Counseling for Cognitive Changech 7

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Counseling for Cognitive Change(ch 7)
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Cognitive Change vs Behavior Change

• Behavior Change dependent on external cues or
  stimuli in the environment
• Cognitive Change Relation between cognitive
  process and eating behavior
• Cognitions A persons thoughts or cognitions at
  a certain point in time
• Strategies for dealing with a persons thoughts
  are often incorporated into behavioral programs

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Examples of Programs

• Weight Control May include
• Behavioral Modification
• Cognitive Change
• Exercise
• Social Support
• And Nutrition

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Cognitive Change Areas

• Cognition and Cognitive Restructuring
• Self-efficacy
• Relapse Prevention

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Cognitions What are they?

• Automatic thoughts
• Internal Dialog
• Self-talk
• Examples of self-talk
• Not related to food
• Related to food

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Cognitive Distortions

• All-or-Nothing thinking I over ate at dinner. I
  will always overeat at dinner.
• Overgeneralization I tried to stay away from
  fried foods before and I couldnt so I will never
  be able to reduce intake of fried foods
• Mental Filter dwells on a negative detail
• Disqualifying the positive
• Jumping to Conclusions

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Cognitive Distortions

• Magnifying and minimizing
• Emotional reasoning
• Should statements
• Labeling and mislabeling
• Personalization

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Cognitive Restructuring

• Emphasis on modifying the clients thinking and
  the assumptions and attitudes that are underlying
• Three phases( not necessarily in order)
• 1. Helping client understand the nature of the
  problem
• 2. Exploration and consolidation of the cognitive
  problem
• 3. The change takes place

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Self-Efficacy

• This is the persons belief or confidence that
  they are able to complete a task, such as eating
  differently.
• Close association between perceived self-efficacy
  and nutrition and health behavior change
• Goal setting appears to enhance a persons
  self-efficacy and satisfaction with performance.

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Dimensions of Efficacy Expectations

• Assessment of clients thoughts about their
  abilities to make change in eating and exercise
• 2 step approach to measure self-efficacy
• 1. From a list of dietary goals or changes, have
  client select the changes they can undertake.
  Work from simpler to more complex
• 2. For each task, ask each client to rate their
  expectancy of success on a 5 point scale

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Sources of Efficacy Information

• Actual Performance if youve done it before, you
  most likely can do it again
• Vicarious Experiences Through the success and
  modeling of others
• Verbal persuasion the least effective but most
  used
• Physiological and Emotional States Lifestyle
  changes may bring hunger, tension, etc.

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Relapse Prevention High-Risk Situation

• Coping response
• Desired Behavior
• Increased Self-Efficacy
• Decreased probability of a lapse or relapse

• No Coping Response
• Maladaptive Thoughts
• Decreased self-efficacy
• Eating disallowed food
• Abstinence violation effect(guilt shame)
• Increased probability of relapse (eating more
  disallowed food)

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Examples of High Risk Situations

• Physiological Feelings of Hunger, fatigue, etc
• Attending social affairs
• Holidays
• Low self-efficacy
• Stress
• Negative talk

• Lack of Social Support
• Interpersonal conflicts
• Positive emotional states, eg fun and celebration
• Negative emotional states or moods, eg
  depression, anxiety, etc.

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Identification of High Risk Situations

• 2 stages
• 1. Identify the specific situations that may pose
  a problem
• 2. Assess the clients coping skills or capacity
  to respond
• You can role play these situations
• Turn to a partner
• One person is the counselor, the second is a
  newly diagnosis DB. Role play the above two
  points.

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Case Studies p 157

• Work in groups of 2 or 3 and select Case one or
  two and work through it
• Use page 141 and following to help with Case 1
• Identify each statement
• Then classify it as to the Type of Distortion
• Then discover a potential Self-defense or coping
  thought
• Report out what you discovered.

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Hinton, P. S. Postpartum exercise and food
intake the importance of behavior-specific
self-efficacy

• JADA 2001 1010 1430-1437
• Objective to examine the relationships between
  psychological characteristics and change in
  exercise and food intake of women in the first
  year postpartum

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Introduction

• Pregnancy has been identified as a period of time
  of increased risk of overweight and obesity.
• To design intervention programs that effectively
  target behavior change, it is important to
  understand the factors that predispose a person
  to engage in the desired behavior change.

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Precede-proceed Model of Health Promotion Planning

• Diagnosis Phase Assess
• Knowledge, attitudes, beliefs that motivate or
  facilitate behavior change
• Implementation Phase
• Target these factors

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Design

• Prospective, cohort study following women from
  pregnancy until 1 year postpartum
• Anonymous questionnaires mailed during pregnancy
  and at one yr postpartum
• Assessed psychosocial barriers, change in food
  intake, and exercise frequency

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Subjects

• N 622 women who enrolled in prenatal care in the
  Bassett Health Care system attrition rate was 20

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Stats

• Mulitvariate linear regression
• With exercise frequency at 1 yr postpartum
• Change in food intake during the second 6 months
  of postpartum were the dependent variables
• Psychosocial factors assessed at 1 yr postpartum
  as the independent variables

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Results

• Higher exercise self-efficacy and having the
  intention to exercise were associated with more
  frequent exercise
• Food intake self-efficacy, body satisfaction,
  weight gain acceptance and drive for thinness
  were significant and higher scores were
  associated with reductions in food intake

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Applications

• Interventions that are aimed at helping women
  make appropriate reductions in food intake and
  get regular exercise should focus on
  self-efficacy
• E.g., Help women set realistic goals for exercise
  postpartum
• Instruct women to mastery level concerning
  exercises they may include postpartum