Bio

Bio


Stewart Agras obtained his M.D. from University College, London, England in 1955 and completed his residency and Fellowship in Psychiatry at McGill University in 1961. Since 1973 he has been a member of the faculty of the Department of Psychiatry at Stanford University School of Medicine. For much of his career his research interests have been in the investigation of behavior change in areas such as treatment compliance, essential hypertension and other cardiovascular risk factors, and anxiety disorders. In 1974 he began one of the first programs in Behavioral Medicine in the United States, a program that continues today at Stanford University. For the last 20-years the majority of his work has been in the area of eating disorders, with studies ranging from epidemiology, basic psychological mechanisms, and treatment.

Dr Agras has been Editor of the Journal of Applied Behavior Analysis and the Annals of Behavioral Medicine, and has served on a large number of Editorial Boards, in addition he has been President of the Association for the Advancement of Behavior Therapy (AABT) and was the first President of the Society for Behavioral Medicine. He has also spent two years at the Center for Advanced Study of the Behavioral Sciences and in addition was co-Director of one of the summer programs for promising young faculty at the Center.

He is presently Professor (Emeritus) of Psychiatry in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, and is continuing his research program in eating disorders.

Boards, Advisory Committees, Professional Organizations


  • Associate Editor, Journal of Applied Behavior Analysis (1971 - 1974)
  • Editor, Journal of Applied Behavior Analysis (1974 - 1977)
  • Editor, Annals of Behavioral Medicine (1987 - 1990)
  • Editorial Board, Appetite (1995 - Present)
  • Editorial Board, International Journal of Eating Disorders (1990 - Present)
  • President, Society for Behavioral Medicine (1978 - 1979)
  • President, Association for the Advancement of Behavior Therapy (1985 - 1986)
  • Chair, NIMH Psychopathology and Clinical Biology Research Review Committee (1989 - 1991)
  • Chair, NIH Health Behavior and Prevention Research Review Committee (1995 - 2000)
  • Fellow, Center for Advanced Study in the Behavioral Sciences (1976 - 1977)
  • Co-Director Summer Institute, Center for Advanced Study in the Behavioral Sciences (1988 - 1988)
  • Fellow, Center for Advanced Study in the Behavioral Sciences (1990 - 1991)

Research & Scholarship

Current Research and Scholarly Interests


The principal theme of my research is the understanding of human feeding and its disorders, namely: obesity, anorexia nervosa, bulimia nervosa, binge eating disorder and selective eating (picky eating) across the age span. Current and past research projects range from basic studies through single site and multicenter clinical trials.

In a large-scale international multisite controlled clinical trial funded by the NIH two types of family therapy for anorexia nervosa are being compared. In addition to being a study site, our laboratory is the data and coordinating center for this study. Several large data sets from previous multisite studies allow for analyses both within and across studies involving large sample sizes. Hence, many secondary questions regarding the eating disorders can be addressed.

A second study is examining two methods of teaching community therapists the skills needed to use interpersonal psychotherapy for eating disorders and depression. This is a cluster randomized study in which college campuses across the US are randomly allocated to one of the teaching methods.

A further study is examining basic questions concerning the prevention of overweight in early childhood in preparation for a large-scale early prevention study. Other studies include the epidemiology and course of picky eating and in collaboration with Dr Jim Lock examining the treatment of bulimia nervosa in adolescents and the effects of using cognitive remediation therapy in adult anorexics.

Clinical Trials


  • Comparison of Two Types of Family Therapy in the Treatment of Adolescent Anorexia Nervosa Not Recruiting

    This study will compare the effectiveness of two different family treatments for the treatment of adolescent anorexia nervosa.

    Stanford is currently not accepting patients for this trial. For more information, please contact William Agras, (650) 725 - 5734.

    View full details

Projects


  • Implementation of evidence-based treatment for on-campus eating disorders, Stanford University

    Despite major advances in developing evidence-based psychotherapies, the adoption of such treatments by community therapists has been slow. Hence, it is important to develop and test different methods to effectively train therapists to implement evidence-based psychotherapies in community settings. College campuses have a relatively high prevalence of eating disorders (EDs) and therefore present an efficient environment to test the implementation of strategies to treat these disorders. We propose to train therapists to implement interpersonal psychotherapy (IPT), evidence-based treatments for EDs. Therapists usually learn about new therapies via a workshop and treatment manual. However, it has been shown that this method does not effectively increase therapist skills, nor does it sustain utilization of these interventions. Hence, in this study we will compare two implementation strategies designed to improve upon this approach. The first is a low intensity strategy with the addition of external expert consultation following the workshop. The second is a theoretically-grounded high intensity approach focused on building internal expertise. In this strategy, a staff member from the counseling center will be trained in IPT and coached to train other staff members within the site to implement IPT. This strategy includes quality-control procedures designed to improve implementation and to ensure treatment fidelity. Twenty-six college counseling centers with approximately 230 therapists will be allocated at random to one of the two implementation strategies. Three centers: Washington University (Implementation and Cost Analysis Center), Rutgers University (Fidelity Monitoring Center), and Stanford University (Data Coordinating Center) will conduct the study. The primary aim is to compare therapist fidelity to IPT for the two training strategies and its consequent impact on client outcome. A secondary aim is to examine the generalization of use of IPT for depression. We hypothesize that the high intensity approach will prove significantly more effective than the low intensity strategy, particularly in sustainability. Exploratory moderator and mediator analyses will illuminate the institutional and therapist variables that affect implementation and client outcomes. Because the two approaches differ in resources, the implementation and service costs for each of the training methods will be determined. Implementation will proceed over a twenty month period with a 12-month follow-up to test sustainability, during which period consultation from Washington University will have ceased. This project continues a long-standing collaboration among the three PIs and centers that have focused in the past on understanding factors underlying eating disorders and on the development of evidence- based psychotherapies. To extend our expertise on implementation theory and procedures, we have established collaborations with faculty from the Dissemination and Implementation Core at Washington University, including Drs. Proctor and Raghavan who are co-investigators on this project.

    Location

    Psychiatry Building, 401 Quarry Road, Stanford, CA 94305

Teaching

2013-14 Courses


Publications

Journal Articles


  • Improving healthy eating in families with a toddler at risk for overweight: A cluster randomized controlled trial. Journal of Developmental & Behavioral Pediatrics Agras, W.S., Hammer, L.D., Huffman, L.C., Mascola, A., Bryson, S.W., Danaher, C.
  • Psychological treatments of binge eating disorder Archives of General Psychiatry Wilson, G. T.,, Wilfley D. E., Agras, W. S. 2010; 67: 94-101
  • Childhood risk factors for thin body preoccupation and social pressure to be thin JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Agras, W. S., Bryson, S., Hammer, L. D., Kraemer, H. C. 2007; 46 (2): 171-178

    Abstract

    Thin body preoccupation and social pressure to be thin (TBPSP) in adolescence are risk factors for the development of full and partial bulimia nervosa and binge eating disorder. This study examined precursors of these potent risk factors.A prospective study followed 134 children from birth to 11.0 years and their parents. Recruitment began in January 1990 and ended in March 1991. The study was completed in December 2002.Two moderators identified different groups at risk for the development of TBPSP. A father with high body dissatisfaction characterized the largest group in which TBPSP was elevated for girls who were concerned about and attempted to modify their weight and for children with fathers who had a high drive for thinness. A child at risk for overweight characterized the second smaller group. Parental behaviors such as overcontrol of their child's eating, together with later pressure from parents and peers to be thin, were related to higher levels of TBPSP.Different pathways lead to the development of eating disorder psychopathology. These results suggest that prevention programs for eating disorders should begin in early childhood, possibly involving parental education and behavior change, and that different prevention programs may be required for different pathways.

    View details for DOI 10.1097/chi.0b01361802bd997

    View details for Web of Science ID 000243737900004

    View details for PubMedID 17242620

  • A comparison of short- and long-term family therapy for adolescent anorexia nervosa JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Lock, J., Agras, W. S., Bryson, S., Kraemer, H. C. 2005; 44 (7): 632-639

    Abstract

    Research suggests that family treatment for adolescents with anorexia nervosa may be effective. This study was designed to determine the optimal length of such family therapy.Eighty-six adolescents (12-18 years of age) diagnosed with anorexia nervosa were allocated at random to either a short-term (10 sessions over 6 months) or long-term treatment (20 sessions over 12 months) and evaluated at the end of 1 year using the Eating Disorder Examination (EDE) between 1999 and 2002.Although adequately powered to detect differences between treatment groups, an intent-to-treat analysis found no significant differences between the short-term and long-term treatment groups. Although a nonsignificant finding does not prove the null hypothesis, in no instance does the confidence interval on the effect size on the difference between the groups approach a moderate .5 level. However, post hoc analyses suggest that subjects with severe eating-related obsessive-compulsive features or who come from nonintact families respond better to long-term treatment.A short-term course of family therapy appears to be as effective as a long-term course for adolescents with short-duration anorexia nervosa. However, there is a suggestion that those with more severe eating-related obsessive-compulsive thinking and nonintact families benefit from longer treatment.

    View details for DOI 10.1097/01.chi.0000161647.82775.0a

    View details for Web of Science ID 000230035300010

    View details for PubMedID 15968231

  • Risk factors for childhood overweight: A prospective study from birth to 9.5 years JOURNAL OF PEDIATRICS Agras, W. S., Hammer, L. D., McNicholas, F., Kraemer, H. C. 2004; 145 (1): 20-25

    Abstract

    To ascertain risk factors for the development of overweight in children at 9.5 years of age.This was a prospective study of 150 children from birth to 9.5 years of age, with assessment of multiple hypothesized risk factors drawn from research reports.Five independent risk factors for childhood overweight were found. The strongest was parent overweight, which was mediated by child temperament. The remaining risk factors were low parent concerns about their child's thinness, persistent child tantrums over food, and less sleep time in childhood. Possible mechanisms by which each of these factors influence weight gain are outlined. Two different pathways to childhood overweight/obesity were found, depending on degree of parental overweight.There is evidence of considerable interaction between parent and child characteristics in the development of overweight. Several of the identified risk factors are amenable to intervention possibly leading to the development of early prevention programs.

    View details for DOI 10.1016/j.jpeds.2004.03.023

    View details for Web of Science ID 000222738500018

    View details for PubMedID 15238901

  • Mediators and moderators of treatment effects in randomized clinical trials ARCHIVES OF GENERAL PSYCHIATRY Kraemer, H. C., Wilson, G. T., Fairburn, C. G., Agras, W. S. 2002; 59 (10): 877-883

    Abstract

    Randomized clinical trials (RCTs) not only are the gold standard for evaluating the efficacy and effectiveness of psychiatric treatments but also can be valuable in revealing moderators and mediators of therapeutic change. Conceptually, moderators identify on whom and under what circumstances treatments have different effects. Mediators identify why and how treatments have effects. We describe an analytic framework to identify and distinguish between moderators and mediators in RCTs when outcomes are measured dimensionally. Rapid progress in identifying the most effective treatments and understanding on whom treatments work and do not work and why treatments work or do not work depends on efforts to identify moderators and mediators of treatment outcome. We recommend that RCTs routinely include and report such analyses.

    View details for Web of Science ID 000178493800002

    View details for PubMedID 12365874

  • Is outpatient cognitive remediation therapy feasible to use in randomized clinical trials for anorexia nervosa? INTERNATIONAL JOURNAL OF EATING DISORDERS Lock, J., Agras, W. S., Fitzpatrick, K. K., Bryson, S. W., Jo, B., Tchanturia, K. 2013; 46 (6): 567-575

    View details for DOI 10.1002/eat.22134

    View details for Web of Science ID 000323436800005

  • Reducing the burden of eating disorders: A model for population-based prevention and treatment for university and college campuses INTERNATIONAL JOURNAL OF EATING DISORDERS Wilfley, D. E., Agras, W. S., Taylor, C. B. 2013; 46 (5): 529-532

    View details for DOI 10.1002/eat.22117

    View details for Web of Science ID 000318779000032

    View details for PubMedID 23658106

  • Is outpatient cognitive remediation therapy feasible to use in randomized clinical trials for anorexia nervosa? The International journal of eating disorders Lock, J., Agras, W. S., Fitzpatrick, K. K., Bryson, S. W., Jo, B., Tchanturia, K. 2013

    Abstract

    OBJECTIVE: There are limited data supporting specific treatments for adults with anorexia nervosa (AN). Randomized clinical trials (RCTs) for adults with AN are characterized by high attrition limiting the feasibility of conducting and interpreting existing studies. High dropout rates may be related to the inflexible and obsessional cognitive style of patients with AN. This study evaluated the feasibility of using cognitive remediation therapy (CRT) to reduce attrition in RCTs for AN. METHOD: Forty-six participants (mean age of 22.7 years and mean duration of AN of 6.4 years) were randomized to receive eight sessions of either CRT or cognitive behavioral therapy (CBT) over 2 months followed by 16 sessions of CBT for 4 months. RESULTS: During the 2-month CRT vs. CBT treatment, rates of attrition were lower in CRT (13%) compared with that of CBT (33%). There were greater improvements in cognitive inefficiencies in the CRT compared with that of the CBT group at the end of 2 months. There were no differences in other outcomes. DISCUSSION: These results suggest that CRT is acceptable and feasible for use in RCTs for outpatient treatment of AN. CRT may reduce attrition in the short term. Adequately powered future studies are needed to examine CRT as an outpatient treatment for AN.

    View details for PubMedID 23625628

  • Longitudinal stability of binge-eating type in eating disorders INTERNATIONAL JOURNAL OF EATING DISORDERS Peterson, C. B., Swanson, S. A., Crow, S. J., Mitchell, J. E., Agras, W. S., Halmi, K. A., Crosby, R. D., Wonderlich, S. A., Berg, K. C. 2012; 45 (5): 664-669

    Abstract

    The purpose of this study was to examine the 2-year longitudinal stability of objective bulimic (binge eating) episodes (OBEs) and subjective bulimic (binge eating) episodes (SBEs) in a multisite eating disorders sample.Participants included 288 females with eating disorder symptoms who were assessed every 6 months using the Eating Disorder Examination.Markov modeling revealed considerable longitudinal variability between types of binge eating over 6-month time intervals with relatively higher probability estimates for consistency between OBEs and SBEs than specific transitions between types for the overall sample as well as for eating disorder diagnostic groups. Transition patterns examining all five time points indicated notable variability in binge-eating patterns among participants.These findings suggest that although longitudinal patterns of binge types are variable among individuals with eating disorders, consistency in OBEs and SBEs was the most common pattern observed.

    View details for DOI 10.1002/eat.22008

    View details for Web of Science ID 000304993700005

    View details for PubMedID 22407944

  • The Mississippi Years (1969-1974) BEHAVIOR MODIFICATION Agras, W. S. 2012; 36 (4): 436-443
  • Moderators and mediators of remission in family-based treatment and adolescent focused therapy for anorexia nervosa BEHAVIOUR RESEARCH AND THERAPY le Grange, D., Lock, J., Agras, W. S., Moye, A., Bryson, S. W., Jo, B., Kraemer, H. C. 2012; 50 (2): 85-92

    Abstract

    Few of the limited randomized controlled trails (RCTs) for adolescent anorexia nervosa (AN) have explored the effects of moderators and mediators on outcome. This study aimed to identify treatment moderators and mediators of remission at end of treatment (EOT) and 6- and 12-month follow-up (FU) for adolescents with AN (N = 121) who participated in a multi-center RCT of family-based treatment (FBT) and individual adolescent focused therapy (AFT). Mixed effects modeling were utilized and included all available outcome data at all time points. Remission was defined as ? 95% IBW plus within 1 SD of the Eating Disorder Examination (EDE) norms. Eating related obsessionality (Yale-Brown-Cornell Eating Disorder Total Scale) and eating disorder specific psychopathology (EDE-Global) emerged as moderators at EOT. Subjects with higher baseline scores on these measures benefited more from FBT than AFT. AN type emerged as a moderator at FU with binge-eating/purging type responding less well than restricting type. No mediators of treatment outcome were identified. Prior hospitalization, older age and duration of illness were identified as non-specific predictors of outcome. Taken together, these results indicate that patients with more severe eating related psychopathology have better outcomes in a behaviorally targeted family treatment (FBT) than an individually focused approach (AFT).

