3. Along with high protein
vs. high carbohydrate diets the weight loss intervention described in this
study utilizes Cognitive Behavior Therapy with the participants. Review the
following supplementary resources and consider the question below.
“Cognitive-behaviouraland other psychological techniques in the dietetic consultation: Suggestionsfor practice “ (Article Discussing Dietetic Interventions Based On Cognitive
Behavior Therapy)
What are some techniques
you would apply from cognitive behavioral therapy in counseling a patient? What
techniques have you used in the past? Were these techniques effective?
posted by Unknown @ 7:46 PM
11 comments
11 Comments:
3. The supplemental article about CBT for this question was very helpful! I was already somewhat familiar with the concepts of CBT, but the article elaborated on this knowledge and helped me recognize how I have already utilized CBT in counseling. CBT is extremely relevant for dietary counseling because of its focus on cognitions and behaviors which together greatly influence health status. People’s health beliefs, attitudes about food, eating patterns, activity habits, etc are all key factors in an individual’s path to optimal nutrition status. I applied many of the CBT techniques discussed in the article during my community rotation at Crossing Healthcare, which is an outpatient clinic offering comprehensive healthcare services to medically underserved populations. Participants in the diabetes prevention classes I taught were often asked to keep journals of their food and activity—a form of self-monitoring. By tracking their food and activity, they became more self-aware, cognizant of their habits, and could easily compare their improvements over time. I used and observed the use of cognitive restructuring in some one-on-one counseling sessions with clients. On multiple occasions, clients expressed very negative attitudes about eating eggs for fear of cholesterol intake, often related to messages they heard in the media about eggs. In these cases, we had to practice cognitive restructuring to help clients understand more accurately how eggs can be an excellent part of a healthy diet. We used scientific evidence and reasoning to show the potential health benefits of eating whole eggs. This approach was often successful in moving clients from a negative to a neutral or positive attitude about considering egg consumption. One final example of CBT application at Crossing, pertains to stress management. A majority of the clients at Crossing face challenges associated with low income. Limited income combined with health problems and family issues created stressful daily circumstances for many clients. In many counseling sessions, clients expressed significant distress pertaining to non-nutrition related issues which needed to be resolved before focusing on the nutrition problem at hand. In some cases, referrals to other professionals were needed to help clients with their stresses. In other situations, allowing the counseling session to shift partially to the client’s personal stresses was needed. Many clients needed to “vent” a bit about their lives before talking about their nutrition problem. Providing empathic feedback to the most stressed clients and giving appropriate advice was often successful. Client stress was often an important consideration when creating nutrition interventions. CBT was well-practiced and highly useful for helping Crossing clients with their nutrition issues.
The cognitive-behavioral theory includes many valuable strategies to bring someone to a motivated, understanding toward nutrition in very simple steps. As from a previous question, goal setting is something to strive for. CBT suggests starting small with achievable goals and working up towards harder goals. In order to find these achievable goals and eventually long-term goals, it is important to practice motivational interviewing. Getting to know the client, understanding their background, and building that trust is important for positive change. Building trust by sharing possible struggles you may have had in the past and how you overcame them can help the client feel that they are not alone and can achieve those goals they have set for themselves. Cognitive restructuring often times is used in interview sessions. When I was a GA for the YMCA Y-FI program, I worked with kids and their families. While the mother of the child I was working with was willing to change her eating habits with her child, she claimed it would be very difficult for her husband to follow. With much encouragement and brief education, she gave it a go and after he ended up liking a homemade ‘healthy’ dish, her mindset changed and was willing to spend more time cooking healthier meals in her home. This change of mindset came from starting with small achievable goals (making a new vegetable dish each week), and motivational interviewing every week and building up the relationship for her to open up to me about struggles with mealtime in the home.
I think many, if not all, of the techniques described the the CBT supplemental resources are valuable tools to use when working with clients on health goals. Different approaches may be more useful in different situations, but having the background knowledge and understanding of CBT to achieve lifestyle changes is invaluable. I used many of the components outlined in the article when providing individualized nutrition consists in my GA position at Health Promotion and Wellness. Clients practiced self-with three-day food diaries, I exercised cognitive reconstruction nearly anytime I was posed with a hot topic diet question, and motivational interviewing shaped the framework of each counseling session. In all I felt all these tactics were effective, though I recognize that practicing the CBT components would allow me to inspire more successful lifestyle modifications. I am particularly fond of socratic questioning and motivational interviewing. Without realizing it, I used these tools in my three-part mindful eating sessions with faculty and staff at ISU. Asking the right types of questions allowed individuals to reflect and explore how their thought processes related to behavior which helped participants grow into more mindless eaters.
Client motivation is key, as the article noted individuals must be self-motivated and amiable for success with weight loss goals. Therefore, when working with clients I try to let them guide me on understanding their level of motivation, their goals, and any potential road blocks. Then, I work with them to further develop their goals (make their goals SMART goals) and find solutions or strategies to avoid/overcome their hesitations/road blocks.
Although for many clients, the patient-centered approach is appropriate and effective, some clients need the traditional approach. When working with cancer patients, I counseled several clients that because of treatments simply did not have the motivation to follow recommendations, so I had to take a more traditional approach “you need to do x, y, and z.”
