Recently I had a session with my client, Jenny. Among others skills, Jenny and I are working on her not having dessert before dinner. In session, Jenny told me that she was distressed because although she was able to resist dessert before dinner, on many occasions she was really tempted earlier in the day and wanted to give in. “I shouldn’t be having these thoughts!” she said to me. In a previous session, Jenny had told me that she had committed to going on a run with a friend one day after work. Although she was really tempted to cancel, Jenny ended up going. I reminded Jenny of this during our session and I asked her, “Did you feel really bad about having thoughts about cancelling the run?” Jenny thought about it and said that, no, she didn’t feel bad about it. Read more
Jamie came into session this week and reported that she has a revelatory experience over the weekend. She was at a dinner party at her sister’s house and was seated next to a (thin) woman named Deanna with whom Jamie had a mild acquaintance. Jamie told me that without even really meaning to, she kept an eye on what Deanna was eating that night and was very surprised to realize that Deanna ate a larger portion of salad with the dressing on the side, had reasonable portions of chicken and asparagus, and had a small portion of the wild rice that was served. She also had no bread, no other side dishes, and nursed one glass of wine throughout dinner. When dessert was served, Deanna passed on the cheesecake and instead ate fresh berries that were served along with it.
Reflecting upon what Deanna ate, Jamie had the realization: she’s working on watching her eating, too. Although theoretically Jamie knows that every thin person she sees is not necessarily naturally thin, it is easy for Jamie to forget this and to think, “It’s not fair that she is thin naturally and I have to work at it.” Jamie confessed that she had always assumed that Deanna was one of the naturally thin people that stayed that way without having to go through any effort. But in observing what Deanna ate at the dinner party, and especially in observing all of the things she didn’t eat, Jamie was once again reminded that many people look the way that they do through hard work and diligence.
Jamie and I talked about what this realization meant for her and Jamie said that once again becoming aware that she is not the only one who has to work at dieting helps counter a lot of her, “it’s not fair that…” thoughts. Jamie and I discussed that while it’s true it’s not fair she has to work hard to achieve and maintain a healthy weight, everyone has unfairnesses in their lives and this happens to be one of hers. I also pointed out to Jamie that she is lucky because some people can’t do anything about their unfairnesses, but this is one that, through hard work and practice, Jamie can and is learning to overcome. Jamie resolved to not let thoughts of unfairness get in the way of achieving her goals and decided that anytime she started to feel that it was unfair she had to work at dieting, she would remind herself, “It’s true it’s not fair, but at least there is something I can do about it,” and whenever she felt resentful looking at a thin person, she would remind herself, “I don’t know what she eats in a day and it’s very likely she’s working just as hard as I am.”
What’s the secret to holiday success? Having a plan. Yes, it really is that simple. Every dieter’s plan is different, and the plans can range from very general to very specific. For dieters who rebel against the notion of having a plan, we ask them, “When has not having a plan in the past ever helped you to reach your weight loss goals?”
My dieter, Jamie, came in to see me this week and we spent most of the session formulating her Christmas Eve plan. Jamie told me that she spends Christmas Day at her sister’s house does well staying in control while she’s there. However, on Christmas Eve Jamie’s whole family comes to her house and she is in charge of cooking for a large crowd. Jamie said that in previous years, the stress of entertaining a lot of people, combined with eating a lot while she was cooking, has led her to eat way too much, feel sick, and then just completely throw in the towel. This year, however, Jamie was determined to have a great Christmas Eve which she could feel good about, both during and after.
Before we made her plan, Jamie identified several areas that have been difficult for her in the past: she gets really stressed, she excessively tastes everything while she cooks, she skips breakfast and lunch, she doesn’t take any time for herself, she usually avoids the scale for the next few days, and she doesn’t respond to sabotaging thoughts like, “I’ve blown it so I might as well start tomorrow,” and “It’s Christmas Eve so it’s okay to eat whatever I want.”
Here is the plan that Jamie and I formulated:
1. Plan in advance to have breakfast and lunch. In the past, Jamie has skipped breakfast and lunch, thinking she will “make up” for it later in the day. This caused her to be extremely hungry when she started to cook, which then led her to eat a lot while she was cooking and during dinner and after, thinking “I skipped breakfast and lunch so it’s okay to have extra now.” For the day, Jamie usually ended up eating way more calories than she would have if she had had a reasonable breakfast and lunch.
