Cognitive Behavioral Therapy (CBT) Cognitive Behavioral Therapy or (CBT) is currently the popular method to provide therapy to the client with weight control maladies. CBT is ostensibly necessary to assist binge eaters and those whom suffer from tendencies to bulimic episodes. According to Brody (2007), "Most popular at the moment is cognitive-behavioral therapy, with or without medication. Since binge eaters have highly irregular eating habits, the behavioral aspect introduces structure to their eating behavior: regular meals, including breakfast, and an afternoon snack if needed." (Brody, 2007)

Rapoport, Clark, & Wardle further ascribe CBT as a comprehensive methodology to address the psychological, not neurological, deficiencies with regard to how the client addresses their weight problem. According to Rapoport, Clark & Wardle (2000), "Cognitive -- behavioural treatment (CBT) for obesity also focuses on weight loss, but incorporates psychological strategies to promote lifestyle change. Recent reviews show that CBT programmes achieve weight losses of between 5 and 20% of weight, with average drop-out rates of 20%." (Rapoport, Clark & Wardle, 2000)

According to Taylor (2010), "One such intervention that has positive impacts both on mood and obesity, either in combination or individually, is that of cognitive behavioral therapy. This type of behavioral program can be tailored to fit both a workplace type setting, or can be provided individually to employees. It has even been shown to be effective when done via the internet, providing strategies and support both to employees and employers that are unable to access tertiary healthcare centres." (Taylor, 2010)

An important research finding with regard to CBT treatment is revealed by Rodriguez-Hernandez, Morales-Arnaya, Rosales-Valdez, Rivera-Hinojosa, Rodriguez-Moran, et al. "Thus, among the strategies used to increase the rate of successful weight loss in adults, cognitive behavioural treatment (CBT), a triphasic focal psychotherapy intervention, is the most well-established psychotherapeutic treatment of problematic psychosocial functioning that characterizes eating disorders and obesity." (Rodriguez-Hernandez, Morales-Arnaya, Rosales-Valdez, Rivera-Hinojosa, Rodriguez-Moran, et al., 2009)

Indeed, according to Mefferd, Nichols, Pakiz, & Rock, "Enrolled study participants were stratified by age and BMI and assigned to either the intervention group or wait-list group. Participants assigned to the intervention group attended group sessions using curriculum based on the new elements of CBT for obesity in addition to the many elements of standard behavioral treatment for obesity, including self-monitoring, realistic goal-setting and cognitive restructuring, as applied to behavior and attitudinal change (relevant to increased physical activity, food choices, and body image)." (Mefferd, Nichols, Pakiz, & Rock, 2007)

Operational Definition & Description of Problem Behavior

The underlying problem that does result in the need for CBT is the constructs that enable the operational definition. These constructs include unhappiness, low self-esteem, and often is a function of physical or mental abuse. Unfortunately, many whom treat clients to encourage weight loss or who evaluate these patients often misunderstand the underlying psychosocial phenomena.

Weiss (2005) provides an example. "In Cognitive-Behavioral Treatment of Obesity the authors claim to present a new cognitive behavioral treatment for obesity. They deem obesity as a medical condition. The population target is patients with a body mass index (BMI) between 30 to 40; the authors disclaim experience with patients above a BMI of 40. They further claim that the use of cognitive-behavioral methods result in an average initial weight loss of about 10% of weight, with a decline in loss after four to six months of trying to lose weight." (Weiss, 2005)

Again, the underlying psychosocial factors are not addressed. According to Mefferd, Nichols, Pakiz, & Rock, (2006) "The intervention (weight-loss) incorporated cognitive-behavioral therapy (CBT), emphasizing physical activity (PA), diet modification to facilitate a modest reduction in energy intake, and strategies to improve body image and self-acceptance." (Mefferd, Nichols, Pakiz, Rock, 2006)

However, Marchesini, Natale, Chierici, Manini, Besteghi, Di Domizio, Sartini, Pasqui, Baraldi, Forlani, and Melchionda, have worked to identify the root cause leading to the contagion of obesity. "The role of obesity as a source of distress has long been proved. It is not limited to areas of physical fitness, in relation to obesity per se and associated diseases, but also involves mental status, due to the stigma of obesity and consequent social isolation. Accordingly, obesity is associated with an impaired response to domains measuring both physical fitness and mental well-being…" (Marchesini, Natale, Chierici, Manini, Besteghi, Di Domizio, Sartini, Pasqui, Baraldi, Forlani, Melchionda, 2002)

Baseline Data

The A1 baseline data provides the weekly exercise time as a function of exercise time...

