Page 189 - Nutrition Counseling and Education Skills: A Guide for Professionals

• A person may alter his or her cognition from being a restrainer to an indulger. (“I lack willpower and never could follow the diet anyway.”)
• The person may rationalize. (“I deserve a break today. I owe myself this food.”)
• The person may change his or her commitment to save face. (“I changed my mind about following this dietary regimen and decided to eat

whatever I want.”)

Lapses affect both people’s thoughts and their feelings. If there is no coping response and the person feels
unable to exert control, he or she experiences a decrease in SE, sometimes coupled with a sense of helplessness
or a passive giving in to the situation. (“It’s no use. I can’t stop myself.”) In this all-or-nothing perspective, a
single lapse leads to giving up. If the person has positive outcome expectancies of immediate gratification from
eating (“It will taste delicious. I will feel better if I eat this.”) and ignores the negative health consequences,
the probability of lapse or relapse is enhanced. The individual experiences a conflict of motives between a
desire to maintain control and the temptation to give in. The person consumes less desirable foods, a lapse has
occurred, and there can be a problem in reestablishing control. After a lapse, the person either copes and gets
back on track or may proceed to relapse.32

It is important to educate clients about the relapse process since it is unlikely that people will recognize the
range of situations that may trigger eating. When the individual’s unique high-risk situations (thoughts,
feelings, people, and situations) are identified, counselors can teach the person to look for cues, such as an
upcoming party, vacation, holidays, or stressful time at work. The client can take preventive action and make
advance decisions about how to cope. The goal of treatment is to help the client learn to anticipate and
prevent the occurrence of lapses and relapse or help the individual recover from a lapse before it escalates into
a full-blown relapse.

Lapses are inevitable. The counselor needs to advise clients to expect this and prepare them to handle it.
Failure to do so deprives the client of the opportunity for developing skills to cope with a lapse or relapse or
minimize damage. Using the term “lapse” avoids the value judgment associated with a term like “cheating” on
the diet. Everyone will, on occasion, overeat or eat tempting foods. Each mistake is viewed as a learning
opportunity, not a personal failure. The goal is to teach the individual how to identify situations with a high
risk for lapse and relapse, to use problem-solving and coping strategies when confronted, and to deal with the
negative thoughts (guilt) that accompany a lapse.

The most dangerous time is that immediately following a lapse.32 The reward of instant gratification may
far outweigh negative health effects in a distant future. Thus, a single lapse, or series of lapses, may snowball
into a full-blown relapse from which it is more difficult to recover. Figure 8-2 is an example of failing to cope
at the grocery store and at home in the presence of the external cue of potato chips. The loss of control and
dysfunctional self-talk results in binge eating and relapse.

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