2. Read Advantages List and Response Cards several times throughout the day, especially right before cooking. Jamie knows that she is more susceptible to sabotaging thoughts around this time, and she also knows that she will be tempted by more food than usual. In session Jamie and I made some Response Cards with responses to sabotaging thoughts that she has had in the past, and she committed to reading those cards, as well as her Advantages List, throughout the day so it would be fresh in her mind exactly why it’s worth it to her to stay in control.
3. Take a walk sometime during the day. While in general Jamie is good at getting herself to exercise, during the holidays, and especially when she is busy all day getting ready for a celebration, her exercise plans can fly right out the window. This year Jamie decided that she would make sure to get some exercise in at some point that day, not only to prove to herself that she can continue to make exercise a priority even when she’s busy, but also so that she can have a few moments to herself to de-stress and calm down.
4. Eat everything sitting down. This, too, is a skill that Jamie is usually pretty very good at. However, when she is cooking and preparing food, setting out appetizers, and wrapping up leftovers, she is much more likely to engage in eating standing up. Jamie realized that having the very strict rule of eating everything sitting down would help her to eliminate a lot of extraneous eating because, by sitting down, it will force her to be more aware and more accountable for every bite that she eats.
5. Limit consumption of alcohol and desserts. Jamie decided that her favorite part of Christmas Eve was the dinner, and she didn’t want to spend too many calories on alcohol and sweets. Jamie realized that she might feel deprived if she cut these things out of her plan completely, but by choosing to have a small amount of each she would still be able to consume them, and as an added bonus, she would be able to enjoy them guilt-free because she would know that she was having a controlled amount that was on her plan.
6. Take time to refocus if stress sets in. Jamie knows that at any point during the day she might start to feel stressed or frenzied, and in the past she would turn straight to food to calm herself down. Jamie realized that if she wants to lose weight and keep it off, she can’t keep eating as a cure for stress. Instead, Jamie and I made a list of several different things that she should immediately start trying if she notices herself getting stressed so that she can calm herself down, refocus her energy, and get right back on track – all without eating a bite.
7. Weigh in the very next morning. One of the biggest reasons dieters get off track, and stay off track, is because they are not accountable for their actions. By knowing that she will have to get on the scale the next morning no matter what, it will be easier for Jamie to stay in control because she will know that she’ll have to face the consequences, either positive or negative, of her Christmas Eve eating.
8. Remember that staying in control feels great, and eating off track feels really bad. This is one of the most important ideas for Jamie to remember because any time she is tempted to start eating out of hand, she can think about how bad that will feel and realize that it’s really not what she wants to do. Jamie has had enough experiences of feeling happy and proud when she staying in control, as well as enough experiences feeling sick and terrible when her eating was out of control, to know 100% that she will feel so much better and be so happy with keeping her control in spite of the numerous temptations.
Jamie came to see me a few weeks ago and one of the items she wanted to put on our agenda for the session was her trouble with ice cream. In the past Jamie has described ice cream as her Achilles heel, and it seemed that it had once again become problematic for her. Jamie told me that she was having difficulty keeping ice cream in her house because she would end up eating way more than one serving at a time, and way more than she had planned.
At that point, Jamie and I had discussed several strategies for her to try. I helped Jamie to identify some of the sabotaging thinking she was having in the moment she was tempted to eat more ice cream than she had planned and came up with responses to them. Some of Jamie’s sabotaging thoughts and helpful responses were:
Sabotaging thought: “It’s okay to eat more than I had planned just this one time”
Response: “It’s not okay to do it this one time because every single time matters. Every time I eat more ice cream than I had planned, I make it more likely I will eat more the next time, too. I need to exercise my resistance muscle, not my giving in muscle.”
Sabotaging Thought: “I deserve more ice cream at night because I was so good during the day and I turned down lots of holiday treats.”
Response: “My body doesn’t know or care how many things I didn’t eat today, it only knows how much I did eat. If I eat more calories than I had planned, I will gain weight.”