    View details for DOI 10.1016/j.brat.2011.11.003

    View details for Web of Science ID 000301019200001

    View details for PubMedID 22172564

  • A 1-year follow-up of a multi-center treatment trial of adults with anorexia nervosa EATING AND WEIGHT DISORDERS-STUDIES ON ANOREXIA BULIMIA AND OBESITY Yu, J., Agras, W. S., HALMI, K. A., Crow, S., Mitchell, J., Bryson, S. W. 2011; 16 (3): E177-E181

    Abstract

    To examine maintenance of recovery following treatment in an adult anorexia nervosa (AN) population.One year follow-up of a randomized clinical trial with 122 participants treated with: cognitive behavioral therapy (CBT), drug therapy (fluoxetine), or a combination (CBT+fluoxetine) for 12 months. Participants were assessed at baseline, end of treatment, and follow-up. The primary outcomes were weight and the global scores from the Eating Disorder Examination (EDE) separately and combined.Fifty-two participants completed the follow-up. Mean weight increased from end of treatment to follow-up. Seventy-five percent (75%) of those weight recovered at end of treatment maintained this recovery at follow-up. Recovery of eating disorder psychopathology was stable from end of treatment to follow-up, with 40% of participants with a global EDE score within normal range. Using the most stringent criteria for recovery, only 21% of the completer sample was recovered.The findings suggest that while adults with AN improve with treatment and maintain these improvements during follow-up, the majority is not recovered. Additionally, further research is needed to understand barriers to treatment and assessment completion.

    View details for Web of Science ID 000303170600005

    View details for PubMedID 22290033

  • Allegiance Bias and Therapist Effects: Results of a Randomized Controlled Trial of Binge Eating Disorder CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE Wilson, G. T., Wilfley, D. E., Agras, W. S., Bryson, S. W. 2011; 18 (2): 119-125
  • Picky eating during childhood: A longitudinal study to age 11 years EATING BEHAVIORS Mascola, A. J., Bryson, S. W., Agras, W. S. 2010; 11 (4): 253-257

    Abstract

    Picky eating is a common disorder during childhood often causing considerable parental anxiety. This study examined the incidence, point prevalence, persistence and characteristics of picky eating in a prospective study of 120 children and their parents followed from 2 to 11 years. At any given age between 13% and 22% of the children were reported to be picky eaters. Incidence declined over time whereas point prevalence increased indicating that picky eating is often a chronic problem with 40% having a duration of more than 2 years. Those with longer duration differed from those with short duration having more strong likes and dislikes of food and not accepting new foods. Parents of picky eaters were more likely to report that their children consumed a limited variety of foods, required food prepared in specific ways, expressed stronger likes and dislikes for food, and threw tantrums when denied foods. They were also more likely to report struggles over feeding, preparing special meals, and commenting on their child's eating. Hence, picky eating is a prevalent concern of parents and may remain so through childhood. It appears to be a relatively stable trait reflecting an individual eating style. However no significant effects on growth were observed.

    View details for DOI 10.1016/j.eatbeh.2010.05.006

    View details for Web of Science ID 000283484700008

    View details for PubMedID 20850060

  • Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia Nervosa ARCHIVES OF GENERAL PSYCHIATRY Lock, J., Le Grange, D., Agras, S., Moye, A., Bryson, S. W., Jo, B. 2010; 67 (10): 1025-1032

    Abstract

    Evidence-based treatment trials for adolescents with anorexia nervosa are few.To evaluate the relative efficacy of family-based treatment (FBT) and adolescent-focused individual therapy (AFT) for adolescents with anorexia nervosa in full remission.Randomized controlled trial.Stanford University and The University of Chicago (April 2005 until March 2009).One hundred twenty-one participants, aged 12 through 18 years, with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement. Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT. Participants were assessed at baseline, end of treatment (EOT), and 6 months' and 12 months' follow-up posttreatment.Full remission from anorexia nervosa defined as normal weight (?95% of expected for sex, age, and height) and mean global Eating Disorder Examination score within 1 SD of published means. Secondary outcome measures included partial remission rates (>85% of expected weight for height plus those who were in full remission) and changes in body mass index percentile and eating-related psychopathology.There were no differences in full remission between treatments at EOT. However, at both the 6- and 12-month follow-up, FBT was significantly superior to AFT on this measure. Family-based treatment was significantly superior for partial remission at EOT but not at follow-up. In addition, body mass index percentile at EOT was significantly superior for FBT, but this effect was not found at follow-up. Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT, but there were no differences at follow-up.Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT, FBT was more effective in facilitating full remission at both follow-up points.clinicaltrials.gov Identifier: NCT00149786.

    View details for Web of Science ID 000282917400005

    View details for PubMedID 20921118

  • A 4-Year Prospective Study of Eating Disorder NOS Compared with Full Eating Disorder Syndromes INTERNATIONAL JOURNAL OF EATING DISORDERS Agras, W. S., Crow, S., Mitchell, J. E., Halmi, K. A., Bryson, S. 2009; 42 (6): 565-570

    Abstract

    To examine the course of Eating Disorder NOS (EDNOS) compared with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).Prospective study of 385 participants meeting DSM-IV criteria for AN, BN, BED, and EDNOS at three sites. Recruitment was from the community and specialty clinics. Participants were followed at 6-month intervals during a 4-year period using the Eating Disorder Examination as the primary assessment.EDNOS remitted significantly more quickly that AN or BN but not BED. There were no differences between EDNOS and full ED syndromes, or the subtypes of EDNOS, in time to relapse following first remission. Only 18% of the EDNOS group had never had or did not develop another ED diagnosis during the study; however, this group did not differ from the remaining EDNOS group.EDNOS appears to be a way station between full ED syndromes and recovery, and to a lesser extent from recovery or EDNOS status to a full ED. Implications for DSM-V are examined.

    View details for DOI 10.1002/eat.20708

    View details for Web of Science ID 000269224000012

    View details for PubMedID 19544557

  • A 4-year prospective study of Eating Disorder NOS compared with full eating disorder syndromes International Journal of Eating Disorders Agras, W. S., Crow, S., Mitchell, J. E., Halmi, K. A., Bryson, S. W 2009; 42: 565-570
  • Is Picky Eating an Eating Disorder? INTERNATIONAL JOURNAL OF EATING DISORDERS Jacobi, C., Schmitz, G., Agras, W. S. 2008; 41 (7): 626-634

    Abstract

    To examine the prevalence of picky eating and the relationship between picky eating, previously supported correlates of picky eating, other child eating and behavioral problems and maternal eating problems in children aged 8-12 years.In a cohort study, 426 8- to 12-year-old children and their primary caretakers (91% mothers) were assessed in a small town community. Potential child eating behaviors associated with picky eating were reported by mothers using the Stanford Feeding Questionnaire. Child eating attitudes and disturbances were obtained from the McKnight Risk Factor Survey, food preferences and avoidances from a food preference list, child behavioral problems were assessed by the Child Behavior Checklist. To assess maternal eating disturbances EDI-subscales 1-3 as well as TFEQ-subscales "disinhibition" and "restraint" were used.Picky and nonpicky eaters differed significantly on all of the child eating behaviors found to be correlates of picky eating in a previous study with younger children. Overall, picky children were reported to avoid foods in general more often than nonpicky eaters. Picky children did not differ from nonpicky children with regard to their own and maternal eating disturbances. However, picky children displayed more problem behaviors comprising both internalizing and externalizing behaviors.The present study does not support the concept that picky eating is associated with disordered eating but rather with a range of behavioral problems.

    View details for DOI 10.1002/eat.20545

    View details for Web of Science ID 000260317100007

    View details for PubMedID 18454484

  • Interactions Between Disturbed Eating and Weight in Children and Their Mothers JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Jacobi, C., Schmitz, G., Agras, W. S. 2008; 29 (5): 360-366

    Abstract

    This study assessed the interaction between disturbed eating behavior and body mass index (BMI) in children aged 8 to 12 and maternal eating problems and BMI.In a cohort study, four hundred twenty-six 8- to 12-year-old children and their primary caretakers (91% mothers) were assessed in a small city. Disturbed eating behavior in children was measured by the "IEG-IEG-Child-Questionnaire," a validated German self-report instrument for children. Disturbed eating behavior in mothers was assessed by TFEQ-subscale disinhibition.Children's BMI was a significant covariate of disturbed eating. Older girls with higher BMI endorsed more problems with eating and weight, and more body dissatisfaction than boys and younger children. Daughters of overweight mothers restrained their own eating behavior more than daughters of normal weight mothers and sons regardless of mothers' weight. Older daughters of overweight mothers were more dissatisfied with their own bodies than younger daughters and children of normal weight mothers. Children of mothers with elevated disinhibition showed more body dissatisfaction than children of mothers with lower disinhibition.The results illustrate the complex and differential relationships between age, gender, BMI, and maternal variables and eating disturbances in children. Preventive interventions for the reduction of disturbed eating in children should be targeted at overweight mothers and mothers with disinhibited eating.

    View details for Web of Science ID 000260147500005

    View details for PubMedID 18766115

  • Costs of remission and recovery using family therapy for adolescent anorexia nervosa: a descriptive report. Eating disorders Lock, J., Couturier, J., Agras, W. S. 2008; 16 (4): 322-330

    Abstract

    This paper reports on the costs of overall treatment for a cohort of adolescent patients with AN treated with a similar regimen consisting of inpatient medical stabilization, outpatient family therapy, and psychiatric medications for co-morbid psychiatric conditions. Most of the costs associated with outcome were secondary to medical hospitalization. However, the overall costs per remission varied widely depending on the threshold used. However, compared to costs described for adults with AN, adolescent treatment costs appear to be lower when families are used effectively to aid in treatment.

    View details for DOI 10.1080/10640260802115969

    View details for PubMedID 18568922

  • Eating disorder symptoms in pregnancy: A prospective study INTERNATIONAL JOURNAL OF EATING DISORDERS Crow, S. J., Agras, W. S., Crosby, R., Halmi, K., Mitchell, J. E. 2008; 41 (3): 277-279

    Abstract

    Previous work suggests that eating disorder symptoms diminish with pregnancy. However, little prospective study has been conducted, and little is known about pregnancy symptoms in eating disorder not otherwise specified. This research prospectively studies both eating behaviors and disordered eating cognitions in pregnant women with various eating disorder diagnoses.Forty-two participants became pregnant during 4-year follow-up of 385 women with full or subthreshold anorexia nervosa, bulimia nervosa, or binge eating disorder. Participants completed the Eating Disorders Examination (EDE) at 6-month intervals. Mixed modeling procedures were used to examine change in eating disorder cognitions, binge eating, and purging.EDE restraint, EDE shape concerns, EDE weight concerns, binge eating, and purging diminished from prepartum to intrapartum, but returned to approximately baseline levels postpartum.In this longitudinal sample of women with diverse eating disorder diagnoses, eating disorder symptoms improved during pregnancy, but worsened postpartum. These results highlight pregnancy as a potential time for eating disorder interventions.

    View details for DOI 10.1002/eat.20496

    View details for Web of Science ID 000254114400012

    View details for PubMedID 18027861

  • Changes in psychopathology and symptom severity in bulimia nervosa between 1993 and 2003 INTERNATIONAL JOURNAL OF EATING DISORDERS Vaught, A. S., Agras, W. S., Bryson, S. W., Crow, S. J., Halmi, K. A., Mitchell, J. E. 2008; 41 (2): 113-117

    Abstract

    This study investigated changes in symptom severity and the psychopathology of patients with bulimia nervosa between 1993 and 2003.Pretreatment data of patients diagnosed with bulimia nervosa, collected between 1993 and 1997 from two multisite studies (N = 263), and from 2001 to 2003 from a third multisite study (N = 233) were compared for differences in psychopathology, eating disorder symptoms, and demographic characteristics.There was a significant increase in baseline age between the cohorts (1993M = 28.7 +/- 7.9, 2001M = 30.3 +/- 8.7, p = 0.036) together with a decrease in personality disorders and in several aspects of eating disorder psychopathology. After controlling for age however, significant pretreatment differences were found only in the restraint subscale on the EDE.Results suggest that the presentation of individuals with bulimia nervosa has changed between 1993 and 2003, in that participants were older and demonstrated less dietary restraint. Hence, comparisons between samples and treatment trials over time must be made with caution.

    View details for DOI 10.1002/eat.20464

    View details for Web of Science ID 000253226300002

    View details for PubMedID 18004720

  • Forty years of progress in the treatment of the eating disorders NORDIC JOURNAL OF PSYCHIATRY Agras, W. S., Robinson, A. H. 2008; 62: 19-24

    Abstract

    This paper reviews progress in the treatment of the eating disorders between 1968 and 2008. In 1968, no evidence-based treatments were available for any of the eating disorders, and binge eating disorder had not yet been described. In 2008, there are still no evidence-based treatments for anorexia nervosa, although a specific form of family therapy (based on the Maudsley model) appears promising. Both psychotherapeutic and psychopharmacological evidence-based treatments are now available for bulimia nervosa and binge eating disorder. Therapist-assisted self-help is a promising approach to treatment because it may reduce the costs of treatment, allow for more adequate dissemination to areas lacking specialty resources and also provide a basis for algorithm-driven approaches to treatment.

    View details for DOI 10.1080/08039480802315632

    View details for Web of Science ID 000260298500004

    View details for PubMedID 18752114

  • A comparison of ethnic groups in the treatment of bulimia nervosa. Eating behaviors Chui, W., Safer, D. L., Bryson, S. W., Agras, W. S., Wilson, G. T. 2007; 8 (4): 485-491

    Abstract

    This exploratory study investigated whether White and ethnic minority bulimic participants differ on key features of eating psychopathology and treatment outcome. Data from a randomized controlled multi-site study comparing the efficacy of either cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT) for 219 women with bulimia nervosa were analyzed. A significant baseline ethnic difference for body mass index (BMI) (p<.001) was found as well as an ethnicity by center interaction for a prior history of depression (p<.05). In addition, there was a significant ethnic difference for the Weight Concerns subscale of the Eating Disorder Examination (EDE). However, once BMI was controlled, this difference did not retain significance. At post-treatment, while all ethnic groups responded with higher abstinence rates to CBT than IPT, an ethnicity by treatment effect was found for the reduction of objective binge eating episodes. Black participants, compared to other groups, showed greater reductions in binge eating episodes when treated with IPT than CBT. Other findings related to secondary outcome measures, though limited by small sample size, are discussed as providing directions for future research.

    View details for PubMedID 17950937

  • Classification of eating disorders: Toward DSM-V INTERNATIONAL JOURNAL OF EATING DISORDERS Wilfley, D. E., Bishop, M. E., Wilson, G. T., Agras, W. S. 2007; 40: S123-S129

    Abstract

    A goal of the DSM-IV revision is to increase clinical and research utility by improving diagnostic validity through reliance on empirical evidence. Currently defined eating disorder (ED) categories have limited validity and require refinement based on data.The available scientific evidence is considered in evaluating the current ED nosology.Specific recommendations include modifying ED classification by retaining categories but adding a dimensional component; removing the amenorrhea criterion for anorexia nervosa (AN); removing the subtypes for AN and bulimia nervosa (BN); making binge eating disorder (BED) an official diagnosis; and unifying the frequency and duration cut-points for BN and BED to once per week for 3 months. Priority research areas should include epidemiologic studies of full-range ED symptomatology and should focus on empirical validation for individual criterion.There are significant issues to address in revising ED nosology as we move toward a more valid and useful DSM-V.

    View details for Web of Science ID 000250229900027

    View details for PubMedID 17685383

  • Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Lock, J., Couturier, J., Agras, W. S. 2006; 45 (6): 666-672

    Abstract

    To describe the relative effectiveness of a short versus long course of family-based therapy (FBT) for adolescent anorexia nervosa at long-term follow-up.This study used clinical and structured interviews to assess psychological and psychosocial outcomes of adolescents (ages 12-18 years at baseline) who were previously treated in a randomized clinical trial using family therapy between 1999 and 2002.Eighty-three percent (71/86) of subjects participated in follow-up assessments of current psychological and psychosocial functioning. In addition, 49% (35) were interviewed using the Eating Disorder Examination. Mean length of follow-up was 3.96 years (range 2.3-6.0 years). There were no statistically significant differences between the two groups on any measure at long-term follow-up. As a whole, the group was doing well with 89% above 90% ideal body weight, 74% with Eating Disorder Examination scores within the normal range, and 91% of postmenarcheal females not on birth control had menstrual return.A short course of family therapy is as effective as a longer course at follow-up.

