Varieties of Cognitive Behavioral Therapy

[plastic toy man speaking to computer: "So this operating system... Does it tell you to do things?"]]

In the short term, many obesity interventions achieve an encouraging degree of success, but a year or five years later, a follow-up shows a different picture. As Childhood Obesity News has described, cognitive behavioral therapy or CBT is designed to promote behavioral change by breaking negative cycles of behavior and restructuring harmful patterns. To fulfill the needs of the all-important long term, a program must support behavior maintenance over time, and minimize the incidence of relapse. To do all that, it must somehow extend its sway beyond the individual and include other domains — the family, peer network, and community.

CBT is such a useful therapeutic modality that it has evolved into another stage, characterized as “enhanced” and identified by the acronym CBT-E. About two-thirds of the clients who opt for it are said to have benefited, at least in the short term. It aims to change maladaptive behaviors and negative pathology, and especially to teach strategies for the prevention of relapse. The Counselling Directory defines CBT-E as a “transdiagnostic” treatment, describing it as:

…an approach comprehensive enough to be applied irrespective of differential diagnosis and appropriate for the mixed patterns of difficulties that people with eating disorders typically experience over time…. It is a structured, tailored form of one-to-one talking therapy in which you and your therapist work together as a team. It focuses on helping you change your eating behaviours now and in the future (it does refer to the past but does not centre on it).

CBT-E was created to address the roots of an eating disorder, whether it manifests as insufficient eating, as in anorexia nervosa, or excessive eating, as in binge eating disorder. That is the “transdiagnostic” part. In addition, the therapy developed branches. In CBT-Ef, the “f” stands for “focused.” It targets the eating disorder psychopathology, and is considered the “default” version.

Then there is CBT-Eb, where the “b” stands for “broad.” It addresses the same issues and also incorporates additional focus on external factors. The directory explains:

In particular, patients with low self-esteem, poor mood-regulation strategies, high interpersonal problems, and high levels of clinical perfectionism are well-suited for CBT-Eb, in which these four core features are targeted.

In any case, 20 weekly outpatient sessions are usually recommended, stretching over five months. Anorexia nervosa seems to be a tougher case, with 40 weekly sessions recommended. The roots of eating disorders are found among the individual’s core beliefs, especially those related to the over-evaluation and control of the person’s weight and body shape. These unhealthy core cognitions or beliefs are what cause maladaptive cognitive and behavior patterns, and those patterns maintain the eating disorder in whatever form it takes. A succinct definition that sums it all up can be found in the “Eating Disorders Glossary”:

Cognitive behavioral therapy (CBT) and Enhanced Cognitive behavioral therapy (CBT-E): A relatively short-term, symptom-oriented therapy focusing on the beliefs, values, and cognitive processes that maintain the eating disorder behavior. It aims to modify distorted beliefs and attitudes about the meaning of weight, shape and appearance which are correlated to the development and maintenance of the eating disorder.

Your responses and feedback are welcome!

Source: “What are CBT-BN, CBT-BED and CBT-E?” CounsellingDirectory.org.uk, 08/08/13
Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
Source: “Eating Disorders Glossary,” feast-ed.org, undated
Image by Mark Anderson

Cognitive Behavioral Therapy: Family-Based or Not?

[close-up of scale]

In the areas of weight management and eating disorders in kids and teens, several different components are involved. Negative behavior cycles need to be broken, and patterns need to be restructured. Some behaviors need to be eliminated, and others put in their place. Equally important is the long-term maintenance of both elements — the permanent extinction of some behaviors and the perpetual repetition of others. If all this can be accomplished, the likelihood of relapse is minimized.

Two major problem categories are anorexia nervosa (AN) and bulimia nervosa (BN). Cognitive behavioral therapy achieved some early successes with those. Basically, all eating disorders have something in common — a constant concern with food, eating, and weight. AN and BN are about the obsessive need to eat less and weigh less. Even though it seems on the surface to be the diametrical opposite, BED or binge eating disorder leading to obesity comes from the same roots – constant concern with food, eating, and weight. BED is included, along with some other diagnoses, in a category dubbed EDNOS, or “eating disorder not otherwise specified.”

