Page 193 - Nutrition Counseling and Education Skills: A Guide for Professionals

8C H A P T E R

Summary

While all theories and models are valuable, additional scientific research is needed as a basis for planning more
effective, evidence-based interventions that are appropriate for the individual client. The nutrition professional
may combine a number of counseling approaches with clients. This chapter describes the use of cognitive
restructuring of negative and dysfunctional thoughts, and outlines methods that increase the client’s self-
efficacy or self-confidence to change a behavior. The problems of lapse and relapse that require coping skills
and relapse prevention approaches are included.

Counselors should give clients a summary or overview of the relapse process. With an increased level of
awareness in high-risk situations, clients are better prepared to utilize their coping skills and take remedial
action to avoid a lapse or relapse. People need to see themselves as capable agents of control rather than as
helpless victims in situations beyond their control.

Review and Discussion Questions

1. What is cognitive therapy?
2. What effect do negative cognitions have on behavioral change?
3. What types of cognitive distortions do people have?
4. Explain the three phases of cognitive restructuring.
5. What is the relationship between an outcome expectancy and an efficacy expectancy?
6. How do self-perceptions of efficacy affect a person’s choice of activities?
7. Explain an individual’s four sources of efficacy information. How does each affect behavior?
8. Explain the relapse model.
9. What are examples of high-risk situations?
10. What strategies can help to prevent relapse?

Suggested Activities

1. Keep a record of what you eat during one day noting your thoughts about food before eating, during eating, and after eating. What percent
are positive? Negative? How did this increase your awareness?

2. Identify your own high-risk situations for eating and how you respond. What happens if you cope with the situation? What happens if you
are unable to cope with the situation? How do you feel?

3. For each of the following client cognitions, forecast how the client will behave. Then develop a more positive, coping thought.
A. “I’ve never been able to stick to any low-calorie diet for more than a week.”
B. “The food doesn’t taste any good without salt.”
C. “There are chocolate chip cookies in the cupboard, and I sure could use a few after the day I’ve had. I deserve a treat.”
D. “Here is a commercial break on my television show. Guess I’ll check the refrigerator.”
E. “That leftover pie looks good, but I don’t need it.”
F. “I’ve blown my whole diet eating that apple pie with ice cream. What’s the use?”
G. “I don’t have time to prepare all of that special food today.”

4. For 2 days, keep a tally of the number of times people use the terms “should,” “shouldn’t,” “must,” “have to,” or “ought to” in statements
about themselves. Or keep a tally of the number of times you use these terms.

5. For 2 or more days, consume a modified diet (low fat, low calorie, restricted sodium, high fiber, etc.). Keep a log of your thoughts. Identify
any high-risk situations.

6. Each evening for 2 days, make a written list of all of your successes or things you accomplished. Give yourself a verbal pat on the back with a
positive cognition.

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