    View details for DOI 10.1097/01.chi.0000215152.61400.ca

    View details for Web of Science ID 000237788200007

    View details for PubMedID 16721316

  • Weight suppression is a robust predictor of outcome in the cognitive-behavioral treatment of bulimia nervosa JOURNAL OF ABNORMAL PSYCHOLOGY Butryn, M. L., Lowe, M. R., Safer, D. L., Agras, W. S. 2006; 115 (1): 62-67

    Abstract

    This study examined weight suppression (difference between highest premorbid weight and pretreatment weight) as a predictor of outcome in 188 outpatients with bulimia nervosa enrolled in a cognitive-behavioral therapy intervention. Participants who dropped out of treatment had significantly higher levels of weight suppression than treatment completers. Of participants who completed treatment, those who continued to engage in binge eating or purging had significantly higher levels of weight suppression than those who were abstinent from bingeing and purging. Results did not change when body mass index, dietary restraint, weight and shape concerns, or other relevant variables were controlled. Relinquishing bulimic behaviors and adopting normal eating patterns may be most feasible for patients who are closest to their highest premorbid weights.

    View details for DOI 10.1037/0021-843X.115.1.62

    View details for Web of Science ID 000236055600007

    View details for PubMedID 16492096

  • Therapeutic alliance and treatment adherence in two interventions for bulimia nervosa: A study of process and outcome JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Loeb, K. L., Wilson, G. T., Labouvie, E., Pratt, E. M., Hayaki, J., Walsh, B. T., Agras, W. S., Fairburn, C. G. 2005; 73 (6): 1097-1106

    Abstract

    The relationship between therapeutic alliance, therapist adherence to treatment protocol, and outcome was analyzed in a randomized trial of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy for bulimia nervosa. Independent observers rated audiotapes of full-length therapy sessions. Purging frequency was the primary outcome variable. There were no significant therapist or Therapist x Treatment effects on outcome. Although results showed high levels of alliance and adherence across treatments, CBT was associated with greater adherence. Across treatments and time points, better adherence was associated with enhanced alliance. Treatment condition and baseline purging frequency, but not adherence, predicted outcome. Early alliance predicted posttreatment purging frequency. In temporal analyses, prior symptom change assessed early in treatment was significantly related to subsequent adherence at midtreatment.

    View details for DOI 10.1037/0022-006X.73.6.1097

    View details for Web of Science ID 000234576600011

    View details for PubMedID 16392983

  • Patterns of eating and abstinence in women treated for bulimia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Shah, N., Passi, V., Bryson, S., Agras, W. S. 2005; 38 (4): 330-334

    Abstract

    The current study sought to determine whether there is an optimal pattern of eating leading to cessation of binge eating and purging in bulimic women.Data on the number of meals and snacks consumed were obtained from the Eating Disorders Examination (EDE) pretreatment and posttreatment, for individuals participating in a randomized controlled study comparing cognitive-behavioral therapy and interpersonal therapy. Records were available for 158 participants.The numbers of meals and snacks eaten from pretreatment to posttreatment increased significantly. A pattern of eating with at least 80 meals combined with at least 21 afternoon snacks within a 28-day period was associated with an abstinence rate of 70%. In contrast, for subjects having 72-80 meals, those having greater than 11 evening snacks have an abstinence rate of 4%.The critical elements of the pattern of eating related to abstinence appear to be the total number of meals consumed and the timing of snacks.

    View details for DOI 10.1002/eat.20204

    View details for Web of Science ID 000233865600006

    View details for PubMedID 16231339

  • Risk factors for childhood overweight CURRENT OPINION IN PEDIATRICS Agras, W. S., Mascola, A. J. 2005; 17 (5): 648-652

    Abstract

    We review the 2004 literature on risk factors for childhood overweight. Given the steady increase in the prevalence of childhood overweight, the identification of risk factors is of increasing importance.A number of studies confirmed that parental overweight is the most potent risk factor for childhood overweight. Childhood temperament was found to mediate the effects of parental overweight with a difficult temperament increasing the risk of overweight. Newer findings implicate regular consumption of fast food and sweetened drinks as risk factors, as well as sedentary behavior; although a meta-analysis suggested that the effects of the latter factor are small. Other work was consistent with the finding that parental overcontrol of children's feeding behavior, particularly for those at high risk of developing overweight, may lead to overweight.Identification of groups of children at high risk for becoming overweight offers the potential for early intervention to reduce the intergenerational transfer of obesity. This is an area for future research because the nature of effective intervention is at present unclear. There is a suggestion that focused behavior change efforts on one target such as reducing the intake of sweetened beverages may be more successful than attempts to make broader dietary changes. There is also evidence that targeting parental behaviors may be more effective than interventions directed solely toward children, suggesting that modification of the environment that a child is exposed to during early development may have a lasting effect.

    View details for Web of Science ID 000231857800016

    View details for PubMedID 16160542

  • Prediction of outcome in bulimia nervosa by early change in treatment AMERICAN JOURNAL OF PSYCHIATRY Fairburn, C. G., Agras, W. S., Walsh, B. T., Wilson, G. T., Stice, E. 2004; 161 (12): 2322-2324

    Abstract

    The authors' goal was to identify predictors of treatment response in bulimia nervosa and, in particular, to attempt to replicate and extend the observation that early change predicts outcome.Predictors of response at the end of treatment and 8-month follow-up were sought from a group of 220 women treated with either cognitive behavior therapy or interpersonal psychotherapy.Early change in frequency of purging was the best predictor of response at the end of treatment and at 8-month follow-up.Early change in treatment is a robust and potent predictor of immediate and longer-term outcome in bulimia nervosa.

    View details for Web of Science ID 000225503500030

    View details for PubMedID 15569910

  • The relationship between parental factors at infancy and parent-reported control over children's eating at age 7 APPETITE Duke, R. E., Bryson, S., Hammer, L. D., Agras, W. S. 2004; 43 (3): 247-252

    Abstract

    The objective of this study was to determine predictors of parental control over children's eating. Data were obtained from 135 children and their parents from the Stanford Infant Growth Study. Assessments were obtained from parents at their child's birth and age 7. Parental body dissatisfaction at their child's birth predicted pressure to eat for both sons and daughters. In addition, minority status, parent being born outside of the United States, and a mother's early return to work predicted parental pressure to eat for sons. For daughters, an early maternal pushy feeding style also predicted parental pressure to eat. Parental hunger, a parental history of eating disorders and parent being born outside of the United States predicted food restriction for daughters. There were no predictors of food restriction for sons. We concluded that parental control appears not always to be simply a reaction to a child's lack of self-control or overweight, but may be present before such issues arise, particularly with the presence of certain cultural factors.

    View details for DOI 10.1016/j.appet.2004.05.006

    View details for Web of Science ID 000225236800003

    View details for PubMedID 15527926

  • An examination of the mechanisms of action in cognitive Behavioral therapy for bulimia nervosa BEHAVIOR THERAPY Spangler, D. L., Baldwin, S. A., Agras, W. S. 2004; 35 (3): 537-560
  • Report of the National Institutes of Health Workshop on Overcoming Barriers to Treatment Research in Anorexia Nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Agras, W. S., Brandt, H. A., Bulik, C. M., Dolan-Sewell, R., Fairburn, C. G., HALMI, K. A., Herzog, D. B., Jimerson, D. C., Kaplan, A. S., Kaye, W. H., le Grange, D., Lock, J., Mitchell, J. E., Rudorfer, M. V., Street, L. L., Striegel-Moore, R., Vitousek, K. M., Walsh, B. T., Wilfley, D. E. 2004; 35 (4): 509-521

    Abstract

    Anorexia nervosa (AN) is associated with serious medical morbidity and has the highest mortality rate of all psychiatric disorders. The National Institutes of Health (NIH) Workshop on Overcoming Barriers to Treatment Research in Anorexia Nervosa convened on September 26-27, 2002 to address the dearth of treatment research in this area. The goals of this workshop were to discuss the stages of illness and illness severity, pharmacologic interventions, psychological interventions, and methodologic considerations.The program consisted of a series of brief presentations by moderators, each followed by a discussion of the topic by workshop participants, facilitated by the session chair.This report summarizes the major discussions of these sessions and concludes with a set of recommendations related to the development of treatment research in AN based on these findings.It is crucial that treatment research in this area be prioritized.

    View details for DOI 10.1002/eat.10261

    View details for Web of Science ID 000221120900237

    View details for PubMedID 15101067

  • Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy PSYCHOLOGICAL BULLETIN Jacobi, C., Hayward, C., de Zwaan, M., Kraemer, H. C., Agras, W. S. 2004; 130 (1): 19-65

    Abstract

    The aims of the present review are to apply a recent risk factor approach (H. C. Kraemer et al., 1997) to putative risk factors for eating disorders, to order these along a timeline, and to deduce general taxonomic questions. Putative risk factors were classified according to risk factor type, outcome (anorexia nervosa, bulimia nervosa, binge-eating disorder, full vs. partial syndromes), and additional factor characteristics (specificity, potency, need for replication). Few of the putative risk factors were reported to precede the onset of the disorder. Many factors were general risk factors; only few differentiated between the 3 eating disorder syndromes. Common risk factors from longitudinal and cross-sectional studies were gender, ethnicity, early childhood eating and gastrointestinal problems, elevated weight and shape concerns, negative self-evaluation, sexual abuse and other adverse experiences, and general psychiatric morbidity. Suggestions are made for the conceptualization of future risk factor studies.

    View details for DOI 10.1037/0033-2909.130.1.19

    View details for Web of Science ID 000187852600002

    View details for PubMedID 14717649

  • Participant recruitment for an anorexia nervosa treatment study INTERNATIONAL JOURNAL OF EATING DISORDERS McDermott, C., Agras, W. S., Crow, S. J., Halmi, K., Mitchell, J. E., Bryson, S. 2004; 35 (1): 33-41

    Abstract

    To investigate the nature of differing recruitment rates for clinical treatment trials for anorexia nervosa and bulimia nervosa.Recruitment rates from a study recruiting women partially recovered from anorexia nervosa were compared with the rates from two studies conducted at the same sites recruiting women with bulimia nervosa.At all sites in the anorexia study, the total number of contacts per month rose steadily over the first 2 years of the recruitment phase then decreased to near zero with the number of participants randomized to the study practically evaporating. In contrast, the bulimia studies screened a larger group of contacts and met monthly randomization goals in the time allotted for recruitment. Participants eligible for a study but with a barrier to participation occurred at a much higher rate in the anorexia study than in the bulimia studies.These results reveal a difficulty in planning recruitment from a small population such as partially recovered anorexics. A small population's total pool size diminishes faster than it is replenished, suggesting that future studies of anorexia nervosa may recruit more successfully from many sites in a short period rather than at a few sites over a long period.

    View details for DOI 10.1002/eat.10231

    View details for Web of Science ID 000187798700005

    View details for PubMedID 14705155

  • The clinical significance of binge eating disorder INTERNATIONAL JOURNAL OF EATING DISORDERS Wilfley, D. E., Wilson, G. T., Agras, W. S. 2003; 34: S96-S106

    Abstract

    Current controversy exists regarding the status of binge eating disorder (BED) as a diagnostic entity. A critique of the literature is provided to address the question of whether BED represents a clinically significant syndrome.The scientific evidence is considered through addressing five questions that are key in evaluating the clinical utility of any mental disorder.Individuals with BED meaningfully differ from individuals without eating disorders, and share important similarities to, yet are distinct from, individuals with anorexia nervosa (AN) and bulimia nervosa (BN). BED is associated with co-occurring physical and mental illnesses, as well as impaired quality of life and social functioning. Questions about the course of the disorder and the optimal treatment regimen for the syndrome need to be explored further.BED's distinctive combination of core eating disorder psychopathology, and other co-occurring physical and psychiatric conditions, impaired psychosocial functioning, and overweight constitute an eating disorder of clinical severity and a significant public health problem.

    View details for DOI 10.1002/eat.10209

    View details for Web of Science ID 000184587900010

    View details for PubMedID 12900990

  • Behavioral validation, precursors, and concomitants of picky eating in childhood JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Jacobi, C., Agras, W. S., Bryson, S., Hammer, L. D. 2003; 42 (1): 76-84

    Abstract

    To validate the concept of parent-reported picky eating using objective, laboratory-based measures and to identify both child and parental precursors and concomitants of picky eating.One hundred thirty-five infants were monitored from birth to 5.5 years. Behavioral measures of picky eating were obtained from standardized feedings at ages 3.5 and 5.5 years in the laboratory and at home. Child precursors were measures of infant sucking behavior; parental precursors were disinhibition of eating, restrained eating, body dissatisfaction, and body mass index. Parentally reported attitudes and behaviors thought to be related to pickiness and parental concomitants were taken from the Stanford Feeding Questionnaire. Child Temperament was assessed by the Children's Behavior Questionnaire.Picky eaters ate fewer foods and were especially more likely to avoid vegetables. Picky girls decreased their caloric intake between ages 3.5 and 5.5, whereas all other children increased their caloric intake. None of the included parental precursors was significantly related to pickiness. Picky eaters demonstrated a different sucking pattern with fewer sucks per feeding session at weeks 2 and 4. Finally, picky children displayed more parent-reported negative affect than nonpicky children.Parentally reported picky eating is associated with a consistent pattern of inhibited and selective eating beginning in infancy.

    View details for DOI 10.1097/01.CHI.0000024900.60748.2F

    View details for Web of Science ID 000180030000013

    View details for PubMedID 12500079

  • Full syndromal versus subthreshold anorexia nervosa, bulimia nervosa, and binge eating disorder: A multicenter study INTERNATIONAL JOURNAL OF EATING DISORDERS Crow, S. J., Agras, W. S., Halmi, K., Mitchell, J. E., Kraemer, H. C. 2002; 32 (3): 309-318

    Abstract

    The diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) establish symptom severity levels, which are used to separate full cases from partial cases. However, the value of these distinctions is unclear.Three hundred eighty-five women with full or partial AN, BN, or BED were assessed at entry into a longitudinal study of eating disorders.Stepwise discriminant analysis revealed that full and partial BN were discriminated by the Yale-Brown-Cornell Eating Disorders Scale total scores (kappa =.46). However, it was not possible to discriminate between full and partial AN or BED. Discriminant analysis also demonstrated clear differences between full AN, BN, and BED.Full BN can be differentiated from partial BN by more severe eating disorder symptoms, whereas both full and partial AN and full and partial BED appear quite similar. These results emphasize the distinct nature of AN, BN, and BED, as well as the similarities between full and partial cases.

    View details for DOI 10.1002/eat.10088

    View details for Web of Science ID 000177666100006

    View details for PubMedID 12210645

  • Predictors of relapse following successful dialectical behavior therapy for binge eating disorder INTERNATIONAL JOURNAL OF EATING DISORDERS Safer, D. L., Lively, T. J., Telch, C. F., Agras, W. S. 2002; 32 (2): 155-163

    Abstract

    To identify predictors of relapse at 6-month follow-up for women with binge eating disorder (BED).Participants were 32 women with BED who had initially achieved abstinence from binge eating after 20 weeks of dialectical behavior therapy (DBT) adapted for patients with BED. Posttreatment predictor variables included the subscales Restraint, Weight Concerns, and Shape Concerns from the Eating Disorders Examination (EDE), the Emotional Eating Scale score, the Rosenberg Self-Esteem Scale, body mass index, and early versus late age of binge eating onset.The largest effect sizes for predicting relapse were found with early onset of binge eating and higher EDE Restraint scores.Previous findings that earlier age of onset (age 16 years or younger) is linked to less successful treatment outcome are now extended to the 6-month follow-up assessment. The finding that higher restraint scores after treatment predict relapse adds to the literature concerning the role of restraint in patients with BED.

