A realistic strategy is the most important thing to bring on vacation. Eric lists the Sabotaging Thoughts and responses to help him stay on track.
In session this week, my dieter, Jason, and I discussed an issue that he was having trouble with: Getting to sleep on time. This is a fairly common problem many of my clients face and it’s an important one to figure out. Studies show that people eat more on days they are sleep deprived than on days that they aren’t, and when people stay up too late, they often want to turn to food to help them stay awake. Both of these things were happening with Jason – he was eating too much at night to help him stay awake to watch “just one more” television show (which never turned into just one more), and he found it much harder to resist cravings and moderate his appetite following a night of missed sleep.
To help him combat his late-night ways, the first thing Jason and I did was institute a bedtime of 11:00pm. Although Jason didn’t initially love the idea of having a “bedtime,” we discussed the pros and cons of having one versus not having one, and Jason was able to see that not having some type of guideline in place for when he would get in bed was leading him to consistently stay up too late, eat too much, and sabotage his weight-loss efforts. It wasn’t worth it. Jason decided that he would also set an alarm on his phone to go off every night at 10:30. That way, it would give him a half hour to wrap things up and remind him that it would soon be time to get in bed. He also decided that he would read his Advantages List when his alarm went off to remind him of all the reasons why it worth it to him to lose weight (and, consequently, why he needed to get in bed).
Jason and I then discussed what sabotaging thoughts might get in the way of him sticking to this bedtime. Here are his thoughts and the response that we came up with:
Sabotaging Thought: I’ll watch just one more show.
Response: One more show is never just one more show. One more show doesn’t work! If it did, I would never stay up too late but I always stay up too late. No more shows.
Sabotaging Thought: It’s okay just this one time to stay up later than I said I would.
Response: “Just this one time” is like “just one more show” – it doesn’t work and I need to prove to myself that I do what I say I’ll do.
Sabotaging Thought: I don’t feel like going to bed right now.
Response: I may not feel like going to bed right now, but I even more don’t feel like sabotaging my weight loss efforts and having to stay overweight. It’s worth it to get in bed.
Sabotaging Thought: It’s not really that important to go to bed on time.
Response: It really is that important. Staying up too late makes me overeat both at night and the next day. Besides, on the days I do go to bed, I feel so much better the next day – rested and alert. I’ll be so happy tomorrow morning I made myself get in bed.
With these strategies in place (a set bedtime, an alarm reminding him of the impending bedtime, and reading his Advantages List and Response Cards if he was tempted to not adhere to it), Jason felt confident that he would finally be able to get himself to bed at a reasonable hour.
My client, Jason, works long hours and isn’t much of a cook. When he gets off work and wants dinner, his options are usually pretty limited. Jason often winds up going to a drive-through restaurant, and he doesn’t usually make the healthiest choices. Jason told me that while there are healthy (or, at least, healthier) options available, he has a hard time sticking to them when the time comes to place his order.
In previous sessions, Jason and I had spent a lot of time talking about how he can stay in control when he eats out with friends. Although Jason used to have very big and very caloric meals every time he went to a restaurant, in the past few months he has made a lot of progress in making healthier choices and not finishing everything on his plate.
In session, Jason and I discussed what strategies he has been using to stay on track at restaurants to see if any of them would translate to the drive-through. Jason told me that the most effective strategy for him has been to look at the menu ahead of time and decide what he’ll have, and then not even look at the menu once he gets to the restaurant. He also has a Response Card that he reads before he goes out to eat:
Every time I stick to my healthy choice I feel great after eating. Every time I veer off track and order something else, I feel guilty after eating. Sticking to my healthy choice not only enables me to lose weight, but it makes me feel so much better.
Jason and I discussed this further and realized that this same exact strategy would be very helpful for him when going through drive-thoughs, too. Jason decided that he would make it a policy to look at the drive-through menu online before he left work at night and decide in advance what to have. When he got to the drive-through window, he would then place his order without looking at the posted menu, just as he does in restaurants.
