Page 190 - Nutrition Counseling and Education Skills: A Guide for Professionals

Figure 8-2 ■ When failing to cope, one’s thoughts affect eating.

Other Treatment Strategies

Coping skills include cognitive responses, such as positive self-talk (“I can do it.”), behavioral responses, such
as calling a friend instead of eating, and beliefs about SE, or judgments concerning whether or not one can
respond effectively. Coping skill training implies the actual acquisition of a new behavior through essential
practice and rehearsal of coping skills. “Practice makes perfect,” as an old saying goes.

Cognitive restructuring may be used also to counter the cognitive and affective components of the
abstinence violation effect (AVE).25 Instead of seeing the first lapse as a sign of failure characterized by
conflict, guilt, shame, and personal attribution, the client can be taught to view it as a single event or small
mistake rather than a total disaster, to renew the commitment to lifestyle change right away, and to learn from
mistakes by reviewing the environmental and psychological factors in the lapse situation.

Clients initiate dietary changes with varying degrees of motivation and commitment. In addition, some
who appear to be highly motivated initially may discover that long-term change is more difficult than first
imagined. Patients who lose some weight, for example, and those who struggle but adhere to their dietary
regimens, may be able to cope with temporary setbacks. Motivation may differ among people from collective
cultures where people interact in the group.26

Food habits or eating behaviors are assumed to be shaped by prior experiences. Changing these habits or
behaviors involves the active participation and responsibility of the client, who becomes the agent of change.
In a self-management program, the individual acquires new skills and cognitive strategies so that behaviors are
under the regulation of higher mental processes and responsible decision-making.

Behavioral rehearsal of either actual or hypothetical high-risk situations, coaching, and feedback from the
counselor are useful. Mental rehearsal through imagined scenarios in which the client engages in coping
responses when temptations are present and feels good about it, may be used to cope with reactions to a lapse.
Role reversal with the client teaching the practitioner how to cope with a high-risk situation and handle a
lapse will give the client more convincing arguments than any counselor could provide. Increasing SE through

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