The mind your health project: a randomized controlled trial of an innovative behavioral treatment for obesity.

OBJECTIVE: To determine whether acceptance-based behavioral treatment (ABT) would result in greater weight loss than standard behavioral treatment (SBT), and whether treatment effects were moderated by interventionist expertise or participants' susceptibility to eating cues. Recent research suggests that poor long-term weight-control outcomes are due to lapses in adherence to weight-control behaviors and that adherence might be improved by enhancing SBT with acceptance-based behavioral strategies. DESIGN AND METHODS: Overweight participants (n = 128) were randomly assigned to 40 weeks of SBT or ABT. RESULTS: Both groups produced significant weight loss, and when administered by experts, weight loss was significantly higher in ABT than SBT at post-treatment (13.17% vs. 7.54%) and 6-month follow-up (10.98% vs. 4.83%). Moreover, 64% of those receiving ABT from experts (vs. 46% for SBT) maintained at least a 10% weight loss by follow-up. Moderation analyses revealed a powerful advantage, at follow-up, of ABT over SBT in those potentially more susceptible to eating cues. For participants with greater baseline depression symptomology, weight loss at follow-up was 11.18% in ABT versus 4.63% in SBT; other comparisons were 10.51% versus 6.00% (emotional eating), 8.29% versus 6.35% (disinhibition), and 9.70% versus 4.46% (responsivity to food cues). Mediation analyses produced partial support for theorized food-related psychological acceptance as a mechanism of action. CONCLUSIONS: Results offer strong support for the incorporation of acceptance-based skills into behavioral weight loss treatments, particularly among those with greater levels of depression, responsivity to the food environment, disinhibition, and emotional eating, and especially when interventions are provided by weight-control experts.

Growth rates of Chinese and American alligators.

Growth rates in two closely related species, Alligator mississippiensis (American alligator) and Alligator sinensis (Chinese alligator), were compared under identical conditions for at least 1 year after hatching. When hatched, Chinese alligators were approximately 2/3 the length and approximately 1/2 the weight of American alligator hatchlings. At the end of 1 year of growth in captivity in heated chambers, the Chinese alligators were approximately 1/2 as long and weighed approximately 1/10 as much as American alligator yearlings. When the animals were maintained at 31 degrees C, Chinese alligator food consumption and length gain rates dropped to near zero during autumn and winter and body weights decreased slightly, apparently in response to the change in day length. At constant temperature (31 degrees C), food consumption by American alligators remained high throughout the year. Length gain rates in American alligators decreased slowly as size increased, but were not affected by photoperiod. Daily weight gains in American alligators increased steadily throughout the year. In autumn, provision of artificial light for 18 h a day initially stimulated both length and weight gain in Chinese alligators, but did not affect growth in American alligators. Continuation of the artificial light regimen seemed to cause deleterious effects in the Chinese alligators after several months, however, so that animals exposed to the normal light cycle caught up to and then surpassed the extra-light group in size. Even after removal of the artificial light, it was several months before these extra-light animals reverted to a normal growth pattern. These findings may be of interest to those institutions engaged in captive growth programs intended to provide animals for reintroduction to the wild or to protected habitat.

The search for the holy grail: heart rate variability and thought field therapy.

Thought Field Therapy (TFT) is one of several unusual psychotherapies that have witnessed rapid growth over the past few years, despite the absence of scientific support. Promoters of TFT frequently cite changes in heart rate variability (HRV) as evidence of TFT's effects. Pignotti and Steinberg (2001) present reports of 39 cases in which HRV was assessed prior to and immediately following TFT. Serious methodological shortcomings preclude interpretation of these data with respect to either the efficacy of TFT or the clinical utility of HRV. Ethical concerns are raised about the aggressive promotion of TFT and the misuse of HRV.

Social anxiety disorder in childhood and adolescence: current status and future directions.

This paper reviews the current status of research on the phenomenology, etiology, maintenance, assessment, and treatment of childhood and adolescent social anxiety disorder (SAD). Despite being one of the most prevalent disorders of childhood and adolescence, SAD paradoxically stands as one of the least recognized, researched, and treated pediatric disorders. The small treatment outcome literature provides preliminary support to the effectiveness of various forms of cognitive behavior therapy. The majority of studies to date, however, are limited by inadequate control conditions. Other findings include some support for the utility of parental involvement in treatment, significant advancements in outcome measures (e.g., normative comparisons, indices of naturalistic social functioning), and impressive durability of gains for the majority of treatments. Future directions are suggested, including experimental and naturalistic studies of developmental pathways and maintenance factors, the incorporation of "positive psychology" constructs (e.g., positive emotions, hope, self-control) in treatment and prevention, and the continued delineation of differences between child, adolescent, and adult manifestations of SAD.

Science and pseudoscience in the development of eye movement desensitization and reprocessing: implications for clinical psychology.

