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Outpatient Behavior Modification

Many people engage in behaviors that contribute to less healthy, enjoyable, or productive lives. Examples include overeating, smoking, and substance abuse. Despite the negative consequences of such behaviors, changing them can be more difficult than simply willing oneself to change. Behavior Modification is the application of demonstrably effective techniques to reduce or eliminate undesirable behaviors.

Weight Management

Obesity is one of the nation’s most serious and fastest-growing health problems. Obese people are at increased risk of many physical diseases, like heart attack, stroke, diabetes, some cancers, and many other chronic diseases. It is believed to be (after smoking) the second leading preventable cause of death in the United States.

While there are clear physical causes and genetic predispositions that contribute to obesity, these are often accompanied by emotional and behavioral factors that make it exceedingly difficult to manage weight effectively. Sadness, anxiety, boredom, and stress often contribute to overeating. Learning to manage these emotions can be key to preventing obesity, and to treating it effectively.

Conquering obesity requires cultivating behaviors that comprise a healthier lifestyle, like exercise and an improved diet. While these general concepts are inherent in most all effective weight loss plans, lifestyle changes that are too radical can sometimes worsen an already precarious physical and/or psychological situation. In cases where individuals are dealing with substantial medical or psychiatric problems, it is often prudent to receive consultation from a healthcare provider.

WellStar suggests a team approach, including a physician and/or dietician to help you develop a healthy diet and exercise plan; and a psychologist to help you discern and control the emotional factors that led to your weight gain, leading to long-lasting and enduring health-focused behaviors.

While many people worry sometimes about weighing too much, eating disorders can result when these concerns become out of control, and begin threatening health and life. Common eating disorders include:

  • Anorexia Nervosa: the belief that you're overweight even when you're dangerously thin, which contributes to excessive food restriction and extreme methods of weight control. Family therapy has been shown to be effective in overcoming anorexia.
  • Bulimia Nervosa: eating extreme portions of food, this is then followed by purging by vomiting or through the use of laxatives. Two types of psychotherapy have been shown to be particularly effective in treating bulimia – cognitive-behavioral, in which patients are helped to attain a realistic view of their appearance; and interpersonal psychotherapy, where quality of relationships are improved.
  • Binge Eating Disorder: intermittent episodes involving extreme overeating, but without the purging behaviors that accompany bulimia. A common treatment approach of WellStar psychologists to the treatment of Binge Eating Disorder involves explanation of the functions of Actor, Observer, and Critic, and subsequent use of cognitive and behavioral interventions to elicit change.

Case Example: An obese patient learns the concepts of Descriptive Psychology and Acceptance and Commitment Therapy. Observing his core values, and realizing that his current health trajectory is likely to compromise his health, and ultimately his ability to participate in activities with his family, he commits to a treatment regimen. After four months, he has lost 85 pounds and reports improved health and relationships with his family members.

Substance Abuse

Addiction refers to the need to use a substance in order to avoid physical and psychological withdrawal symptoms. Addiction typically begins with the abuse of a substance, whereby an individual's use is accompanied by negative consequences, such as interpersonal, academic, work-related, or legal problems. Eventually, an individual might become substance dependent. When this occurs, an individual has developed tolerance, having to consume more and more of the substance to get the same effect. When a person becomes dependent, the substance of choice often becomes the dominant and motivating force in a person's life.

Most people drink alcoholic beverages safely; for many, moderate consumption of alcohol (one drink a day for women, two for men) is enjoyable and may even have health benefits. For some people, however, including individuals with a disposition to problematic drinking behavior, abstinence is recommended. Heavy alcohol intake increases risk of accidents, liver and heart disease, cancer, and pancreatitis, and has the potential to endanger personal and professional relationships and success.

About one in 12 adults in the United States is alcohol dependent or abuses alcohol; people with other psychiatric disorders are approximately four times more likely to abuse alcohol as are individuals with no mental illness (

Drug abuse results in about 40 million serious illnesses and injuries and about 40,000 deaths per year in the United States. It has the potential to cause family disintegration, child abuse, academic failure, and loss of productivity and employment. In recent years, abuse of legal, prescription drugs (often painkillers) has become increasingly prevalent and responsible for many of the same problems as illegal drugs have been.

Treatment of addictive behavior necessitates a thorough assessment of a patient's behavior, including the type of substance(s) used, the frequency of use, the duration of use, the presence of other underlying psychiatric problems, and the extent to which a person's life is endangered in light of their addiction. There is not a one-size-fits-all approach with regards to treatment, but there are conceptual similarities. WellStar's Clinical Psychologists are careful to ensure that treatment is provided appropriately to individuals who are dealing with addictive behaviors, such as drug or alcohol dependence. If a patient's drug or alcohol abuse is severe, it often warrants treatment via inpatient, intensive outpatient, or residential treatment programs. In such cases, our psychologists will assist in connecting the patient with the appropriate treatment structure. In other situations, substance abuse can be managed effectively via traditional outpatient treatment approaches. The framework offered by ACT is often effective, and combined with adjunct recommendations such as regular 12-step meetings, and medication management.

Smoking Cessation

Smoking is the leading preventable cause of death in the United States, killing more than 435,000 people annually. It contributes to myriad diseases, most prominently heart disease, stroke, and many cancers. More than 70 percent of smokers say they would like to quit, and health improves immediately upon quitting. However, quitting can be difficult, and may require repeated attempts.

A combination of counseling and medication is more effective than either counseling or medication alone. Your WellStar physician can prescribe medications that help reduce tobacco dependence, and your psychologist will help you set a quit date, anticipate and face the challenges you will face as you withdraw from nicotine, and help you procure an environment in which quitting is as painless as possible.

In the process of becoming a tobacco-free environment, WellStar has embarked on the development of a smoking cessation program, which involves several, parallel treatments. In addition to using adjunct nicotinic and non-nicotinic medications, we offer a menu of treatment interventions including, telephone assessment and reassessment, individualized CBT, and biofeedback. WellStar psychologists work in collaboration with the Pulmonary and Oncology (cancer treatment) service lines to provide these comprehensive treatment options to patients and WellStar employees.

Case Example: An older adult male who is very close to his granddaughter states that he wants to quit smoking. It is suggested that he write his granddaughter’s name on each cigarette in the pack he has with him. Surprised, he asks why his psychologist would make such this suggestion. He realizes that his cigarettes have the potential to compromise his health, and thus his relationship with his granddaughter. The patient establishes a quit date - his granddaughter’s birthday. He announces to his family that he has decided to quit smoking and tells his granddaughter of his decision. Committed to his core values, he remains smoke free.