Phase A1 is the benchmark data, alternatively is A2, for the sample as this is the pre-intervention data that indicates the performance prior to the requisite intervention. The A1 baseline data indicates exercise time to be approximately 105 minutes. Therefore, before the intervention was applied, the exercise time was at a baseline of 105 minutes.
Just short of two full hours of comprehensive and integrated exercise the duration for each interval, which is a function of the workout session, is 15 minutes. As this is before the intervention, the goal is to enable the growth of the workout session and thus extend the interval time. Each baseline did last for a total of four weeks. There were a total of 7 intervals during the four-week period.

According to Marchesini, Natale, Chierici, Manini, Besteghi, Di Domizio, Sartini, Pasqui, Baraldi, Forlani, and Melchionda, (2002), "Our CBT program is based on the LEARN program for weight control. It includes 12 weekly sessions, chaired by doctors and dieticians, involving groups of 8-12 patients. They are taught about BMI and regular weight control, and are instructed on principles of calorie counting and monitoring daily food by an eating diary, with the use of a residential manual." (Marchesini, Natale, Manini, Besteghi, Di Domizio, Sartini, Pasqui, Baraldi, Forlani, Melchionda, 2002) The importance of the aforementioned result is to conclusively prove the importance of nutrition and of nutrient uptake as critical to the symbiotic nature of weight loss to exercise.

Description of the Intervention

B1 intervention involved a psychometric response to a series of questions designed to obtain emotional responses to then be linked to potential negative thoughts. The EM and TMD form were to be filled out immediately after exercising, at any time during the four-week experiment. The TMD form was to be used to record any negative feedback regarding exercise during the act of physically exercising, during the actual physical exertion.

Additionally, the client was specifically requested to list further thoughts that would encourage the act of exercise. The intervention is psychological in nature and requires the immediate and direct input of the client during the 'heat of the moment'. CBT intervention is therefore a psychological response data form that requires the input of the client during and immediately after exercising.

Schedule reinforcement was critical as the clients would not want to complete the exercise to the full duration of the allotted interval time. By enabling the reinforcement, the quality of the data was more substantial which is critical to observing values consistent with the population parameter and population statistic. The use of monitoring sheets is a direct intervention and comprises the observation and data collection portion of the aggregate methodology involved with pursuing B1.

The psychological response to the B1 metric produced a much longer interval regarding total exercise time for week two over the pre-intervention exercise time exhibited via the A1 result. Approximately 160 minutes were allocated for exercise time in week two, which is 55 minutes or approximately one additional hour over the baseline data pertaining to A1.

A2: Withdrawing Treatment

Upon withdrawing the treatment, a relapse in behavior became evident. The decrease from the baseline result (A1) as well as the intervention data (B1) to the level of (A2), which is allocated over the course of week three, provide, critical information regarding the importance of enabling the response of the client to ostensibly establish a method of motivation and psychological encouragement necessary to persevere during the act of physical exertion.

Without the response data form of EM and TMD respectively, the motivation to discontinue with the exercise became exceedingly overwhelming. The primary reason of relinquishing the progress achieved with the intervention was listed as 'lack of energy and disinterest, or "I can't be bothered." Indeed, the defeatist attitude is primarily a function of a lack of internal grit, inherently a psychological makeup incumbent to many individuals who are able to strive and persist through physical agony resulting from the lactic acid building attributed to physical exercise.

Introduction of the second treatment: B2

When the treatment was re-administered during week four under phase (B2) intervention, the weekly exercise time increased considerably, nearly returning to the level realized by the week 2 or (B1) primary intervention point. The slight decrease in B2 from B1 may be attributed to the peak/ebb effect which decidedly leads to a drop off of a percentage below that of 100%, which is the week 2. Although consistent with the notion of intervention as causal to an increased amount of exercise, B2 does show diminishing marginal returns when compared to B1. This does lead one to believe that subsequent removal of the intervention tactic and then reintroduction of the intervention will further yield diminishing marginal returns.

Result of the intervention (level of…