Deborah Beck Busis, LCSW, Director, Beck Institute Weight Management Program
A critical part of conducting modern, values-focused CBT is helping clients identify and make progress toward their important goals. Unsurprisingly, many clients have goals related to their health and fitness, including changing their habits around eating and nutrition, exercise, and sleep. Even clients who don’t initially express goals related to wellness may discover that improving their health can support other important goals (e.g., the grandmother who wants to run around with her grandchildren but finds she doesn’t have as much energy as she would like). CBT provides a powerful framework to help clients make changes that support their health. As Director of the Weight Management program at Beck Institute, I not only help clients achieve their personal health goals in my own practices, but I also teach and supervise therapists to use cognitive and behavioral strategies with clients who struggle to implement changes that can improve their overall wellbeing.
When clients express the goal of changing their eating and nutrition, I first work with them on how they eat, helping them institute good eating habits like eating sitting down, slowly, and mindfully. I then work with them on why they eat. They start labeling urges to eat as being due to actual hunger or to another experience, such as craving, boredom, tiredness, or negative mood. They do experiments to help them decastrophize hunger, and they learn specific techniques to overcome cravings and emotional eating. Next, we tackle when they eat, helping them figure out an eating schedule that works for them. It’s helpful for them to decide in advance when (within a range) mealtimes and snack times are. Then it’s crystal clear to them when they have decided in advance to eat and when they’ve decided not to eat. This eliminates the burden of figuring out whether they should eat spontaneously every time they think about food or eating throughout the day. Finally, we focus on what they eat, making plans in advance and, for most of them, doing some type of tracking, whether or it’s calories, macros, or points.
Throughout every step of this process, I use CBT techniques to help clients successfully put these skills into practice. For every skill we discuss, I always ask them, “When will it be hardest to practice it this week? What sabotaging/automatic thoughts are you likely to have that could get in the way? What practical problems might interfere with following your plan?” We then spend time every session coming up with helpful responses to predicted sabotaging thoughts and doing problem-solving, so that when either arises, clients know exactly how to handle them and are able to respond effectively.
I also prepare clients in advance for the inevitability of making mistakes. After all, this is a learning process, and no one would expect to learn to play tennis without missing a ball. In fact, even professional tennis players miss balls. But when they do, they don’t give up! They just refocus and try to hit the next one. One of the most common sabotaging thoughts I see in my clients and in my supervisees’ clients is, “I’ve made an eating mistake. I’ve blown it for the day so I might as well keep eating and get back on track tomorrow/Monday/January 1, etc.”
I remind clients that in virtually no other area of life would they ever buy into the idea, “Since I messed up, it makes sense to keep messing up.” If they were driving on the highway and missed their exit, they wouldn’t think, “I’ve blown it for this trip,” and drive five more hours in the wrong direction. Instead, they would get off at the very next exit and get right back on track. I help clients learn from mistakes by figuring out what they’d like to say or do differently the next time so that when a similar circumstance arises in the future, they know exactly how to handle it.
I spend a lot of time with clients gathering evidence of what truly does make them feel good and what does not, to help them overcome what I call the “belief/reality disconnect.” Initially, clients continue to believe that getting to eat as much as they want will be great and not allowing themselves to do so will feel like deprivation. I ask clients to notice how they predict they’ll feel if they eat off plan—and then how they actually feel once they do that. They invariably find the following: What they initially thought would make them feel good, doesn’t. Overeating usually makes them feel out of control, uncomfortably full, or regretful. And they find that sticking to their plan (which we make sure is reasonable and not overly restrictive!) makes them feel great. I help clients gather this evidence at every opportunity.
When I’m working with a client on healthy sleep or exercise goals, the framework is the same. I start small, with achievable goals, and work up from there. Every step of the way we discover potential roadblocks and collaboratively create responses to unhelpful thinking and solutions to problems. I prepare them in advance to learn from their mistakes. We also gather evidence to counter the belief/reality disconnect: “How did it feel after you got yourself to exercise yesterday morning even though you didn’t want to in the moment? How did it feel the next day when you stayed up an extra two hours watching TV instead of giving yourself the opportunity to get a full night’s sleep?”
These CBT techniques and many others help clients achieve a wide array of health and wellness goals. I hope you’ll join me for an upcoming Weight Management workshop to learn more or inquire about one-to-one consultation for help in implementing strategies with clients in both the short- and long-term.