In session, Jamie made some new Response Cards with these helpful ideas on them and committed to reading them right before she had her nightly ice cream treat. Jamie and I also devised a plan for what she would do when she finished her serving of ice cream, including immediately putting her bowl and spoon in the dishwasher and turning to a list of distraction techniques to employ until the craving for more had passed.
Jamie came back to see me the following week and reported that ice cream continued to be a problem for her and she was feeling bad about her lack of control. Jamie reported that even though she was reading her Response Cards, sabotaging thoughts were continuing to hound her and she was struggling on an almost nightly basis. She said that every time she set out to have ice cream, she would have the thought, “I’ll be able to stop after one serving,” although that rarely was the case.
Jamie and I then talked about what our next plan of attack should be. I reminded Jamie that, while the ultimate goal is for her to be able to keep anything in the house and know she can stay in control, if a particular food item is consistently giving her trouble it can be a good idea to just not keep it in the house for the time being. Jamie and I discussed the fact that she was constantly putting herself through a struggle each night because even when she was able to limit her intake to one serving, it was very hard for her to do so. On any given night, the thought, “I’ll be able to stop after one serving,” was either not true, or it was true but required a lot of struggle and effort on Jamie’s part.
By the end of the session, Jamie came to the conclusion that right now, even though she really liked ice cream, it just wasn’t worth it to her to keep it in the house. I reminded Jamie that she doesn’t have to keep ice cream out of her house forever; rather this is just for a limited time while she builds back up her resistance muscle. Jamie also decided that if she really wanted ice cream, she could go out and buy a single serving of it so she wouldn’t have to struggle to stop eating. Undoubtedly Jamie will keep ice cream in her house in the future, but for right now the negatives outweigh the positives.
Jamie came in to see me this week and discussed a situation that had happened the day before. Jamie told me that she woke up, had her normal breakfast, and then went to work. At 10:00am she had her usual snack to tide her over until her 12:30 lunch break. However, at about 10:30 she started to feel very hungry. Because Jamie and I have spent time in the past helping her learn to differentiate between hunger and non-hunger, she could tell that it was hunger she was experiencing, not thirst, a craving, or just a desire to eat. Looking ahead, Jamie knew he lunch was still a formidable two hours away and she was sitting at her desk with a hungry stomach.
When Jamie first came to see me she had a fear of hunger that was leading her to load up at meals and carry snacks with her just in case hunger should choose to strike. This is why I had had Jamie do a hunger experiment (which is to skip lunch one day and eat nothing between breakfast and dinner) twice over the course of a month to prove to herself that hunger comes and goes and that at its worst, hunger pains rate as only mildly painful. Before Jamie did this experiment she wrote out a pain chart and assigned numbers, 1 through 10, to her most painful experiences. For Jamie, 1 was a mild headache, 5 was a bad toothache, and 10 was the time she broke her leg and needed surgery. When Jamie did the hunger experiment, not only did she find that the hunger came and went and she forgot about it when she got distracted, but when she was feeling hunger pangs they only rated, at their highest, at about a 2 or 2.5. Through the hunger experiment Jamie definitively learned that hunger will not kill her and that if she gets busy she won’t even feel it most of the time.
However, Jamie had done these hunger experiments a few months ago and by the time her hunger before lunch rolled around this week, Jamie had begun to forget what she had previously proved to herself. Jamie told me that she started to have thoughts like, “Oh no, I’m hungry and lunch isn’t for another two hours. This is really bad and I’m going to get so hungry and be too distracted to get any work done. I’ll never make it until lunch time.” Because of these sabotaging thoughts, Jamie seriously considered having another snack and began to look for one until she realized that didn’t have any other food packed and so she couldn’t. Jamie told me that was the best thing that could have happened to her because she was forced to wait out her hunger and not put a band aid on it, like she would have done in the past. When Jamie accepted that she wasn’t going to be able to have a snack despite her desire to have one, she was able to turn her attention back to work and start tackling a project that had been hanging over her head.
Like she experienced in the past, before Jamie knew it an hour had passed and she realized she had barely been feeling much, if any, hunger during that time. Jamie did experience some hunger pangs again when she took a breather, was no longer distracted, and turned her attention to thoughts of food, but by that point she was easily able to tell herself, “Lunch is only an hour away. I can definitely wait an hour to eat and I know I’ll be so happy I did. I just have to get myself involved in work again and the hunger will go away like it always does.”
