Abstract
In the history of behavior therapies for inpatient treatment of anorexia nervosa (AN), behavior restrictions have been used in an attempt to remove various stimuli that sustain a vicious cycle of abnormal behavior. This is also aversive conditioning, whose aim is to guide the patient toward appropriate behavior. However, Fukamachi adopted a psychotherapeutic method where a daily self-report is incorporated into a traditional operant-conditioning inpatient protocol, which includes behavior restriction. He named this "Behavior-Restriction Therapy". In two books (1987, 1989), he hypothesized that the protocol's dual structure could disrupt an AN inpatient's rigidly fixd ideas about food and weight. In this study, we examined the Fukamachi's hypothesis with a questionnaire and the follow-up survey. The "Behavior-Restriction Therapy" was applied to 31 serious and moderate female anorectics (AN-restricting type [n=13] and AN-binge eating and purging type [n=18]) who were admitted to the internal medicine and rehabilitation wards of our hospital between 1998 and 2004. The questionnaire was administered upon discharge. When asked what contributed most to their recovery, 18 of the 31 people (58.1%) said the behavior restriction, four people (12.8%) said the removal of the restriction, 8 people (25.8%) said both, and one patient (3.2%) credited another factor. Most of anorectics commented that although the restriction caused them anguish at first, it also brought them relief and respite, either at the time it was applied or in the long run. The follow-up surveys were administered for at least three years, on each occasion to assess eating behavior and social adaptation. Twenty-nine of the 31 former patients were able to be tracked in this way. The surveys revealed that 14 out of 16 anorectics among those who had felt that the restriction contributed most to their recovery were able to normalize their eating behavior. But all four people who had attributed their recovery to the removal of the restriction suffered a recurrence of abnormal eating behavior. These findings suggest that the use of the behavior restriction, as applied in Fukamachi's inpatient protocol, is more than simply aversive conditioning, it can actually help anorectics change dysfunctional thinking patterns responsible for their abnormal food intake and weight control behavior.
