Parental bonding and anxiety: differences between African American and European American college students.

Empirical evidence suggests that early home environments characterized by low care and high overprotection are positively associated with the adult expression of anxiety. While available evidence supports this position for European Americans, there has been no examination of the relationship between perceived parental rearing practices and anxiety among African Americans despite the theoretical assertion that African American parenting environments may be characterized as somewhat more overprotective than European Americans. This study investigated the relationship between maternal rearing patterns and trait and state measures of anxiety and depression among a sample of 59 African American and 55 European American college students. Results indicated that both groups reported similar levels of anxiety, depression, perceived care, and perceived overprotection. European Americans exhibited the typical pattern of a negative relationship between anxiety, depression, and care and a positive relationship between anxiety and overprotection. African Americans evidenced a similar negative relationship between anxiety, depression, and care, but no relationship between anxiety, depression, and overprotection. Furthermore, specific aspects of ethnic identity (i.e., ethnic achievement, ethnic behaviors) were found to be negatively associated with measures of trait anxiety among African Americans but not European Americans.

Behavioral choice treatment promotes continuing weight loss: preliminary results of a cognitive-behavioral decision-based treatment for obesity.

Twenty-four obese women were randomly assigned to 1 of 2 group treatments: behavioral choice treatment (BCT) or traditional behavioral treatment (TBT). BCT uses decision theory to promote moderate behavior change that can be comfortably, and therefore permanently, maintained. Groups completed a moderate-intensity walking program and obtained feedback from computerized eating dairies. The TBT group evidenced greater weight loss at posttreatment. However, the TBT group also evidenced a trend to regain weight, whereas the BCT group continued a slow weight loss during follow-up. Exercise followed a similar pattern. Both groups decreased in restraint and increased in self-esteem.

The conceptual relationship between panic disorder and male erectile dysfunction.

Despite evidence of a relationship between sexual dysfunction and panic disorder, there have been few clinical reports addressing the nature of the association between these phenomena. We present three case reports of men diagnosed with panic disorder with agoraphobia, who presented for treatment of erectile problems. In each of the three cases, the similarity between sensations experienced during sexual arousal and those experienced during panic attacks is noted. The purpose of these case presentations is to stimulate further empirical examination of sex-panic states and to alert practitioners of the possible assessment and treatment implications for such individuals. The symptomatic overlap exhibited in these cases is conceptualized from both a psychobiological model of panic disorder and from Barlow's model of sexual dysfunction in an effort to provide a theoretical framework to guide future research and clinical assessment.

A sequential behavioral analysis of craving sweets in obese women.

This study compared 40 female participants in a behavioral weight loss program who frequently reported craving sweets to 40 who rarely reported craving sweets using 2-week behavioral eating diaries. The two groups were compared on physiological, demographic, and questionnaire measures and no significant differences were found. There were no significant differences in macronutrient intake either overall or in a wide range of specific situations. The relative proportions of carbohydrate, protein, and fat consumed in association with craving sweets differed only slightly from the composition of other meals and snacks. Carbohydrate and protein intake when craving sweets was similar to breakfasts while the relative amount of fat consumed when craving sweets was comparable to episodes of overeating. The two groups differed in their reporting of moods with the high-craving group reporting more boredom and less stress than the low-craving group. The relationship between situational and mood variables and reports of craving sweets did not differ between the two groups. Craving sweets was negatively associated with hunger and was not associated with meal skipping. A sequential analysis demonstrated that eating in response to craving sweets triggers an abstinence violation effect. These data are not consistent with the hypothesis that sweet craver's consume high-carbohydrate, low-protein meals and snacks in order to self-medicate depression caused by serotonin depletion. Instead, the data suggest that we should further explore the role of food palatability and food-related cognitions in order to understand craving sweets.

The role of breakfast in the treatment of obesity: a randomized clinical trial.

Fifty-two moderately obese adult women were stratified according to their baseline breakfast-eating habits and randomly assigned a weight-loss program. The no-breakfast group ate two meals per day and the breakfast group ate three meals per day. The energy content of the two weight-loss programs was identical. After the 12-wk treatment, baseline breakfast eaters lost 8.9 kg in the no-breakfast treatment and 6.2 kg in the breakfast treatment. Baseline breakfast skippers lost 7.7 kg in the breakfast treatment and 6.0 kg in the no-breakfast treatment. This treatment-by-strata-by-time interaction effect (P less than 0.06) suggests that those who had to make the most substantial changes in eating habits to comply with the program achieved better results. Analyses of behavioral data suggested that eating breakfast helped reduce dietary fat and minimize impulsive snacking and therefore may be an important part of a weight-reduction program.

The effects of aerobic exercise on psychological adjustment: a randomized study of sedentary obese women attempting weight loss.

This study evaluated the psychological effects of aerobic conditioning in 40 moderately obese, sedentary women participating in a 12-week behavioral weight loss program. Participants were randomly assigned to a no-exercise or moderate walking condition. Emotional impact of the treatment was assessed in two ways: (1) Subjects reported subjective mood prior to each eating episode and (2) the SCL-90-R was administered before and after the program. Exercisers lost more weight and body fat than non-exercisers. Both groups of subjects showed numerous improvements in mood as a result of participating in the weight loss program. Exercise had no specific differential effect on emotions as measured by daily mood ratings or the SCL-90-R. Exercise did not appear to add appreciably to the psychological benefits of losing weight in this sedentary obese population. Future studies utilizing longer periods of aerobic exercise training, larger sample size, and exercise specific measures are recommended.

