Nutrition Counseling Theories PDF

Dr. 8th Lecture  COGNITIVE RESTRUCTURING (CR) It is a concept that requiresthe client to change the way s/he thinks about slips in positive dietary habits. For example: The client who says, “I might as well give up. I just ate that forbidden cake. What is the use in even tryin...

Dr. 8th Lecture  COGNITIVE RESTRUCTURING (CR) It is a concept that requiresthe client to change the way s/he thinks about slips in positive dietary habits. For example: The client who says, “I might as well give up. I just ate that forbidden cake. What is the use in even trying?” This client might restructure his/her internal monologue by saying “ If I have 1 piece at this special event, that is fine! 40  RATIONAL-EMOTIVE THERAPY (RET) Albert Ellis determined that [irrationality is the most frequent source of individuals problems]. Self-talk-the monologues individuals have with themselves is the major source of emotion-related difficulties individual’s problems. RET was founded by Albert Ellis as one of many models of CBT.  CONTINUED-RET The major purposes of rational-emotive therapy RET are: To demonstrate to clients that negative self-talk, & the cause of many of their problems should be reevaluated & eliminated along with illogical ideas]. Clients' major goals in RET are: To look to themselves for positive reinforcement of behavior.  CONTINUED- RET RET focuses on: Sustained changes in emotions, life philosophy & behavioral changes designed to emphasize overall values. The primary goal is to help people live rational & productive life.  CONTINUED- RET EXAMPLE: In dietary counseling, a client with hyperlipidemia might say: “I know that I need to stop saturated fat to maintain healthy lifestyle overall.” However, It is hard to think of avoiding all those foods that I love for the rest of my life. Is that really living? The RET counselor in this case can help change negative self-talk to more positive thoughts by illustrating the benefits of change on his\her overall lifestyle.  CONTINUED- RET (EXAMPLE)  The client might respond: “I know that in the long run, eating in a healthful way is the best choice” “It will allow me to be more active with my grandchildren, something very dear to me.” “Yes, my goal will be to focus my thoughts on how changes in eating will affect my entire life, & especially those things I value most.” (his grandchildren) SOME QUOTES IN CHANGE & CREATE YOUR OWN! TRANSTHEORETICAL MODEL (TTM)  What is TTM? It uses stages of change to integrate processes & principles across theories of intervention, hence the name transtheoretical. It emerged from more than 300 theories of psychotherapy. This model was stablished by Prochaska & colleagues (1982) when conducted a study with smokers to quit smoking. Then, it has been used for many years to alter addictive behaviors.  HOW WE CHANGE OUR BEHAVIOR? CORE CONSTRUCTS OF TTM  Change is not viewed as a single event , such as “ I will eat less sodium starting today. So, people who need to make changes progress through 6 identified stages.  TRANSTHEORETICAL MODEL (TTM) Stages of Change “Is a process in which clients progress through a series of 6 motivational stages: 6. Termination/ Relapse 5. Maintenance 4. Action 3. Preparation 2. Contemplation 1. Pre-contemplation  A spiral model of the stages of change. In changing, a client moves up this spiral to maintenance.  If relapse occurs, s/he must reenter the spiral again at some points. STAGE (1):PRE- CONTEMPLATION [No intention of changing in the next 6 months] a)This is the point at which the patient has not even contemplated having a problem or needing to make a change (not interested in change) & thus has no plans to change eating practices or start exercising in the near future. b)A person in this stage needs information & feedback to raise his or her awareness (consciousness raising) of the problem & possibility of change. c)Nutrition advice for eating changes is counter productive at this point. CONTINUE- STAGE (1) Examples: For client ignoring the relationship between a high- fat diet & CHD, you may ask: “ Have you thought about eating less fat ( or more fruits & vegetables) in the past 6 months? At this stage, a person with high levels of LDL may need to know the benefits of a lower LDL blood level, for example, & the risks of not addressing the problem. An attempt to focus instead on making dietary change may not be effective in pre-contemplation. STAGE (2):CONTEMPLATION [ Intending to change but not soon] a)Once some awareness of the problem arises, the person enters a period of ambivalence (the contemplation stage). b)The contemplator seesaws between reasons to change & reasons to stay at the same time. c) At this stage the counselor works with the patient on advantages (pros) & disadvantages (cons) of making dietary changes. Examples: You may ask :“What are the pros & cons of doing it ?” “ What do you think about eating less fat? “What are the barriers to do the actions?”  