Jason also came up with an additional strategy: Since he tends to frequent the same drive-throughs, he decided that for each one he would come up with a few different meal combinations and record them in his phone. That way, if he was in a rush to leave work, he wouldn’t have to spend time looking up the menu, he could just pick something from his phone. Jason also made the following Response Card to keep in his car and read when he was waiting in line to place his order:
I’ve already decided what to order so I don’t even need to look at the menu or consider what else I might want. The decision has been made, and sticking to this decision will make me feel so much better. It’s worth it.
With these strategies in place, Jason was finally able to stay in control both when eating out in restaurants and when going through the drive-through.
A few months ago my client, Susan, went on vacation with her friend, Caroline, and Caroline’s two kids. After the trip, Susan and I spent some time in session discussing what had gone well and what could have gone better. This was especially important because we knew that Susan was again going away with Caroline and her children in a few weeks.
Susan told me that the major area that needed improvement was dessert. While it was great that she and Caroline took a walk every morning, they also stopped at a local donut and bagel shop on the way home so that Caroline could get breakfast for her kids. Susan told me that more often than not, she would go inside with Caroline, be tempted by everything she saw and smelled, and would end up buying and eating at least one donut before she walked out the door. Not only was this problematic from a calorie perspective, but Susan told me that it also threw off her eating for the rest of the day, because when she got home she wasn’t hungry for her usual healthy and satisfying breakfast, but then got very hungry an hour or two later, and would eat something which would throw off her lunch, and so on.
Susan also struggled with treats when she, Caroline, and the kids would take their after dinner boardwalk stroll during which everyone picked out a treat for dessert. This was difficult for Susan because not only would she eat what she bought, but she would also end up eating some of Caroline’s dessert, too (because Caroline, lacking a big sweet tooth, always had extra and Susan always developed a craving for it).
In session Susan and I first talked about how she would handle the stop at the donut and bagel shop. Since Susan knew she’d prefer to have dessert at night when everyone else was eating it (and since she also knew that she couldn’t eat two desserts a day and not gain weight) and because donuts were always gone very quickly and then negatively impacted her eating the rest of the day, Susan decided that she would rather just not have any donuts in the morning. To help her follow through with this, we came up with a two part strategy.
1. Susan wouldn’t even go into the donut shop with Caroline, thus limiting her exposure to temptations, and would wait outside to do stretching or check her email on her phone.
2. While Caroline was in the shop, Susan would read the following Response Card:
I have a healthy, satisfying, and delicious breakfast waiting for me at home. I’m not having a donut because it will be gone too quickly, negatively impact my eating, and make me feel guilty. It’s worth it to wait!
Susan and I then discussed how she would handle dessert at night. Since Susan knew that she was highly susceptible to craving what everyone else was eating, and since she was in the habit of sharing some of Caroline’s desserts, she decided that the best course of action would simply be to order whatever Caroline ordered. Having just been on vacation with Caroline, Susan knew that she, too, would enjoy whatever Caroline decided to have, and if they both had the same thing, then Susan didn’t have to worry about going overboard eating two desserts. To help her stick to this plan, Susan made the following Response Card:
Whatever Caroline gets for dessert, I’m sure to like. If I get something different, the whole time I am eating my dessert I will be craving whatever Caroline has, thus diminishing my enjoyment in my own dessert and causing me to eat Caroline’s extras. Just order what Caroline orders.
In session with Susan last week, she told me that she had just gotten back from her second beach trip with Caroline and her kids – and it was a huge success. Susan said that these strategies, along with the Response Cards that helped her implement them, took her from overindulging and feeling guilty, to enjoying her food and feeling great.
I described in Part I how I helped Angie make her Advantages List. This was only half the battle, however, and our next job was figuring out how she could get herself to read it every morning. I told Angie that it would be best for her to read her Advantages List first thing in the morning, before she ate anything for the day, and asked her when, during her morning routine, she might be able to incorporate this. Angie decided that it would be best if she kept it on her bedside table and read it first thing in the morning before other people (like her husband and kids) started asking her to do things. I asked Angie if she would mind if her husband saw her list, and she told me that while he was very supportive, her list was private and she preferred that no one else in the family read it. Because of this, Angie decided that she would keep the list in the drawer of her bedside table.