It looked promising

Ten years ago, the United Kingdom’s Health Development Agency (using sources from everywhere) issued a report called The Management of Obesity and Overweight. Authored by Caroline Mulvihill and Robert Quigley, the report was subtitled “An analysis of reviews of diet, physical activity and behavioural approaches.” Among many other useful explorations of the literature, it offered a comparison between behavioral modification programs that were family-based and those that were not family-based. Reviewing family-based modalities that had been tried so far, the researchers wrote:

These programmes included behaviour modification, dietary and exercise education, with a mix of sessions involving the child, parent(s) and, in some cases, the entire family. The review concluded that while some findings appear promising, the small size of some of the studies and the disparate nature of the interventions mean there is ‘at present insufficient evidence to recommend any specific programme’.

Although family-based programs were regarded favorably, there was not at the time enough solid evidence for the authors to recommend any specific one. They also looked at reports about behavior modification programs without parental involvement – well, one, actually, because that’s all they could find in the literature, and it involved kids from 9 to 19 years of age. The report says:

This compared a three-part cognitive–behavioural ‘obesity-training’ programme combined with a calorie-reduced diet and an exercise programme, against a group that received the same diet and exercise component but received muscle relaxation training instead of the psychological component. The intervention lasted for six weeks. Both groups significantly reduced their percentage overweight over the course of a year. No statistically significant differences were found between the two treatment groups.

Progress

Almost a decade later, the U.S. National Institutes of Health issued a report titled Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents. Despite the development of successful treatment programs, relapse and non-recovery still were prominent occurrences. In fact, AN patients were noteworthy for dropping out before the end of the structured treatment programs, and because of non-completion, could not even be counted in the relapse vs. non-relapse statistics.

Family-based behavioral treatment for obesity still looked promising because of short-term successes, but once the intervention was over, patients would revert to old behaviors and gain weight. Families are especially crucial because for the most part children and youth cannot avoid living with them. For a kid, the family home and the people in it are the most significant and influential features of the environment, and if they don’t change, the outcome of any intervention that involves only the child is apt to be dismal. The report puts it this way:

The persistence of weight-related problems may occur because environmental stimuli, which had fostered the previously learned, maladaptive behaviors, have not been modified.

This is reminiscent of a famous quotation attributed to Albert Einstein (though he probably didn’t say it), the one about how doing the same thing over and over again, and expecting different results, is the definition of insanity.

Your responses and feedback are welcome!

Source: “The Management of Obesity and Overweight,” Prevenzione PDF, October 2003
Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
Image by kpspap95

Cognitive Behavioral Therapy for Eating Disorders

[top ten fitness facts related to the benefits of exercise on the brain, stress and energy levels, and overall health]

The National Institutes of Health website offers a succinct definition of Cognitive Behavioral Therapy and its usefulness:

CBT is the most established psychological treatment for BN (bulimia nervosa) and BED (binge eating disorder), with demonstrated efficacy over pharmacological and other psychological therapeutic options. The goal of treatment is to identify, monitor, and tackle the cognitions and behaviors that maintain the disorder while heightening the motivation for change.

CBT is said to have “accumulated one of the largest bodies of research evidence in any psychological field.” Its techniques have been around for at least 20 years, subjected to constant refinement, and adapted to more and more situations, as it becomes clear that the various types of eating disorders are fundamentally more alike than different.

There was a period when a lot of attention centered around AN (anorexia nervosa), BN, and EDNOS. Actually about 70% of problems came under the last heading, which stands for “eating disorder not otherwise specified,” including not only binge eating but other behavior patterns close to, but not exactly aligned with, the official descriptions of AN and BN. What they all have in common is the patient’s constant preoccupation with food and body weight, along with the potential for alleviation by CBT which, while not universally successful, seems to be the best hope so far.

Another trait shared by all eating disorders is the possibility of permanent damage to the individual’s health, which is also true of obesity. Since the explosion of the childhood obesity epidemic, the world is full of children who have joined the risk pool for developing serious lifelong conditions like metabolic syndrome, Type 2 diabetes, and heart disease. Obese kids are also in danger of going too far in the opposite direction and sliding into other kinds of eating disorders like AN or BN.

As Childhood Obesity News has discussed, there seems to be a set of core cognitions (or what Dr. Bryan P. Walsh simply calls unhealthy beliefs) associated with the risks that obesity brings. They are “body dissatisfaction, dietary restriction, overvaluation of weight and shape, negative affect, and low self-esteem,” according to researchers in the CBT field.

