PubMed · 14001677
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J WOLPE. 1963-04-20. Behaviour therapy.. https://doi.org/10.1016/s0140-6736(63)91658-1
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Obesity has become an increasingly important public health problem. Recent evidence suggests that obesity has become a close second to tobacco use as a preventable cause of death in the United States. During the past decade an increase in the prevalence of type 2 diabetes in adolescents has been observed. The association of type 2 diabetes and obesity is well established and most adolescents with type 2 diabetes have body mass index (BMI) in a range that would already be considered obese in an adult. Childhood overweight is also associated with the atherosclerotic process. In the Bogalusa autopsy study, Berenson et al. found that the extent of fatty streaks and fibrous plaques in the aorta and coronary arteries was associated with BMI. There are three modalities currently available for the treatment of overweight in children and adolescents, including behavioral approaches, pharmacologic approaches, and surgical approaches. Surgical intervention may be considered if the BMI > or = 40 kg/m2 and a severe medical comorbidity including type 2 diabetes, obstructive sleep apnea or pseudotumor cerebri, or if the BMI is > or = 50 kg/m2 and comorbid conditions such as hypertension, dyslipidemia, or the metabolic syndrome are present. Behavioral intervention is usually made by a psychologist, behavioral therapist, dietician, or exercise physiologist. There is evidence that the effect of behavioral therapy for weight loss in childhood will be longer lasting than that seen in adults.
The token economy is a treatment intervention based on principles of operant conditioning and social learning. Developed in the 1950s and 1960s for long-stay hospital patients, the token economy has fallen out of favor since that time. The current review was undertaken as part of the 2003 update of the schizophrenia treatment recommendations of the Patient Outcomes Research Team (PORT). A total of 13 controlled studies of the token economy were reviewed. As a group, the studies provide evidence of the token economy's effectiveness in increasing the adaptive behaviors of patients with schizophrenia. Most of the studies are limited, however, by methodological shortcomings and by the historical context in which they were performed. More research is needed to determine the specific benefits of the token economy when administered in combination with contemporary psychosocial and psychopharmacological treatments.