Effect of positive reinforcement, informational feedback, and contingency contracting on a bulimic anorexic female

Abstract

Effects of reinforcement and feedback on the weight and caloric intake of a bulimic anorexic female were studied in a modified reversal design. Also studied was the effect of instructions on vomiting and effects of desensitization and contracting on weight and intake. The following phases were run: baseline, reinforcement, reinforcement plus feedback, reinforcement, reinforcement plus feedback plus desensitization, and desensitization plus contingency contracting. Results showed that feedback had a powerful influence. Also, instructions were effective in eliminating vomiting. When desensitization to thoughts which the patient had (which led her to feel as though she was a “bad person”) was initiated, there was an increase in intake and weight. Interpretation of weight data was complicated because the patient developed edema which required treatment. This complication emphasized the importance of making reinforcement contingent on both weight gain and intake. A 6-month outpatient follow-up treatment period, during which desensitization and contracting were employed, suggested that treatment results were maintained. The discussion emphasizes this study's uniqueness in that it reports treatment of a bulimic anorxic. The fact that data for a 6-month follow-up period are reported is particularly important in light of recent criticisms of behavioral treatment of anorexia nervosa.