The National Obesity Observatory in the United Kingdom has identified four major areas that must be addressed — behavioral, biological, psychological, and social. Experts there arrived at the conclusion that it is more effective to concentrate on psychological factors than to focus specifically on weight loss.

In both Britain and the U.S., there are not enough practitioners to go around, so entrepreneurial professionals are busy modifying CBT into a self-help modality available via electronic devices. Overweight youth are best served by interventions whose behavioral components modify both activity and diet. The NIH website says parents take an active role in this:

Parents are also encouraged to utilize a behavioral reward system, in which successful goal completion (e.g., weight loss, reduced caloric intake, increased physical activity) is reinforced with rewards that are interpersonal and/or promote healthy behavior (e.g., family outings, bike riding, ice skating).

The page also discusses family intervention strategies, centered around self-monitoring and stimulus control, which is a fancy way of saying “don’t keep potato chips and ice cream in the house.” Since parental success with weight control is a strong predictor of success in the kids, parents are strongly urged to step up and be excellent role models.

Your responses and feedback are welcome!

Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
Source: “What are CBT-BN, CBT-BED and CBT-E?” CounsellingDirectory.org.uk, 08/08/13
Image by trutherbot

Behavioral Economics and School Lunches

[graphic of people being served at a cafeteria]

When a human is unhappy with the way things are going, three courses of action are possible: change other people (usually frustratingly futile), change oneself (difficult to varying degrees), or change the environment. Sometimes modifying the environment can be astonishingly effective, as a science called behavioral economics has shown when applied to school lunches.

School districts across the country are caught between a rock and a hard place. The meals they provide have to meet nutritional standards, which often means spending more money. If the food is so unfamiliar that kids don’t even want to try it, or if they try it and don’t like it, the school loses money. When schools have to discontinue the popular items that kids are willing to pay for, they lose even more money. But David R. Just and Brian Wansink, writing for Choices magazine, explain how this problem can be managed:

By using tools that will both increase the sales of more nutritional foods and decrease the sales of less nutritional foods, behavioral tools can achieve nutritional goals while having a minimal impact on the bottom line.

What tools are they talking about? Simple rearrangement, for one. The authors describe a Minnesota school where kids waiting to pay for their lunches had ample leisure time to contemplate an array of chips, snacks, and desserts. Placing such attractive nuisances at the checkout station is a familiar tactic used by grocery stores to encourage impulse buying. But in a school cafeteria setting, it is inappropriate and counterproductive. So Just and Wansink moved the junk food and placed fruit in that location, which increased not only the amount of fruit the kids bought, but the amount of it they actually ate.

At a middle school in New York state, moving the salad bar had a noticeable effect on the popularity of salads, and not just because of the novelty. Salad sales remained strong. Changing the physical environment can also help to discourage the consumption of high-calorie, low-nutrition items. Research has shown that keeping the lid of an ice cream freezer closed can cut ice cream sales to students in half.

The basics

This method of helping kids develop good eating habits employs two simple principles: reactance and self-attribution. Reactance stems from a natural resentment against coercion, inspiring a spirit of rebellion that does not bode well for long-term behavioral change. Sure, we can stop kids from eating cookies at lunch by refusing to offer them, but the heavy-handed approach only guarantees the consumption of more cookies after school. It’s more effective in the long run to tuck the cookie machine away in a lightly trafficked area of the building. If soda vending machines have to be present, they too should be exiled to an out-of-the-way spot.

Self-attribution is the dignity of making one’s own decisions, and parenting courses emphasize its importance even with very young children. “Do you want some corn for supper?” might be met with resistance. “Which would you rather have — corn or peas?” is a question that can produce amazing results. The child is so jazzed about having a choice, and making a choice, that the reality of eating a vegetable is of secondary importance. It works for older kids, too. When a school rule requires a kid to put a vegetable on the plate, only about a third of those vegetable servings actually get eaten. When there are two or more choices of vegetable, the likelihood of actual consumption increases. The authors write:

[T]he object of using behavioral economics in school lunch rooms is to guide choices in a way that is subtle enough that children are unaware of the mechanism. These subtle changes often have the advantage of being relatively cheap and easy to implement…. To preserve choice, we will necessarily have to allow some individuals to purchase items that are less nutritious. But we can make these choices less convenient or less visible.

Find out more about these theories and their implementation at SmarterLunchrooms.org.

