The present status of operant conditioning for the treatment of anorexia nervosa.
Operant rewards still spark short-term eating, but lasting change needs more tools and long tracking.
01Research in Context
What this study did
The author looked back at 20 years of operant programs for adults with anorexia.
He summed up every reward-based weight-gain plan he could find.
No new experiment was run; this is a story-style review.
What they found
Operant tricks got patients to eat and gain weight while they were in hospital.
Once rewards stopped, most people lost the weight again.
Long-term data were almost missing.
How this fits with other research
Webb et al. (1999) later showed the same reward rules work with food-refusing preschoolers.
Burack et al. (2004) moved the field toward CBT, adding thoughts to the mix.
Vanderlinden et al. (2012) and Alfonsson et al. (2015) kept the CBT line for binge-eating adults.
Together they show: rewards start eating, but thoughts and feelings keep it going.
Why it matters
If you treat severe food refusal, use quick reinforcers to jump-start meals.
Then add CBT pieces to help the client keep the new weight after discharge.
Track data for months, not days, so you can see if the plan really sticks.
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02At a glance
03Original abstract
Operant conditioning appears to be an effective short-term method of weight restoration in anorexia nervosa, although it may offer only modest advantages over alternative methods of inducing weight gain. Programs differ widely in the selection of treatment setting, target behaviors, positive and negative reinforcers, reinforcement schedules, facilitating conditions, and supplementary modalities employed, and it remains unclear how each of these variables may contribute to treatment outcome. The scarcity of long-term follow-up data after 20 years of investigation is puzzling; by default, the calculation of risk/benefit ratios has depended on the theoretical biases of the observer. The accumulation of clinical experience does appear to have had some moderating effect on the polarized positions initially assumed by the advocates and opponents of operant conditioning. The approach has gained acceptance as a useful but circumscribed component of multimodal treatment programs, and in recent years is often supplemented with a variety of behavioral and cognitive-behavioral strategies designed to deal with a broader range of anorexic symptomatology.
Behavior modification, 1987 · doi:10.1177/01454455870114003