COGNITIVE-BEHAVIORAL THERAPY AND WEIGHT-LOSS

The weight-loss industry is alive and well. If one is overweight, the choices of diets, nutritional supplements, herbal remedies, exercise programs, support groups, and motivational programs are endless. If devouring a carton of ice cream doesn’t stress you out, ruminating about one’s weight-reducing options can sufficiently reduce one to tears.

If there is a quick fix to maintaining the loss of weight, I have yet to see it. There are plenty of ways to lose weight, but what about the process of keeping it off? Often people bounce around from one dietary plan to another as their weight fluctuates during their quest for the perfect plan. They may deny the reality that there is no panacea for proper weight maintenance. It is a multi-faceted process.

Often, individuals become obsessive with the weight-loss pattern. Weight-loss and weight maintenance can become a ritualistic, compulsive cycle. Charlie Whitfield, author and addictions expert calls the pattern the “repetition cycle.” Anxiety and depression mount, followed by the urge to eat, leading to self-indulgence, and ending with symptoms of self-blame and guilt. Then the cycle of abuse repeats itself. Paradoxically, those who follow an addictive quest to lose weight may actually end up sabotaging their own goals.

From childhood, we are conditioned to believe that the only way we can change is when we are coerced. Therefore, we learn to mistrust our instincts and believe that if we give ourselves enough rope, we’ll hang ourselves. Without exploring the psychological issues that may be triggering weight problems, most people will be doomed to repeat a pattern of self-defeating behavior. We must understand that we are more than the pleasure center of our brain. We are much more than the darkest side of our soul. Many may say that if I am not intolerant of my mistakes, how will I learn to motivate myself to change? However, real change only occurs when we learn to respect and value who we are with all of our faults.

Because of its value in dealing with an individuals thinking, distortions, and beliefs, cognitive therapy is the most effective therapeutic treatment for those who seek to lose and maintain weight. Cognitive therapy helps people make rational assessments of their weight, and assists people in responding with self-affirmation to their maladaptive thinking about eating and body perception. Whatever one’s demons happen to be, people need to move forward and treat themselves as if they deserve the best things to happen in their life.

Self-defeating thinking and behavior tend to perpetuate the cycle of unhealthy eating. No amount of exercise or nutritional support will address the need for individuals to learn to rationally respond to their maladaptive eating patterns. Unhealthy eaters are typically overwhelmed by self-blame. A downward spiral is set in motion by the way in which the person views himself. Unhealthy eaters will label themselves as being “fat” (whether they are or not), and will chastise themselves for not making progress in losing weight. Viewing oneself as an “overweight louse” is not an effective way of motivating oneself for change. In fact, browbeating oneself for being less than perfect only intensifies the cycle of unhealthy eating abuse. Self-blame is a form of tyranny which keeps one stuck in the midst of the problem.

Cognitive therapy teaches the unhealthy eater to quit the self-blame, realistically assess the problem, and to set practical goals for change. The therapist may say, “Does eating too much make you a horrible person? In the scheme of things, how awful was it that you ate that extra helping of cake?” Realistic appraisal follows, “what do you think you can do next time to make sure that you don’t overdo it?”

Cognitive therapists also assess body misperception. Many people who eat in an unhealthy fashion may tell others that they are fat. Labeling oneself in a negative manner is one of many cognitive distortions that hinder weight-loss progress. In many cases, the individual’s concept of their weight may be exaggerated. The therapist may say, “Does calling oneself morbidly obese change anything? Or where’s the evidence that you are as overweight as you think you are?”

Most unhealthy eaters experience thwarted anger. Rather than direct their resentment at the source of their difficulties, they self-sabotage by internalizing their anger and directing it toward themselves through unhealthy eating. They may feel frustrated by the conditional nature of a relationship, may have a family member who humiliated them about their weight, or experienced rejection through social betrayal. As confidence was stripped away, they developed a negative concept of self which fueled their unhealthy eating pattern. The self-blaming message is usually, “I guess I really am a slob, so the best I can do is to continue to prove it to myself.”