Your responses and feedback are welcome!

Source: “Smarter Lunchrooms: Using Behavioral Economics to Improve Meal Selection,” ChoicesMagazine.org, undated
Image by Joe McKendry

Obesity and Various Therapies

[animated image of thin boy on diving board expanding to obese proportions]

Attention modification training (AMT) has been employed with children before, to treat anxiety and a number of other mental health issues. One of its most important uses is the treatment of substance abuse problems. Since food is a widely abused substance, AMT offers hope in the effort to end childhood obesity. Perhaps the most startling thing about a recent study is the implication that a single session of attention modification can make a significant difference in behavior.

The AMT study was carried out by the UC San Diego School of Medicine. Lead author Kerri Boutelle, PhD, believes that AMT training, based on classic Pavlovian conditioning, could be provided in the form of a computer game. The subjects in the exploratory study were 24 kids between 8 and 12 years of age, all overweight or obese, divided into two groups. PsychCentral’s senior news editor, Rick Nauert, describes how the study worked:

One group underwent an attention modification program (AMP) in which they watched pairs of words quickly flash upon a computer screen. One was a food word, such as “cake;” the other was a non-food word, such as “desk.” After the words had flashed and disappeared, a letter appeared on-screen in the place of either the food word or the non-food word.

The viewing child was asked to immediately press the right or left button associated with the letter’s location…. The AMP trained attention away from food words because the letter always appeared in the spot of the non-food word while in the other group, the condition trained attention was split with the letter appearing half of the time in the food word location and half in the non-food word location.

Although obesity obviously has multiple contributing factors, the theory behind AMT says that a major factor is “an abnormal neurocognitive or behavioral response to food cues.” Some people are inherently oversensitive to food cues, but they can be turned around. These researchers believe that the victim can be trained to ignore or disregard specific cues so their problematic nature is neutralized.

Two-way street

Mental health disorders can lead to obesity, just as obesity can cause mental health disorders. It is also apparent that the longer a person has been obese, the more difficult reversal is. This is one reason why so much emphasis is placed on early intervention. When people get older, behavioral therapy still has a chance, although as Dr. Pretlow says, “Overeating needs to be addressed much deeper.” To get to the root causes of obesity in an individual is obviously vital. But the world simply doesn’t have the resources to provide years of talk therapy for every morbidly obese person.

There is definitely a place for “interventions that break maladaptive behavior patterns before they become ingrained.” Adolescents with eating disorders who participate in cognitive behavioral therapy have higher recovery rates than adults, says the National Institutes for Health. When symptoms have existed for a shorter time, with less severity, treatment has a better chance of success.

One of the first things any behavioral therapy has to do is identify what behavior is modifiable. For most people, it is totally possible to increase their physical activity, to drink more water, to limit their sedentary time interacting with computers, and to consume more vegetables and fruits. Dr. Bryan P. Walsh wrote:

We become what we think about all day long. If you want to be skinny or more fit, you need to act lean, feel lean and do the things a fit person does. The more you feel, experience, and act as if you have already achieved your goals, the more likely the goals will become your reality. True, this can be very difficult to do, but if you do not have the right attitude for fat loss, you won’t achieve fat loss.

In ending addiction, 12-step programs have a well-deserved reputation for efficacy if, as the saying goes, the person works the program. Still, they are not the only way out. There have always been people who managed somehow to do it on their own with a “fake it till you make it” strategy. It isn’t easy, but it’s like an acting job. You act like a person who doesn’t eat sugar, until you become a person who doesn’t eat sugar.

Acknowledging rules takes strength and so does following them by rote. Sometimes people never get to the root causes of their addictions, but succeed in escaping from them anyway. Success is much more likely when basic problems are discovered and addressed.

Your responses and feedback are welcome!

Source: “Attention Training Helps Kids Avoid Obesity,” PsychCentral.com, 02/17/14
Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
Source: “The Missing Fat Loss Manscript,” FatIsNotYourFault.com, 2010
Image by Tumblr

 

Kellogg — Good Corp, Bad Corp

[Kellogg World Headquarters]

Kellogg World Headquarters in Battle Creek, Mich.

