Single subject design in experimental research

¶ … client in question is a relatively young white female. At 30 years of age, she has recently been divorced from her husband of several years. At the present time her ex-husband has custody of her two children she had had during the course of their relationship together. Her children's ages are eight and ten years of age. Currently, she works at a local public school where she is employed as a teacher's assistant. However, she has not yet earned her Bachelor's Degree which results in a relatively low salary due to lack of accreditation. Although her children do not presently live with her, she does share her home with her unemployed mother, whom she solely supports. Despite such economic hardships, the client is in good health physically. She also enjoys her association with a small social support system.

Target Problem or Situation

Despite this social support system, the client has been having a hard time dealing with the events and circumstances she has recently experienced in her life. She has been diagnosed with clinical depression, and exhibits several behavioral features of this diagnosis. Recently, she has witnessed her own ambition slowly decreasing, experiencing less and less motivation as she participated in her life activities. Most days she has very little desire to do anything, straying away from pleasurable activities and social events. Along with this, she has been loosing focus and concentration in numerous daily situations. Despite sleeping an average of ten to twelve hours per night, she finds herself tired most of the day, typical of individuals suffering from depression. She constantly feels hopeless in the situations which shape her life. The recent events which have put her in this position have left her feeling utterly helpless. The fact that she cannot care for her children based on her current condition has a serious affect on her outlook on life.

Physical symptoms exhibited include a loss of appetite and weight loss. In fact, she has lost an astounding fifteen pounds within the short duration of only the past month. It is this behavior which proves the most dangerous to her own health and well being. It is a common symptom of depression, "Disturbances in appetite are reported by 77-90% of all depressed patients," (Lucca & Smeraldi 2006: 1). It can also have a detrimental affect to the attempt to treat deeper issues association with depression through pharmacological means. Such rapid weight losses can result in serious physical conditions, including dehydration. This a commonly exhibited behavior of individual's suffering from bouts of depression (IU School of Medicine 2009). Without the strength of a healthy physical condition, she stands no hope of pulling herself together psychologically and achieve the real changes she wants in her life. Along with hindering her from exhibiting more energy and capability to deal with her depression, her lack of appetite can have serious ramifications to her health, both immediately and later on down the line. Such severe weight loss and failure to provide the body the energy and nutrients it needs may cause physical damage to her vital organs and other bodily functions. This would only add to the misery of her condition, and hinder a healthy recovery in the present or future. This is therefore the obvious behavior which stands to be changed through intervention. The lack of appetite and allowance of such drastic weight loss will therefore be the focus of this current inquiry. Increasing the client's appetite is essential in this case. It would help her gain the physical strength necessary to go through pharmaceutical treatment for her clinical depression. After all, "Just as you cannot stop a person's leg bleeding by talking to them, you cannot stop depression without medical treatment," (MFI Fellowship:4). Therefore, the desired results of this research would be increase appetite as a way to help gain weight and keep the patient healthy, so that she may pursue pharmacological treatment if her depression does not subside later on down the line.

Intervention

In order to prepare the client to face her deeper demons of depression, she needs to be in top physical shape. Yet, this will never happen with her current loss of appetite. In order to curb this loss and kick up her health, a strict exercise regiment implemented over a long duration of time will prove to be the most effective. In fact exercise proves to be the best natural method to help increase appetite, "Exercise is one of the best no pharmacologic approaches to appetite stimulation," (Meiner 2004:152). Rather than endanger the client with mixing pharmaceuticals if she does begin an anti-depressant regiment, a natural solution is necessary to provide the best results possible. The amount and intensity of the exercise will also prove important. As a working woman with dependents to care for, it is obvious that she will not be ably to wholly devote herself to working out. However, even small amounts of exercise implemented within an already set schedule can help improve her current situation, "Encouraging 30 minutes of exercise can potentially increase appetite overall," (Meiner 2004:152). Exercise is therefore the best natural intervention for the current situation at hand.

The intervention then within the context of this study aims to provide the client a strict exercise regiment in which she can use as a method to help encourage her appetite to increase. This regiment must include a variety of elements in order to provide the efficiency the client deserves as she enters into her treatment of her depression. The regiment must be able to fit into her schedule, and since she works during days is best in the evenings. This will also be beneficial because it will be before dinner, therefore allowing her to work up a hunger before sitting down to eat. It should include the flexibility of different types of exercise as to not further create boredom with the regiment. Lastly, it will also help to place the client in more social situations where she can have interaction with others without formalities which may turn her off socially. She can also work out with her own friends or family, therefore using her social support system to help her begin her recovery.

