . T h i s can be a c c o m p l i s h e d by b u y i n g , f i x i n g and s e r v i n g s m a l l e r q u a n t i t i e s of food. F o r 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 o f p o t a t o e s o n l y s e r v e y o u r s e l f one moderate s i z e p o r t i o n of p o t a t o e s ; One u s e f u l method t o c u t down s e r v i n g s i s to s i m p l y use a s m a l l s i z e d p l a t e . T h i s 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 o r o t h e r f a t t e n i n g food as l o n g as you keep the quant 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 o f l e s s l i k e d foods. This techn i q u e 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 " f o r b i d d e n f r u i t " i n our w e i g h t c o n t r o l program; you s i m p l y have to c u t down the t o t a l q u a n t i t i e s of food e a t e n . 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 o f l e a v i n g a l i t t l e b i t of e v e r y t h i n g on your p l a t e when you f i n i s h . Many p e o p l e f e e l c o m p e l l e d t o f i n i s h e v e r y t h i n g 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 t o waste money may l i e a t the r o o t o f 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 ( h e a r t o p e r a t i o n s , u s e l e s s 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 f o r c e y o u r s e l f t o p o l i s h o f f the remnants o f a ham. Throw them o u t , f e e d them t o the dog, or whatever and p l a n a s m a l l e r p o r t i o n n e x t time. This technique i s e s p e c i a l l y appropriate f o r restaurant eating. Do not eat e v e r y t h i n g put b e f o r e you s i m p l y because you have p a i d f o r it. Y o u ' l l be p a y i n g a much s t e e p e r p r i c e i f you do. 3. Eat S l o w l y . I t t a k e s q u i t e a w h i l e f o r your f o o d i n t a k e t o r e g i s t e r w i t h the b r a i n , so i f you e a t f a s t you may o v e r s h o o t y o u r body's needs. B e g i n 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 b e f o r e p u t t i n g the n e x t of the f o r k . A c t u a l l y , put y o u r f o r k down between b i t e s . Toward the end o f the m e a l , i n t e r r u p t y o u r e a t i n g f o r 2 t o 5 minutes so t h a t you can get i n the h a b i t o f s t a r t i n g o r s t o p p i n g your e a t i n g at w i l l . It i s i m p o r t a n t t h a t you i n i t i a l l y t r y t h i s when you are m o d e r a t e l y 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 s t o p e a t i n g d e s p i t e moderate hunger. R e q u i r e y o u r s e l f t o d e l a y second h e l p i n g s by a t l e a s t 10 m i n u t e s .  170 Q u a l i t y C o n t r o l Techniques 1. Keep a s u p p l y <£ d i e t e t i c o r u n f a t t e n i n g foods on hand. A g a i n , the t e m p t a t i o n t o snack o r o v e r e a t i s g r e a t when y o u have an u n l i m i t e d s u p p l y o f sweets on hand. You w i l l be l e s s tempted i f y o u r l a t e n i g h t t e m p t a t i o n r e q u i r e s a b r i s k w a l k t o t h e s t o r e r a t h e r than t o t h e r e f r i g e r a t o r . Make i t e a s i e r t o 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 n o t keep sweets around t h e house. I f t h e c h i l d r e n need them f o r l u n c h e s , buy o n l y enough f o r them. Keep a s u p p l y o f d i e t e t i c foods i n b r i g h t and s h i n y c o n t a i n e r s ( e . g . , always have c o l d d i e t pop on hand and a c o n t a i n e r o f c e l e r y s t i c k s i n t h e r e f r i g e r a t o r ) . Do n o t keep c o l d b e e r i n the r e f r i g e r a t o r ( i f b e e r i s y o u r d o w n f a l l ) . A l s o , r e a r r a n g e d y o u r cupboards so t h a t f a t t e n i n g snacks a r e i n s t r a n g e , h a r d - t o - r e a c h p l a c e s b u t d i e t e t i c ones a r e r i g h t up f r o n t . 