Previously, Childhood Obesity News considered the strange split personality of Kellogg. The corporation has donated money and support to a lot of good causes. For instance, FoodCorps (part of AmeriCorps) is an organization with more than 100 local groups in 31 states. It subsidizes 50 workers, by paying them stipends, to work on projects to reduce childhood obesity and increase access to healthful food. FoodCorps is supported by $2 million in private funding, much of which comes from the W. K. Kellogg Foundation. According to Nancy Knoche’s reportage for Nonprofit Quarterly:

At the same time however, a group of corporate agricultural businesses and farms will be spending fifteen times as much–$30 million–on a public relations campaign to show that they are “committed to provide healthy choices.”

And isn’t Kellogg one of them? Isn’t Kellogg one of the corporate agricultural businesses that spends a fortune on public relations and lobbying to ensure that the government does not make too many rules about what they may advertise to whom?

For Time, Alice Park reported on online “advergames,” which she characterizes as insidious. Every month, about 1.2 million kids enjoy puzzles and arcade-like games while exposing themselves to the constant presence of company logos and the unremitting psychological pressure to express gratitude to the company by buying and consuming its products. In fact, some features of the games are not accessible unless junk food is bought.

The effects

A research team began by studying the online presence of corporations that had voluntarily pledged to abide by the Better Business Bureau’s CFBAI, or Children’s Food and Beverage Advertising Initiative. While they may have cleaned up their act in regard to television advertising, they were still working hard to capture the attention and brand loyalty of kids through advergames. Kids in one study spent 88% more time on advergame sites than on other Web pages.

But that was only part of the research led by Dr. Jennifer Harris, director of Rudd Center for Food Policy & Obesity, who worked with 152 kids between 7 and 12 years old. It was set up so each child would play two randomly assigned games, with a snack break in between. The available foods included grapes and carrots, and processed fruit snacks, cookies, crackers, and chips. Of course every move was watched and recorded, and the children were questioned about their fondness for the various foods and their beliefs about the foods’ healthfulness. Park writes:

Harris and her colleagues chose two advergames featuring unhealthy foods, two featuring healthy foods, and two control games that didn’t include advertising for any products…. The children who played the healthy advergames designed by Dole ate as much of the unhealthy foods as the youngsters who played the unhealthy advergames, but they also ate 50% more grapes and carrots than the unhealthy game players.

So, one thing the healthy games did was to make the subjects more likely to overeat — but at least some of the calories they consumed also contained nutrients. But wait, there is more:

The children playing the unhealthy advergames for PopTarts [made by Kellogg] and Oreos, however, ate 56% more unhealthy snacks compared to those playing the healthy games, and 16% more compared to those in the control group. These youngsters also ate less fruits and vegetables than children playing either the healthy or control games.

The researchers concluded that advertising embedded in the games influenced children to choose junk food and reject healthful food. But though Kellogg can be extensively implicated, the most egregious example originates with another company that makes candy and promotes a game called Mystic Chewie whose slogan is “I Predict You’ll Be Hooked.”

In Britain, when accused of harboring 14 advergames on its website, Kellogg slid through on a technicality. Only kids in Canada, where the rules are not so strict, are supposed to access that website. Kellogg’s nominally British website only offered one game, which promoted a government-approved product. Not amused by such hair-splitting, the Local Government Association (to which the UK’s 400 local councils all belong) became inspired to crack down on loopholes and, at the very least, require health warnings on Internet advergames.

On the other hand, Kellogg is kind enough to offer online visitors an ingenious tool that consumers can use to identify which of its products contains the most sugar, as well as the most fat, salt, fiber, or calories.

Your responses and feedback are welcome!

Source: “Waging a Battle against Obesity – Young Leaders vs. Corporate Interests,” NonprofitQuarterly.org, 08/26/11
Source: “Can Online Games Influence What Kids Eat?” Time.com, 01/10/12
Source: “ ‘I Predict You’ll Be Hooked’- Makers of sugary foods exploiting loophole to target kids with free internet ‘advergames’,” Mirror.co.UK, 03/22/14
Source: “Taste the Possibilities,” Kelloggs.com
Image by Battle Creek CVB

 

Childhood Obesity and Unanswered Questions

[two brothers looking at a tablet computer]

A few years ago, European countries tried something that seemed to work for a moment in time, then fell apart. Kellogg was one of the giant companies, along with Coca-Cola and McDonald’s, that made a voluntary pledge to not market unhealthful food products “to children under the age of 12 on TV, print and internet.”