Unhealthy eaters can untwist their maladaptive thinking and meet their weight goals by:

Learning to rationally respond to negative thinking. For example, instead of saying, “I’ll never meet my weight goals, I’m just worthless,” one might say, “Just relax and be patient, Rome wasn’t built in a day.”
Identify cognitive distortions such as castastrophizing, labeling, personalizing, and black and white thinking. An example might be, “If I can’t lose 5 lbs. this week I might as well give up” (black/white thinking).
Instead of being unkind to yourself, talk to yourself the same compassionate way you would to a dear friend who is experiencing the same weight problem.
Instead of assuming your negative thoughts are accurate, examine the evidence that supports your conclusions. “If I don’t lose 15 lbs., will people really think I am hopelessly obese?”
Instead of taking full responsibility for your weight problem, you can assess the many factors that may have contributed to it and address those issues with the support of others.
Set a realistic agenda. Ask yourself, “What would it be worth to me to stop my unhealthy eating? How hard am I willing to work on a rational solution?”
Evaluate weight maintenance progress based upon the process – the effort you put in – rather than the outcome. Your efforts are within your control, but the outcome may not.
Substitute language that is less emotionally loaded. “I shouldn’t have eaten that extra helping” can be redefined as, “It would have been preferable if I hadn’t eaten more.”

Often, people will expose themselves to a diet that will dramatically assist them in losing excessive weight only to have the weight return. Instead of “quick fix” diets, setting a realistic agenda for weight-loss is a more rational, thoughtful approach. A slow, gradual loss of weight helps us to more easily adjust to the psychological ramifications of body perception change. Weight-loss goals need to be established because we prefer the change, not because others want it for us. Feeling coerced to change, or sensing that others acceptance of us is conditional upon weight-loss will lead to resentment and a feeling of helplessness in our quest to change. Instead, we must vow to learn the difference between self-indulgence and self-respect and work to put self-kindness into our everyday experience and choose our relationships based upon these positive qualities.



James P. Krehbiel, Ed.S., LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. He is the author of Stepping Out of the Bubble, the story of courage and risk taken by those who seek to better their lives. James can be reached at www.krehbielcounseling.com.

HOW TO RESPOND TO TRAGEDY

Rabbi Harold Kushner, the author of When Bad Things Happen to Good People, wrote about his response to personal tragedy. His son Aaron had premature aging, and eventually died from this disease. The pain from the Rabbi’s loss provoked a crisis of faith. Kushner wrote his book for those "who have been hurt by life," to assist them in finding a faith that provides reasonable answers to aid them in coping with their suffering. Kushner explores the random nature of life and how certain spiritual explanations for tragedy left him feeling empty.

Recently, I made a trip to visit a friend who has terminal cancer. This was no easy task. I knew that it would be our last visit. I struggled over the issue of what things I wanted to explore to make sure that the time we spent together was uplifting for both of us. I was apprehensive about "saying the right things," but as I drove to her house I kept reminding myself to "just let things be the way they are." It was a time of closure and healing for both of us.

All of us are confronted with times of suffering. It is an inevitable part of the human condition. We are abused by a partner, we lose a job, we are betrayed by bandits who rob our homes, we experience the death of loved ones and we struggle with serious illness. No reasons adequately explain our hurt and disappointment. We are left with our grief.

Often, family and friends make honest attempts to respond to our trauma, but they may make matters worse through insensitive comments. In the name of God, they may make comments that leave us feeling annoyed and misunderstood - the very thing we do not need. Here are some of the unhelpful comments that I am referring to:

God will never ask more of us than we can endure.
Try not to think about it.
God is trying to teach you a lesson.
Don't let it get you down.
Everything that happens in life happens for a purpose.
God has singled you out because he recognizes your strength.
Getting upset about it doesn't do any good.
If you are not healing from your affliction, you lack faith in God.
Just remember, other people have it worse than you.

Trying to figure out why misfortune happens to us is fruitless. Some things appear to happen for no reason. As Kushner indicates, although there is ample evidence of God's handiwork among us, people are unable to accept random acts that occur within the universe. This leaves us feeling deprived of structure and security. I believe it’s not our searching for the reason for affliction that's important, it is our reaction to. This is where our faith in God becomes important. When one is "down and out" here is what you can to say to people:

Tell me how you feel about what happened?
That must feel awful.
It's not your fault that this happened.
Tell me how I can help you?
Would you like to talk more about it?
I am sorry that happened to you.
I'll keep in touch more often.
I'll pray for you and your family.
I'll be there for you.

We need to learn to be more sensitive to those who are suffering. As a partner or friend, our role is not to fix matters, but to learn to become a good listener. We must listen without trying to provide reasons and explanations that are not helpful. As I said, we must "just be there and let things be the way they are."


James P. Krehbiel, Ed.S., LPC, is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His book, Stepping Out of the Bubble is available at www.booklocker.com. James can be reached at www.krehbielcounseling.com.