2. A v o i d h i g h c a l o r i e snacks. I f y o u r cupboards a r e f i l l e d w i t h r e a d y - t o - e a t g o o d i e s , y o u a r e much more l i k e l y t o g i v e i n t o t h a t l a t e n i g h t snack t e m p t a t i o n . Quick p r e p a r a t i o n foods a r e a l s o u n a d v i s a b l e . I f y o u have t o have a snack, t r y t o make i t a l e s s p r e f e r r e d one o r somet h i n g w i t h n u t r i t i o n a l v a l u e ( e . g . , a bowl o f c e r e a l ) . S u b s t i t u t e popcorn f o r p o t a t o c h i p s ; the former t a k e s time t o p r e p a r e and has fewer calories. 3. Do n o t adorn f a t t e n i n g f o o d s . A v o i d s e a s o n i n g w h i c h 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 y o u have t o have a soda o r b e e r , e i t h e r have i t o n l y m o d e r a t e l y c o l d ( p r e f e r a b l y warm) o r have a l e s s p r e f e r r e d b r a n d . Do n o t 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 t h e h e l p o f 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 v e r y h e l p f u l i n your e f f o r t s t o l o s e w e i g h t . Now i s t h e t i m e t o 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 t o l o s e w e i g h t . Research has i n d i c a t e d t h a t t h i s i s i m p o r t a n t i n h e l p i n g y o u t o see your w e i g h t l o s s program through t o a s u c c e s s f u l completion. I n a d d i t i o n ask your f a m i l y and f r i e n d s t o do the f o l l o w i n g : (a) n o t t o c r i t i c i z e y o u r f a t n e s s b u t r a t h e r t o p r a i s e y o u f o r y o u r w e i g h t management p r o g r e s s ; (b) t o p r e p a r e and s e r v e y o u s m a l l q u a n t i t i e s o f low c a l o r i e f o o d s ; (3) n o t t o o f f e r y o u a d d i t i o n a l food a t r e g u l a r meals o r at p a r t i e s ; (d) t o engage i n nonfood a c t i v i t i e s such as t a k i n g a w a l k around the b l o c k r a t h e r than h a v i n g an e v e n i n g snack. 2. E a t o n l y i f y o u a r e hungry. T h i s may sound f o o l i s h , b u t many p e o p l e e a t a t 8, 12, and 6 — n o t because they a r e hungry a t the t i m e s — but because they a r e g e n e r a l l y c o n s i d e r e d t h e " r i g h t " times t o e a t . L e t y o u r stomach g u i d e y o u r e a t i n g ; n o t t h e c l o c k o r the stomachs o f y o u r f r i e n d s o r f a m i l y . Don't f e e l compelled t o e a t because of s o c i a l p r e s s u r e s , You can s i t a t t h e f a m i l y d i n n e r t a b l e and converse w i t h o u t e a t i n g . I f p o s s i b l e e a t s e v e r a l b a l a n c e d 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 t o n i b b l e , t r y t o w a i t f o r p r o g r e s s i v e l y l o n g e r p e r i o d s o f time (5 m i n , 8 min., e t c . ) b e f o r e i n d u l g i n g ( i f t h e l a t t e r can't be a v o i d e d ) . S e t a t i m e r f o r your d e l a y p e r i o d and do n o t s e t u n t i l i t b u z z e s . By p r o g r e s s i v e l y l e n g t h e n i n g t h e d e l a y , you w i l l l e a r n t o 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 b e f o r e y o u e a t . I f y o u a r e e a t i n g by y o u r s e l f , p r e p a r e t h e meal, f i x y o u r p l a t e , and then p u t e v e r y t h i n g away b e f o r e y o u s i t down t o e a t . T h i s w i l l i n s u r e t h a t y o u don't c o n t i n u e a d d i n g t h i n g s t o your p l a t e . I f t h e e n t i r e l o a f o f b r e a d i s l y i n g r i g h t t h e r e i n f r o n t o f y o u , y o u a r e much more l i k e l y t o r e a c h f o r a few e x t r a p i e c e s . Get i n t h e h a b i t o f s e t t i n g l i m i t s b e f o r e you b e g i n e a t i n g . 