In the United Kingdom, Ofcom is the agency that regulates the communication industry, and by a strange coincidence, it was right around that time when Ofcom banned the advertising of such foods on children’s TV programs. It’s easy for a company to promise not to do what it has been forbidden to do anyway. In mid-2010, Ofcom reviewed the results to see how the ban affected behavior, and found that in the time since 2007, children had watched 37% less junk food advertising.

Although the voluntary pledge covered the Internet, the Ofcom ban did not, and before too long the importance of the omission became apparent, especially when mobile devices came into wide use and were owned by more and more children. Also, officials had apparently not foreseen the massive participation by children in social media. Recently Harry Wallop looked into the matter for Britain’s Channel 4 and found that at least six junk food manufacturers used Facebook to directly engage with children. He wrote:

We created an account for a fictional child who talked excitedly about their upcoming 11th birthday on various food brand pages — no less than three brands responded positively, including Kellogg’s Krave brand of sugary cereal.

Through the power of TV publicity, Kellogg was shamed into apologizing for reaching out to an imaginary girl whose Facebook post mentioned that it was her 11th birthday. The company promised to be more vigilant in future, but this has the earmarks of a “we had to try it” strategy, like when a sleazy business double-bills the clients to see if they are paying attention because otherwise they pay that month’s fee twice.

Advertising is, of course, most effective when not readily identifiable as such. This is especially true when children are the target. An important exploration of advertising’s impact was “The Food Marketing Defense Model: Integrating Psychological Research to Protect Youth and Inform Public Policy,” published in 2009. Two of this paper’s authors were Dr. Kelly Brownell and social psychologist John A. Bargh, and the third was Dr. Jennifer Harris, director of Rudd Center for Food Policy & Obesity at Yale University.

The necessity for such scrutiny becomes more glaringly obvious as time goes on. Harris had found in other research, for instance, that a child might spend as much as 20 minutes at a time playing a corporate “advergame” online. Many people find the idea of kids soaking up 20-minute commercials utterly unacceptable. Solutions have been proposed, and some of them tried. Sweden took the extreme measure of disallowing any television marketing aimed at children, and varying degrees of restriction are practiced in other places. But here is a problem — the need for even more studies measuring the results. The Food Marketing Defense Model says:

Discourse on the relative merit of these solutions is limited … by lack of thorough evaluation, open questions regarding how food marketing affects youth, and incorrect assumptions about how to protect them against negative influences.

Your responses and feedback are welcome!

Source: “Food companies play games with children’s TV advertising ban,” Telegraph.co.uk, 06/12/14
Source: “The Food Marketing Defense Model: Integrating Psychological Research to Protect Youth and Inform Public Policy,” NIH.gov, 2009
Image by Neeta Lind

 

Childhood Obesity and Boredom

[graffiti that reads 'boredom']

In his examination of the life of novelist and MacArthur Fellow David Foster Wallace, D.T. Max noted, “With the help of researchers, Wallace assembled hundreds of pages of research on boredom, trying to understand it at an almost neurological level.”

“They sentenced me to twenty years of boredom,” goes the lyric of a Leonard Cohen song. “Boredom kills brain cells,” says poet and NPR broadcaster Andrei Codrescu. According to novelist Hector Malot, “Being bored is the worst kind of sickness.” Cartoonist Ace Backwords once proposed that boredom, not hatred, is the opposite of love. Evelyn Waugh’s biographer said of him, “The thing he feared most in life was boredom.” National Book Award winner Jonathan Franzen wrote, “Boredom is the soil in which the seeds of addiction sprout.”

Surprising results

Last time, Childhood Obesity News referenced the recent University of Virginia study in which psychologist Timothy D. Wilson left people alone in rooms with their thoughts. He found that, given the opportunity, people confronted by the intense discomfort of boredom would relieve it by voluntarily self-administering jolts of pain.

But that came later. At first, the experimental subjects (male and female, ages 18 to 77) were simply placed in a room devoid of distraction for 6 to 15 minutes, and it bothered them a lot more than seemed reasonable. As a variation, Wilson allowed the stimulus-free periods to be carried out at home. When the reports came in, his team learned that participants were no happier to be alone with their thoughts in their own familiar environments. Some found the boredom so undesirable, they even cheated.