    View details for DOI 10.1002/eat.10080

    View details for Web of Science ID 000177207600004

    View details for PubMedID 12210657

  • Cognitive-behavioral therapy for bulimia nervosa: Time course and mechanisms of change JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Wilson, G. T., Fairburn, C. C., Agras, W. S., Walsh, B. T., Kraemer, H. 2002; 70 (2): 267-274

    Abstract

    Cognitive-behavioral therapy (CBT) is an effective treatment of bulimia nervosa, but its mechanisms of action have not been established. In this study the authors analyzed the results of a randomized control trial comparing CBT with Interpersonal Psychotherapy (IPT) to identify possible mediators of change of CBT for BN and its time course of action. Reduction in dietary restraint as early as Week 4 mediated posttreatment improvement in both binge eating and vomiting. Measures of self-efficacy concerning eating behavior, negative affect, and body shape and weight at midtreatment were also significantly associated with posttreatment outcome at 20 weeks. No evidence was found that the therapeutic alliance mediated treatment outcome. CBT had a significantly more rapid treatment effect than IPT, with 62% of posttreatment improvement evident by Week 6.

    View details for DOI 10.1037//0022-006X.70.2.267

    View details for Web of Science ID 000174805100001

    View details for PubMedID 11952185

  • Dialectical behavior therapy for binge eating disorder JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Telch, C. F., Agras, W. S., Linehan, M. M. 2001; 69 (6): 1061-1065

    Abstract

    This study evaluated the use of dialectical behavior therapy (DBT) adapted for binge eating disorder (BED). Women with BED (N = 44) were randomly assigned to group DBT or to a wait-list control condition and were administered the Eating Disorder Examination in addition to measures of weight, mood, and affect regulation at baseline and posttreatment. Treated women evidenced significant improvement on measures of binge eating and eating pathology compared with controls, and 89% of the women receiving DBT had stopped binge eating by the end of treatment. Abstinence rates were reduced to 56% at the 6-month follow-up. Overall, the findings on the measures of weight, mood, and affect regulation were not significant. These results support further research into DBT as a treatment for BED.

    View details for DOI 10.1037//0022-006X.69.6.1061

    View details for Web of Science ID 000172841500020

    View details for PubMedID 11777110

  • Early body mass index and other anthropometric relationships between parents and children INTERNATIONAL JOURNAL OF OBESITY Safer, D. L., Agras, W. S., Bryson, S., Hammer, L. D. 2001; 25 (10): 1532-1536

    Abstract

    To assess longitudinally the relationship between measures of adiposity in children over the first 8 y of life with that of their parents and to explore the role of parental adiposity in the development of childhood adiposity.Longitudinal study of measures of adiposity in children.A community sample from three health service systems including 114 children followed annually from infancy to age 8 and their 228 biological parents.Measurements were assessed at baseline for parents (6 months post-partum for mothers) and at regular intervals for children beginning at age 2 months. Measurements included weight, height, triceps skinfold, subscapular skinfold, midarm circumference, waist and hip.The major findings were: (1) significant correlations between parental body mass index (BMI), both maternal and paternal, and their biological offspring first emerged at age 7; (2) children with two overweight parents had consistently elevated BMI compared to children with either no overweight parents or one overweight parent. These differences became significant beginning at age 7.This study supports the hypothesis that familial factors (biological and/or environmental) affecting the development of adiposity emerge at specific ages and are related to the adiposity of both parents.

    View details for Web of Science ID 000171515800021

    View details for PubMedID 11673777

  • Subtyping binge eating-disordered women along dieting and negative affect dimensions INTERNATIONAL JOURNAL OF EATING DISORDERS Stice, E., Agras, W. S., Telch, C. F., HALMI, K. A., Mitchell, J. E., Wilson, T. 2001; 30 (1): 11-27

    Abstract

    Because etiologic and maintenance models of binge eating center around dieting and affect regulation, this study tested whether binge eating-disordered (BED) individuals could be subtyped along dieting and negative affect dimensions and whether subtypes differed in eating pathology, social functioning, psychiatric comorbidity, and response to treatment.Three independent samples of interviewer-diagnosed BED women (N = 218) were subtyped along dieting and negative affect dimensions using cluster analysis and compared on the outcomes of interest.Cluster analyses replicated across the three independent samples and revealed a dietary subtype (63%) and a dietary-depressive subtype (37%). The latter subtype reported greater eating and weight obsessions, social maladjustment, higher lifetime rates of mood, anxiety, and personality disorders, and poorer response to treatment than did the dietary subtype.Results suggest that moderate dieting is a central feature of BED and that affective disturbances occur in only a subset of cases. However, the confluence of dieting and negative affect signals a more severe variant of the disorder marked by elevated psychopathology, impaired social functioning, and a poorer treatment response.

    View details for Web of Science ID 000169077300002

    View details for PubMedID 11439405

  • Practice guidelines for eating disorders BEHAVIOR THERAPY Wilson, G. T., Agras, W. S. 2001; 32 (2): 219-234
  • Predicting children's reported eating disturbances at 8 years of age JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Jacobi, C., Agras, W. S., Hammer, L. 2001; 40 (3): 364-372

    Abstract

    To examine differential parental influences on eating attitudes and behaviors of 8-year-old children with a specific focus on gender effects and to assess the specificity of this relationship.One hundred eight infants were monitored from birth and interviewed at age 8 for eating disturbances and negative affect with an adaptation of the McKnight Risk Factor Survey. Parental measures included the Three Factor Eating Questionnaire subscales Disinhibition and Restraint as well as body mass index, assessed at study entry.No gender differences were found for frequencies of children's self-reported eating disturbances. Higher maternal restraint scores predicted worries about being too fat in girls but not in boys. Higher maternal disinhibition scores also differentially predicted weight control behaviors in their daughters. Negative affect in the child was (weakly) predicted by higher maternal body mass index. No association between paternal predictors of disturbed eating and the child's eating disturbances and negative emotionality was found.The impact of maternal eating disorders and disturbances is much stronger than that of fathers and is specifically directed at their daughters. The clinical importance of these disturbances in terms of precursors of adolescent eating disorders has to be determined by monitoring the sample through puberty.

    View details for Web of Science ID 000167200000017

    View details for PubMedID 11288779

  • Perfectionism in women with binge eating disorder INTERNATIONAL JOURNAL OF EATING DISORDERS Pratt, E. M., Telch, C. F., Labouvie, E. W., Wilson, G. T., Agras, W. S. 2001; 29 (2): 177-186

    Abstract

    This study examined self-oriented (SOP), socially prescribed (SPP), and other-oriented (OOP) perfectionism in 127 obese women with binge eating disorder (BED).Relationships between eating disorder and general psychopathology variables and SOP, SPP, and OOP were assessed. Levels of SOP, SPP, and OOP in the BED sample were compared with those of 32 normal weight women with bulimia nervosa (BN) and 60 obese non-eating-disordered individuals (NED). Structural equation modeling (SEM) was used to test models of the maintenance of BED.Only SPP was significantly associated with eating disorder variables related to BED. All three groups demonstrated similar levels of SPP and OOP. BN and BED groups scored significantly higher than the NED group on SOP only. SEM resulted in two models with good fits.Further research is needed on the roles of SPP and SOP in BED and on weight and shape overconcern in BED maintenance models.

    View details for Web of Science ID 000166971300008

    View details for PubMedID 11429980

  • The development of behavioral medicine HISTORY OF THE BEHAVIORAL THERAPIES: FOUNDERS' PERSONAL HISTORIES Agras, W. S. 2001: 219-232
  • Test-retest reliability of the eating disorder examination INTERNATIONAL JOURNAL OF EATING DISORDERS Rizvi, S. L., Peterson, C. B., Crow, S. J., Agras, W. S. 2000; 28 (3): 311-316

    Abstract

    The purpose of this investigation was to determine the test-retest reliability of the Eating Disorder Examination (EDE).This study examined the test-retest and interrater reliability of the EDE in 20 adult women with a range of eating disorder symptoms. Trained assessors administered the EDE to participants on two separate occasions, ranging from 2 to 7 days apart.Test-retest correlations were.7 or greater for all subscales and measures of eating disorder behaviors except for subjective bulimic episodes and subjective bulimic days. Interrater reliability was uniformly high with correlations above.9.Results provide further support for the reliability of the EDE, but suggest that smaller binge episodes may not be reliable indicators of eating pathology.

    View details for Web of Science ID 000088936300008

    View details for PubMedID 10942917

  • Fluoxetine for bulimia nervosa following poor response to psychotherapy AMERICAN JOURNAL OF PSYCHIATRY Walsh, B. T., Agras, W. S., Devlin, M. J., Fairburn, C. G., Wilson, G. T., Kahn, C., Chally, M. K. 2000; 157 (8): 1332-1334

    Abstract

    This was an investigation of whether treatment with fluoxetine is useful for individuals with bulimia nervosa who do not respond to psychotherapy or relapse afterward.Twenty-two patients with bulimia nervosa who had not responded to, or had relapsed following, a course of cognitive behavior therapy or interpersonal psychotherapy were randomly assigned to receive placebo (N=9) or fluoxetine (60 mg/day, N=13) for 8 weeks.The median frequency of binge eating in the previous 28 days declined from 22 to four episodes in the fluoxetine group but increased from 15 to 18 episodes in the placebo group. Similarly, purging frequency in the previous 28 days declined from 30 to six episodes in the fluoxetine group but increased from 15 to 38 episodes in the placebo group.Fluoxetine may be a useful intervention for patients with bulimia nervosa who have not responded adequately to psychological treatment.

    View details for Web of Science ID 000088520100026

    View details for PubMedID 10910801

  • Outcome predictors for the cognitive behavior treatment of bulimia nervosa: Data from a multisite study AMERICAN JOURNAL OF PSYCHIATRY Agras, W. S., Crow, S. J., HALMI, K. A., Mitchell, J. E., Wilson, G. T., Kraemer, H. C. 2000; 157 (8): 1302-1308

    Abstract

    The aim of this study was to discover clinically useful predictors of attrition and outcome in the treatment of bulimia nervosa with cognitive behavior therapy.Pretreatment, course of treatment, and outcome data were gathered on 194 women meeting the DSM-III-R criteria for bulimia nervosa who were treated with 18 sessions of manual-based cognitive behavior therapy in a three-site study. Differences between dropouts and nondropouts and between recovered and nonrecovered participants were first examined descriptively, and signal detection analyses were then used to determine clinically significant cutoff points predicting attrition and abstinence.The dropouts were characterized by more severe bulimic cognitions and greater impulsivity, but it was not possible to identify clinically useful predictors. The participants with treatment failures were characterized by poor social adjustment and a lower body mass index, presumably indicating greater dietary restriction. However, early progress in therapy best predicted outcome. Signal detection analyses revealed that poor outcome was predicted by a reduction in purging of less than 70% by treatment session 6, allowing identification of a substantial proportion of prospective failures.A cutoff point based on reduction of purging by session 6 usefully differentiates patients who will and will not respond to cognitive behavior therapy for bulimia nervosa, potentially allowing early use of a second therapy.

    View details for Web of Science ID 000088520100020

    View details for PubMedID 10910795

  • Group Dialectical Behavior Therapy for binge-eating disorder: A preliminary, uncontrolled trial BEHAVIOR THERAPY Telch, C. F., Agras, W. S., Linehan, M. M. 2000; 31 (3): 569-582
  • A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa ARCHIVES OF GENERAL PSYCHIATRY Agras, W. S., Walsh, B. T., Fairburn, C. G., Wilson, G. T., Kraemer, H. C. 2000; 57 (5): 459-466

    Abstract

    Research suggests that cognitive-behavioral therapy (CBT) is the most effective psychotherapeutic treatment for bulimia nervosa. One exception was a study that suggested that interpersonal psychotherapy (IPT) might be as effective as CBT, although slower to achieve its effects. The present study is designed to repeat this important comparison.Two hundred twenty patients meeting DSM-III-R criteria for bulimia nervosa were allocated at random to 19 sessions of either CBT or IPT conducted over a 20-week period and evaluated for 1 year after treatment in a multisite study.Cognitive-behavioral therapy was significantly superior to IPT at the end of treatment in the percentage of participants recovered (29% [n=32] vs 6% [n=71), the percentage remitted (48% [n=53] vs 28% [n = 31]), and the percentage meeting community norms for eating attitudes and behaviors (41% [n=45] vs 27% [n=30]). For treatment completers, the percentage recovered was 45% (n= 29) for CBT and 8% (n= 5) for IPT. However, at follow-up, there were no significant differences between the 2 treatments: 26 (40%) CBT completers had recovered at follow-up compared with 17 (27%) IPT completers.Cognitive-behavioral therapy was significantly more rapid in engendering improvement in patients with bulimia nervosa than IPT. This suggests that CBT should be considered the preferred psychotherapeutic treatment for bulimia nervosa.

    View details for Web of Science ID 000086927500005

    View details for PubMedID 10807486

  • Dissonance prevention program decreases thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms: A preliminary experiment INTERNATIONAL JOURNAL OF EATING DISORDERS Stice, E., Mazotti, L., Weibel, D., Agras, W. S. 2000; 27 (2): 206-217

    Abstract

    Because psychoeducational primary prevention programs for eating disorders have met with little success, this preliminary experiment tested a dissonance-based targeted preventive intervention.Female undergraduates (N = 30) with elevated body image concerns were assigned to a three-session intervention, wherein they voluntarily argued against the thin ideal, or a delayed-intervention control condition. Participants completed a baseline, termination, and a 1-month follow-up survey.The intervention resulted in a subsequent decrease in thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptomatology, with most changes remaining at the 1-month follow-up.These preliminary results suggest that this dissonance-based targeted prevention intervention reduces bulimic pathology and known risk factors for eating disturbances, and provide experimental support for the claim that thin-ideal internalization contributes to body dissatisfaction, dieting, negative affect, and bulimic symptoms.

    View details for Web of Science ID 000085402800009

    View details for PubMedID 10657894

  • Subtyping bulimic women along dietary restraint and negative affect dimensions JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Stice, E., Agras, W. S. 1999; 67 (4): 460-469

    Abstract

    Etiologic models of bulimia center on dieting and negative affect, yet no research has subtyped bulimic individuals according to whether they fit dietary versus negative affect profiles. This study subtyped 265 bulimic women along dieting and depressive dimensions and tested whether subtypes showed differences in eating pathology, clinical correlates, and treatment response. Cluster analysis revealed a pure dietary subtype (62%) and a mixed dietary-depressive subtype (38%). Whereas dietary and dietary-depressive bulimic women showed similar levels of bulimic behaviors, the latter reported more eating and weight obsessions; social maladjustment; higher rates of mood, anxiety, eating, impulse control, and personality disorders; and poorer treatment response. Results suggest dieting is a central feature of bulimia, but depressive affect occurs in only a subset of cases. However, the combination of dieting and depressive affect seems to signal a more severe variant of bulimia.

    View details for Web of Science ID 000081881900002

    View details for PubMedID 10450616

  • Can mothers influence their child's eating behavior? JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Drucker, R. R., Hammer, L. D., Agras, W. S., Bryson, S. 1999; 20 (2): 88-92

    Abstract

    This study examined the relationship between general maternal parenting style, maternal eating cues, and a child's eating behavior during mealtime. We expected that the general style would relate to the number of specific eating cues and that mothers who used more eating prompts would have children that ate more and at a faster rate. Seventy-seven children (39 girls, 38 boys), aged 3.5 years, visited the laboratory with their mothers for a videotaped lunch. Videotapes of each laboratory visit were coded for the child's eating rate and maternal parenting style, which was measured as the level of maternal control and support and the number and type of eating prompts given during a meal. Caloric intake was also calculated. The number and rate of verbal and physical encouragements and discouragements were significantly related to measures of general maternal parenting style and meal duration. The rates of food offers, food presentations, and total prompts were all significantly related to the child's rate of calorie intake. However, a mother's level of support or control was not related to the child's eating behavior. Although general maternal parenting style did not predict the child's eating behavior, these behaviors were related to the frequency of maternal eating prompts, which in turn were significantly related to the number of calories eaten and the time spent eating by the child. Children who ate the fastest had mothers who delivered eating prompts at a higher frequency. These findings may have implications for the development of obesity later in childhood, as a function of rapid eating or of poor self-regulation.