5. Buy and p r e p a r e food on a f u l l stomach. Never go shopping when you a r e hungry. You a r e much more l i k e l y t o buy i n d i s c r i m i n a t e l y ( b o t h i n q u a n t i t y and i n type) when y o u a r e hungry. Also, i f eating while prep a r i n g a meal i s a problem, p r e p a r e t h e e v e n i n g meal i m m e d i a t e l y a f t e r you have f i n i s h e d l u n c h . I t won't h u r t i t t o s i t f o r a few h o u r s . T h i s w i l l reduce y o u r t e m p t a t i o n t o n i b b l e . 6. S e p a r a t e e a t i n g from a l l o t h e r a c t i v i t i e s . When y o u e a t , devote y o u r e n t i r e a t t e n t i o n t o e a t i n g . Many weight problems r e s u l t from the type o f e a t i n g t h a t becomes almost u n c o n s c i o u s ; t h a t I s , y o u may be munching on peanuts w h i l e w a t c h i n g t h e news w i t h o u t r e a l i z i n g what y o u a r e d o i n g . I f y o u spend a l o t o f time i n t h e k i t c h e n , y o u may f i n d y o u r 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 s u r e t h a t when y o u eat y o u do n o t h i n g e l s e — t h a t i s , no t e l e v i s i o n , no r e a d i n g , no phone calls, etc.  172  E x e r c i s e t o Weight R e d u c t i o n The r o l e o f p h y s i c a l e x e r c i s e i n w e i g h t r e d u c t i o n has o f t e n been belittled. I t has been s t a t e d , f o r example, t h a t one must c l i m b t h e s t a i r s t o t h e t o p o f t h e Empire S t a t e B u i l d i n g and down a g a i n r e p e a t e d l y f o r f o u r h o u r s i n o r d e r t o l o s e one pound o f body f a t . Such s t a t i s t i c s would dampen t h e e n t h u s i a s m o f t h e most a r d e n t devotee o f e x e r c i s e . Howe v e r , i t i s a l s o t r u e t h a t i f t h a t same i n d i v i d u a l c l i m b e d t h e 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 a g a i n f o u r t i m e s a day, he would l o s e t h a t pound o f f a t i n t h i r t y days o r s i x w o r k i n g weeks. T h i s would r e s u l t i n a y e a r l y l o s s o f a p p r o x i m a t e l y n i n e pounds. I t i s n o t n e c e s s a r y f o r e x e r c i s e t o be p r o l o n g e d and e x h a u s t i n g f o r i t t o be e f f e c t i v e . Short b u t r e g u l a r p e r i o d s o f e x e r c i s e w i l l make t h e same c o n t r i b u t i o n and can be a u s e f u l and e n j o y a b l e p a r t o f y o u r w e i g h t r e d u c t i o n p r o gram. I t has been c l e a r l y demonstrated t h a t when d i e t and e x e r c i s e a r e combined, r e g u l a r e x e r c i s e i n c r e a s e s t h e r a t e o f w e i g h t l o s s . Furthermore, i t i s w e l l known t h a t t h e o v e r w e i g h t i n d i v i d u a l w i l l b u r n more c a l o r i e s p e r minute t h a n h i s l e a n c o u n t e r p a r t when c a r r y i n g o u t t h e same t a s k . I t has been found t h a t , i n a d d i t i o n t o i n c r e a s e d w e i g h t l o s s , e x e r c i s e h e l p s d i e t e r s t o r e t a i n needed body f l u i d s and m a i n t a 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 o f c a l o r i e i n t a k e i s n o t e x c e s s i v e . When a d i e t i s too s e v e r e , the body's r a t e o f m e t a b o l i s m changes and reduces t h e e f f e c t i v e n e s s o f exercise. E x e r c i s e has y e t