With the list out of sight, I was concerned that Angie might forget to read it, and asked her if she had any ideas on how to solve this potential problem. Angie said that another thing she does every morning before she gets out of bed is take her medication, and so we decide that she would put a sticky note on her medicine bottle, which would cue her to read her list.
After figuring out these logistical issues, Angie and I then discussed what thoughts might get in the way of her reading her list every morning. Angie told me it was possible she might think something like, “I’m too busy/rushed to read my list this morning.” To help combat this thought, I asked Angie to read her list aloud to me in session, and Angie was surprised to hear that it only took her 35 seconds to read the entire list. “Isn’t it worth 35 seconds in the morning if it will help you lose weight and keep it off?” I asked her. Angie agreed that it certainly was worth 35 seconds, and to help her remember that it would only take this short amount of time, Angie decided that she would write the number “35” on the sticky note she was attaching to her medicine bottle.
Angie also identified that the thought, “It’s okay if I skip reading my list this morning, I know what it says,” might get in the way of her reading her list this week. Angie and I discussed this thought and I let her know that, at least for right now, it was not good enough to just think about the items on her Advantages List, she actually has to read it, not only because reading it helps enter it in the brain more firmly but also because Angie needs to prove to herself that she can do it, whether or not she feels like it. With these ideas in mind, Angie made the following Response Card:
“Whether or not I feel like reading my list, do it anyway! It’s an important step in helping me lose weight and besides, it will only take 35 seconds.”
Although Angie didn’t feel comfortable having her list out in the open, she didn’t mind having this Response Card on her bedside table, so she decided to keep it right next to her medicine bottle so she would see it and read it first thing every morning.
With these strategies in place, Angie felt confident that she was off to a good start and would be able to read her list every morning.
This week I had a session with my dieter, Sarah. Although in recent weeks Sarah has been doing well with her dieting skills, she told me that one food in particular keeps tripping her up: french fries. Sarah has two young children and she and her family often go out to eat. Sarah told me that she usually goes into meals with the plan of not having any french fries, but more often than not ends up eating some off of her kids’ plates. Sarah told me that most children’s meals in restaurants come with french fries, and since her kids never finish what’s on their plates, the fries call out to Sarah until she eventually gives in and eats some.
When Sarah came to see me she was feeling distressed because, although she knew continually overeating fries was a problem, she didn’t know how to control herself around them. The first thing I discussed with Sarah is that she needs a French Fry Plan – she needs to plan in advance whether or not she’s going to have fries each time she eats out. I reminded Sarah that since she really likes fries, it’s not reasonable to expect that she’ll never eat any. The goal isn’t to never eat fries; rather it’s to plan in advance when she’s going to have them and when she’s not so she’s able to stay in control. This way, she doesn’t have to sit through meals looking at fries and struggling about whether or not to give in and have some, because the decision will already be made.
I also discussed with Sarah that during the meals when she plans to have fries, it’s crucial to order her own fries separately. Even if the meal she orders doesn’t come with fries and her kids’ meals do, she still needs to get her own side order. The reason for this is so that Sarah can start sending herself the message that it’s never okay to eat fries off her kids’ plates. If she’s going to eat fries, it means that she eats her own fries. This is important because if Sarah some of the time allows herself to eat her kids’ fries (and there leaves the possibility of doing so open), then they will continue to call out to her, even during meals when she’s planned to not have any. If Sarah has the rule, “I never eat fries off my kids’ plates,” then it will be much easier to resist every time they eat out because she won’t have to even consider (and therefore struggle about) whether or not to have some of theirs. Sarah and I discussed the fact that, while this may end up costing her a few extra dollars, it’s 100% worth it because it will drastically reduce her french fry struggle (not to mention helping Sarah reach her enormously important weight loss goals).
I then asked Sarah what sabotaging thoughts she is likely to have during the meals when she hasn’t planned to have fries but is tempted to do so. Sarah said that some of the thoughts she may have are, “I’ll just have one. One won’t matter,” and “I really like fries and I just want to eat them.”
