Eight patients with bulimia nervosa were treated using purely behavioral techniques in the absence of explicit cognitive procedures. All were systematically assessed before and after treatment; seven were reassessed at a 1-year follow-up. As a group, they showed substantial improvement in terms of eating habits, a global index of specific psychopathology, and mental state. These changes were comparable to those previously obtained in an Oxford sample of patients using a cognitive behavioral treatment. These findings raise the question as to whether cognitive procedures are necessary to produce change in patients with bulimia nervosa.

Behavioral treatment of Bulimia nervosa

The behaviour of binge eating, or compulsive eating, i.e. consuming large quantities of food in short periods and beyond the point of subjective hunger, has been reported in obese individuals (e.g. Stunkard 1959; Marcus et al. 1985), in anorexic patients (e.g. Beumont et al. 1976; Garfinkel and Garner 1982) and in people of normal weight (e.g. Wardle 1980; Edelman 1981). Various operational definitions have been proposed which specify, for example, the amount eaten (Katzman et al. 1984) or the length of the episode (American Psychiatric Association 1980). However, the crucial feature which distinguishes binge eating from normal excessive eating is that the episode is experienced as being outside the control of the eater (Abraham and Beumont 1982; Fairburn 1983).

Cognitive Therapy for Bulimia

Nathan H. Azrin (1930–2013) contributed extensively to the fields of experimental and applied behavior analysis. His creative and prolific research programs covered a wide range of experimental and applied areas that resulted in 160 articles and several books published over a period of almost 6 decades. As a result, his career illustrates an unparalleled example of translational work in behavior analysis, which has had a major impact not only within our field, but across disciplines and outside academia. In the current article we present a summary of Azrin’s wide ranging contributions in the areas of punishment, behavioral engineering, conditioned reinforcement and token economies, feeding disorders, toilet training, overcorrection, habit disorders, in-class behavior, job finding, marital therapy, and substance abuse. In addition, we use scientometric evidence to gain an insight on Azrin’s general approach to treatment evaluation and programmatic research. The analysis of Azrin’s approach to research, we believe, holds important lessons to behavior analysts today with an interest in the applied and translational sectors of our science.

Barbara Winter

Papers

Bulimia: a case illustration of the superiority of behavioral over cognitive treatment.