Wilson borrowed equipment from a colleague and took the experiment to the next level. Subjects were told that while in the room devoid of other stimuli, they could give themselves a mild electrical zap to the ankle. They were allowed to try it out ahead of time, so they would know what kind of sensation to expect. What happened? Judy McGuire reported for Today:

Many people are so uncomfortable with quiet contemplation that many of them — and especially men — would rather experience minor electrical shocks than spend time alone with their thoughts.

We also considered the known devastating effects of boredom on deaf children and youth, and learned that it can cause depression, frustration, anxiety, exhaustion, headache, muscular tension, stress, lack of concentration, and even stomach troubles and eating disorders. To varying degrees, these same problems apply to any children and teens who experience boredom.

Dr. Pretlow suggests that often the feeling identified as boredom could be anxiety or background stress with an inaccurate label slapped on it. For teenagers especially, and particularly for boys, admitting to anxiety or stress can be tantamount to confessing weakness. Admitting to boredom, on the other hand, can make a kid feel sophisticated and superior. Dr. Pretlow is very interested in the tendency of young people to snack when there is nothing to do. He says:

More and more in our studies it seems that overeating in young people (and probably in adults as well) is due mainly to nervous eating or boredom, rather than comfort eating (depression) or cravings/addiction.

McGuire interviewed psychotherapist Teri Cole, who remarked that “people are endlessly self-soothing in the moment.” To escape boredom they will do anything from eating ice cream to shocking themselves with electricity. But psychotherapist Paula Carino noted that quiet time is essential to our well-being, because in it we “learn to tolerate difficult feelings and thoughts.” The good news is, what people perceive as boredom can be repurposed and made into a helpful tool. If we resist the impulse to escape from contemplative isolation, we can burrow into it and deal with those difficult feelings and thoughts. McGuire wrote:

Cole and Carino recommend meditation for their clients, and indeed Wilson pointed out that research subjects who already practiced meditation had a much easier time with the experiment. Studies have shown that along with improving one’s powers of concentration, meditation also lowers blood pressure and revs up your immune system.

Clearly, meditation is one of the coping skills that can help kids free themselves from the “boredom eating” habit.

Your responses and feedback are welcome!

Source: “Farther Away: ‘Robinson Crusoe,’ David Foster Wallace, and the island of solitude,” NewYorker.com, 04/18/11
Source: “Shocking study: People would rather jolt themselves than be alone with their thoughts,” Today.com, 07/03/14
Image by Julian Frost

The Impact of Boredom

[teenagers looking bored]

Boredom is a subject not often addressed, maybe because it is so boring. What can be said about it? More often than not, boredom leads to trouble. As we know from social media, a large number of adolescent communications begin with “I was bored, so I….” Often, what follows is something a parent would prefer not to have happened.

Judy McGuire reports for Today on a brand new University of Virginia study that was undertaken because Professor Timothy D. Wilson, who teaches cognitive psychology,

…wondered what would happen when people had nothing to distract them from themselves. So he put his subjects in an otherwise empty room with nothing to read, look at or hear for six to 15 minutes.

We will return to Wilson after a relevant digression. Actually, a population has long existed that fulfills the “nothing to hear” criterion. Deaf people suffer deeply from boredom. They don’t long for the opportunity to be alone with their thoughts. They are alone with their thoughts too much. Boredom wreaks serious emotional consequences on deaf children, in the form of isolation and a tendency toward withdrawal. They can suffer from

…sadness or depression, worry and frustration, anxiety and suspiciousness, self-criticism and low self-esteem/self-confidence … tiredness or exhaustion, headache, vertigo, tense muscles, stress, eating and/or sleeping disorders and stomach disorders.

Deaf children are likely to be irritable, angry, and even combative. How many of these negative states of mind and body can be attributed to the corrosive influence of boredom?

This is counterintuitive, but boredom can cause inattentiveness. It might seem like the limitation of distracting stimulation should at least aid concentration, but unfortunately the opposite can be true. In many cases, the negative psychological effects of deafness include poor concentration and the inability to resist distraction.

University of West Florida researchers J. D. Watt and F. E. Davis studied 50 deaf adolescents with regard to depression and boredom proneness. Not surprisingly, the inability to hear makes deaf teenagers more boredom-prone and more depressed than their hearing counterparts, and the report augments both those findings with the adjective “significantly.”