Research on natural methods of appetite stimulation show that the specifics of the exercise routine implemented can have an impact on the actual results. For example, the level of intensity of the exercise routine is highly correlated with the levels of appetite increase or decrease. In higher level workouts, the body uses more energy, and therefore must replenish more, "When you workout at a high level of exertion, your body will start to break down glucose in the muscles for fuel and that will make you hungrier," (Leon 2009:1). Although higher intensity workouts will eventually keep the patients weight low, her weight will also prove to be at a healthy balance. This is achieved through appetite stimulation which then nourishes the body and allows for the burning of healthy fat, but the retention of other caloric material which can help increase energy and alertness, another problem the patient has been exhibiting. Along with higher intensity workouts, the bodily state in which that work out are conducted also proves important. Exercising on an empty stomach can cause the body to "crave those carbs in abundance post exercise," (Leon 2009:1). Therefore, in the planning of exercise regiments, both client and advisor should consider the time of day, and how much the client would have had to eat prior to workout. The optimal level would be some food consumed earlier in the day; thus not a completely empty stomach, but one well on its way. One other element, which many do not consider when implementing exercise regimes, is that of temperature. Research has found that in many cases that temperature is one such factor that has a serious affect on the stimulation of appetite in individuals (Leon 2009). In one study, conducted at the University of Florida, found that individuals who exercised in colder temperature during aquatic exercises actually had a larger increase in appetite than those who conducted their routines in warm or hot water, "Results indicate people may consume more calories after exercising in cold water," (Morton 2005:1). Considering these types of details will prove to best provide an efficient intervention to help increase the patient's appetite, therefore placing her in the best physical shape to deal with the other negative symptoms of her depression.

Exercise can also have a greater improvement based on the fact that the client is a female. This places her at a greater advantage to utilize regular exercise as a method to help increase the amount and frequency of meals eaten on a daily and weekly basis. Research has found that some circumstances of exercise can actually decrease appetite in some individuals, "What is less well-known is that exercise can also reduce your appetite," (Leon 2009:1). However, this does not apply to the current situation based on the fact that the client is female. Most individual's who actually exhibit a decrease in appetite happen to be men, "Men tend to have a greater reduction in appetite immediately after working out at moderate to high intensity levels than women do," (Leon 2009:1). In fact, most women tend to eat more after a work out on average than their male counterparts. Along with increasing the client's health, a regular exercise regiment may have a positive affect on the other symptoms of depression she has been exhibiting. Exercising within a social situation can also have the potential to open up social situations and keep the mind focused, both of which can also have a favorable outcome in terms of stimulating the client's appetite. In fact, an exercise routine would in deep perk up not only the body, but also the mind, "stay socially active and mentally alert. Both tend to increase appetite," (Clemen-Stone et al.:658). This is further evidence which would prove regular exercise as the best natural method for intervention which would provide the most favorable results.

The duration of that exercise is also an important key to the desired results of an increase in appetite.

Due to the nature of the client's diagnosis, a longer duration is more efficient in providing for the success of the intervention designated in getting the client to eat more often and larger amounts. Depression is a long afflicting disease, "The expression 'clinical depression' describes a group of illnesses that are characterized by an excessive or long-term depressed mood that affects a person's life," (MFI Fellowship 2008:1). Therefore, the regiment for exercise must have a lengthy duration in order to not fail at some future point in the client's fight with depression. The patient's recent weight loss was dramatic, over 15 pounds within a month's span. In order to prevent a relapse of this situation from occurring again, it will prove necessary to keep up this regiment as long as possible. With this, recovery for the depression can begin; which in and of itself provides further relief from the pains of a lack of eating, "Similarly, recovery from depression is often followed by improved appetite, greater intake and potential increase in weight," (Theleritis et al. 2006:1). These are the solid justifications of the exercise regiment as a method to help curb the lack of appetite.

Hypothesis

With this regiment implementation, it is hypothesized that the client's appetite will increase. With this increase will come more food eaten, therefore helping provide the strength and nutrients she needs to fight the rest of the symptoms caused by her depression. With a regiment of a medium to high intensity exercise three nights a week her appetite has a high chance of increasing. If this hypothesis proves successful, the client has a better chance at recovering from her depression. It may also provide her body the strength to turn toward more drastic pharmacological methods to help ease the other symptoms cause by her depression.

Variables and Objectives of the Intervention

The independent variable (x) proves to be the frequency of the exercise, which is the actual intervention itself. This is to be measured through number of meals eaten daily, as recorded in a log by the client. Our research will compare the independent variable of the exercise implementation to the dependent variable (y) of the change in her appetite. The frequency of meals is to be recorded by the client herself. They represent the desired behavior which is to be changed in order to aid the client on her journey to fight depression while at the same time remaining healthy. Our main objective in this intervention is then to increase the patient's appetite through exercising more.

Instruments and Intervention Strategies

Due to the fact that there is no way for the client to eat every meal within a supervised context, the only way to record such data in a real-time application is through utilizing a log to record the frequency of her meals. And so, this research did ask the client to compile a log of how many times a day she ate, and around what time those meals were. This data can be entered into the log as simply with the date and time of the meal. At the end of each week, the log was collected from the client and analyzed accordingly with her scheduled exercise regiments each week. It can then be transferred quite easily into numerical data which can be put through statistical testing to analyze the viability of the hypothesis.