a n o t h e r b e n e f i t t o t h e 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 intake severely i n o r d e r t o y i e l d e n c o u r a g i n g r e s u l t s . The d e p r i v a t i o n and hunger t h a t o f t e n accompany d i e t i n g p r o b a b l y c o n t r i b u t e more t o an i n a b i l i t y t o adhere t o a w e i g h t l o s s program than any o t h e r f a c t o r . By m o d e r a t e l y d e c r e a s i n g i n take and i n c r e a s i n g e x p e n d i t u r e , such d i s c o m f o r t s can be a v o i d e d . By i n c r e a s i n g e x e r c i s e , a more r e 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 e n j o y e d . I n a d d i t i o n , however, i t i s n e c e s s a r y t o weave i n c r e a s e d energy exp e n d i t u r e i n t o t h e n a t u r a l f a b r i c o f d a i l y l i v i n g . A l t h o u g h not measura b l e , such i n c r e a s e s w i l l undoubtedly i n f l u e n c e energy e x p e n d i t u r e and have some e f f e c t on body w e i g h t . One s h o u l d be as c o n s c i o u s o f how she uses h e r body as she i s o f what she p u t s i n t o i t and how f a s h i o n a b l y i t i s bedecked, b u t 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 o u r s t h i s would c a l l f o r a k i n d o f d i u r n a l h e r e s y . F o r example, w h i l e t h e t e l e p h o n e company e x t o l s the v i r t u e s o f adding e x t e n s i o n t e l e p h o n e s t o save 70 m i l e s o f w a l k i n g p e r y e a r , t h i s s h o u l d be seen by t h e w e i g h t c o n s c i o u s p e r s o n as an e x p e n s i v e l e i s u r e c o s t i n g as much as 15 excess pounts o f body f a t i n 10 y e a r s . I n t h e same v e i n , department s t o r e s which p r o v i d e c o n v e n i e n t e l e v a t o r s and e s c a l a t o r s b u t p o o r l y l i t s t a i r w e l l s c a t e r t o t h e conveni e n c e b u t n o t t h e h e a l t h o f t h e i r customers, as do t h e p u r v e y o r s o f g o l f c a r t s , power (and even r i d i n g ) lawn mowers, m e c h a n i c a l snow s h o v e l s , e l e c t r i c garage d o o r s , c a r v i n g k n i v e s , i c e c r u s h e r s , can o p e n e r s , t o o t h b r u s h e s , and even p a r k i n g l o t s w h i c h y i r t u a l l y e l i m i n a t e w a l k i n g from  173  s h o p p i n g t o u r s . To surmount t h e s e many f o r c e s which would l e a 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 t o t h i n k b e f o r e she saves even a s i n g l e c a l o r i e o f energy and then a c t t o expend t h a t c a l o r i e . This i s done by w a l k i n g u p s t a i r s every time i t i s a p p r o p r i a t e i n s t e a d of w a i t i n g f o r t h i n g s to accumulate on the bottom step o r s e n d i n g an o t h e r w i s e 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, s t a n d i n g i n s t e a d of s i t t i n g , and w a l k i n g i n s t e a d o f s t a n d i n g v e r y t i m e i t i s p r a c t i c a b l e t o choose the more e n e r g e t i c option. F i n a l l y w h i l e t h e s e 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 t o make a number o f 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 r a c k and the c o f f e e pot on a n o t h e r f l o o r , u s i n g the t o i l e t at the f a r end o f the h a l l , o r 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 i n c r e a s e the amount of energy expended o v e r the c o u r s e of a y e a r . But none o f t h e s e a d j u s t m e n t s w i l l be a u t o m a t i c ; some w i l l be the s u b j e c t o f 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 f a c e o f these odds r e