C H A R L O T T E C A P E R T O N - K I L B U R N , M S , R D N , L D N , C S S D , F A N D , C E D R D D I R E C T O R O F S P O R T S N U T R I T I O N , C O L L E G E O F C H A R L E S T O N - A T H L E T I C S N F L P E R F O R M A N C E - P R I V A T E P R A C T I C E A U T H O R E M A I L : N F L P E R F O R M A N C E @ Y A H O O . C O M T W I T T E R : @ P E R 4 M A N C E F U E L
DISCLOSURE Coautho hor- - Wi Winning T The W e War Wi Within: N : Nutrition T Ther erapy f for C Clien ents w with E Eating D Disorder ers
OBJECTIVES: Ut Utili lize C CBT t techni hniques u useful t l to e eating ng d disorder c cli lient nts. . Create e effective s sessions ns f for c cli lient nts. . Und nderstand nd ho how t to i imple leme ment nt e effective C CBT d dialo logue.
COGNITIVE BEHAVIOR THERAPY (CBT) BRIEF REVIEW Most e effective i in t n the he t treatme ment nt o of B BN a and nd B BED D Structured t treatme ment nt f focuses o on p n present nt a and nd f future t thr hrough s h ski kills lls t traini ning ng a and nd e education n The heory- i - int nterconne nnected § Thoughts (cognitive) and § Actions (behavior) Cha halle lleng nge i irrationa nal b l beli liefs § New healthier thoughts and actions can occur by restructuring Heali ling ng b by u y und nderstand nding ng s self lf Work t k toward r rema maini ning ng c calm o lm or ne neutral i l in a n a d difficult lt s situation n
CBT SHOWS EFFECTIVE USE WITH Self / Personal Growth Individual Clients Groups Marriage / relationships Family Workplace Varying Intellectual ability/learning impairments Caution: C n: Cogni nitive t the herapies d do no not a appear t to w work w k with c h cogni nitive i impairme ment nt
COGNITIVE DISTORTIONS HAVE COGNITIVE AND BEHAVIORAL FACTORS THAT MAINTAIN THEM. Event nt Attitudes, V , Valu lues, B , Beli liefs § Emotional Response § Behavioral Response
MAINTAINING FACTORS INCLUDE: Beha havioral F l Factors Cogni nitive F Factors ~ ~ Weight ht-c -cont ntrol b l beha haviors Over-evaluation of weight § dietary restraint and shape § restriction Negative body image § binge-eating Core beliefs about self- § purging behaviors worth Self lf-ha -harm m Negative self-evaluation Body c y che hecki king ng Perfectionism Body a y avoidanc nce
CBT s stresses e education a n and nd s ski kills lls t traini ning ng t tha hat he help lp t the he p patient nt g gain a n a t tho horough h und nderstand nding ng o of the hems mselv lves a and nd t the heir e eating ng d disorder s so t tha hat he heali ling ng c can n occur. .
REQUIRES A COLLABORATIVE EFFORT BETWEEN NUTRITION THERAPIST AND CLIENT Nutrition T n The herapist R Role le Cli lient nt R Role le § Express concern § Listen § Define goals § Encourage § Teach if needed § Implement learning § Help client determine goals
SUCCESS WITH CLIENTS Requires mo more t tha han ju n just he help lping ng w with h beh ehaviors o of b bing ngeing ng a and nd purging ng. . Int Intervent ntions ns p prima mary f y focus o on d n dietary r y restraint nt a and nd t the he dys ysfunc nctiona nal t l tho hought hts a about “ “bad” f foods, b , body w y weight ht a and nd sha hape. . Winning The War Within: Nutrition Therapy for Clients with Eating Disorders, 3 rd edition 2017
PRESENT AND FUTURE-ORIENTED FOCUS CBT he help lps t the he c cli lient nt § Moni nitor thinking and heighten awareness of thinking § Recogni nize the connection between certain thoughts and maladaptive behaviors § Exami mine ne the validity of particular beliefs § Try o y out more realistic and appropriate interpretations; and § Gr Gradual mo l modification n of the underlying assumptions that are fundamental determinants of beliefs, as well as self-defeating behaviors. Winning The War Within: Nutrition Therapy for Clients with Eating Disorders, 3 rd edition 2017
IRRATIONAL THINKING/COGNITIVE DISTORTIONS Being convinced of an untrue reality (believing you’re overweight when you’re 85lbs.) Other examples of Cognitive Distortions Filtering (“This food is so full of fat, it makes me feel bad the rest of the day.”) Black and White thinking/Polarized Thinking (“I didn’t eat what I should have or breakfast, so what does it matter if I eat or what I eat the rest of the day.”) Overgeneralization - (“The last time I ate dairy I had diarrhea, I have a dairy allergy) Jumping to Conclusions (“People think I am fat if they see me eating bread.”) Catastrophizing/Magnifying or Minimizing Personalization Grohol, J. (2016)