A behavioral taxonomy of obese female participants in a weight-loss program.

To create a behavioral classification of obesity, 2-wk baseline food diaries were obtained from 236 obese women entering weight-loss programs. Subjects monitored food intake along with the social, environmental, and emotional context in which each meal occurred. Variables representing situation-specific eating behaviors were statistically extracted from greater than 11,000 eating episodes. Hierarchical cluster analysis identified five distinct groups of subjects on the basis of similarity of eating patterns. The five groups were (1) moderately healthy eating habits, (2) chronic food restrictors, (3) alternating diet-binge eaters, (4) emotional overeaters, (5) unrestricted meal overeaters. The five groups differed on questionnaire measures of emotional adjustment and eating behavior but did not differ on dropout rates, amount of weight lost, or exercise compliance. The chronic food restrictors had significantly less lean body mass, lower resting metabolic rates, and higher waist-to-hip ratios than did the unrestricted meal overeaters.

Obesity: a biogenetic or biobehavioral problem.

A great deal of effort is being expended to investigate the biogenetic basis of the development and maintenance of obesity and the regulation of food intake. The task of developing and validating theoretical models of the regulation of food intake and its relationship to body weight is hampered by a lack of basic descriptive data. This study investigated the eating behavior of 96 obese women by conducting a microanalysis of 2-week baseline behavioral eating diaries. Subjects were in approximate energy balance consuming a high-fat diet (41 percent of kcal from fats) averaging 1978 kcal/day. Self-reported episodes of overeating and impulsive eating occurred frequently and were associated with situational antecedents such as eating in the car, snacking alone, friends, restaurants, availability of forbidden foods, craving sweets, tired, irritable, bored, depressed, and skipping meals. Markov chain analysis showed that overeating and impulsive eating were positively autocorrelated, suggesting the presence of an abstinence violation effect. These data suggest that eating behavior is often controlled by environmental, cognitive, and affective variables and that a complete understanding of obesity will require an integrated biobehavioral approach.

Effects of significant weight gain on chronic pain patients.

This study examined the effect of significant weight gain on physical, demographic, behavioral, and psychosocial factors in a representative sample of chronic pain patients. One hundred fifty-five chronic pain patients who reported gaining more than 15 pounds since the onset of their pain were compared with 341 pain patients who stated that their weight had remained the same since the onset of their pain. All patients were given a medical examination and each patient completed a comprehensive pain questionnaire and an SCL-90. Results showed that a significant relationship exists between weight gain and decreased physical activity, increased emotional distress, and accident liability. This study suggests that the inclusion of weight management training in multidisciplinary pain centers may play an important part in the rehabilitation of chronic pain patients.

Evaluation of an alternating-calorie diet with and without exercise in the treatment of obesity.

This study examined the effects of calorie alternation and exercise on weight loss. Moderately obese women (130-160% of ideal body weight) were randomly assigned to an alternating- or constant-calorie diet with or without aerobic exercise. Both diets provided an average of 1200 kcal/d over a 12-wk period; daily intake of subjects in the alternating-diet condition varied in a prescribed pattern from 600 to 1800 kcal/d. Exercising subjects walked 5 d/wk. All subjects participated in an intensive outpatient behavior-modification program. At the end of the study, exercised subjects had greater reductions in body weight and body fat percentage than did nonexercised subjects. The type of caloric restriction did not affect weight or fat loss. Changes in resting metabolic rate did not differ among groups. Alternating calories was neither beneficial nor detrimental as a weight-loss strategy whereas exercise was clearly beneficial in weight-loss therapy.

Identification of high-risk situations in a behavioral weight loss program: application of the relapse prevention model.

The relapse prevention model has recently been applied to the treatment of obesity in order to explain why people stop practising caloric restriction and hence stop losing weight. This study attempted to identify environmental, affective and physiological variables characterizing 'high risk' situations that lead individuals to either overeat or eat unplanned meals, thereby violating the rules of dietary abstinence. Thirty-five individuals (5 male; 30 female) at least 20 percent above ideal body weight were instructed to keep a continuous record of their eating behavior during a 10-week behavioral weight loss program. Each eating episode was entered into the computer as a separate behavioral observation resulting in 3066 usable observations. Log-linear analysis of multidimensional contingency tables was used to fit Markov chains to the data in order to examine whether dietary slips (overeating; unplanned eating) could be predicted from the following antecedents or pairs of antecedents: meal, people, place, mood, and hunger. Antecedents found to be associated with conditional probabilities 25 percent greater than the unconditional probabilities for unplanned meals and overeating (very much; some) are reported. Three basic categories of high-risk situations emerge: positive social interactions, negative emotions, and physiological craving. Individual differences were observed in the unconditional probabilities of the target behaviors, in exposure to high-risk situations, and in impulsive eating in response to meal, people, place, and hunger.

The influence of problems with concentration and memory on emotional distress and daily activities in chronic pain patients.

This study examined concentration and memory problems in chronic pain patients as they related to emotional distress and interference with daily activity. Three hundred and sixty-three chronic pain patients were divided into two groups based on how much they expressed difficulty in concentrating and remembering things. Each patient was given a physical examination and completed a pain evaluation questionnaire and an SCL-90. Physician ratings of the patients' depression and anxiety were also obtained. The results showed that problems in concentration and memory were related to emotional distress, poor family support, and interference with daily activities. It is suggested that techniques to improve concentration and memory should be incorporated as part of a multidisciplinary pain program.