Page 171 - Nutrition Counseling and Education Skills: A Guide for Professionals

There are three fundamental propositions in CBT: (1) Cognitions are learned and can affect one’s
behaviors, thoughts, and feelings; (2) A person’s cognitive activity can be monitored and changed using
evidence-based intervention strategies; and (3) Cognitive change may effect a desired behavior change. The
major aim is to produce changes in the automatic thoughts that maintain a person’s behavior that needs to be
changed. There is a difference between thinking “I can’t do it.” and “I can try.”4,8

CASE ANALYSIS 1

Mrs. Jones: “I have always been heavy. I don’t think that I can ever lose weight.”
YOUR RESPONSE:

NOTE: In each Case Analysis for this chapter, “Your Response” indicates an opportunity for you to practice
cognitive counseling. Rather than giving advice, seek further information with a paraphrase or a thought or a
feeling Mrs. Jones expresses or a reflective summary of what she said.

It is evident that “multiple interventions at multiple levels are often needed to initiate and sustain behavior
change.”9 Evidence exists to support the use of a combination in facilitating modification of targeted dietary
habits, weight, and cardiovascular and diabetes risk factors.9 Weight control programs, for example, may
include assessing readiness to change, motivational interviewing, stimulus control, cue reduction, self-
monitoring, cognitive restructuring, self-efficacy, outcome evaluations, realistic goal setting, physical activity,
stress management, relapse prevention, contracting, social support, and dietary change.3,10

People who are overweight can benefit from cognitive-behavioral strategies to reduce weight, especially
when combined with exercise and dietary strategies, at least in the short term. The practitioner needs to
individualize a nutrition counseling intervention that is directed toward resolving the nutrition diagnosis. The
assumption that a person’s knowledge will lead to improved food choices is only partially correct as other
factors are influential.

CBT applies interventions and techniques to modify dysfunctional and negative thoughts and beliefs that
may underlie a problem. It focuses on what people think or thinking errors rather than what they do.
Introduced by Aaron T. Beck in the 1960s, it explores the relationship between cognitive processes or
thoughts and the lifestyle problem in question, such as the need for changes in food, exercise, and health
behaviors.1 These types of thinking affect one’s feelings, moods, and how one acts.

The key is to realize that it is not events by themselves that may affect behavior, but how we perceive the
events mentally. Feeling tired and somewhat unhappy after a long day of work, for example, may be perceived
in different ways. Some may feel happy to be home while others may think of a food or drink reward or treat.
What goes through your mind at the end of a tiring day? How does it affect your choice of behaviors? Over
time, these thoughts become automatic so that they are repeated when one finds oneself in the same situation
again.

The approach in working with clients is problem-oriented in helping them identify their thoughts about
food and eating in specific daily situations. Distorted thinking and unrealistic cognitive appraisals of events
can negatively affect one’s feelings and behaviors.8 While the client may consider the thoughts as “truths,”

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