IRRATIONAL THINKING/COGNITIVE DISTORTIONS Other examples of Cognitive Distortions Control Fallacies- Two ways external control (helpless, victim of fate; feeling this way keeps one stuck and feeling not able to affect their own life or unable to make a difference in the world) and internal control (feel responsible for everyone around and is left exhaustive from trying to fill all the needs of others and guilty when unable to do so) Fallacy of Fairness -(”She can eat anything she wants and doesn’t gain weight.”) Blaming Should’s- (“I really should exercise. I shouldn’t be so lazy.”) Emotional Reasoning- ( “I feel it therefore it must be true.”) Fallacy of Change- Global Labeling/Mislabeling- (”I am such a failure- I can never stick to what I plan to eat.”) Always Being Right Grohol, J. (2016)
TREATMENT PROCESS Beha havioral P l Pha hase: p : pla lan f n for s stabili lizing ng e eating ng a and nd e eli limi mina nating ng s sym ymptoms ms. Int Intens nsified e emo motions ns Tools ls ( (coping ng s strategies) f for ma mana naging ng f feeli ling ngs a are d develo loped a and nd b become me a an i important nt p part o of t the he w work. Psycho hoeducation CBT i inc nclu ludes i in-s n-session a n activities a as w well a ll as “ “ho home mework” k”. . Winning The War Within: Nutrition Therapy for Clients with Eating Disorders, 3 rd edition 2017
HOMEWORK TECHNIQUES Journa nali ling ng Unr nraveli ling ng C Cogni nitive Di Distortions ns Cogni nitive R Restructuring ng Beha havior M Modification n Education n Rela laxed B Breathi hing ng Experient ntial A l Activities Int Intent ntiona nal R l Reframi ming ng Tho hought ht s stopping ng
IRRATIONAL BELIEFS ARE THE SELF-DEFEATING RULES Core beliefs are underlying rules that guide how people react to the events and circumstances in their lives.
IRRATIONAL BELIEFS 1. I need love and approval from those around me. 2. I must avoid disapproval from any source. 3. To be worthwhile as a person I must achieve success at whatever I do. Clean eating makes me a worthy person. (their definition of clean eating) 4. I can not allow myself to make mistakes.- “I must eat perfect . Only healthy foods.” 5. People should always do the right thing. When they behave obnoxiously, unfairlyor selfishly, they must be blamed and punished. 6. Things must be the way I want them to be.
IRRATIONAL BELIEFS 7. My unhappiness is caused by things that are outside my control – so there is nothing I can do to feel any better. 8. I must worry about things that could be dangerous, unpleasant or frightening – otherwise they might happen. 9. I must avoid life’s difficulties, unpleasantness, and responsibilities. 10. Everyone needs to depend on someone stronger than themselves. 11. Events in my past are the cause of my problems – and they continue to influence my feelings and behaviours now. 12. I should become upset when other people have problems, and feel unhappy when they’re sad. 13. I shouldn’t have to feel discomfort and pain. 14. Every problem should have an ideal solution.
ABC ’ S A → B → C A = Activating Event B = Beliefs, Thoughts, Attitudes, Assumptions C = Consequences, Feelings, Emotions, Behaviors, Actions
WORK WITH CLIENTS ON Fact no not a assumptions ns ( (Rationa nal) l) § What are the medical & physical consequences of your behaviors? § How effective are laxatives or vomiting? Structured a and nd d directive- H - How d does t the he b body u y use c calo lories? H How d does me metaboli lism m cha hang nge t thr hrough h refeeding ng p process? W Wha hat i is no norma mal e l eating ng? Listen a n and nd u use t techni hniques f for r restructured r rationa nal t l thi hinki nking ng
TREATMENT PROCESS Cognitive Phase: strategies for change, Identifying a and c cha hanging c cues(triggers), Connecting behaviors to thoughts and emotional patterns that perpetuate the problems (“I will only be happy if I can lose this weight”) Restructuring thoughts perspectives and ideas (“my self-worth doesn’t depend on my size or shape”). Setting consequences of behaviors (setting goals) and experimenting with high risk. Winning The War Within: Nutrition Therapy for Clients with Eating Disorders, 3 rd edition 2017
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