q u i r e s a f i r m commitment t o s t r o n g l y embracing e x e r t i o n as a b a s i c t h r e a d 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 v o l u n t e e r f o r t h i s w e i g h t c o n t r o l s t u d y , we want y o u t o know what t h i s p a r t o f t h e experiment i s g o i n g t o be l i k e . You w i l l spend up t o 24 hours l y i n g on a bed i n a d a r k , somewhat s o u n d - r e d u c i n g room, and y o u a r e i n s t r u c t e d t o remain r e a s o n a b l y q u i e t w h i l e i n the room. That i s t o s a y , y o u a r e n o t p e r m i t t e d t o s i n g , w h i s t l e , t a l k t o y o u r s e l f , e t c . ; a l s o , you a r e asked t o r e f r a i n from moving around the room, s i t t i n g upon the b e d , 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 a t y o u r b e d s i d e through p l a s t i c s t r a w s , and you a r e f r e e t o take them a t w i l l . From time t o t i m e , messages w i l l be p r e s e n t e d t o you o v e r an intercommunicat i o n system, and a l s o you may be asked q u e s t i o n s about how y o u a r e f e e l i n g , and so on. A t a l l times w h i l e you a r e i n t h e room, t h e r e w i l l be a m o n i t o r i n the room n e x t door t o y o u 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 i n t e r c o m s e t t o make sure t h a t you a r e a l l r i g h t , and t h a t you a r e o b e y i n g the i n s t r u c t i o n s t o l i e s t i l l w i t h o u t moving around t h e room, t a l k i n g to y o u s e l f , o r the l i k e . S e v e r a l hundred s u b j e c t s 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 o f s i t u a t i o n , and v e r y few o f them have found i t s t r e s s f u l o r u n p l e a s a n t , 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 n e g a t i v e , you may end t h e experiment s i m p l y be g e t t i n g • o f f the bed and w a l k i n g out o f t h e room. I f y o u d e c i d e t o do t h i s , y o u s h o u l d n o t f e e l t h a t 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 u n p l e a s a n t , and t h e r e i s no p a r t i c u l a r r e a s o n why they s h o u l d f o r c e themselves t o c o n t i n u e i n i t . You s h o u l d f e e l a s s u r e d t h a t among these s e v e r a l hundred s u b j e c t s , none has e v e r e x p e r i e n c e d any extremely undesirable or l a s t i n g s i d e e f f e c t s .  P e t e r S u e d f e l d , Ph.D • Project Director  >  I have read the above i n f o r m a t i o n , and agree t o p a r t i c i p a t e i n t h e p r o j e c t as d e s c r i b e d . DATE PRINTED NAME:  SIGNATURE AGE:  ADDRESS TELEPHONE NO.  SOCIAL INSURANCE NO.  176  MOTIVE CHECKLIST Below i s a l i s t o f d i f f e r e n t reasons t h a t people have f o r w a n t i n g t o l o s e w e i g h t . Under each reason i s a s c a l e r a n g i n g from v e r y import a n t ( 5 ) , to not a t a l l i m p o r t a n t ( 1 ) . C i r c l e the number which r e p r e s e n t s how i m p o r t a n t each o f t h e s e reasons i s f o r you i n your d e c i s i o n t o j o i n t h i s program. F o r example, i s i m p r o v i n g y o u r appearance v e r y i m p o r t a n t t o you? C i r c l e t h e 5 under that p a r t i c u l a r reason. 1.  Improve my  appearance  1 not a t a l l important 2.  Improve my  2 not very important .  2  Demonstrate  2  Improve s o c i a l 1  5.  4  5  3  3  4  5  3  4  5  4  5  3  4  5  3  4  5  opportunities 2  2  3  P r e p a r e f o r some upcoming event 1  7.  3  Improve employment o p p o r t u n i t i e s . 1  6.  5 very important  self-control  1  4.  4 fairly important  health  1  3.  