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Anorexia, a case study & model on treatment

A selection from what stands above all other introductory works on scientific psychology


The Analysis of Human Operant Behavior

Ellen P Reese, 1966

A section of the modular Introduction to Psychology:  A Self-selection Textbook


FIGURE 35 A-D.  Successful treatment of an anorexic patient by behavior therapy. A: Patient before therapy, weighing 47 pounds. B: after eight weeks of therapy just before discharge as an outpatient. C: after ten months as an outpatient, prior to readmission to hospital for a month of further therapy during which she gained an additional seven pounds. D: three months after final discharge, shortly before patient completed home-study course in practical nursing and received her cap and uniform. (After Bachrach, A. ]., Erwin, W. J., and Mohr, J. P. "The Control of Eating Behavior in an Anorexic by Operant Conditioning Techniques." In L. Ullmann and L. P. Krasner [Eds.], "Case Studies in Behavior Modification." New York: Holt, Rinehart, and Winston, 1965, pp. 153-163.)


When a generalized reinforcer or a variety of reinforcers is used, it is often unnecessary to institute any particular deprivation procedures. However, in serious cases which demand immedi­ate attention, it may be necessary to withhold what­ever reinforcers can be identified so that they can be made contingent upon desired behavior. This was the case with a patient treated by Bachrach et al. (1965). The patient suffered from anorexia nervosa, a chronic failure to eat, and was in danger of death. She is shown in Figure 35A as she looked at the start of behavior therapy. At this time, she was 5 feet, 4 inches tall, weighed 47 pounds, and could stand only with assistance. In the words of the authors, she gave "the appearance of a poorly preserved mummy suddenly struck with the breath of life" (Bachrach et al, 1965, p. 154). Before therapy, she lived in an attractive hospital room with pictures, flowers, and a pleasant view; and she had free access to visitors, radio, television, and a record player. Because she appeared to enjoy these things, she was moved to a barren hospital room and allowed no visitors. She was deprived of visitors, television, music, flowers, etc., so that these stimuli could be used to reinforce eating behavior. The only reinforcer she was al­lowed was her knitting, and this was available at all times. (The hospital personnel were apprised of the reasons for this "inhuman treatment" and convinced that it was more humane than allowing the patient—who had not been cured by eight pre­vious hospitalizations—to die.)

The attention and sympathy with which the nurses had formerly coaxed the patient to eat were also withdrawn. Each of the authors ate one meal a day with the patient; the nurses were allowed to say only "good morning" when they entered the room to attend her other needs. Thus the social reinforcement which had helped to maintain non-eating behavior was withdrawn so that it could be used to strengthen eating.

The authors shaped eating behavior by talking with her when she picked up her fork, lifted food toward her mouth, chewed food, and so forth. They also shaped the amount of food eaten by allowing her the radio or television after meals at which she ate increasing amounts  of the  food on her plate. Later on, as she began to gain weight, other reinforcers were introduced; she was allowed to choose her own menu,  invite another patient to dine with her, or dine with the other patients. Note that these reinforcers were directly related to,  as well as contingent upon, eating behavior. Still later the reinforcers  included walks, visits, and mail. The effectiveness of this treatment can be judged from the remaining photographs of Fig­ure 35.

When she was discharged as an outpatient, new controls had to be devised to replace those that were possible in the hospital.  They resembled those described above under Self-Control and include several of the procedures of Table 3.  The help of the patient’s family was enlisted, and they were cautioned against making an issue of eating or reinforcing invalid behavior (incompatible with normal eating).  They were never to let her eat alone, and were to discuss only pleasant topics at meals (social reinforcement during eating).  They were to follow a rigid schedule for meals, with an alarm clock and a purple tablecloth as discriminative stimuli; and they were to encourage her to dine out with other people under enjoyable conditions. 

