Etiology was the speaker s next area, one whose progress is impaired by stigma. It is clearly not a volitional choice, any more than one can choose to be schizophrenic. The evidence is strong that people cannot always conform, otherwise obesity would vanish as its victims all took up just eating a little less each day. Though it may once have held sway, not many now see insight-oriented individual psychotherapy as the treatment of choice. Behavior therapy based on the reconditioning approach can alter laboratory measurements of attraction patterns, but there is major difficulty transferring the results from the treatment setting to the real world.
Treatment using aversion is an abysmal failure.
Behavior therapy based on the cognitive approach can be helpful, said the speaker, particularly for the problem of craving, as the Betty Ford Clinic s well regarded experience demonstrates. This includes group treatment and probably works because it so directly confronts the denial and rationalization that sustain the disorder. This of course assumes that the individual is serious enough to get involved in open and honest dialogue. Relapse prevention also comes under this heading, identifying and implementing the needed changes in lifestyle. There was not time for detailed discussion of the biological modalities, surgery and medication, except to point out that so far these cannot change one s orientation, but are helpful in reducing the intensity of the drive.