3 somewhat important  P l e a s e my 1  2  spouse o r f r i e n d s 2  I f you have o t h e r reasons f o r j o i n i n g the program p l e a s e l i s t them here and put a number from 1 t o 5 r e p r e s e n t i n g how i m p o r t a n t t h a t r e a s o n i s t o you.  177  Spouse Involvement Form has d e c i d e d to p a r t i c i p a t i n a program d e s i g n e d to h e l p her c o n t r o l o v e r - e a t i n g and l o s e excess w e i g h t . A program of t h i s k i n d i s a b i g j o b and a t times w i l l be v e r y d i f f i c u l t . I t i s for t h i s reason t h a t y o u r s u p p o r t and a s s i s t a n c e are c r u c i a l to the success o f 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 t e c h n i q u e s have been developed t o 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 o r d e r t o a v o i d e a t i n g a l l the time wherever one might be, i t i s i m p o r t a n t t o arrange f o r her t o e a t i n o n l y one room, such as the d i n i n g room, and not do a n y t h i n g 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 a s p e c t would be t o encourage your w i f e / f r i e n d t o eat i n one p l a c e 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 s t e p . The t e c h n i q u e s are many and i n s t e a d o f l i s t i n g them a l l h e r e , I would l i k e t o r e q u e s t t h a t you a c q u a i n t y o u r s e l f w i t h the program by r e a d i n g the s h o r t b o o k l e t t h a t we w i l l be s u p p l y i n g y o u r w i f e / f r i e n d . I would l i k e t o add t h a t f o r the program to be e f f e c t i v e and l o n g l a s t i n g , i t must be t a k e n c o m p l e t e l y s e r i o u s l y and f o r an i n d e f i n i t e p e r i o d o f t i m e . T h i s i s not a c r a s h d i e t w i t h a p i e c e of choO c o l a t e cake a t 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 emphas i z e enough the i m p o r t a n c e of your s u p p o r t to the s u c c e s s of t h i s a t tempt t o l o s e and m a i n t a i n a new low w e i g h t .  178 You can be o f a s s i s t a n c e t o t h e program by p r o v i d i n g us w i t h some i n f o r m a t i o n about t h e c u r r e n t e a t i n g h a b i t s o f your w i f e / f r i e n d . She has a l r e a d y g i v e n us i n f o r m a t i o n and w i l l c o n t i n u e t o do t h i s , however, i n an e x p e r i m e n t a l program l i k e t h i s , i t i s v e r y i m p o r t a n t t h a t we c o l l e c t as much i n 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 . P l e a s e answer as b e s t as y o u can the f o l l o w i n g q u e s t i o n s about your wife/friend's eating habits: 1. 2.  How many meals does she e a t a day? Average number . A How w e l l b a l a n c e d a r e the.-meals she e a t s ? check one: '  3.  How a p p r o p r i a t e f o r someone on a d i e t i s t h e food she e a t s ? check one:  4.  v e r y a p p r o p r i a t e - v e r y few f a t t e n i n g foods somewhat a p p r o p r i a t e about average somewhat i n a p p r o p r i a t e not a t a l l a p p r o p r i a t e - m o s t l y f a t t e n i n g foods  How w e l l do y o u t h i n k she has s n a c k i n g under c o n t r o l ? check one:  5.  very poorly balanced - not very n u t r i t i o u s ' n o t v e r y b a l a n c e d - some n u t r i t i o u s foods b u t m o s t l y junk foods about average - some n u t r i t i o u s foods - some j u n k foods f a i r l y b a l a n c e d - m o s t l y 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  n e v e r snacks r a r e l y snacks sometimes snacks frequent snacking always s n a c k i n g  Does she o f t e n t u r n down f a t t e n i n g foods when they a r e o f f e r e d ? check one: __  ;  always t u r n s down f a t t e n i n g foods f r e q u e n t l y t u r n s down f a t t e n i n g foods sometimes t u r n s down f a t t e n i n g foods r a r e l y t u r n s down f a t t e n i n g foods n e v e r t u r n s down f a t t e n i n g foods  179 Two Month I n t e r v i e w NAME I.  