The enormous popularity recently achieved by Eye Movement Desensitization and Reprocessing (EMDR) as a treatment for anxiety disorders appears to have greatly outstripped the evidence for its efficacy from controlled research studies. The disparity raises disturbing questions concerning EMDR's aggressive commercial promotion and its rapid acceptance among practitioners. In this article, we: (1) summarize the evidence concerning EMDR's efficacy; (2) describe the dissemination and promotion of EMDR; (3) delineate the features of pseudoscience and explicate their relevance to EMDR; (4) describe the pseudoscientific marketing practices used to promote EMDR; (5) analyze factors contributing to the acceptance of EMDR by professional psychologists; and (6) discuss practical considerations for professional psychologists regarding the adoption of EMDR into professional practice. We argue that EMDR provides an excellent vehicle for illustrating the differences between scientific and pseudoscientific therapeutic techniques. Such distinctions are of critical importance for clinical psychologists who intend to base their practice on the best available research.

Cosmetic breast augmentation surgery: a critical overview.

Despite the ban on silicone gel breast implants in 1992, the last decade witnessed a dramatic increase in the number of cosmetic breast augmentation procedures performed in the United States. According to the American Society of Plastic Surgeons, over 132,000 women in this country underwent the procedure in 1998. This is an underestimate of the actual number of breast augmentations performed annually, as increasing numbers of nonsurgeon physicians are now performing cosmetic surgery. Given the rising number of women who now seek cosmetic breast augmentation surgery, it is likely that women's healthcare providers will be asked by their patients about breast augmentation. This review is designed to provide an overview of the medical and psychological literature on cosmetic breast augmentation. We begin with a history of breast augmentation, including an overview of the controversy of silicone breast implants and the Institute of Medicine's report on their safety published in 1999. We also discuss the psychological characteristics of breast augmentation patients, reviewing both preoperative and postoperative studies. We conclude with suggestions for future research as well as a discussion of the clinical relevance of this area for women's healthcare professionals.

Eye Movement Desensitization and Reprocessing: an analysis of specific versus nonspecific treatment factors.

Incremental validity and incremental efficacy have become important issues in the evaluation of psychological assessment and intervention procedures. Incremental validity in assessment is that shown by novel measures over and above established ones. Incremental efficacy is that shown by novel treatments over and above nonspecific and established treatment effects. In this paper, we critically examine the question of whether Eye Movement Desensitization and Reprocessing (EMDR) possesses efficacy above and beyond nonspecific treatment effects and components that are shared with well-established interventions. A review of recently published efficacy studies reveals that (a) the effects of EMDR are largely limited to verbal report indices, (b) eye movements and other movements appear to be unnecessary, and (c) reported effects are consistent with nonspecific treatment features. Examination of individual studies shows that control procedures for nonspecific features have been minimal. We analyze EMDR for nonspecific treatment features and suggest experimental controls to examine the incremental efficacy of EMDR.

Cognitive biases in generalized social phobia.

Judgmental biases for threat-relevant stimuli are thought to be important mechanisms underlying the etiology and maintenance of anxiety disorders. The authors hypothesized (a) that people with generalized social phobia (GSP) would rate negative social events but not nonsocial events as more probable and costly than would nonanxious controls (NACs) and (b) that cognitive behavioral treatment would decrease probability and cost estimates for social but not nonsocial events. Participants with GSP and NACs were assessed twice, 14 weeks apart, during which the former received cognitive behavioral therapy. Those with GSP evidenced socially relevant judgmental biases prior to treatment, and these were attenuated following treatment. Reduction in cost estimates for social events, but not in probability estimates, mediated improvement in social phobia. Results are discussed in light of emotional processing theory.

Relationship between locus of control and performance on the National Board of Medical Examiners, Part I, among black medical students.

Several investigators have recently suggested that nonacademic factors may be particularly important in the performance of minority medical students. This study examined the relationship between the personality variable of locus of control and black medical students' performance on the National Board of Medical Examiners I. Subjects included 50 third- and fourth-year medical students of African-American, Caribbean, and African backgrounds from 4 medical schools. An internal locus of control was correlated with test performance, whereas the more traditional index of the Medical College Admissions Test was not. Implications of these results for the preparation, admission, and training of black medical students are discussed.

Relationship between locus of control and performance on the national board of medical examiners, part 1, among black medical students

Several investigators have recently suggested that nonacademic factors may be particularly important in the performance of minority medical students. This study examined the relationship between the personality variable of locus of control and black medical students' performance on the National Board of Medical Examiners I. Subjects include 50 third - and fourth-year medical students of African-American, Caribbean, and African backgrounds from 4 medical schools. An internal locus of control was correlated with test performance, whereas the more traditional index of the Medical College Admissions Test was not. Implications of these results for the preparation, admission, and training of black medical students are discussed (AU)

Eye movement desensitization: a critique of the evidence.

The scientific evidence supporting the efficacy of eye movement desensitization (EMD), a novel intervention for traumatic memories and related conditions, is reviewed. The sparse research conducted in this area has serious methodological flaws, precluding definite conclusions regarding the effectiveness of the procedure. Clinicians are cautioned against uncritically accepting the clinical efficacy of EMD.

Validity of the distinction between generalized social phobia and avoidant personality disorder.