All four contributors agreed CBT is a valuable tool in nutrition counseling.
Utilized techniques include: : journaling, self monitoring, stress management, cognitive restructuring in education, motivational interviewing, goal setting, and Socratic questioning.
Multiple contributors shared a tendency to employ CBT techniques instinctually out of habit and empathy as a portion of nutrition counseling sessions.
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One CBT aspect not yet mentioned is recognizing and dealing with mismatches between treatment goals.
Have you had an experience of mismatched treatment goals, between the patient's motivations for change and your ideal motivations for change? How did you address the dissonance?
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Including cognitive-behavioral theory is key in assuring clients are motivated and ready to make lifestyle changes. I especially enjoyed that this article mentions stress management is important in CBT. I would apply this strategy of addressing stress and offering relaxation techniques to my patients because I believe stress is a large trigger for others to go off of their diet or relapse to old lifestyle habits. In addressing coping mechanisms early on, I believe this risk could be reduced.
I have tried similar CBT's this article mentions, such as recognizing the patient is ready to change via the stages of change model and socratic questioning in asking open-ended questions during motivational interviewing. All such methods have been successful.
It is clear from everyone's responses that CBT is a crucial part of effective diet counseling. Getting to know a client, understanding their motivations, and meeting clients where they are at in terms of readiness to change are key to goal achievement. Rachel, the example of discrepancies in treatment goals I think of is clients that want to lose weight to look better. Several clients I have counseled about weight loss indicated their desire to lose weight stems from their belief that losing weight will improve their looks and make them more attractive. In these instances, it is helpful to offer them reassurance that they are beautiful as they are and capable of achieving their goals. It is also helpful not to discourage them from using a change in looks as motivation for change. I do like to mention that a very important component of weight loss is also improvement in health status and reduced risk for many diseases. Reminding them that looks are not the only reason to try to lose weight, but that the health implications of weight loss and the associated lifestyle changes are very beneficial in the short and long term.
I feel like many of the CBT techniques mentioned in the additional resource article are already tactics implemented in dietetics. With a shift in nutrition counseling to focus on motivational interviewing, tactics like self-monitoring and asking open-ended questions (aka Socratic questioning in the article) allow clients to reflect on their thoughts and actions to build their own motivation. Additionally, the concept of recognizing when a patient is ready for change is a direct reflection of our use (as nutrition professionals) of the stages of change model. I have used these tactics and will continue to use them to help individualize goals to my clients. Depending on the person, these tactics have been effective- but only when the client was motivated intrinsically to change.
Rachel, you bring up one of the trickier tactics to address in dietetics. I interpret the mismatching of treatment goals to mean differences in perspective depending on experience. For instance, to draw upon the example from question #1, my client may be strictly focused on losing 30 lbs. However, I would have different goals/outcomes for her that focus on increasing fruit and vegetable intake and increased self-confidence (positive body image). I would work through my counseling sessions with the client to reach a "happy medium," where the outcomes I desire coincide with the goals of the client. Like the article concludes, behavior changes is the root of bridging the gap between the different sets of goals/outcomes.
If appropriate based on my client, I would use every single one of the techniques listed in the article regarding cognitive behavioral therapy. After reflecting on my past counseling experiences, I have utilized BT, CT, and CBT during past counseling sessions. It was eye-opening to see some methods that I have used or attempted to use in counseling be written on paper in an organized and easy to understand way. Black and white thinking in a common theme I have seen in individuals who struggle with weight management. Another way to think of it is an “all or nothing” way of thinking. The article emphasized the importance of setting smaller, specific, and realistic goals to grant the person a sense of achievement.
As I stated in my first comment, I think reward mechanisms are important to implement when creating goals. It helps individuals stay motivated and continue the desired behavior change. In my first comment I highlighted how individuals are often used to using food as reward, so implementing a reward for weight-loss can be complicated. It’s also difficult because when it comes to weight-loss people use long-term rewards such as fitting into an old pair of jeans, or feeling confident in a swim suit. It’s difficult to create short-term rewards that are reoccurring and feasible – it requires individualization. To change behaviors one must really break down the behavior and understand the response and consequence of each behavior. This process is not easy, but with time and practice behavior change can occur. This may require an interdisciplinary approach, but dietitians can be aware of the methods used in psychology to help further the patient’s care.
I think all of the tools mentioned in the CBT can be valuable depending on what motivates your patient/client. I learned in my behaviors class that every individual is motivated in different ways. Therefore, as I keep mentioning it is important to build rapport with your patient/client and figure out what will motivate them. I think all techniques mentioned in the CBT can be successful, but for different people. I think we have learned in class how important motivational interviewing is in helping individuals both gain and lose weight. Everyone needs motivation and it is our job as nutrition professionals to be that motivation for others. As we have learned in our counseling class Socratic questioning will help you better understand your clients goals and what your client wants, which is so important.
As Noel also mentioned I think relaxation is a great technique that could fit into everyones lifestyle. For starters, we live in a fast paced society and many people are stressed on a day-to-day basis. I think relieving stress makes it easier to focus on the main goal.
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