D A T E  C a l o r i e plan? % o f days on % o f days o v e r % o f days under Graphing  II.  yes  Jio  Exercise average c a l o r i e s / d a . pattern: regular_ sporadic Graphing  III.  .  yes  how o f t e n how o f t e n no  Habits  % o f time  E a t i n g i n one p l a c e (when home) Not d o i n g a n y t h i n g e l s e K e e p i n g p r o b l e m foods out o f s i g h t and r e a c h Working on s p e c i f i c p r o b l e m times G e t t i n g h e l p from o t h e r s Use s m a l l e r p l a t e ' Measure p o r t i o n s Keeping s a f e foods a v a i l a b l e Eating slowly Payoff plan 1.  4 A great deal  ]  .  3 Somewhat  2 A little bit  1 Not a t a l l  4 A great  5 Very much  Do you f e e l b e t t e r about y o u r s e l f ? 1 2 Not a t a l l A little bit  3.  ]  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 Completely  2.  '  3 Somewhat  deal  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 Extremely  4 A great deal  3 Somewhat  2= A little bit  cont'd.  1 Not a t a l l  180 4.  How much d i f f i c u l t y have y o u had thus f a r  5.  How much d i f f i c u l t y do y o u f o r e s e e h a v i n g f o r  (0-100)  the n e x t f o u r months (0-100) 6.  How many times have, y o u read the book?  7.  What i s y o u r o p i n i o n o f t h e book?  1 Worthless  2 Of l i t t l e V a l u e  3 Somewhat u s e f u l  S.D. E x p e r i e n c e Has i t helped? Have y o u thought o f t h a t e x p e r i e n c e much? What was i t l i k e ? ( P l e a s a n t - U n p l e a s a n t ) Message: Have they helped? Have y o u t r i e d r e l a x a t i o n s i n c e then? Have y o u thought o f them?  4 Very u s e f u l  5 Extremely U s e f u l  181  S i x Month  Interview  NAME 1.  DATE  Do you f e e l t h a t f o r you the p r o g r e s s has been s u c c e s s f u l o r unsuccessful?  1 completely unsuccessful  2 fairly unsuccessful  21 neither successful nor unsuccessful  4 fairly successful  5_ completely successful  Comments: 2, Do you f e e l t h a t your a t t i t u d e toward e a t i n g has changed s i n c e the b e g i n n i n g o f t h e program? 5  4  changed completely  changed a great deal  3.  4  changed completely  changed a great deal  1 not a t a l l changed  changed a little  changed somewhat  changed? 1  2  3  not a t a l l changed  changed a little  changed somewhat  Do you f e e l b e t t e r about y o u r s e l f ?  1 not a t a l l 5.  2  Have y o u r a t t i t u d e s toward y o u r h e a l t h i n g e n e r a l 5  4.  3  2 a little  3 somewhat  4 a great  deal  5 v e r y much  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 not a t a l l  2 a little  3 somewhat  4 a great  deal  5 extremely  6.  What do you t h i n k a r e t h e most i m p o r t a n t a s p e c t s of t h e program?  7.  What a r e the w o r s t a s p e c t s o f t h e program?  8.  How c o u l d t h e program be improved? cont'd....  S i x Month I n t e r v i e w . (cont'd) 9.  What i s the g r e a t e s t problem you had w h i l e on the program?  10. What have y o u l e a r n e d about y o u r s e l f d u r i n g t h e program? 11.  Do y o u t h i n k you w i l l use t h i s program i n t h e f u t u r e ?  12. Do y o u f e e l i t i s p o s s i b l e f o r you t o r e a c h your g o a l w e i g h t ? 13. G e n e r a l Comments  

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