In session, Jamie and I discussed her triumph and what she has learned from it. Jamie reported that she was glad she was forced to undergo another smaller hunger experiment because it helped remind her of things she already knew but had forgotten somewhat. Jamie and I discussed the fact that she might continue to be a little bit vulnerable to fearing hunger, but whenever she needed to she could always do another hunger experiment and prove to herself, over and over again, that hunger is not an emergency and she can definitely wait it out.
I asked Jamie to think about the week to come and what sabotaging thoughts she might have that would get in the way of her enacting her exercise plan. Jamie reported that she might think:
• 20 minutes is almost nothing and it won’t do anything anyway
• It’s too hard to get myself to do it
• I’ll never be able to keep it up so why should I start
• I’m too busy/rushed/stressed to exercise this week, I’ll start next week
• I just don’t feel like exercising right now
[Do any of these sound familiar to you?]
In session I helped Jamie to examine each one of those thoughts and come up with responses to them. Here are Jamie’s new responses:
Sabotaging Thought: 20 minutes is almost nothing and it won’t do anything anyway
Response: 20 minutes is MUCH better than 0 minutes. I can work up from here but it’s important to start off smaller so that I don’t fall back into my all-or-nothing habit by having too hard of a goal and then getting overwhelmed and quitting, like I have done so many times in the past.
Sabotaging Thought: It’s too hard to get myself to do it
Response: The hardest part is just getting my sneakers on. Once I get myself out the door it will be easier. I’ve proven to myself that I can do hard things where dieting is concerned so I know I can do this hard thing, too. It’s so worth it!
Sabotaging Thought: I’ll never be able to keep it up anyway so why should I start
Response: In the past I’ve never kept up with exercise because I didn’t know how to identify and respond to my sabotaging thoughts. Now I have learned to talk back to the thoughts that would get in the way of my exercising consistently and I’ve also learned how to make diet and exercise a TOP priority and to not make excuses.
Sabotaging Thought: I’m too busy/rushed/stressed to exercise this week, I’ll start next week
Response: When has “starting next week” EVER helped me to reach my goals? I need to start doing these things THIS MINUTE or I never will. Besides, exercise will actually help me calm down and make me less stressed, not more. And being busy is NO excuse because I won’t be able to do all those other things if I’m not healthy.
Sabotaging Thought: I just don’t feel like exercising right now
Response: It’s true, I don’t feel like exercising. But even more I don’t feel like being overweight, putting my health at risk, and not being able to run around with my kids. Even though I don’t feel like it I just have to do it anyway because the payoff will be more than worth it.
I had Jamie write down each one of these responses onto Response Cards and part of her homework was to read them every single day until the ideas started to get more into her head.
I also discussed with Jamie that just doing the exercise is not the only important factor because it’s also very important what she says to herself while she’s doing it. I pointed out to Jamie that if, while she’s walking, she says to herself the whole time, “This is terrible. I hate doing this. I really wish I didn’t have to ever exercise. This stinks and I should be doing 100 other things right now,” then she’s going to have a pretty bad time and it’s going to be that much harder for her to get herself to exercise the next time. On the other hand, if Jamie says to herself while she’s walking, “Okay, I may not like this all that much but it’s GREAT that I’m doing this. This is so important for my health and my well-being and I know I’m going to get so many positive things in return. I deserve lots of credit for doing this,” then she’s likely going to have a much better time, actually end up feeling good about it, and will have an easier time getting her sneakers on the next time.
The bottom line: I had to help Jamie change her thinking so that she would be able to effectively change her behavior.
Last week in session, my dieter, Jamie, and I tackled the question of exercise. Should she do it? How much should she do? How much is reasonable to do? What types of exercise can she do? Will she hate doing it? How will she fit it into her busy schedule? How will she get herself to do it?
Like many of my dieters, when Jamie first came to see me she was a classic all-or-nothing exerciser, meaning she was either exercising intensely 7 days a week or she wasn’t exercising at all. Jamie had very little middle ground and was always either “on” her exercise plan or “off” of it. Jamie had also told me that she really hated to exercise and she was not looking forward to the day that I would “make” her do it.
