Page 186 - Nutrition Counseling and Education Skills: A Guide for Professionals

Figure 8-1 ■ Cognitive-behavioral model of the relapse process.

Source: Modified from Marlatt GA, Gordon JR, eds. Relapse Prevention. New York, NY: Guilford Press; 2005.

High-Risk Situations
The problem of giving in to temptation is a challenge for clients engaging in dietary and other health behavior
changes. Most people making lifestyle changes experience temporary setbacks. If they don’t know how to cope
and recover, they may give up all efforts and relapse permanently.

RP is based on a group of cognitive–behavioral strategies for assisting people who are changing a behavior.
The self-management program is designed to help individuals identify, anticipate, and cope with cravings and
setbacks, thus maintaining adherence to the targeted changed habits.30

A distinction exists between a “lapse” and a “relapse.” A lapse, such as one overeating episode at a
restaurant, is a slight error, or one instance of return to a previously discontinued food behavior. A lapse
should not be viewed as a personal failure leading to feelings of guilt, but as a learning experience as one
examines the immediate precipitating circumstances and ways to correct them in the future.

The goal is to assess with clients their high-risk situations associated with relapse.31 For a person on a
restricted diet, common tempting situations are emotional distress, negative emotions, moods, feelings,
cravings, social situations, and negative physiologic states.26 These include clients’ exposure to events, places,
persons, thoughts, and other cues to eating ranging in different intensities.

Negative emotional moods and feelings, such as depression, anxiety, stress, frustration, anger, boredom,
loneliness, and feelings of deprivation prior to or at the time of the lapse are related to relapse.29 Uncontrolled
eating is a common response when a person is alone. The emotional reactions increase the chance that one
lapse will occur and increase to a relapse. Negative cognitions, self-defeating thoughts, and low SE ratings are
of concern because they are predictive of relapse. Individuals with positive cognitions and perceived SE tend
to call upon their coping skills and regulate their behaviors better. Bandura does not believe that appropriate
behavior, such as choosing appropriate foods and avoiding others, is achieved by a feat of willpower. When
people do not behave optimally even though they know what they should do, thoughts or cognitions may be
mediating the relationship between what one knows and what one does.11,16

Positive emotional states in which one desires to increase feelings of pleasure or celebrate an event are also a
problem. A study of dieters found that negative emotional states occurring when the individual was alone and
positive emotional states involving other people, such as at social gatherings, were both difficult high-risk
situations to handle, suggesting that managing these situations should be incorporated into nutrition
counseling.29

Besides individual factors, situational or environmental factors also play a role in relapse. The support of
family, friends, or self-help groups is associated with better success, while interpersonal conflicts, such as
disagreements or hassles in relationships with family, friends, or an employer, may signal the possibility of
relapse.

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