In other words, boredom is no joke; it’s a non-trivial shaper of human experience and development. Lack of stimulation can work on people’s heads, and it can do damage. That’s why police officers, when they bring someone in for questioning, will leave the witness/suspect alone in a bare room for a while, to begin the softening-up process. In corrective institutions solitary confinement is, for the overwhelming majority of prisoners, a dreaded punishment.

Next time: Back to Wilson’s experiment.

Your responses and feedback are welcome!

Source: “Shocking study: People would rather jolt themselves than be alone with their thoughts,” Today.com, 07/03/14
Source: “Impact of hearing loss on development of children,” AlliedRehab.com, 07/10/14
Source: “The prevalence of boredom proneness and depression among profoundly deaf residential school adolescents,” ResearchGate.net, January 1992
Image by Erich Ferdinand

More Advice from the Formerly Fat

[Woman looks at tall stack of donuts. Accompanying quote: 'Food is the most widely abused anti-anxiety drug in America, and exercise is the most potent yet underutilized antidepressant. ' --Bill Philips]

Dr. Pretlow has always emphasized the importance of identifying problem foods, and there is a very good reason for that recommendation. Many formerly obese patients, when faced with the seemingly overwhelming task of cutting down on food, have found an incredible advantage in narrowing the range by pinpointing the worst food villains. To work on eliminating them first gives a person an incredible head start toward achieving and maintaining a healthy weight.

This excerpt is from exercise physiologist Dean Kriellaars, who playfully characterizes a person’s problem food as a “Miss Vickie,” because that brand of potato chips used to be his particular downfall. He told a reporter:

She’s a lovely woman. She never says no to me. She smells great. But I had to kick her out. I broke up with her. Everybody’s got a Miss Vickie.

From what Kriellaars told a reporter about one of his former clients, another fallacy becomes obvious, and that is the human ability to fool oneself with words. This person’s “Miss Vickie” was something called a “skinny latte.” One of those concoctions only has 300 calories — what could go wrong? Turns out, drinking four of them every day removes any potential for “skinny.” Once that problem was identified, the client was able to shed nearly 90 pounds.

The website Reddit reliably supplies real-life anecdotes from real people like the formerly obese “roccala,” who used to weigh 300 pounds but got down to 175 and has maintained that weight for three years. This person made the bold choice to continue eating the same volume of food — “as much as I wanted” — but only if it was fresh and chemical-free. Within those parameters, a moment’s reflection will confirm how astonishingly few dining possibilities remain.

“Roccala” also concluded that sugar makes a lousy anti-depressant and began using exercise, instead of sweets, to banish the stress of daily life. Another suggestion is to chew more thoroughly because digestion is supposed to start in the mouth, as the beginning of a process that uses nutrients more efficiently. Of course, we all need to remember that the brain doesn’t immediately receive the “enough” message, and it’s always a good idea to finish a meal slightly hungry because the satiated feeling will arrive within 15 or 20 minutes.

This formerly obese person also counsels stomach shrinkage, a natural process that takes place over time, once you change habits and eat smaller amounts. Also, “Water — make it your best friend.” That is excellent advice for anyone, whether their “Miss Vickie” is soda or sweetened coffee or tea. Plain water is always a superior refreshment to any other fluid.

Not 100% on board

“Roccala” makes one sketchy suggestion, to have a cheat day on which you can eat anything you want. Granted, this does seem to work for some people. But Dr. Pretlow does not advise incorporating a cheat day into the program. If a problem food is truly an addictive substance, comparable to a drug, abstinence is the only way out. Recovering alcoholics don’t get to drink on one day a week, because it absolutely doesn’t work.

Adopting a consistently healthful diet does have the advantage of making a person lose the cravings that previously existed. Many formerly obese people are very enthusiastic about the “ketogenic diet,” which was originally developed to treat childhood epilepsy, testifying that it removes the craving for carbohydrates and sweets.

Many formerly obese people swear by the technique of calculating the cost, which can now be done with technological means. What price will you pay for indulging in an eclair? How many calories does that attractive nuisance contain, and how many minutes will you have to run to erase those calories? Does this sound like a good deal? Really?

Your responses and feedback are welcome!

Source: “Tips for trimming the fat,” WinnipegFreePress.com, 08/24/2013
Source: “Hello! HamPlanet Boogie2988 here sitting down the fried chicken long enough to answer your questions,” Reddit.com, 10/28/13
Image by pinimg.com

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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