    View details for Web of Science ID 000079667500003

    View details for PubMedID 10219686

  • Development of feeding practices during the first 5 years of life ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Hammer, L. D., Bryson, S., Agras, W. S. 1999; 153 (2): 189-194

    Abstract

    To understand the transition from breast-and bottle-feeding to solid-feeding and factors that might affect the duration of breast- and bottle-feeding.Cohort followed up from birth with relatively well-educated, middle-class parents.Community sample recruited from 3 suburban newborn nurseries (a teaching hospital, community hospital, and large health maintenance organization).One hundred ninety-one healthy full-term infants.Assessment of feeding practices through the ages of complete weaning from breast- and bottle-feeding.More than 90% of participants breast-fed for at least 2 weeks. Infants of older mothers were weaned from the breast later than infants of younger mothers. First-born infants were weaned from the breast earlier than later-born infants. Eighty-four percent of infants bottle-fed at some time during the first year of life. More than 40% of the cohort was still receiving bottles at 24 months of age, 16% at 36 months, and 8% at 48 months. The duration of breast- and bottle-feeding was related to maternal work status; mothers who returned to work during the first 3 months postpartum weaned sooner from the breast and later from the bottle than women who returned to work after 3 months postpartum.The frequency of late bottle-weaning in this well-educated, middle-class cohort was unexpected and was related to the timing of the mother's return to work. The impact of prolonged bottle-feeding on later growth and adiposity deserves further investigation.

    View details for Web of Science ID 000078473900012

    View details for PubMedID 9988250

  • Cognitive-behavioral therapy for the eating disorders PSYCHOTHERAPY INDICATIONS AND OUTCOMES Agras, W. S. 1999: 197-210
  • Does the size of a binge matter? INTERNATIONAL JOURNAL OF EATING DISORDERS Pratt, E. M., Niego, S. H., Agras, W. S. 1998; 24 (3): 307-312

    Abstract

    The aim of this study was to examine whether objective and subjective binges differ significantly from each other in relation to measures of psychopathology in a sample of women who meet DSM-IV diagnostic criteria for bulimia nervosa.Baseline data from the Eating Disorder Examination (EDE) were analyzed and the average of the sum of and the difference between objective and subjective binge episodes were converted to z scores. Regressions were run with other baseline measures including the Structured Clinical Interview for Diagnosis of DSM-III-R (SCID) I and II disorders, EDE subscales, and psychological measures.We found no significant difference between the two types of binges on all but one measure, the "Can Do" subscale of the Self-Efficacy Questionnaire, in a regression with the z score of total binges.The lack of significant findings questions the diagnostic validity of the "large amount of food" criterion used to define binge eating in the DSM-IV.

    View details for Web of Science ID 000075518600008

    View details for PubMedID 9741041

  • The effects of caloric deprivation and negative affect on binge eating in obese binge-eating disordered women BEHAVIOR THERAPY Agras, W. S., Telch, C. F. 1998; 29 (3): 491-503
  • Predicting onset and cessation of bulimic behaviors during adolescence: A longitudinal grouping analysis BEHAVIOR THERAPY Stice, E., Agras, W. S. 1998; 29 (2): 257-276
  • Subjective or objective binge: Is the distinction valid? INTERNATIONAL JOURNAL OF EATING DISORDERS Niego, S. H., Pratt, E. M., Agras, W. S. 1997; 22 (3): 291-298

    Abstract

    The aim of this study was to examine the validity of the distinction between objective and subjective binge episodes.Data were analyzed from 101 women who received 12 weeks of cognitive-behavioral therapy (CBT) for binge eating in a previous treatment study. Binges recorded by participants on daily food records were rated as either subjective or objective according to the Eating Disorder Examination rating guidelines. Unpaired t tests were performed to determine the relationship between type of binge, psychopathology, and other descriptive measures, including response to treatment.These analyses revealed no significant differences between types of binge episodes. Of note is the observation that objective binge episodes appeared to decrease more rapidly than subjective episodes during treatment.Future research should continue to investigate whether "large amount of food" is an appropriate criterion for the diagnosis of binge eating.

    View details for Web of Science ID A1997XT53100008

    View details for PubMedID 9285266

  • The effects of extending cognitive-behavioral therapy for binge eating disorder among initial treatment nonresponders INTERNATIONAL JOURNAL OF EATING DISORDERS Eldredge, K. L., Agras, W. S., Arnow, B., Telch, C. F., Bell, S., Castonguay, L., Marnell, M. 1997; 21 (4): 347-352

    Abstract

    The study was designed with the aim of determining whether extending group cognitive-behavioral therapy (CBT) would enhance outcome among individuals with binge eating disorder (BED) who failed to stop binge eating after an initial 12-week CBT intervention.Forty-six participants who met diagnostic criteria for BED were randomly allocated to either a 12-week group CBT intervention or a waiting list control condition. At the end of 12 weeks, treated participants who met clinical criteria for improvement subsequently received 12 sessions of behavioral weight loss. Remaining participants received 12 additional sessions of CBT for binge eating.Fifty percent of treated participants improved with the initial 12-week course of CBT. There was a strong trend for the extension of CBT to affect improvement in binge eating among initial nonresponders (6 of 14 subjects no longer met diagnostic criteria for BED). Overall, extending CBT led to clinical improvement in 66.7% of all treated participants, with treatment gains occurring through session 20.The results suggest that an extended course of CBT (i.e., longer than 12 weeks) will likely maximize the number of potential responders to treatment.

    View details for Web of Science ID A1997WV96800007

    View details for PubMedID 9138046

  • One-year follow-up of cognitive-behavioral therapy for obese individuals with binge eating disorder JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Agras, W. S., Telch, C. F., Arnow, B., Eldredge, K., Marnell, M. 1997; 65 (2): 343-347

    Abstract

    The results of a 1-year posttreatment follow-up of 93 obese women diagnosed as having binge eating disorder (BED) and treated with group cognitive-behavioral therapy (CBT) followed by weight loss treatment are described. The group as a whole maintained both reductions in binge eating and abstinence rates fairly well. However, they regained the weight lost during treatment. Those who stopped binge eating during CBT maintained a weight loss of 4.0 kg over the follow-up period. In contrast, those who continued to binge gained 3.6 kg. Twenty-six percent of those abstinent after CBT met criteria for BED at follow-up and had gained weight, whereas the remaining 74% had lost weight. Stopping binge eating appears critical to sustained weight loss in BED.

    View details for Web of Science ID A1997WP24900019

    View details for PubMedID 9086701

  • Pharmacotherapy of bulimia nervosa and binge eating disorder: Longer-term outcomes PSYCHOPHARMACOLOGY BULLETIN Agras, W. S. 1997; 33 (3): 433-436

    Abstract

    The longer-term effects of antidepressant medication, with and without the addition of psychotherapy, for the treatment of bulimia nervosa and binge eating disorder are reviewed. The use of a single antidepressant agent results in recovery of about 25 percent of patients entering treatment; continued treatment is accompanied by relapse in about one-third of these patients. Substituting one or more antidepressants for the initial agent in patients who fail to improve or cannot tolerate side effects improves long-term maintenance. Adding cognitive-behavioral therapy (CBT) may prevent relapse once medication is discontinued, and the combination of CBT and antidepressant treatment is more effective than a single medication. There is also evidence that antidepressant treatment combined with CBT is more effective than placebo plus CBT. The problem of how to sequence medication and CBT has not been resolved, although a recent study demonstrating that pharmacotherapy is more cost-effective than CBT suggests that treatment might begin with medication.

    View details for Web of Science ID A1997XZ32800016

    View details for PubMedID 9550889

  • The aversiveness of specific emotional states associated with binge-eating in obese subjects AUSTRALIAN AND NEW ZEALAND JOURNAL OF PSYCHIATRY Kenardy, J., Arnow, B., Agras, W. S. 1996; 30 (6): 839-844

    Abstract

    The aim of this study was to examine the hypothesis that non-purge-related binge-eating in obesity is maintained by a 'trade-off' in which a highly aversive emotional state is exchanged for a less aversive state.Ninety-eight obese binge-eaters meeting the DSM-IV criteria for binge-eating disorder were contrasted with 65 non-binge-eating controls on their perceived distress associated with negative mood states usually experienced before and after binges.Binge-eaters reported significantly greater distress and lower tolerance of negative mood compared to controls. Furthermore, when compared with controls, binge-eaters reported that emotions typically reported before binges (e.g. anger) were more aversive than those reported after (e.g. guilt).These results were interpreted as supporting the 'trade-off' theory and have implications for the treatment of binge-eating disorder.

    View details for Web of Science ID A1996WC06500020

    View details for PubMedID 9034475

  • Do emotional states influence binge eating in the obese? INTERNATIONAL JOURNAL OF EATING DISORDERS Telch, C. F., Agras, W. S. 1996; 20 (3): 271-279

    Abstract

    The purpose of this experimental investigation was to test the hypothesis that negative affective states trigger disinhibited eating in the form of binge eating in subjects with binge eating disorder (BED).BED subjects and weight-matched non-eating disordered subjects (NED) attended a laboratory experiment during which they were randomly assigned to a negative or neutral mood induction procedure prior to being served a multi-item buffet. The dependent variable of interest was postmood induction caloric intake.There were no significant differences in caloric intake between subjects in the negative and neutral mood conditions. However, negative affect was associated with eating episodes labeled binges, and associated with loss of control.Our findings suggest that mood may be an important factor that discriminates overeating and binge eating.

    View details for Web of Science ID A1996VP66500006

    View details for PubMedID 8912039

  • The effects of short-term food deprivation on caloric intake in eating-disordered subjects APPETITE Telch, C. F., Agras, W. S. 1996; 26 (3): 221-233

    Abstract

    The primary aim of this experimental investigation was to examine the effects of short-term dietary restriction on caloric consumption in eating disordered subjects. Subjects with bulimia nervosa, binge eating disorder, and overweight non-eating disordered subjects, attended a laboratory experiment during which they were randomly assigned to either a 1 h or a 6 h food deprivation condition prior to being served a multi-item buffet. The primary measure of interest was calories consumed during the laboratory experiment. Subjects deprived of food for 6 h consumed significantly more calories at the buffet compared to subjects in the 1 h food deprivation condition. However, caloric intake during the entire laboratory day was not affected by the experimental manipulation. Subjects in the longer deprivation condition apparently compensated at the buffet for the caloric restriction, but did not overcompensate.

    View details for Web of Science ID A1996UR39100002

    View details for PubMedID 8800479

  • Maintenance following a very-low-calorie diet JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Agras, W. S., Berkowitz, R. I., Arnow, B. A., Telch, C. F., Marnell, M., Henderson, J., Morris, Y., Wilfley, D. E. 1996; 64 (3): 610-613

    Abstract

    The authors posed 2 questions in this randomized study of maintenance procedures in which participants were followed for 15 months after completion of a very-low-calorie diet: Would stimulus narrowing during the reintroduction of solid food, achieved by the use of prepackaged foods, improve weight losses and the maintenance of those losses as compared with the use of regular food? Would reintroduction of foods dependent on progress in losing or maintaining weight be superior to reintroduction on a time-dependent basis? Neither the stimulus narrowing condition nor the reintroduction procedure enhanced either maximum weight loss or maintenance of those losses. The stimulus narrowing condition appeared to be poorly tolerated; compliance and attendance were poorer in this condition than in the regular food condition.

    View details for Web of Science ID A1996UU47000023

    View details for PubMedID 8698956

  • COMPARING THE COST-EFFECTIVENESS OF PSYCHIATRIC TREATMENTS - BULIMIA-NERVOSA PSYCHIATRY RESEARCH Koran, L. M., Agras, W. S., ROSSITER, E. M., Arnow, B., Schneider, J. A., Telch, C. F., Raeburn, S., Bruce, B., Perl, M., Kraemer, H. C. 1995; 58 (1): 13-21

    Abstract

    We conducted an exploratory post hoc study that compared the cost effectiveness of five treatments for bulimia nervosa: 15 weeks of cognitive behavioral therapy (CB) followed by three monthly sessions, 16 weeks (Med16) and 24 weeks (Med24) of desipramine (< or = 300 mg/day), and CB combined with desipramine for those durations (Combo16 and Combo24). We illustrate how a treatment's cost effectiveness varies according to when evaluation is done and how effectiveness and cost are defined. At 32 weeks, Med16 appears the most cost-effective treatment, and Combo16 appears the least. At 1 year, Med24 appears the most cost-effective treatment, and Combo16 appears the least. Using this post hoc analysis as an example, we discuss the pitfalls and limitations of cost-effectiveness analysis of psychiatric treatments.

    View details for Web of Science ID A1995RW58200002

    View details for PubMedID 8539308

  • GENERAL POPULATION-BASED EPIDEMIOLOGIC-STUDY OF EATING DISORDERS IN NORWAY INTERNATIONAL JOURNAL OF EATING DISORDERS Gotestam, K. G., Agras, W. S. 1995; 18 (2): 119-126

    Abstract

    In a questionnaire-based study of eating disorders in a representative sample of the general female population of Norway, the lifetime prevalence of eating disorders was 8.7% with a point prevalence of 3.8%. The lifetime prevalence of binge eating disorder (BED) was 3.2%, bulimia nervosa (BN) 1.6%, and anorexia nervosa (AN) 0.4%. Eating disorders not otherwise specified (EDNOS) had a lifetime prevalence of 3.0%. Point prevalence of BED was 1.5%, BN 0.7%, AN 0.3%, and EDNOS 1.3%.

    View details for Web of Science ID A1995RN63100002

    View details for PubMedID 7581413

  • THE EMOTIONAL EATING SCALE - THE DEVELOPMENT OF A MEASURE TO ASSESS COPING WITH NEGATIVE AFFECT BY EATING INTERNATIONAL JOURNAL OF EATING DISORDERS Arnow, B., Kenardy, J., Agras, W. S. 1995; 18 (1): 79-90

    Abstract

    The development of the Emotional Eating Scale (EES) is described. The factor solution replicated the scale's construction, revealing Anger/Frustration, Anxiety, and Depression subscales. All three subscales correlated highly with measures of binge eating, providing evidence of construct validity. None of the EES subscales correlated significantly with general measures of psychopathology. With few exceptions, changes in EES subscales correlated with treatment-related changes in binge eating. In support of the measure's discriminant efficiency, when compared with obese binge eaters, subscale scores of a sample of anxiety-disordered patients were significantly lower. Lack of correlation between a measure of cognitive restraint and EES subscales suggests that emotional eating may precipitate binge episodes among the obese independent of the level of restraint.

    View details for Web of Science ID A1995RE82800008

    View details for PubMedID 7670446

  • DOES INTERPERSONAL THERAPY HELP PATIENTS WITH BINGE-EATING DISORDER WHO FAIL TO RESPOND TO COGNITIVE-BEHAVIORAL THERAPY JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Agras, W. S., Telch, C. F., Arnow, B., Eldredge, K., Detzer, M. J., Henderson, J., Marnell, M. 1995; 63 (3): 356-360

    Abstract

    The aim of this quasi-experimental study was to examine the effectiveness of group interpersonal therapy (IPT) in treating overweight patients with binge eating disorder who did not stop binge eating after 12 weeks of group cognitive-behavioral therapy (CBT). Participants in this study were randomly allocated to either group CBT or to an assessment-only control group. After 12 weeks of treatment with CBT, 55% of participants met criteria for improvement and began 12 weeks of weight loss therapy, whereas the nonresponders began 12 weeks of group IPT. Over the 24-week period, participants who received treatment reduced binge eating and weight significantly more than the waiting-list control group. However, IPT led to no further improvement for those who did not improve with CBT. Predictors of poor outcome were early onset of, and more severe, binge eating.

    View details for Web of Science ID A1995RA10700004

    View details for PubMedID 7608347

  • Binge eating disorder: Current state and future directions CLINICAL PSYCHOLOGY REVIEW Castonguay, L. G., Eldredge, K. L., Agras, W. S. 1995; 15 (8): 865-890
  • THE LAST-SUPPER - EMOTIONAL DETERMINANTS OF PRETREATMENT WEIGHT FLUCTUATION OBESE BINGE EATERS INTERNATIONAL JOURNAL OF EATING DISORDERS Eldredge, K. L., Agras, W. S., Arnow, B. 1994; 16 (1): 83-88

    Abstract

    The tendency of some dieters to overeat and gain weight prior to beginning a diet is well known. We examined whether emotional variables might account for this phenomenon among a group of 86 obese individuals preparing to begin a treatment program for binge eating and weight loss. Whereas subjects' baseline mood state (anger, anxiety, and depression) did not influence pretreatment weight variability, the self-reported tendency to overeat in response to specific negative emotions had a significant influence. Specifically, subjects who characteristically overeat in response to anger and depression gained weight pretreatment, whereas subjects who overeat in response to anxiety lost weight. The findings are discussed in relation to the influence of specific cognitive and emotional responses to the prospect of dieting.