As soon as I heard that from Jamie – that I would “make” her do it – I immediately reminded her that my job wasn’t to make her do anything because these were not MY goals for her, they were her goals for herself. I pulled out Jamie’s Advantages List and asked her how important all of those things were and Jamie responded that they were the most important things to her and agreed that she would be willing to try new things if it meant she could achieve them.
In session last week, I discussed with Jamie the fact that she might not need to exercise to lose weight, but almost definitely would need to exercise to maintain her weight and she unquestionably needed to exercise to have good health. Since a lot of Jamie’s goals involved having better health, preventing future health problems, and being able to be more active with her children and husband, I reminded her that all of those things implied a better level of fitness, which she would not be able to achieve without some form of exercise. Albeit reluctantly, Jamie agreed that exercise seemed like a necessary evil.
The first thing Jamie and I did was discuss what type of exercise plan would be reasonable for her. Jamie initially told me that since she would have to exercise again, she might as well do as much as she can so that the weight would come off more quickly. I reminded Jamie that we are working on getting her away from all-or-nothing thinking of all kinds, and besides, when has being an all-or-nothing exerciser ever helped her to maintain an exercise plan and reach her goals?
Jamie and I decided that since she loved the fall season, and since the weather was cooling down, she would start off by walking outside for at least 20 minutes 3 days this week. I encouraged Jamie to not make her plan for more days or for more minutes/hours this first week because setting too hard of a plan would only be counterproductive. I discussed with Jamie the fact that it’s always important to set reasonable homework because that way she can achieve it and feel good about it. If Jamie had decided to make her plan for 6 days that week and instead was only able to walk on 4 days, she would wind up feeling bad about the 2 days she didn’t walk, instead of feeling great about the 4 days she did. Jamie and I then discussed what would be the easiest time for her to get this walk in, knowing that the earlier in the day she aimed to do it, the more likely she would be to get it done. Jamie decided that 3 days this week she would get up a half hour earlier and get her walk out of the way before her kids woke up.
Now that Jamie had her exercise plan, the next step, which will be covered in Part 2, was to discuss with Jamie how she would get herself to actually institute the plan, in part by helping her to identify in advance what sabotaging thoughts might get in the way of this.
Sometimes the old adage, “out of sight, out of mind,” can be extremely useful for dieters to keep in mind. Take the dieter who walks into the break room at work to get a cup of coffee and suddenly sees a box of donuts on the table. She might immediately think, “Those look so good, I really want to have one.” Let’s say the dieter resists and then goes back to her desk with her coffee. She might then spend the next few minutes or hours thinking, “I really want one of those donuts,” or “it’s not fair that I can’t have a donut,” and mentally struggling with whether or not to go back for one. The interesting thing about this (extremely common) scenario is that if the dieter had never walked into the break room and seen the donuts, she probably would never have wanted one in the first place and she definitely wouldn’t have had to think about whether or not to have one for the next few hours. In situations like this we remind dieters that they are not really being deprived of a donut because if they had not seen them, the possibility would never have existed.
Jamie had a situation similar to this over the weekend when she attended a friend’s wedding. Jamie told me she went into the wedding with the plan of having one or two glasses of wine, only raw vegetables during cocktail hour, eating about half of her entrée, and having a small piece of cake for dessert. This was her plan because she knew that the food would be rich and even taking in that amount would be more than she would normally eat. Jamie stuck to her plan during cocktail hour and dinner and then got busy dancing and talking to her friends. Jamie was having a great time and at some point someone mentioned to her that the desserts were out but were in separate room. Jamie realized at that moment that she hadn’t even remembered her plan to have a small piece of cake because she hadn’t seen the desserts and therefore hadn’t thought about it (which she found surprising as she loves wedding cake).
At that point Jamie had to decide whether or not to actually go into the dessert room to seek it out. Jamie thought about it and realized that because the wedding cake wasn’t prominently displayed, her natural association between weddings and cake broke, which proved to Jamie that part of the reason she always had wedding cake was because she saw everyone else eating it. Jamie also thought about the fact that if she did go into the dessert room, likely she would be confronted with a lot more desserts that she would be able to eat and might end up feeling deprived. Because at that moment Jamie wasn’t feeling deprived since she wasn’t looking at all the desserts she wasn’t eating, and because she was also feeling good about what she had eaten, Jamie decided to forgo the dessert room and continue having fun.