CONTINUE STAGE (2) The balance between pros & cons can result in ambivalence that keeps people at this stage for long periods of time, even months or years. STAGE (3): PREPARATION [INTENDING to change in the next month, but not today] a) It is a window of opportunity that either allows the patient to move forward or fall back into contemplation. b) At this point, the patients need help in finding a change strategy or goal that is acceptable, achievable & appropriate. CONTINUE STAGE (3) c) Patients may report small changes in the problem behavior. Example: Reading a few food labels or buying fat-free ice cream, drinking fresh juice instead of soda, downloading fitness & health applications on his/her devices.. etc STAGE (4):ACTION [Recent Changes in Food Choices] a)The patient engages in actions that bring about change. b)At this point, the goal is to produce a change in the problem area by actively modifying food choices, behaviors, environments or experiences. You may ask : “ What are you doing differently ? “ Example: Reduction in the number of cigarettes or switching to low-tar and low-nicotine cigarettes were formerly considered acceptable actions.  STAGE(5): MAINTENANCE [Changes have become a habit maintained for 6 months] During this stage, the challenge is to sustain the change accomplished by previous action & to prevent relapse. Based on self-efficacy data, researchers have estimated that maintenance lasts from 6 months -5 years. Example: After 12 months of continuous abstinence, 43% of individuals returned to regular smoking!  STAGE(6):TERMINATION /RELAPSE [changes maintained for 5 years] If relapse occurs, the client’s task is to start the change process again rather than become stuck in this stage. Slips & relapses are normal, expected occurrences as a client seeks to change any long-standing pattern of behavior. CONCLUSION OF TTM  TTM VERSE TRADITIONAL NUTRITION COUNSELING Behavior change is more successful using TTM rather than the traditional model … Why? Research data have shown that the value of the TTM is in determining in which stage an individual is & then using change processes matched to that stage while, traditional nutrition counseling assigning the same intervention techniques to everyone, regardless of the readiness or stage of change. TTM VERSE TRADITIONAL NUTRITION COUNSELING -CONTINUE Also, traditional model focuses on the change process matched to the action & maintenance stages( this works well for persons who are actively trying to make a behavior change). However, most individuals with a problem dietary behavior are in a pre- action stage that includes one of the following: Pre contemplation, contemplation or preparation. These individuals are not yet ready to change. NOTE! The traditional model mistakenly assumes that the patient is already in the action or maintenance stage; this may be one of the reasons for lack of success in long – term maintenance of many intervention programs. MOTIVATIONAL INTERVIEWING (MI) MODEL MI draws from TM MI was originally developed from work with “ addictive behaviors “ MI is an approach designed to “ help clients build commitment & reach a decision to change “. What is MI ? It is a particular way to help clients recognize & begin to resolve their concerns & problems. The clients are responsible for making the changes. MI -CONTINUE The main goals of MI are : 1.To increase intrinsic motivation, so that clients are able to express the rational for the changes. 2.Persuasion & support are key elements of this style of counseling. The Importance of MI: MI is useful in overcoming resistance & establishing clear motivation, once a client is ready to make a change, other strategies such as behavioral therapy & cognitive behavioral therapy are needed. MI- CONTINUED MI is described as having an “ Elicit-Provide-Elicit” framework. How? - Elicit :the counselor elicits what the client understands or needs about the situation. - Provide: provides information in a neutral manner - Elicit: elicits what the client thinks about the provided information.  MI- CONTINUED In this way, the counselor directs the client toward motivation to change. Once the client is motivated to change, behavioral motivation or cognitive counseling strategies are often started.  REFERENCES Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: Theory, research, and practice (4th ed.). San Francisco, CA, US: Jossey-Bass. Judith Beto, Betsy Holli (2018). Nutrition Counseling and Education Skills: A Guide for Professionals (7th ed.). North America. https://www.prochange.com/transtheoretical-model-of-behavior-change http://sphweb.bumc.bu.edu/otlt/MPH- Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html