Page 177 - Nutrition Counseling and Education Skills: A Guide for Professionals

thoughts; (4) substitute more realistic thoughts for distorted ones; and (5) identify and alter underlying beliefs
and assumptions that predispose him or her to engage in faulty thinking patterns.8 This homework is
important to help the client understand and overcome eating problems, recognize lack of coping, and avoid
lapses and relapse. The counselor reviews the homework records with the client at the next appointment,
reinforcing any positive and coping thoughts while helping clients recognize and reevaluate negative ones.

The client’s learned internal dialogue or self-talk may be positive and supportive, negative, or neutral.
Positive cognitions support behaviors, as for example, “These dietary changes are not so bad.” Negative
cognitions inhibit people’s ability to change, such as, “These dietary changes look difficult to follow”.
Thoughts can be self-critical, such as “I’m fat,” or self-indulgent, such as “I deserve a treat.”

In eating disorders, such as anorexia nervosa and bulimia nervosa, dysfunctional thoughts and beliefs about
“fattening” foods, fear of weight gain, body image distortion, and feelings of low self-worth require
identification, challenging, and restructuring.6 In managing subordinates, an employee may be thinking, “I
like my job,” or “This job is boring.” Thoughts affect one’s feelings and behavior.

Because cognitions are learned responses, the counselor views the client’s cognitions as behaviors that can
be modified or changed. Many people cannot improve their eating habits until they recognize and change
their thoughts about food, eating, drinking, and exercise. Overeating and drinking can be an individual’s way
of coping with stress, depression, and other emotions. The approach is to help the client get rid of
unproductive, debilitating thoughts or beliefs and adopt more positive, constructive ones. In the Women’s
Intervention Nutrition Study (WINS), for example, dietitians applied behavioral, cognitive, and motivational
counseling techniques including identifying negative thoughts about diet change and cognitive restructuring
to turn negative thoughts into positive ones.14

Exploring the Problem
During the second phase, the counselor helps the client to explore and consolidate the cognitive problem
found in self-monitoring records. As the client reports negative, self-defeating, and self-fulfilling prophecy
aspects of thoughts, the counselor can ask how these affect actual behavior and how they can be modified into
more positive, coping thoughts. For example:

“What happens when you are thinking you are bored and want to eat something?”
“What happens when you think you are too tired after working all day to do any cooking?”
“What happens when you think the food isn’t as good tasting or satisfying as before?”

Note that the counselor does not provide advice or solutions to the problem and must resist this temptation.
While the counselor may be tempted to give advice, it is not helpful. Rather than providing answers, asking
clients questions about their thoughts promotes self-discovery, thus helping people learn to solve their own
problems. Clients need to recognize that negative thoughts sabotage lifestyle change and decrease motivation.

What good does it do to focus on negative thoughts? Is there another way to look at the situation or a
different explanation?

What is the worst that could happen versus the likeliest outcome? What if it happens?
What is the factual evidence supporting or challenging this negative thought? Is it really true?
How helpful or hurtful is this to my goals?

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