Agras, W. Stewart

Major Contributions to the Field

From the broadest perspective, I believe my most salient contribution has been, along with a few other pioneering academic psychiatrists, to introduce behavior therapy procedures to the field of psychiatry. Later, I was influential in the development of behavioral medicine in the United States, establishing one of the first behavioral medicine programs and helping to found the Society for Behavioral Medicine, becoming the first president of that organization.

From a research perspective, my first contribution together with Leitenberg and colleagues was to demonstrate that environmental contingencies such as reinforcement were widely applicable across a variety of psychiatric syndromes, such as phobias, obsessivecompulsive disorder, anorexia nervosa, and schizophrenic delusions, using controlled single-case experiments. Moreover, the use of such contingencies was often significantly therapeutic in these disorders. Having demonstrated this important principle, we, together with David Barlow and others, went on to show that exposure to, and practice in, a feared situation was necessary for recovery in all phobic disorders. Isaac Marks and his colleagues at the Institute of Psychiatry in London reported the same finding working with different methods, and the finding has been replicated by others.

I became interested in the use of nonpharmacological treatment for essential hypertension, investigating the effects of relaxation training and weight loss on blood pressure, demonstrating their effectiveness either as a first level of treatment or as an adjunctive treatment to pharmacological management. In the late 1970s, it became evident that the number of patients with bulimia nervosa coming to our clinics for treatment was rapidly increasing. This led our group to conduct some of the first studies using variants of cognitive-behavioral therapy (CBT) for bulimia nervosa, investigating the combination of medication and CBT and extending our findings to binge-eating disorder. Cognitive-behavioral treatment appears to be the most effective approach for both bulimia nervosa and bingeeating disorder, more effective than medication or other psychotherapies. However, we also showed that interpersonal therapy, although slower to work, appears to be equally effective in the longer term. Other work included laboratory studies investigating the proximal triggers of binge eating. Paralleling these investigations, we have just completed a study of children and their families from birth to 11 years of age aimed at identifying early risk factors for obesity and the eating disorders.

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