Jamie and I discussed this situation in session and how powerful “out of sight, out of mind,” can be because by not seeing the desserts, it was easy for her not to have any. Jamie anticipated my first question and told me that looking back now, she was definitely not sorry she didn’t have any cake and instead felt proud of herself for how well she did at the wedding. Jamie and I discussed what she can learn from this situation and I helped her write a new Response Card so that she could remember this experience. Jamie’s card said, “If I hadn’t seen it, I wouldn’t have wanted it anyway. Just pretend it doesn’t exist and move on – I’ll be so happy later if I do.”
When Jamie came in my office this week, she reported feeling disappointed. Jamie thought she had kicked her emotional eating habits because, through lots of practice, she became adept at not eating when she was feeling sad or stressed. This was something that Jamie had struggled with a lot at first because initially she thought she would not be able to handle feeling sad or stressed without turning to food. Through our work together, Jamie learned that negative emotions are not going to kill her and she can do other things to comfort herself which will not have the end result of jeopardizing her diet and ultimately making her feel worse. Jamie always gave herself a lot of credit for being able to handle these negative emotions without turning to food by using a multitude of other distracting techniques, like calling her sister or a friend, going for a walk, taking a shower, painting her nails, or listening to relaxing music.
Yesterday evening, however, Jamie was out with a friend for dinner and midway through she got a phone call from her mother who made her angry and they ended up getting into a fight. Jamie hung up the phone, still feeling mad. Even though she’d almost finished the amount of food she had carefully portioned off from her plate that she would eat at dinner (and was planning to bring the rest home for lunch the next day), Jamie told me that she then proceeded to eat almost everything that was left on her plate, seemingly without noticing what she was doing. It wasn’t until Jamie looked down at her near-empty plate that she realized she had just engaged in emotional eating, but this time it was in response to anger, not sadness or stress and felt discouraged. I asked Jamie what she did after she realized this and Jamie reported that she left the restaurant, took a walk with her friend, and then called her mother to work the situation out. I then asked Jamie if she had proceeded to order dessert at the restaurant or had gone home and eaten whatever was in her house. In an almost puzzled fashion, Jamie answered, “of course not.” I recognized what was going on here –Jamie was only focusing on the one mistake she had made that night and was not seeing all the multitude of great things she had done immediately after.
I asked Jamie what she might have done a few years ago when she felt angry or worked up like that and she reported that she probably would have gone on to eat a lot more food to soothe herself. I also asked Jamie what she would have done in a situation in which she made an eating mistake and Jamie acknowledged that she probably would have gone on to eat a lot more the rest of the night, thinking she had blown it. Jamie and I discussed how very differently she handled this situation and all of the important things that she deserved credit for. Jamie was able to see that she deserved credit for:
- Once she realized she had eaten more than she planned, she did not catastrophize and continue to eat out of hand the rest of the night
- After dinner she took a walk to calm herself down instead of turning to more food
- She got problem-solving oriented and called her mom to work out the problem
- She was able to identify what was going on – that she was eating because she was angry – and respond to sabotaging thoughts that were urging her to keep eating
- She was ready to learn from the situation and would be more aware of all forms of emotional eating in the future
I pointed out to Jamie what I point out to all of my dieters: that ALL dieters and maintainers make mistakes, they are just able to recover from them right away. Jamie and I discussed the fact that, without even realizing it, this is exactly what Jamie did because as soon as she realized she had eaten more than she planned, she put the brakes on eating right away. We also talked about the fact that instead of feeling good about this situation and how she had proved to herself that she can recover right away, Jamie was actually making herself feel worse by only focusing on the one thing she did wrong, instead of the 20 positive things she did right after. Jamie and I decided that as part of her homework this week, she would start focusing more on giving herself credit for all the positive things she did, both big and small.
The Beck Diet Program was developed by Dr. Judith S. Beck with Deborah Beck Busis, LCSW.
Beck Institute for Cognitive Behavior Therapy is a leading international source for training, therapy, and resources in CBT.
One Belmont Avenue, Suite 700
Bala Cynwyd, PA 19004-1610