Page 188 - Nutrition Counseling and Education Skills: A Guide for Professionals

Negative self-talk
Lack of social support from family, friends, or coworkers
Interpersonal conflicts
Positive emotional states (i.e., fun and celebration of an event)
Negative emotional states or moods (i.e., depression, anxiety, frustration, anger, boredom, loneliness,

feeling deprived, upset, sad, or worried)

Box 8-4 ■ Examples of High-Risk Situations

Identification and Assessment of High-Risk Situations
Assessment of high-risk situations may be viewed as a two-stage process. In the first stage, an attempt is made
to identify specific situations that may pose a problem for a client in terms of a lapse or relapse. Self-
monitoring food records are helpful in identifying these situations as well as in raising the individual’s
awareness of food choices made. Self-monitoring is an intervention in itself that may reduce some of the
behaviors.

Eating may be an automatic response that cannot be dealt with until there is a conscious awareness that one
is eating without any conscious decision to do so. SE ratings can be assessed by giving clients descriptions of
specific situations and asking them to rate how difficult it would be to cope. Situations with the lowest SE
ratings are the highest risk situations for a lapse.32 The counselor may ask the client to identify the difficulty of
coping on a 5-point scale, with 5 being the most difficulty. Descriptions of past relapses may be informative.
People who coped successfully may have relied on avoidance of events or on cognitive strategies, such as
thinking positively about goals for change or the negative consequences of a lapse.

Coping versus Failure to Cope in High-Risk Situations

There are two possibilities when a person is in a high-risk situation—a coping response or lack of one. If the
individual copes, SE is increased and there is less probability of a lapse or relapse. For example, the client
thinks coping thoughts: “I’m not hungry so I won’t eat,” “I’ll take a walk instead of eating,” or “I’ll phone my
friend instead of eating.”

After identifying high-risk situations, the second stage is an assessment of the client’s coping skills or
capacity to respond involving both thoughts and actions. One can evaluate these in simulated situations with
role-playing or in written form. An individual can role-play responses to high-risk situations with the
counselor or fellow group members.

Abstinence from less preferable foods is frequently viewed by individuals from an all-or-nothing
perspective. Marlatt postulates a cognitive and affective “abstinence violation effect” (AVE) when a person
violates the commitment to change food choices and consumes a food that he or she should not eat.25 The
cognitive component examines whether the lapse is considered internal and uncontrollable or external and
controllable. The affective component is related to feelings of guilt, shame, and hopelessness. Possible
responses to giving in to temptation are the following:

• One feels guilty, has lowered self-esteem, and blames oneself for the loss of control or indulgence in food. (“I shouldn’t have eaten it, but I
did. I’m guilty.”)

• An obese individual may continue to eat to relieve the guilt (“I ate one cookie and I blew it. I might as well eat the whole bag.”)

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