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Journal
of
Consulting
and
Clinical
Psychology
1985, Vol.
53, No. 5,
698-703
Copyright
1985
by the
American
Psychological
Association,
Inc.
0022-006X/85/$00.75
Ambulatory Computer-Assisted Therapy
for
Obesity:
A
New
Frontier
for
Behavior Therapy
Kent
F.
Burnett,
C.
Barr Taylor,
and W.
Stewart
Agras
Laboratory
for the
Study
of
Behavioral Medicine
Department
of
Psychiatry
and
Behavioral Sciences
Stanford
University School
of
Medicine
A
behavioral treatment program
for
obesity
was
implemented using
an
interactive
microcomputer system small enough
to be
carried
by
subjects throughout their
normal daily routines. Treatment
effects
observed
in 6
subjects
who
received this
experimental treatment were compared with those observed
in 6
matched control
subjects
who
received
a
similar treatment program implemented without computer
assistance. Mean weight loss
after
the 8
postbaseline study weeks
was
8.1
Ib
(3.7
kg;
SD = 2.7
Ib
or 1.2 kg) for the
experimental subjects compared
with
3.3
Ib
(1.5
kg;
SD
= 3.2
Ib
or
1.5
kg) for the
control subjects. Mean weight loss
at 8
months
posttreatment
was
17.7
Ib
(8.0
kg; SD =
13.8
Ib
or 6.3 kg) for the
experimental
subjects
compared with
2.3
Ib
(1.0
kg; SD = 7.3
Ib
or 3.3 kg) for the
control subjects.
Ambulatory
computer-assisted therapy provides important
new
opportunities
for
conducting behavior therapy
and
research
in
real-life
settings.
The
behavioral treatment
of
obesity relies
heavily
on
self-monitoring
to
provide feedback
concerning
behavior—feedback
that
is
often
delayed
until
the
next meeting with
the
ther-
apist,
whether individually,
or
more
usually,
in
a
group. Such delayed feedback,
as
well
as
therapeutic instructions
and
reinforcement,
is
by
no
means ideal.
The
impact
of
microcom-
puters
on
behavior therapy,
however,
has
sparked innovative trends
in
clinical practice
and
research (Russo,
1984),
and
recent tech-
nical
advances
in
portability
of
microcom-
puters
now
provide
new
pathways
for
fulfilling
the
potential
of
behavioral treatments based
on
self-monitoring.
The
development
of so-
phisticated, lightweight portable computers,
This
research
was
based
in
part
on a
doctoral dissertation
study
conducted
by the
senior author. Financial
support
for
this research
was
provided
by the
Laboratory
for the
Study
of
Behavioral Medicine
at
Stanford.
We
gratefully
acknowledge
the
scholarly counsel
pro-
vided
by
John
D.
Krumboltz
and
Helen
C.
Kraemer
on
many
important research issues involved
in
this study.
We
also
gratefully
acknowledge
the
important contribution
of
Robert
lafaldano
and
Kevin Casey
who
helped counsel
clients
and
Satish Herekar, William
G.
Haven,
and
Lyman
D.
Black
who
provided valuable
consultation
on
microcomputer design
and
implementation.
Requests
for
reprints should
be
sent
to C.
Barr
Taylor,
Laboratory
for the
Study
of
Behavioral Medicine,
De-
partment
of
Psychiatry
and
Behavioral Sciences, Stanford
University
School
of
Medicine,
Stanford,
California
94305.
which
can be
continually
and
easily carried
by
clients, permits implementation
of
procedures
for
more systematic collection
of
self-report
data
in the
natural environment
and
provision
to
clients
of
immediate
feedback,
instructions,
and
reinforcement based
on the
data.
In
the
present research,
a
portable micro-
computer system
was
developed
to
examine
the
feasibility
of
providing on-line behavioral
treatment
of
obesity, using some important
principles
of
behavior change such
as
response
cuing,
immediate feedback
on
goal attainment
level
for
target behaviors,
and
response-con-
tingent positive reinforcement
and
instructions
to
augment
the
effects
of
self-monitoring
of
weight-related
behavior.
The
importance
and
effectiveness
of
each
of
these
behavior-change
procedures
has
been well-established
in
labo-
ratory-based learning experiments
and in a
number
of
applied settings (Bandura, 1969).
However,
although continuous
attention
to
behavior
change
has
proved
feasible
within
in-
stitutional settings
or by
means
of
portable
biofeedback
devices, such continuous attention
to
behavior change
in
free-living
individuals
has
been clinically impractical
and
technolog-
ically
impossible
until
recently.
As
an
initial test
of the
feasibility
of
using
such
a
device,
a
small group
of
clients
was
ran-
domly
selected
to
receive
a
weight loss pro-
gram, either using
a
portable
microcomputer
698
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