Clinical Description of Cognitive Restraint and its Practical Consequences (pp. 179-200)
Authors: Zermati, Jean-Philippe; Apfeldorfer†, Gérard (Groupe de Réflexion sur l’Obésité et le Surpoids Paris, France)
Abstract: The dietetic or cognitivo-behavioral approaches of obesities and moderate overweight give disappointing results and are shown to favour various food behavioral problems and other psychopathological disorders. The approach centered on the concept of set-point and the taking into account of cognitive restraint are presented in the form of an alternative. The regulation of the energy reserves entails a control of the food intake controlled by the alimentary sensations. Increase in the fat mass expresses a failure of the regulation system and could represent a rise in or a passing of the set-point. The two situations are clinically characterized by the alimentary sensations analysis. The passing of the set-point is due to behavioral modifications that owe to emotion-induced alimentary responses and to cognitive restriction. Both phenomena combine to facilitate food over-consumptions. Hermann and Polivy’s description of cognitive restraint is taken up and its semiology is deepened. The person with cognitive restraint can be in a state inhibition with or without loss of control. In the latter, one can distinguish: a) a phase with dominant cognitions where the subject deliberately gives up listening to his/her hunger and satiety sensations to submit to rules allegedly capable of controlling the weight; b) a phase with dominant emotions where the physiological sensations are blurred and where the eating behavior is controlled by unconscious cognitive processes and emotions. The eater ends up organizing his/her eating behavior around the fear of lacking, of the frustration-guilt pair and the disorder of the comforting process. The state of inhibition frequently alternates with losses of control described as hyperphagic bouts, compulsions or bulimic crises. The disturbed relation with the fat body, the emotional disorders interact with the perception of the hunger and satiety sensations and obstruct it. The cognitivo-behavioral treatment of cognitive restraint is described from clinical examples: the patient is taught the perception of alimentary sensations, the reintroduction of demonized and over-consumed food items and self-assertiveness. One uses cognitive therapy in the dietary and non-dietary fields, and social avoidance behaviour desensitising. The goal of this treatment is to make it possible for the patient to go back to a weight corresponding his/her set-point by adopting an eating behavior based on the physiological systems of regulation of his/her energy reserves.