    View details for Web of Science ID A1994NU24300008

    View details for PubMedID 7920585

  • PSYCHOSOCIAL TREATMENT OF PHOBIA AND PANIC DISORDERS PSYCHIATRY-INTERPERSONAL AND BIOLOGICAL PROCESSES Zarate, R., Agras, W. S. 1994; 57 (2): 133-141

    Abstract

    Intervention packages combining cognitive restructuring techniques and exposure exercises have become the psychosocial treatments of choice for panic, agoraphobia, and social phobia. Exposure and related desensitization techniques are the treatment of choice for all variants of simple phobia. Combining psychotropic medication and cognitive-behavior therapy suggests strategies that offer new opportunities for increasing the number of individuals with anxiety disorders who can be effectively treated with a biobehavioral approach.

    View details for Web of Science ID A1994NX01700005

    View details for PubMedID 7938332

  • ONE-YEAR FOLLOW-UP OF PSYCHOSOCIAL AND PHARMACOLOGICAL TREATMENTS FOR BULIMIA-NERVOSA JOURNAL OF CLINICAL PSYCHIATRY Agras, W. S., ROSSITER, E. M., ARNOW, Telch, C. F., Raeburn, S. D., Bruce, B., Koran, L. M. 1994; 55 (5): 179-183

    Abstract

    This study examined the outcome 1-year posttreatment of the use of desipramine, cognitive-behavioral therapy (CBT), and their combination in the treatment of bulimia nervosa.Sixty-one patients meeting DSM-III-R criteria for bulimia nervosa were randomly assigned to one of five groups--desipramine (withdrawn at 16 or 24 weeks), CBT (18 sessions), or the combined treatment (18 sessions of CBT plus desipramine withdrawn at 16 or 24 weeks)--and were followed to 1-year posttreatment.At 1-year follow-up, both the combined 24-week treatment and CBT alone were significantly superior in reducing binge eating to desipramine given for 16 weeks. The combined treatment was also superior to 16 weeks of desipramine in reducing emotionally driven eating and dietary restraint. Only 18% (2 of 11) of those receiving 16 weeks of desipramine were free of binge eating and purging at follow-up compared with 78% (7 of 9) of those receiving the combined 24-week treatment. The other groups fell between these two extremes.With the exception of the group treated for 16 weeks with desipramine alone, maintenance of improvement appeared satisfactory with all the treatments. Since the poorest results were found with 16 weeks of desipramine treatment, this study suggests that desipramine should be continued for at least 24 weeks either alone or combined with CBT. The broadest gain in reducing the psychopathology associated with bulimia nervosa was found with the combined 24-week treatment.

    View details for Web of Science ID A1994NQ97600001

    View details for PubMedID 8071266

  • WEIGHT-LOSS, COGNITIVE-BEHAVIORAL, AND DESIPRAMINE TREATMENTS IN BINGE-EATING DISORDER - AN ADDITIVE DESIGN BEHAVIOR THERAPY Agras, W. S., Telch, C. F., Arnow, B., Eldredge, K., Wilfley, D. E., Raeburn, S. D., Henderson, J., Marnell, M. 1994; 25 (2): 225-238
  • Weight loss, cognitive-behavioral, and desipramine treatments in binge eating disorder. Behavior Therapy Agras WS, Telch CF, Arnow B, Eldredge K, Wilfley DE, Raeburn SD, Henderson J, Marnell M. 1994; 25: 209-238
  • OBESITY, BINGE-EATING AND PSYCHOPATHOLOGY - ARE THEY RELATED INTERNATIONAL JOURNAL OF EATING DISORDERS Telch, C. F., Agras, W. S. 1994; 15 (1): 53-61

    Abstract

    Obese female subjects with binge eating disorder BED; (N = 107) completed the Beck Depression Inventory, Symptom Checklist-90, Inventory of Interpersonal Problems, and Rosenberg Self-Esteem Scale. Subjects were divided into moderate or severe binger on the basis of scores on the Binge Eating Scale, and grouped into moderately or severely obese by performing a median split on their weights. Spearman correlational analyses were performed to determine the relationship between psychopathology and obesity and psychopathology and binge eating. Analyses of variance (ANOVAs) were then performed using scores on the psychological measures with subjects grouped both by severity of obesity and severity of binge eating. The results indicated that in our sample, obesity and scores on the measures of psychiatric symptomatology were unrelated. However, a significant positive relationship was found between binge eating severity and degree of psychiatric symptomatology. We suggest that binge eating may account for the observed relationship between obesity and psychopathology reported in previous studies. We discuss the importance of assessing BED when conducting research with obese individuals.

    View details for Web of Science ID A1994MN20100006

    View details for PubMedID 8124327

  • GROUP COGNITIVE-BEHAVIORAL THERAPY AND GROUP INTERPERSONAL PSYCHOTHERAPY FOR THE NONPURGING BULIMIC INDIVIDUAL - A CONTROLLED COMPARISON JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Wilfley, D. E., Agras, W. S., Telch, C. F., ROSSITER, E. M., Schneider, J. A., Cole, A. G., SIFFORD, L., Raeburn, S. D. 1993; 61 (2): 296-305

    Abstract

    This study evaluated the effectiveness of group cognitive-behavioral treatment (CBT) and group interpersonal psychotherapy (IPT) for binge eating. Fifty-six women with nonpurging bulimia were randomly assigned to 1 of 3 groups: CBT, IPT, or a wait-list control (WL). Treatment was administered in small groups that met for 16 weekly sessions. At posttreatment, both group CBT and group IPT treatment conditions showed significant improvement in reducing binge eating, whereas the WL condition did not. Binge eating remained significantly below baseline levels for both treatment conditions at 6-month and 1-year follow-ups. These data support the central role of both eating behavior and interpersonal factors in the understanding and treatment of bulimia.

    View details for Web of Science ID A1993KW45900016

    View details for PubMedID 8473584

  • THE EFFECTS OF A VERY-LOW-CALORIE DIET ON BINGE-EATING BEHAVIOR THERAPY Telch, C. F., Agras, W. S. 1993; 24 (2): 177-193
  • BINGE EATING IN FEMALES - A POPULATION-BASED INVESTIGATION INTERNATIONAL JOURNAL OF EATING DISORDERS Bruce, B., Agras, W. S. 1992; 12 (4): 365-373
  • STRESS TEST REACTIVITY IN PANIC DISORDER ARCHIVES OF GENERAL PSYCHIATRY Roth, W. T., MARGRAF, J., Ehlers, A., Taylor, C. B., Maddock, R. J., Davies, S., Agras, W. S. 1992; 49 (4): 301-310

    Abstract

    The psychological and physiological reactivity of 52 patients with panic disorder to mental arithmetic, cold pressor, and 5% carbon dioxide inhalation tests was compared with that of 26 age- and sex-matched normal subjects. In general, patients with panic disorder were neither more physiologically reactive to these stressors than normal subjects nor slower to recover from them, but they were tonically more anxious and much more likely to ask to stop carbon dioxide inhalation or to report panic attacks during this test. Patients who reported panic attacks (46%) had manifested greater anticipatory anxiety before the gas was delivered, accompanied with increased beta-adrenergic cardiac tone. Thus, anticipatory anxiety can be an important factor in panic provocation. Physiological measures varied greatly in their sensitivity to phasic or tonic anxiety. Carbon dioxide stimulated large increases in respiratory minute volume, but these increases were no greater for patients than for normal subjects.

    View details for Web of Science ID A1992HM91400006

    View details for PubMedID 1558464

  • BINGE EATING AMONG THE OBESE - A DESCRIPTIVE STUDY JOURNAL OF BEHAVIORAL MEDICINE Arnow, B., Kenardy, J., Agras, W. S. 1992; 15 (2): 155-170

    Abstract

    Nineteen obese females applying for treatment for binge eating were administered a semistructured interview assessing the presence or absence of food restrictions, thoughts, feelings and physical sensations associated with binges, typical precipitants to binges, and factors identified as useful in avoiding binge eating. Both negative mood and abstinence violations emerged as important precipitants. The results also suggested that these precipitants constitute separate, independent pathways to binge eating. Implications of these findings with respect to restraint theory are discussed.

    View details for Web of Science ID A1992HR49400004

    View details for PubMedID 1583679

  • THE FUTURE OF BEHAVIOR-THERAPY PSYCHOTHERAPY Wilson, G. T., Agras, W. S. 1992; 29 (1): 39-43
  • THE EATING PATTERNS OF NON-PURGING BULIMIC SUBJECTS INTERNATIONAL JOURNAL OF EATING DISORDERS ROSSITER, E. M., Agras, W. S., Telch, C. F., Bruce, B. 1992; 11 (2): 111-120
  • IMIPRAMINE AND ALPRAZOLAM EFFECTS ON STRESS TEST REACTIVITY IN PANIC DISORDER BIOLOGICAL PSYCHIATRY Roth, W. T., MARGRAF, J., Ehlers, A., Haddad, J. M., Maddock, R. J., Agras, W. S., Taylor, C. B. 1992; 31 (1): 35-51

    Abstract

    The reactivity of 40 panic disorder patients on mental arithmetic, cold pressor, and 5% CO2 inhalation stressors was tested before and after 8 weeks of treatment with imipramine, alprazolam, or placebo. Mean levels of subjective and physiological stress measures were compared during a baseline before any stressors were given, and at anticipation, stressor, and recovery periods for each stressor. After treatment, imipramine patients differed from the other two treatment groups on the prestressor baseline in showing higher systolic blood pressure (mean difference about 10 mmHg), higher diastolic blood pressure (10 mm Hg), higher heart rate (15 bpm), less respiratory sinus arrhythmia, shorter pulse transit time, and lower T-wave amplitude. Respiratory measures, electrodermal measures, body movement, and self-reported anxiety and excitement did not distinguish the groups. Reactivity to the stress tests was unaffected by the medications, but tonic differences present in the baseline persisted.

    View details for Web of Science ID A1992GX47400004

    View details for PubMedID 1543796

  • PHARMACOLOGICAL AND COGNITIVE-BEHAVIORAL TREATMENT FOR BULIMIA-NERVOSA - A CONTROLLED COMPARISON AMERICAN JOURNAL OF PSYCHIATRY Agras, W. S., ROSSITER, E. M., Arnow, B., Schneider, J. A., Telch, C. F., Raeburn, S. D., Bruce, B., Perl, M., Koran, L. M. 1992; 149 (1): 82-87

    Abstract

    This study examined the relative effectiveness of desipramine, cognitive-behavioral therapy, and their combination in the treatment of bulimia nervosa, together with the effects of withdrawing medication after two different lengths of treatment.Seventy-one patients meeting DSM-III-R criteria for bulimia nervosa, recruited from an eating disorders clinic or by advertisements, were assigned at random to one of five groups: desipramine (withdrawn at 16 or 24 weeks), combined treatment (medication withdrawn at 16 or 24 weeks), and cognitive-behavioral therapy (15 sessions). All treatments were conducted individually in an outpatient clinic. The primary outcome measures were binge eating and purging rates assessed at pretreatment, 16, 24, and 32 weeks. The results were analyzed as three groups (medication, cognitive-behavioral therapy, and combined treatment) at 16 weeks and as five groups at subsequent assessments.At 16 weeks, both cognitive-behavioral therapy and the combined treatment were superior to medication given for 16 weeks in reducing binge eating and purging. At 32 weeks, however, only the combined 24-week treatment was superior to medication given for 16 weeks. The combined treatment was also more effective in reducing dietary preoccupation and hunger. Continuing cognitive-behavioral therapy appeared to prevent relapse in patients withdrawn from medication at 16 weeks.Overall, the results favor the use of a combination of medication and cognitive-behavioral therapy in the treatment of bulimia nervosa, with medication continued for at least 24 weeks.

    View details for Web of Science ID A1992GX04000012

    View details for PubMedID 1728190

  • NONPURGING BULIMIA - A DISTINCT SUBTYPE OF BULIMIA-NERVOSA INTERNATIONAL JOURNAL OF EATING DISORDERS McCann, U. D., ROSSITER, E. M., KING, R. J., Agras, W. S. 1991; 10 (6): 679-687
  • ARE ANTIDEPRESSANTS APPETITE-SUPPRESSANTS IN BULIMIA-NERVOSA EUROPEAN JOURNAL OF PSYCHIATRY ROSSITER, E. M., Agras, W. S., McCann, U., Schneider, J. A., Gotestam, K. G. 1991; 5 (4): 224-231
  • IMPROVING THE EFFECTIVENESS OF COMPUTER-ASSISTED WEIGHT-LOSS BEHAVIOR THERAPY Taylor, C. B., Agras, W. S., Losch, M., Plante, T. G., Burnett, K. 1991; 22 (2): 229-236
  • MECHANISMS OF ACTION IN COGNITIVE BEHAVIORAL AND PHARMACOLOGICAL INTERVENTIONS FOR OBESITY AND BULIMIA-NERVOSA JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Craighead, L. W., Agras, W. S. 1991; 59 (1): 115-125

    Abstract

    In the treatment of obesity, anorexiant medication appears to enhance restraint, presumably through altering internal cues, and facilitates weight loss with behavioral treatment. However, relapse occurs once medication is withdrawn. Antidepressants appear to work similarly, and initial evidence suggests the same limitations. Long-term combined pharmacologic and behavioral treatment, however, may be useful for some individuals not responding positively to behavioral treatment alone. In the treatment of bulimia nervosa, antidepressants appear to enhance restraint, whereas cognitive behavioral treatment decreases restraint. Thus, these modalities appear to be incompatible, and highly restrictive eating is not desirable for those of normal weight. However, for individuals not responding to cognitive-behavioral treatment, long-term pharmacologic treatment may be an alternative, perhaps combined with a more compatible psychological treatment.

    View details for Web of Science ID A1991EV98700013

    View details for PubMedID 2002126

  • HIGH BLOOD-PRESSURE AND MARITAL DISCORD - NOT BEING NASTY MATTERS MORE THAN BEING NICE HEALTH PSYCHOLOGY Ewart, C. K., Taylor, C. B., Kraemer, H. C., Agras, W. S. 1991; 10 (3): 155-163

    Abstract

    Theories linking anger and blood pressure (BP) reactivity to cardiovascular disease must be able to identify naturally occurring stressors that arouse emotion with sufficient frequency to cause chronic physiologic stress. We examine the impact of normal family arguments on 43 patients (24 women, 19 men) with essential hypertension. Patients and their partners discussed a threatening disagreement for 10 min while BP and conversation were recorded. Discussing problems increased BP, but the causal pathways differed by sex. In women, hostile interaction and marital dissatisfaction were associated with increased BP; "supportive" or "neutral" exchanges were unrelated to BP. In men, BP fluctuations were related only to the patient's speech rate. These findings are consistent with other research on sex differences in communication and social problem-solving styles and implicate different mechanisms (frequent anger, active coping) through which marital discord could increase risk. Implications for intervention are considered.

    View details for Web of Science ID A1991FR19200001

    View details for PubMedID 1879387

  • SUCCESSFUL TREATMENT OF NONPURGING BULIMIA-NERVOSA WITH DESIPRAMINE - A DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY AMERICAN JOURNAL OF PSYCHIATRY McCann, U. D., Agras, W. S. 1990; 147 (11): 1509-1513

    Abstract

    Twenty-three women with nonpurging bulimia underwent a 12-week, double-blind, placebo-controlled trial of desipramine hydrochloride. Repeated standardized rating scales, mood assessments, and self-reports of dietary habits were used to measure changes in binge frequency and cognitive processes associated with food intake. The women who received desipramine reduced their frequency of binge eating by 63%, but women receiving placebo increased their frequency of binge eating by 16%. Twelve weeks after initiating treatment, 60% of the treatment group but only 15% of the placebo group abstained from binge eating. The women who received desipramine showed significantly more dietary restraint and reported significantly less hunger, suggesting that desipramine acts to suppress appetite. These preliminary findings suggest that the therapeutic effects of desipramine established in the treatment of purging bulimia nervosa extend to patients with nonpurging bulimia.

