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Unread April 16th, 2007, 09:06 PM
James Pretzer James Pretzer is offline
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Join Date: Jun 2004
Posts: 283
Default CBT for weight loss

Weight loss has become a major challenge despite the constant of fad diets being promoted in the media. Judy Beck has waded into the fray with a book of her own which focuses on using CT techniques to improve adherence to any reasonable diet and exercise regimen. Her new book, The Beck Diet Solution was featured on NPR. Check it out at http://www.npr.org/templates/story/s...toryId=9521105

In an article she wrote for the National Psychologist she asserts that exercise and nutritional counseling are essential components of effective programs, as are the following CBT techniques:
  • Education regarding dietary information needed to select a highly nutritious diet that is flexible enough for planned indulgences and which they can maintain for their lifetime, with minor modifications.

    Realistic goals. Therapists should urge them to set only short-term goals (e.g., to lose 5 pounds) and to plan to lose weight very slowly. Dieters should develop the expectation that they will not lose weight every week, even if they maintain a consistent caloric intake and exercise level.

    Guidance in selecting an appropriate exercise plan.

    When therapists provide the above information, dieters often have a host of negative thoughts that, left unchecked, could result in non-adherence to their diet or exercise program. Therapists need to help them effectively respond to their thinking using standard cognitive restructuring techniques.

    Self-monitoring. Dieters need to learn to plan their eating ahead of time and engage in daily self-monitoring in writing of their weight, food intake, and exercise. Reading a card, several times a day, which reminds them of all the reasons they want to lose weight can help continually motivate them to do this work. After several months, many dieters can discontinue daily written records but will need to reinstitute this strategy, either during their active weight loss phase or during lifetime maintenance, if their weight plateaus or rises for several weeks in a row. They often need cognitive restructuring if they are reluctant to do these tasks.

    Problem-solving. Therapists need to help dieters anticipate and solve problems they are bound to encounter, such as finding time and energy for dieting and exercising, dealing with “food pushers,” uncooperative family members, eating out, and eating while traveling. Cognitive restructuring is often required when dieters reject reasonable solutions.

    Accountability and support. Dieters need a “diet coach.” This role can be fulfilled initially by the therapist and later by a supportive, problem-solving oriented friend or family member.

    Change in eating habits. Therapists need to provide strong rationales for dieters to eat every single meal and snack slowly and mindfully while sitting down and to develop a system for self-monitoring. Cognitive restructuring can help dieters who resist making this behavioral change understand that they can keep using unhelpful eating habits or they can be thinner, but they can’t get or remain thinner with unhelpful habits.

    Responding to sabotaging thoughts. Many thoughts represent self-deluding thinking: “It’s okay to eat this because....I’m happy/I’m sad/everyone else is eating it/it’s just a little piece/it’s a celebration/I’m hungry/I’ve already cheated.”

    Experiments to decrease fear and increase tolerance of hunger and craving. Even if they are not fully aware of it, dieters often fear hunger and overeat to avoid feeling uncomfortable. They need to deliberately postpone meals occasionally (health permitting) to prove to themselves that they can withstand hunger and craving.

    Maintenance: Dieters need to be taught skills to motivate themselves to adhere to a maintenance diet and exercise program for life, for example, by continually reminding themselves about the benefits of weight loss. They need to have a written plan containing the diet strategies they’ve already learned for days when the scale goes three pounds or more above their maintenance weight.

    Therapists need to pace treatment according to the individual. Most dieters require significant preparation, including education, nutritional counseling, problem-solving, and cognitive restructuring before they’re ready to start.
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