Disorders of pervasive social anxiety and inhibition are divided into 2 categories, generalized social phobia (GSP) and avoidant personality disorder (APD). We explored the discriminative validity of this categorization by examining the comorbidity of GSP and APD and by comparing these groups on anxiety level, social skills, dysfunctional cognitions, impairment in functioning, and presence of concurrent disorders. Results from 23 subjects showed high comorbidity of the 2 diagnoses: All subjects who met criteria for APD also met criteria for GSP. APD was associated with greater social anxiety, impairment in functioning, and comorbidity with other psychopathology, but no differences in social skills or performance on an impromptu speech. GSP and APD seem to represent quantitatively different variants of the same spectrum of psychopathology rather than qualitatively distinct disorders. We also investigated a proposed social phobia subtyping scheme.

The effects of feedback on the behavior of depressed inpatients in two structured interactions.

This study examined the responsivity of depressives' behavior to contingent social feedback within the framework of Coyne's and Lewinsohn's models of depression. Subjects included 10 depressed inpatients, 8 nondepressed psychiatric inpatients, and 10 nondepressed individuals. Each subject participated in two structured interactions with an experimenter in baseline phases and phases in which ongoing contingent feedback was provided by a pair of observers. The results revealed that the behavior of all three subject groups was responsive to the feedback in both interactions. The results are consistent with past research demonstrating social skills problems among depressed individuals but do not support the notion of a social skill deficit in depression. The results are consistent with Coyne's model of depression and suggest that the problematic social behavior often associated with depression may be modifiable by immediate veridical feedback from others.

Effectiveness of matched, mismatched, and package treatments of depression.

The three purposes of this study were: (a) to determine if treatment that is matched to a depressed subject's problematic behavioral response class (irrational cognitions, social skills problems, few pleasant events) is more effective in alleviating depression than is mismatched treatment; (b) to determine if a package treatment is as effective as or more effective than a matched treatment and more effective than a mismatched treatment in alleviating depression; and (c) to determine if a specific treatment produces more changes in its logically-related response class than in logically-unrelated response classes. Nine depressed women were assigned to one of three multiple baseline designs across subjects; subjects in each design received, respectively, matched, mismatched, or a package treatment. Results strengthened two hypotheses, that matched treatment and package treatment are both effective in alleviating depression. Specific treatments did not, however, differentially affect their logically-related response classes.

Protein nutrition in the alligator.

1. Fourteen different protein-containing diets were fed to small alligators. Their rates of digestion and their nutritional values were determined by following changes in free amino acids in the plasma. 2. Fish, chicken and nutria were digested rapidly and all their component essential amino acids disappeared quickly and at the same rate. When given in the dry, fat-free form the amino acids were released and assimilated about 50% faster than when fat was included. 3. None of the isolated proteins tested (casein, gelatin, edestin, gliadin, corn gluten and soy) proved nutritionally adequate and all but gelatin digested slowly and incompletely. 4. One diet compounded of salts, vitamins and mixed commercial animal products was tested. It showed promise but it was lacking in methionine and isoleucine. 5. It was concluded that dry, powdered, preparations from whole animals could prove a satisfactory, stable diet for alligator husbandry. 6. Prolonged force-feeding of an animal diet increased the percent of nitrogen excreted as NH3 over that excreted in urates.

Energy production per circulatory cycle: a constant in resting land vertebrates?

Correcting for differences in blood flow, resting alligators, caimans, lizards, turtles, rats and dogs deaminated amino acids at the same rate. Each produced about 21 calories/kg during one complete circulatory revolution, irrespective of body temperature, size or species. Uniform O2 and substrate A-V differences are responsible for the phenomenon.

Reaction velocities in vivo: standardization of kinetic "constants" by correction for blood flow.

1. The results of kinetic studies in vitro are difficult to apply to metabolic reactions in vivo. 2. In living vertebrates reaction rates are usually first-order and for a particular reaction the rate "constant", k, varies with the several thousand-fold variations in metabolic rate. 3. Therefore, in the kinetic equation (formula: see text) since K varies with metabolic rate, Vmax and/or Km will aslo vary. 4. However, reaction rates for a series of different substrates were similar in animals varying widely in metabolic rate if corrections were made for differences in blood flow. 5. The observation that metabolic rate (reaction rate) is directly dependent on blood flow (Coulson et al., 1977) allowed derivation of new kinetic constants which were valid in vivo. 6. Introduction of a flow term into the observed first-order equations yields an "affinity constant", K, or a "flow constant", KF, somewhat analogous to Km, which allows one to predict reaction rates in animals of different metabolic rates. 7. The defining equations are (formula: see text) where V = reaction velocity in mmol/hr/kg tissue, [S] = millimolar substrate concentration in the blood, k = In 2/tau (tau the half-life) and F = blood flow in 1/hr/kg tissue. 8. Thus, K = k/F = 1/KF. The KF's for the initial step in the degradation of 17 amino acids in rats, dogs, lizards, turtles and alligators were similar, demonstrating the similarity of enzyme affinities in different species.