    View details for Web of Science ID A1990EF65800013

    View details for PubMedID 2221164

  • NEW PHARMACOLOGICAL APPROACHES TO OBSESSIVE-COMPULSIVE DISORDER - TREATMENT OF SOCIAL PHOBIAS - DISCUSSION JOURNAL OF CLINICAL PSYCHIATRY MICHELS, Insel, T. R., Agras, W. S., Yudofsky, S. C. 1990; 51: 56-58
  • AN EMPIRICAL-TEST OF THE DSM-III-R DEFINITION OF BINGE INTERNATIONAL JOURNAL OF EATING DISORDERS ROSSITER, E. M., Agras, W. S. 1990; 9 (5): 513-518
  • SKIN-CONDUCTANCE HABITUATION IN PANIC DISORDER PATIENTS BIOLOGICAL PSYCHIATRY Roth, W. T., Ehlers, A., Taylor, C. B., MARGRAF, J., Agras, W. S. 1990; 27 (11): 1231-1243

    Abstract

    Skin conductance habituation was compared between 38 patients meeting DSM-III criteria for Panic Disorder and 29 normal controls. Approximately half of each group was randomly assigned to be given 100 dB SPL tones and the other half 75 dB tones. All indices pointed to slowed habituation in patients compared with normals: number of trials to response habituation, total number of responses, and slope of decline of skin conductance level. Patient-normal differences were not significantly larger for 100 dB than for 75 dB. In addition, patients compared with normals had more nonspecific fluctuations, higher skin conductance levels, and a shorter response latency to the first stimulus. Stepwise discriminant analyses classified patients and normals better in the 100 dB than in the 75 dB condition, and showed that the various skin conductancy variables were largely redundant at the higher intensity.

    View details for Web of Science ID A1990DF72900007

    View details for PubMedID 2191728

  • MOTOR-ACTIVITY AND TONIC HEART-RATE IN PANIC DISORDER PSYCHIATRY RESEARCH Clark, D. B., Taylor, C. B., Hayward, C., King, R., MARGRAF, J., Ehlers, A., Roth, W. T., Agras, W. S. 1990; 32 (1): 45-53

    Abstract

    Motor activity and tonic heart rate were monitored in 62 drug-free panic disorder patients and 40 normal control subjects. Mean daily activity, mean waking heart rate controlled for activity, and mean sleeping heart rate were determined. Panic disorder patients without phobic avoidance showed higher activity than control subjects or patients with limited or extensive avoidance. Similarly, an "inverted U", relationship between trait anxiety and activity was observed. On the other hand, neither mean waking nor sleeping heart rate showed significant differences between patients and controls, suggesting that the differences previously reported in laboratory studies result from anticipatory anxiety.

    View details for Web of Science ID A1990DC99700006

    View details for PubMedID 2349312

  • DEVELOPING COMPUTER-ASSISTED THERAPY FOR THE TREATMENT OF OBESITY BEHAVIOR THERAPY Agras, W. S., Taylor, C. B., Feldman, D. E., Losch, M., Burnett, K. F. 1990; 21 (1): 99-109
  • COGNITIVE-BEHAVIORAL AND RESPONSE-PREVENTION TREATMENTS FOR BULIMIA NERVOSA JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Agras, W. S., Schneider, J. A., Arnow, B., Raeburn, S. D., Telch, C. F. 1989; 57 (2): 215-221

    Abstract

    This study was designed to assess the additive effects of major components of cognitive-behavioral treatment for bulimia nervosa. Seventy-seven female patients with bulimia nervosa were allocated at random to one of four conditions: wait-list control, self-monitoring of caloric intake and purging behaviors, cognitive-behavioral treatment, and cognitive-behavioral treatment combined with response prevention of vomiting. In the treatment conditions, participants were seen individually for fourteen 1-hr sessions over a 4-month period. All the treatment groups showed significant improvement, whereas the wait-list control group did not. Cognitive-behavioral treatment was, however, the most successful in reducing purging and in promoting positive psychological changes. Fifty-six percent of participants in this condition ceased binge eating and purging by the end of treatment, and the frequency of purging declined by 77.2% during the same period. Of the three treatment conditions, only cognitive-behavioral treatment was superior to the wait-list control. At the 6-month follow-up, 59% of the cognitive-behavioral group were abstinent, and purging had declined by 80%. Cognitive-behavioral treatment was significantly superior to the other treatment groups at this time. Thus, the addition of response prevention of vomiting did not enhance the efficacy of cognitive-behavioral treatment, and the evidence suggests that it may have had a deleterious effect.

    View details for Web of Science ID A1989T859000004

    View details for PubMedID 2708607

  • ROLE OF COGNITIVE APPRAISAL IN PANIC-RELATED AVOIDANCE BEHAVIOUR RESEARCH AND THERAPY Telch, M. J., Brouillard, M., Telch, C. F., Agras, W. S., Taylor, C. B. 1989; 27 (4): 373-383

    Abstract

    The present study examined several dimensions of panic cognitions to test whether panic appraisals predict phobicity among panic sufferers. Thirty-five patients meeting DSM-III-R criteria for panic disorder with minimal or no phobic avoidance were compared to 40 patients meeting DSM-III-R criteria for panic disorder with agoraphobia (severe). The two groups looked strikingly similar on measures of panic symptoms, panic frequency and panic severity. As expected, patients diagnosed as having panic disorder with agoraphobia reported significantly more depression and phobic avoidance than patients with PD. Striking differences emerged on each of the following panic appraisal dimensions: (a) anticipated panic, (b) perceived consequences of panic, and (c) perceived self-efficacy in coping with panic. In each case, patients with panic disorder and agoraphobia reported significantly more dysfunctional panic appraisals than patients with panic disorder and no avoidance. Of those panic appraisal dimensions studied, anticipated panic emerged as the most potent correlate of agoraphobic avoidance. These findings support the hypothesis that cognitive appraisal factors may play an important role in the genesis or maintenance of phobic avoidance among panic patients.

    View details for Web of Science ID A1989AH15600007

    View details for PubMedID 2775146

  • TREATMENT OUTCOME EVALUATION METHODOLOGY - AN OVERVIEW ADVANCES IN BEHAVIOUR RESEARCH AND THERAPY Agras, W. S. 1989; 11 (3): 215-220
  • CHANGES IN SELF-REPORTED FOOD-INTAKE IN BULIMICS AS A CONSEQUENCE OF ANTIDEPRESSANT TREATMENT INTERNATIONAL JOURNAL OF EATING DISORDERS ROSSITER, E. M., Agras, W. S., Losch, M. 1988; 7 (6): 779-783
  • RELATIONSHIPS BETWEEN THE EATING BEHAVIORS OF PARENTS AND THEIR 18-MONTH-OLD CHILDREN - A LABORATORY STUDY INTERNATIONAL JOURNAL OF EATING DISORDERS Agras, W. S., Berkowitz, R. I., HAMMER, L. C., Kraemer, H. C. 1988; 7 (4): 461-468
  • AUTONOMIC CHANGES AFTER TREATMENT OF AGORAPHOBIA WITH PANIC ATTACKS PSYCHIATRY RESEARCH Roth, W. T., Telch, M. J., Taylor, C. B., Agras, W. S. 1988; 24 (1): 95-107

    Abstract

    Twenty-three patients meeting DSM-III criteria for agoraphobia with panic attacks and 14 age-, race-, and sex-matched nonanxious controls were tested in the laboratory and on a test walk in a shopping mall. The patients were tested before and after about 15 weeks of treatment with placebo and exposure therapy, imipramine and exposure therapy, or imipramine and initial antiexposure instructions. Controls were tested twice at a similar interval, but without any treatment. On test day 1, patients compared to controls showed higher average heart rate and skin conductance levels and greater numbers of skin conductance fluctuations in the laboratory, and higher heart rates before and during the test walk. Between pretreatment and posttreatment tests, clinical ratings improved and skin conductance levels decreased in all treatment groups. Heart rate levels in the laboratory, on the other hand, decreased in patients on placebo and rose in patients on imipramine. Thus, imipramine compromises the usefulness of heart rate as a measure of emotional arousal. Higher pretreatment heart rates predicted greater clinical improvement.

    View details for Web of Science ID A1988N420300012

    View details for PubMedID 3393620

  • DIETARY RESTRAINT OF BULIMIC SUBJECTS FOLLOWING COGNITIVE-BEHAVIORAL OR PHARMACOLOGICAL TREATMENT BEHAVIOUR RESEARCH AND THERAPY ROSSITER, E. M., Agras, W. S., Losch, M., Telch, C. F. 1988; 26 (6): 495-498

    View details for Web of Science ID A1988R171500008

    View details for PubMedID 3240233

  • SO WHERE DO WE GO FROM HERE BEHAVIOR THERAPY Agras, W. S. 1987; 18 (3): 203-217
  • RELAXATION TRAINING FOR ESSENTIAL-HYPERTENSION AT THE WORKSITE .2. THE POORLY CONTROLLED HYPERTENSIVE PSYCHOSOMATIC MEDICINE Agras, W. S., Taylor, C. B., Kraemer, H. C., SOUTHAM, M. A., Schneider, J. A. 1987; 49 (3): 264-273

    Abstract

    This article reports the findings of a study designed to evaluate the long-term effectiveness of an industry-based relaxation training program in the treatment of hypertensives whose blood pressures were not well controlled by antihypertensive medication. Following a three-stage screening process, 137 participants were randomly allocated to either relaxation training (RT) or to blood pressure monitoring (BPM) at two worksites. Participants continued to receive medical care from their primary physicians during the course of the study. The advantage for participants receiving RT, in terms of mean blood pressure changes, was modest and of short duration. However, a larger proportion of participants in the RT group came into good control (blood pressures below 90 mm Hg) than in the BPM group following treatment (69.4% vs 41.5%, p less than 0.001). This advantage continued to 24 months' follow-up (63.9% vs 47.7%, p less than 0.05). At 30 months' follow-up there was no significant difference between the groups (75.0% vs 70.8%). Within-group analyses revealed that the BPM group also achieved significant blood pressure lowering which was maintained during the study. The largest initial difference between the two groups was for individuals whose entry diastolic blood pressures were most out of control despite several years of pharmacologic treatment. No difference was found between the two groups in the prescription of antihypertensive medication.

    View details for Web of Science ID A1987H693600005

    View details for PubMedID 3299443

  • DOES A VIGOROUS FEEDING STYLE INFLUENCE EARLY DEVELOPMENT OF ADIPOSITY JOURNAL OF PEDIATRICS Agras, W. S., Kraemer, H. C., Berkowitz, R. I., Korner, A. F., Hammer, L. D. 1987; 110 (5): 799-804

    Abstract

    A prospective study of a cohort of healthy infants observed from birth to 2 years of age was carried out to investigate factors influencing the development of early adiposity. Infant suckling was measured in the laboratory twice during the first month of life. Multiple regression analyses revealed that parental educational level and a measure of feeding behavior, the interval between bursts of suckling, accounted for 18% of the variance in triceps skinfold measures at 1 year of age. A lower level of education and shorter interburst interval were associated with increased adiposity. Two feeding variables, pressure of suckling and the number of reported feeds per day, accounted for 21% of the variance in skinfold thickness at 2 years of age. Fewer, but larger, feeds and a higher sucking pressure were associated with a greater degree of adiposity. It seems that a vigorous infant feeding style, consisting of sucking more rapidly, at higher pressure, with a longer suck and burst duration, and a shorter interval between bursts of sucking, is associated with higher caloric intake and greater adiposity. The early development of this feeding style suggests that it may be a genetically endowed behavior. Breast-feeding protected against early adiposity only to the age of 6 months in this cohort of infants.

    View details for Web of Science ID A1987H158300029

    View details for PubMedID 3572635

  • BULIMIA IN MALES - A MATCHED COMPARISON WITH FEMALES INTERNATIONAL JOURNAL OF EATING DISORDERS Schneider, J. A., Agras, W. S. 1987; 6 (2): 235-242
  • IMIPRAMINE IN THE TREATMENT OF BULIMIA - A DOUBLE-BLIND CONTROLLED-STUDY INTERNATIONAL JOURNAL OF EATING DISORDERS Agras, W. S., Dorian, B., KIRKLEY, B. G., Arnow, B., Bachman, J. 1987; 6 (1): 29-38
  • PERSONALIZED VERSUS USUAL CARE OF PREVIOUSLY UNCONTROLLED HYPERTENSIVE PATIENTS - AN EXPLORATORY ANALYSIS PREVENTIVE MEDICINE Hovell, M. F., Black, D. R., MEWBORN, C. R., Geary, D., Agras, W. S., Kamachi, K., Kirk, R., Walton, C., Dawson, S. 1986; 15 (6): 673-684

    Abstract

    This study was conducted to explore whether the quality of provider care may contribute to blood pressure reduction and whether other factors related to the treatment of hypertension may explain decline in blood pressure. In the study, 46 uncontrolled (greater than or equal to 140/90 mm Hg), medically treated hypertensive patients who received more personalized care differed significantly in the magnitude of blood pressure reduction from 36 usual-care patients (10/7 vs 2/2 mm Hg means for systolic and diastolic blood pressure reduction, respectively). About twice as many experimental patients as controls were reclassified as having "controlled" blood pressure, and this difference reached statistical significance. A multiple regression analysis for personalized-care subjects showed that no dynamic variables were related to blood pressure changes. It was postulated that more personalized care may have accounted for the significant difference between groups in blood pressure reduction. Similar personalized monitoring services might be important additions to usual medical care in order to control blood pressure more fully in high-risk hypertensive patients.

    View details for Web of Science ID A1986E957000012

    View details for PubMedID 3797398

  • AUTONOMIC CHARACTERISTICS OF AGORAPHOBIA WITH PANIC ATTACKS BIOLOGICAL PSYCHIATRY Roth, W. T., Telch, M. J., Taylor, C. B., SACHITANO, J. A., Gallen, C. C., KOPELL, M. L., MCCLENAHAN, K. L., Agras, W. S., Pfefferbaum, A. 1986; 21 (12): 1133-1154

    Abstract

    We compared electrodermal and heart rate measures of autonomic activation between patients meeting DSM-III criteria for agoraphobia with panic attacks and controls in terms of tonic level, reactivity to various types of stimuli, recovery, habituation, and spontaneous variability. The most striking differences between groups in the laboratory were higher tonic levels of skin conductance and heart rate among patients. Patients' heart rates were also tonically elevated in a test situation outside the laboratory. Certain measures of habituation and spontaneous variability also differed between groups, but there were only weak and inconsistent differences in reactivity to, or recovery from, stimuli with diverse qualities of novelty, startlingness, intensity, or phobicity. The elevated activation levels may be signs of a chronic state or may be phobic responses to the testing situations. A minority of patients failed to show these elevated levels.

    View details for Web of Science ID A1986D850400004

    View details for PubMedID 3756263

  • LACTATE INFUSIONS AND PANIC ATTACKS - DO PATIENTS AND CONTROLS RESPOND DIFFERENTLY PSYCHIATRY RESEARCH Ehlers, A., MARGRAF, J., Roth, W. T., Taylor, C. B., Maddock, R. J., Sheikh, J., KOPELL, M. L., MCCLENAHAN, L., Gossard, D., BLOWERS, G. H., Agras, W. S., KOPELL, B. S. 1986; 17 (4): 295-308

    Abstract

    Ten patients with panic disorder or agoraphobia with panic attacks and 10 normal controls received infusions of normal saline (placebo) and sodium lactate in a single-blind design. The time course of changes in the dependent variables was closely monitored, and expectancy biases and demand characteristics were minimized. Lactate increased self-reported anxiety and heart rate equally in patients and controls. The only variables showing statistically different responses between the groups were systolic and diastolic blood pressure. Overall, in both groups, the effects of lactate were quite similar to states of natural panic or anxiety for both self-report measures and heart rate. Patients had a tendency to endorse somatic symptoms indiscriminately. Our data do not support response to lactate as a biological marker of proneness to panic attacks.

    View details for Web of Science ID A1986C200600006

    View details for PubMedID 3714912

  • AMBULATORY HEART-RATE CHANGES IN PATIENTS WITH PANIC ATTACKS AMERICAN JOURNAL OF PSYCHIATRY Taylor, C. B., Sheikh, J., Agras, W. S., Roth, W. T., MARGRAF, J., Ehlers, A., Maddock, R. J., Gossard, D. 1986; 143 (4): 478-482

    Abstract

    Of 33 "panic" attacks reported by patients wearing an ambulatory solid-state heart rate/activity monitor for 6 days, 19 (58%) occurred at heart rates disproportionate to activity levels and different enough from surrounding heart rates to indicate a distinct physiologic state. Intense panic attacks with three or more symptoms were the most readily identified. ECG monitoring found the elevated heart rates to be sinus tachycardias. Heart rate elevation did not occur during anticipatory anxiety episodes. Ambulatory heart rate recordings confirm the presence of major physiologic changes during self-reported panic attacks.

