Repeated Measures in Case Studies Relating Social Competence and Weight Loss in Two Obese Adolescents
Meyer, Sonia Beatriz, Barbosa, Debora Regina, The International Journal of Behavioral Consultation and Therapy
In individual behavior therapy two clients were evaluated using behavior categories created by the therapist. Both clients were observed to improve in terms of social competence. One demonstrated a significant inverse correlation between improvement of social competence and weight loss during treatment (16 sessions) and lost weight. The other required longer treatment (40 sessions), but also demonstrated the same tendency of results at the end of intervention. Based on this evaluation, it was postulated that behavior therapy targeted to issues of social competence could be part of treatment for weight loss, and be combined with other therapeutic modalities.
Keywords: Case study, repeated measures, relations among responses, behavior therapy, obesity; social skills; adolescent; social competence.
Obesity has gained more attention due to its high incidence, as well as the difficulties and failures related to its various treatments. Work with obese adolescents is critical, given the likelihood of becoming an obese adult (Jelalian & Saelens, 1999, Neinstein, 1996).
Obesity is a complex problem whose origins are based on a number of interrelated factors. Inadequate emotional response, and social and psychological difficulties are invariably cited as part of the general problematic that involves obesity; these include rejection by a peer group, dating difficulties, isolation, depression, aggressiveness, anxiety, and low self-esteem.
All these aspects have great importance for the healthy development of an individual, especially during adolescence, and a satisfactory and adjusted performance in these social fields presupposes the development of certain social abilities.
Recently, a number of avenues of research in behavior therapy have dealt with questions associated with relations among variables and among responses. Functional analysis is the instrument used for deciding which behaviors should be targeted during intervention, since it is common for the presented complaint to be part of a complex of interrelated behaviors--a response class--which will be discovered during therapy, as well as its function and incompatibilities (Meyer, 1997).
In the case of overeating, functional analysis must indicate the behavioral function, in other words, what are the consequences reinforcing the overeating. It also has to identify if there are any other behaviors in the behavioral repertoire of the individual that have a similar function to overeating but that are not harmful to the individual. If not, new behaviors may need to be installed. These other behaviors can involve directly or indirectly a variety of social abilities and would be then differentially reinforced. Thus, if the generic function of overeating is the avoidance of difficult social situations for the client, the procedure derived from this analysis may be educating or strengthening behaviors that may transform social approaches in pleasant occasions, instead of feared. If the main maintaining consequence of excessive caloric ingestion is the attention from the family, the change strategy which derives from this analysis may be reinforcing direct communication forms. In this case, the client can start to request attention in a direct form and no longer in an indirect and inadequate form, namely overeating.
Multiple behaviors have been emphasized in clinical research (Sturmey, 1996) and the complex question of which behaviors require treatment during therapy has been much debated, since the majority of clients present multiple and interrelated problems. Novel forms of treatment must deal with this question and try to discover and develop more adequate and important new replacement behaviors, which could become concurrent responses "against" the behavioral problem and favor adaptation.
The relation between responses was also pointed out by Craighead, Kazdin and Mahoney (1994); many behaviorists believe, they note, that behavioral problem alteration may result in improving other aspects in the individual's life, or that beneficial treatment effects may be generalized for other behaviors. …