Three years later behavior therapy was started (and nearly a year after she was finally discharged) the patient had completed one training program and was enrolled in business school.  In addition to classes and extra activities, she was a dormitory advisor for 25 girls.  Although she had lost some weight, she was eating regularly and enjoying an active life.  As this article goes to press, five years after the start of therapy, we have learned from Dr. Bachrach that the patient is maintaining her weight between 78 and 80 pounds (self report) and that she is working “happily and successfully in a university hospital newborn nursery.” 




The issue is that although we have verbal behavior and apply cognitive analysis, something must be running in the background.  This something is operant conditioning.  What applies to cats and seals, applies to men and women.  Each of has things that we ought not do, but yet can’t break the habit.  It is not a weak mind/will but rather the pattern of operant conditioning is in conflict with prudent analysis of behavior, and dominates.  To change the behavior entails changing the operant reinforcers that have produced the behavior.  The above examples show you how scientific psychology works.  


This is from the nuts and bolts work explaining scientific psychology; the best philosophical work is Science and Human Behavior, by B. F. Skinner, Macmillan Company, 1953.  It was used in my graduate Philosophy of Psychology course.  Skinner had in his long university teaching and research career spent a significant amount of time discussing and defending scientific psychology.  He found that of his critics, Carl R. Rogers (1902-1986) was the best.   He benefited both from graduate philosophy courses and numerous discussion with other professors.  Science and Human Behavior shows the results.

B.F. Skinner
born March 20, 1904, Susquehanna, Pa., U.S.
died Aug. 18, 1990, Cambridge, Mass.


in full  Burrhus Frederic Skinner   American psychologist and an influential exponent of behaviourism, which views human behaviour in terms of physiological responses to the environment and favours the controlled, scientific study of response as the most direct means of elucidating man's nature.

Skinner was attracted to psychology through the work of the Russian physiologist Ivan Pavlov on conditioned reflexes, articles on behaviourism by Bertrand Russell, and the ideas of John B. Watson, the founder of behaviourism. After receiving his Ph.D. from Harvard University (1931), he remained there as a researcher until 1936, when he joined the faculty of the University of Minnesota, Minneapolis, where he wrote The Behavior of Organisms (1938).

As professor of psychology at Indiana University, Bloomington (1945–48), Skinner gained some measure of public attention through his invention of the Air-Crib, a large, soundproof, germ-free, air-conditioned box designed to serve as a mechanical baby tender, supposed to provide an optimal environment for child growth during the first two years of life. In 1948 he published one of his most controversial works, Walden Two, a novel on life in a utopian community modeled on his own principles of social engineering.

As a professor of psychology at Harvard University from 1948 (emeritus 1974), Skinner came to influence a generation of psychologists. Using various kinds of experimental equipment that he devised, he trained laboratory animals to perform complex and sometimes quite exceptional actions. A striking example was his pigeons that learned to play table tennis. One of his best-known inventions, the Skinner box, has been adopted in pharmaceutical research for observing how drugs may modify animal behaviour.

His experiences in the step-by-step training of research animals led Skinner to formulate the principles of programmed learning, which he envisioned to be accomplished through the use of so-called teaching machines. Central to his approach is the concept of reinforcement, or reward. The student, learning by use of the machine at his own pace, is rewarded for responding correctly to questions about the material he is trying to master. Learning is thereby presumably reinforced.

In addition to his widely read Science and Human Behavior (1953), Skinner wrote a number of other books, including Verbal Behavior (1957), The Analysis of Behavior (with J.G. Holland, 1961), and Technology of Teaching (1968). Another work that generated considerable controversy, Beyond Freedom and Dignity (1971), argued that concepts of freedom and dignity may lead to self-destruction and advanced the cause of a technology of behaviour comparable to that of the physical and biological sciences. Skinner published an autobiography in three parts: Particulars of My Life (1976), The Shaping of a Behaviorist (1979), and A Matter of Consequences (1983). The year before his death, Recent Issues in the Analysis of Behavior (1989) was published.

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