    View details for Web of Science ID A1986A725500010

    View details for PubMedID 3953890

  • AMBULATORY MONITORING OF PATIENTS WITH ANXIETY AND PANIC CLINICAL NEUROPHARMACOLOGY Taylor, C. B., Roth, W. T., Agras, W. S., MARGRAF, J., Ehlers, A. 1986; 9: 37-39
  • ENHANCING AGORAPHOBIA TREATMENT OUTCOME BY CHANGING COUPLE COMMUNICATION PATTERNS BEHAVIOR THERAPY Arnow, B. A., Taylor, C. B., Agras, W. S., Telch, M. J. 1985; 16 (5): 452-467
  • A COGNITIVE BEHAVIORAL GROUP TREATMENT OF BULIMIA BRITISH JOURNAL OF PSYCHIATRY Schneider, J. A., Agras, W. S. 1985; 146 (JAN): 66-69

    Abstract

    This study describes a group treatment of bulimia using an adaptation of Fairburn's (1981) cognitive behavioural approach. Thirteen bulimic women with a self-reported average of 24 self-induced vomiting episodes per week were treated in two groups; each group met once a week for 16 weeks. The primary outcome measure was the number of self-reported vomiting episodes; pre- and post-treatment measures of eating attitudes, depression, assertiveness, and global level of psychological distress were also evaluated. Vomiting frequency decreased to an average 2.2 times per week (a 91% improvement) with seven patients abstinent by the end of treatment. Significant pre- to post-treatment changes were also demonstrated on measures of depression, eating attitudes, and assertiveness. Six-month follow-up data on 11 patients indicate a mean vomiting frequency of 3.8 per week; six patients maintained their progress. Although Fairburn had greater success using an individual cognitive behavioural approach, the results of the present study are promising for the development of a cost-effective treatment.

    View details for Web of Science ID A1985AEE4900012

    View details for PubMedID 3856460

  • PHYSICAL-ACTIVITY AND ADIPOSITY - A LONGITUDINAL-STUDY FROM BIRTH TO CHILDHOOD JOURNAL OF PEDIATRICS Berkowitz, R. I., Agras, W. S., Korner, A. F., Kraemer, H. C., Zeanah, C. H. 1985; 106 (5): 734-738

    Abstract

    Physical activity was reassessed in cohort of 52 children aged 4 to 8 years whose activity had been measured during the first 3 days of life. Neonatal adiposity was not significantly correlated with parental adiposity, neonatal physical activity, or gender, nor was neonatal activity significantly correlated with adiposity in childhood. Neonatal adiposity did not predict adiposity in childhood. However, in a stepwise multiple regression, parental adiposity and the children's daytime high activity levels were significantly associated with childhood adiposity. The age or gender of the child did not significantly correlate with childhood adiposity. As parental adiposity increased or daytime high activity of a child decreased, the adiposity in a 4- to 8-year-old child was likely to increase.

    View details for Web of Science ID A1985AHF6000007

    View details for PubMedID 3998913

  • AMBULATORY COMPUTER-ASSISTED THERAPY FOR OBESITY - A NEW FRONTIER FOR BEHAVIOR-THERAPY JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Burnett, K. F., Taylor, C. B., Agras, W. S. 1985; 53 (5): 698-703

    View details for Web of Science ID A1985ARV5500016

    View details for PubMedID 4056186

  • COMBINED PHARMACOLOGICAL AND BEHAVIORAL TREATMENT FOR AGORAPHOBIA BEHAVIOUR RESEARCH AND THERAPY Telch, M. J., Agras, W. S., Taylor, C. B., Roth, W. T., Gallen, C. C. 1985; 23 (3): 325-335

    View details for Web of Science ID A1985AHA9400011

    View details for PubMedID 2860892

  • THE RELATION BETWEEN NEONATAL AND LATER ACTIVITY AND TEMPERAMENT CHILD DEVELOPMENT Korner, A. F., Zeanah, C. H., Linden, J., Berkowitz, R. I., Kraemer, H. C., Agras, W. S. 1985; 56 (1): 38-42

    Abstract

    Evidence from several longitudinal studies suggests that individual activity characteristics tend to persist over time and to influence the development of temperamental style. The activity of 50 children whose motility had been monitored by an electronic activity monitor when they were neonates was again monitored by an ambulatory microcomputer when they were 4-8 years old. Additionally, the parents of these children filled out the Behavioral Style Questionnaire by McDevitt and Carey. The results showed that the level of the children's day and night activity was unrelated. The vigor of neonatal movements was later positively related to high daytime activity. Also, the least vigorous infants tended to become the most inactive children during the day. The results further showed that the most active neonates became children who, as perceived by their parents, tended to approach rather than withdraw from new experiences.

    View details for Web of Science ID A1985ACR7800004

    View details for PubMedID 4039245

  • COMPARISON OF 2 GROUP TREATMENTS FOR BULIMIA JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY KIRKLEY, B. G., Schneider, J. A., Agras, W. S., Bachman, J. A. 1985; 53 (1): 43-48

    View details for Web of Science ID A1985ADG6700005

    View details for PubMedID 3856582

  • COMBINING BEHAVIORAL TREATMENTS TO REDUCE BLOOD-PRESSURE - A CONTROLLED OUTCOME STUDY BEHAVIOR MODIFICATION Jacob, R. G., Fortmann, S. P., Kraemer, H. C., Farquhar, J. W., Agras, W. S. 1985; 9 (1): 32-54

    View details for Web of Science ID A1985AAQ8300003

    View details for PubMedID 3977813

  • REDUCING BLOOD-PRESSURE REACTIVITY DURING INTERPERSONAL CONFLICT - EFFECTS OF MARITAL COMMUNICATION TRAINING BEHAVIOR THERAPY Ewart, C. K., Taylor, C. B., Kraemer, H. C., Agras, W. S. 1984; 15 (5): 473-484
  • THE CONTRIBUTION OF AROUSAL AND PERFORMANCE IN REDUCING SPIDER AVOIDANCE BEHAVIOURAL PSYCHOTHERAPY Katz, R. C., Stout, A., Taylor, C. B., Horne, M., Agras, W. S. 1983; 11 (2): 127-138
  • THE TREATMENT OF ANOREXIA-NERVOSA - DO DIFFERENT TREATMENTS HAVE DIFFERENT OUTCOMES PSYCHIATRIC ANNALS Agras, W. S., Kraemer, H. C. 1983; 13 (12): 928-?
  • RELAXATION THERAPY IN HYPERTENSION HOSPITAL PRACTICE Agras, W. S. 1983; 18 (5): 129-137

    View details for Web of Science ID A1983QQ03000023

    View details for PubMedID 6404788

  • BEHAVIORAL MEDICINE IN THE 1980S - NONRANDOM CONNECTIONS JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Agras, W. S. 1982; 50 (6): 797-803

    View details for Web of Science ID A1982PS27800002

    View details for PubMedID 7174973

  • RELAXATION TRAINING - BLOOD-PRESSURE LOWERING DURING THE WORKING DAY ARCHIVES OF GENERAL PSYCHIATRY SOUTHAM, M. A., Agras, W. S., Taylor, C. B., Kraemer, H. C. 1982; 39 (6): 715-717

    Abstract

    Controlled studies have demonstrated that relaxation training can lead to significant in-clinic blood pressure (BP) reductions in patients with essential hypertension. We examined the BP-lowering effect of relaxation training during the working day. Forty-two patients being treated for essential hypertension with diastolic BPs greater than 90 mm Hg were randomized into either a relaxation training program or no treatment. Multiple BP measurements were made during the working hours, using an ambulatory monitoring device, before and after training. Significant work-site differences between groups were evident after treatment both for systolic and diastolic pressures. These results suggest that relaxation therapy leads to a reduction in BP that is evident in the natural environment, providing new evidence that the procedure is a useful adjunct to the treatment of hypertensive patients.

    View details for Web of Science ID A1982NT57800012

    View details for PubMedID 7046680

  • THE EFFECT OF A STANDARDIZED PSYCHOLOGICAL STRESSOR ON THE CARDIOVASCULAR-RESPONSE TO PHYSICAL EFFORT SOON AFTER UNCOMPLICATED MYOCARDIAL-INFARCTION JOURNAL OF PSYCHOSOMATIC RESEARCH Taylor, C. B., Davidson, D. M., Houston, N., Agras, W. S., DeBusk, R. F. 1982; 26 (2): 263-268

    Abstract

    To determine whether a standardized psychological stressor combined with physical stress might disclose ischemic abnormalities not evident with physical stress alone, 30 men, mean age 54, were evaluated seven weeks after clinically uncomplicated myocardial infarction. In the first 20 patients, two symptom-limited treadmill tests (TM) were performed on the same day, with and without superimposed psychological quiz (Q). In the next 10 consecutive patients, the Q was administered at a submaximal level (4 METs). When TM and TM + Q responses were compared, no significant differences were noted in the maximal levels of heart rate (HR), systolic blood pressure (SBP), rate pressure product, or in the prevalence of ischemic ST segment depression or angina pectoris. The HR and double product at which ischemic ST segment depression and angina pectoris appeared were similar for the two types of testing. The psychological stress of a psychological quiz may not, of course, approximate the effect of the more severe stressors individuals may encounter in their daily routines.

    View details for Web of Science ID A1982NN60100019

    View details for PubMedID 7077557

  • PLANNING RECRUITMENT CIRCULATION Agras, W. S., Marshall, G. D., Kraemer, H. C. 1982; 66 (6): 54-?
  • EXPECTATION AND THE BLOOD-PRESSURE-LOWERING EFFECTS OF RELAXATION PSYCHOSOMATIC MEDICINE Agras, W. S., Horne, M., Taylor, C. B. 1982; 44 (4): 389-395

    Abstract

    In a study of the blood-pressure-lowering effects of relaxation training in patients with essential hypertension, instructions concerning the relaxation procedure were varied so that one group was told to expect delayed blood-pressure-lowering and the other group immediate lowering. The systolic blood pressure decrease during the training period in the immediate lowering group was 17.0 mm Hg, compared with 2.4 mm Hg for the delayed group (p = 0.001). Diastolic blood pressure changes were not significantly different. Measures of therapy credibility and perceived relaxation failed to differentiate the groups. The implications of these findings for future research and for clinical practice are considered.

    View details for Web of Science ID A1982PH26300006

    View details for PubMedID 6755527

  • BEHAVIORAL-APPROACHES TO THE TREATMENT OF ESSENTIAL-HYPERTENSION INTERNATIONAL JOURNAL OF OBESITY Agras, W. S. 1981; 5: 173-181

    Abstract

    The experimental literature documenting the effectiveness of relaxation training and related approaches, and the behavioral treatment of overweight, in the management of essential hypertension is briefly reviewed. In both cases the immediate outcome in terms of blood pressure lowering and the persistence of effects of therapy over time favor the use of these methods as adjuncts to the treatment of essential hypertension. Preliminary data from recent experimental work concerning the the psychological mechanisms involved in relaxation therapy and evidence for generalization of the effects to the work environment are also presented.

    View details for Web of Science ID A1981LU75100020

    View details for PubMedID 7016783

  • CLINICAL RESEARCH IN BEHAVIOR-THERAPY - HALFWAY THERE BEHAVIOR THERAPY Agras, W. S., Berkowitz, R. 1980; 11 (4): 472-487
  • THE CALIFORNIA DROUGHT - A QUASI-EXPERIMENTAL ANALYSIS OF SOCIAL-POLICY JOURNAL OF APPLIED BEHAVIOR ANALYSIS Agras, W. S., Jacob, R. G., Lebedeck, M. 1980; 13 (4): 561-570

    Abstract

    The effect of fines for failure to conserve water during the California drought of 1976 to 1978 was evaluated in a retrospectively arranged multiple-baseline design across three San Francisco Bay area cities. The data indicated that, on a community level, significant savings of water occurred regardless of whether fines were introduced or not. However, on an individual level, fines appeared to have an effect on private, as opposed to commercial or industrial, consumers who had received at least one fine. The limitations imposed on these conclusions by the quasi-experimental nature of the design were highlighted. Possible reasons for water conservation in the absence of fines were discussed within the framework of stimulus control. It was suggested that an area for future research should be the delineation of stimulus parameters involved in producing behavior change in entire communities.

    View details for Web of Science ID A1980KU54400002

    View details for PubMedID 16795633

  • RELAXATION TRAINING 24-HOUR BLOOD-PRESSURE REDUCTIONS ARCHIVES OF GENERAL PSYCHIATRY Agras, W. S., Taylor, C. B., Kraemer, H. C., Allen, R. A., Schneider, J. A. 1980; 37 (8): 859-863
  • COMPARISON OF SEX-TYPED MOTOR BEHAVIOR IN MALE-TO-FEMALE TRANSSEXUALS AND WOMEN ARCHIVES OF SEXUAL BEHAVIOR Barlow, D. H., Mills, J. R., Agras, W. S., Steinman, D. L. 1980; 9 (3): 245-253

    Abstract

    Eight presurgical male-to-female transsexuals emitted significantly more feminine behaviors on a validated sex role motor behavior checklist than eight feminine women. Transsexuals also emitted more masculine behaviors than feminine women, although the total number of masculine behaviors in each group was far less than the total number of feminine behaviors. Indications for the management of transsexuals as well as the functions of sex role motor behavior in our society are discussed.

    View details for Web of Science ID A1980JX21000007

    View details for PubMedID 7396696

  • EMPIRICAL SELECTION OF MATCHING FACTORS IN MATCHED-PAIRS AND MATCHED-BLOCKS SMALL-SAMPLE RESEARCH DESIGNS BEHAVIOR THERAPY Kraemer, H. C., Jacob, R. G., Jeffery, R. W., Agras, W. S. 1979; 10 (5): 615-628
  • COMPARISON OF TREADMILL EXERCISE TESTING AND PSYCHOLOGIC STRESS-TESTING SOON AFTER MYOCARDIAL-INFARCTION AMERICAN JOURNAL OF CARDIOLOGY DeBusk, R. F., Taylor, C. B., Agras, W. S. 1979; 43 (5): 907-912

    View details for Web of Science ID A1979GT79500005

    View details for PubMedID 433773

  • RECRUITMENT FOR THE CORONARY PRIMARY PREVENTION TRIAL CLINICAL PHARMACOLOGY & THERAPEUTICS Agras, W. S., Marshall, G. 1979; 25 (5): 688-690

    Abstract

    A preliminary account of some aspects of recruitment for the Coronary Primary Prevention Trial is provided. Extension of recruitment sources to include various forms of community screening resulted in more rapid acquisition of potential participants than was possible when recruitment was restricted to the more traditional sources of physician and laboratory referral. Extended recruitment was supported by augmented data feedback and by the development of the job of recruitment coordinator at each participating clinic. The identification of delays in reaching the maximal recruitment rate from particular sources points to the need for detailed planning of a recruitment campaign before large-scale clinical trials are begun.

    View details for Web of Science ID A1979GV68000019

    View details for PubMedID 373955

  • RELAXATION THERAPY IN TREATMENT OF HYPERTENSION - REVIEW ARCHIVES OF GENERAL PSYCHIATRY Jacob, R. G., Kraemer, H. C., Agras, W. S. 1977; 34 (12): 1417-1427

    Abstract

    The literature on the use of relaxation or relaxation-like procedures (relaxation therapy) in the treatment of hypertension was critically reviewed. Relaxation therapy resulted in greater reduction of blood pressure than placebo or other control procedures. A positive relationship was found between the average blood pressure decrease and the average pretreatment pressure. Relaxation-like therapies shared the features of muscular relaxation, regular practice, mental focusing, and task awareness. Research on the relative contributions of these components indicated that task awareness adds to the treatment effect in the laboratory setting, and that regular practice is necessary for optimal results in the clinical setting. The role of muscular relaxation and mental focusing is unclear. We concluded that relaxation therapy may become a useful adjunct to medication in the clinical management of hypertension, especially for individuals whose blood pressures remain high despite pharmacological treatment.

    View details for Web of Science ID A1977EE92400003

    View details for PubMedID 400780

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