Page 170 - Nutrition Counseling and Education Skills: A Guide for Professionals

If you think you can or you think you can’t, you’re right.

—Henry Ford

Introduction

The prevention and treatment of health problems and chronic diseases require theory- and evidence-based
interventions. Changing behaviors is a challenge for most people, many of whom are coping with a serious
health problem. The Stages of Change discussed in Chapter 5 examines people’s readiness to change. The
professional then decides which theory to consider in counseling for behavior change.

Cognitive Behavior Theory integrates two theoretical approaches—the behavioral approach described in
Chapter 7 and a cognitive approach. The behavioral approach focuses on observable, measurable behaviors,
such as overeating, and concentrates on the interaction of the person’s external environment and behavior.

The cognitive approach focuses on the role of the mind, specifically on cognitions or one’s thoughts, as
determinates of behaviors and feelings. Behavioral explanations require knowing what people are thinking and
feeling internally. It is one’s thinking that causes people to feel and act the way they do. How we think
(cognition), feel (emotion), and act (behavior) all interact. Cognitive behavior theory seeks to modify a
person’s thinking and belief system to bring about changes in behaviors.1 As indicated in the above quote by
Henry Ford, your thoughts influence what you believe you can or cannot do. An advantage is that we can
change the way we think in order to feel and act better.

There are a number of evidence-based theories of behavioral change that may be appropriate in a nutrition
counseling intervention. This chapter explores cognitive-behavioral therapy, self-monitoring client’s
cognitions and emotions, identifying maladaptive and negative thoughts related to food and eating as the basis
for cognitive restructuring, and relapse prevention. Enhancing client self-efficacy (SE) and the influence of
observational learning, or modeling, are components of social cognitive theory. These are factors within the
person’s internal thoughts that affect eating and health behaviors.

Validated behavior change theories are integral to the Nutrition Care Process guiding nutrition assessment,
interventions, and outcome evaluation.2 There is growing evidence that interventions developed with
theoretical foundations are more effective than those lacking one and that combining multiple theories,
models, and approaches leads to better results. These methods are important in client-centered disease
prevention and management.3

Cognitive–Behavioral Therapy

Cognitions may be defined as one’s thoughts or perceptions at a particular moment in time. These thinking
patterns can profoundly influence people’s behaviors, actions, and feelings. Many emotions we feel are
preceded and caused by a thought.4 When strategies for dealing with a client’s cognitions are incorporated
into behavioral programs, the term “cognitive–behavioral therapy” (CBT) is used.

Eating disorders, for example, are essentially cognitive disorders. For bulimia nervosa, CBT is an effective
treatment and leading evidence-based treatment for eating disorders.5,6 In adults with eating disorders, CBT
was found to be a “potent treatment.” Evidence-based forms of CBT had strong outcomes in routine clinical
settings.7

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