Some people who are struggling to lose weight may benefit from trying cognitive behavioral therapy (CBT). This therapy approach emphasizes the influence of thinking over mood and behavior and involves identifying maladaptive thoughts and challenging them with more effective beliefs.
It’s not what happens to us that determines how we react; rather it’s how we think about or interpret the events around us that determine how we react.
For example, if someone believes, “I’m not good at nutrition,” then he or she won’t feel much hope to improve nutrition.
But a belief such as, “I can decrease stress eating at night by eating mindful dinners at least once a week,” incites more hope for change.
How could CBT help with someone’s weight loss journey?
The therapist would help the client identify core beliefs and the validity of those beliefs, then help the client challenge maladaptive beliefs to work toward more effective self-talk and behavior.
Individuals who have dieted a lot tend to have all-or-nothing beliefs like “Either I eat perfectly or the whole day’s shot,” or “I shouldn’t eat any cookies but I caved and ate one—might as well eat the whole bag now. I have zero self-discipline.”
The therapist helps the client find the middle ground by practicing beliefs such as, “Every meal or snack is an opportunity to follow my meal plan—nobody eats perfectly.”
The therapist might team with a dietitian to help the client follow a meal plan including one serving of cookies (instead of zero or the whole bag).
How does CBT incorporate principles of behavior modification?
We know that positive reinforcement is more effective than punishment for behavior change. However, we often forget this fact when it comes to weight loss.
We punish ourselves by thinking, “I’m fat and disgusting—I need to buckle down,” when beliefs like, “All I can do is my best,” or “Keep going—one small change at a time,” are more effective to motivate behavior change.
When using CBT, therapists will help clients set challenging yet realistic goals. It’s important to remember that extreme weight-loss goals are often unrealistic.
Who should consider this type of therapy?
Clients who prefer more structured approaches and are willing to engage in homework may benefit more from CBT.
However, for individuals with eating disorders, CBT may be part of a treatment plan that will be more involved than simply challenging maladaptive beliefs.
Eating disorder treatment is a specialty involving psychological, nutritional, and medical care.
Some individuals prefer acceptance-based approaches like mindfulness or another form of counseling called Acceptance and Commitment Therapy (ACT) over CBT. These other approaches emphasize noticing thoughts and feelings without reacting to them, instead of changing thoughts.
How long does this therapy take?
CBT is one of the most empirically validated treatments for behavior change. But change is hard, requiring persistence and effort.
Clients need to engage in therapy and complete homework assignments to help them challenge beliefs. Depending on symptom duration and severity, therapy can take months or even years.
CBT tends to be briefer than other treatments, but treatment frequency and length depends on the severity and complexity of presenting symptoms, as well as on treatment goals.
Jennifer Carter is Lead Sport Psychologist at The Ohio State University Wexner Medical Center.