In response to these sabotaging thoughts, Sarah made the following Response Cards:
By the end of session, Sarah had a very clear plan of how to deal with her french fry troubles. Here are the steps of her plan:
1. Always plan in advance whether or not to eat fries at any given meal.
2. When I am going to have fries, make sure to order my own.
3. Remember – the fries on my kids’ plates are completely off limits. I just never eat them.
4. Read my French Fry Response Cards before meals when I haven’t planned to have fries.
5. Enjoy meals out even more because I’ll no longer be struggling about whether or not to eat the fries on my kids’ plates.
This week, I had a session with my dieter, Emily. Emily told me that she and her sister are planning a trip home this weekend to celebrate their mother’s birthday, and that she thought it would be hard in a number of ways: Emily would be off of her usual routine, she would be spending a long time in the car, she would have fewer occasions to exercise, and she would not be in control of her food. Beyond these practical matters, Emily also told me that saying in control of her eating might be difficult because she would be experiencing more stress, which puts her in danger of engaging in emotional eating. Although Emily loves her family, she also finds that being around them for an extended period of time can be stressful (in part because they often comment about what she does and doesn’t eat).
In session, Emily and I spent most of the time coming up with strategies for both her practical and psychological concerns. Emily knew that one the most helpful things she can do for herself is to make a general plan for her eating and exercise over the weekend. Emily decided that she would plan ahead and bring meals and healthy snacks in the car so that she wouldn’t have to worry about finding healthy choices on the road or being tempted by unhealthy food. Emily also decided that she would make it priority to take at least a 20 minute walk each day that she at home, which would have the dual benefit of getting in some exercise and also being a stress-reliever.
Emily and I also discussed what sabotaging thoughts that might come up this weekend. Emily said that her family often watches what she eats and makes comments, and although they are usually well-meaning, they cause Emily stress. I pointed out to Emily that because she is now an adult, she doesn’t have to worry about “rebelling” against family by sneaking food or worry about what they will say about her eating because the only person she has to answer to is herself. Emily I discussed this idea further and she made the following Response Card:
Emily and I also discussed the emotional eating aspects that might come into play this weekend and what strategies she can use if she’s feeling negative emotions, like taking a walk outside, working on deep breathing and relaxtion, or calling a friend. We also discussed the fact that going home is more of an emotional experience for her, and therefore it’s normal that Emily would feel that way. Just because she’s feeling stressed doesn’t mean anything is wrong, and just because she’s feeling stressed doesn’t mean she has to do anything about it. It will go away on its own, as it always does. Emily made the following Response Card:
Emily and I also discussed the fact that she should go into the weekend knowing and expecting that it will be more difficult to maintain control over her eating; this way she won’t be surprised when it happens. As long as Emily knows this ahead of time and fortifies herself, when the difficulty hits, she will be ready and prepared.
Last week, Dr. Judith Beck and I presented at a Bariatric Surgery conference and we spoke about helping bariatric surgery patients change their thinking to help them better adjust to their new lifestyles and stick with their new way of eating. Here are some sabotaging thoughts and responses that are particularly relevant for people who have had (or are thinking about having) some type of bariatric surgery.
Sabotaging Thought: Now that I’ve had the surgery, it’s not fair that I can’t eat normally.
Response: I need to change my definition of ‘normal’ eating. I actually am eating 100% normally for someone who has had bariatric surgery. The way I used to eat is no longer normal (and remember – it was likely never really “normal” in the first place because it caused me to be overweight). My new normal is following my diet.
Sabotaging Thought: I won’t be able to take part in big celebratory meals anymore
Response: I can still celebrate occasions without overeating or overdrinking. I don’t have to make toasts with alcohol in my glass, I can celebrate a birthday even though I’m only eating a little (or no) cake, and I can still take part in the social aspects of special events regardless of what I eat. What I’m eating or not eating does not have to determine how much enjoyment I get. Besides, once I lose weight, I’ll get to enjoy looking and feeling great – which will be so much more pleasurable.
Sabotaging Thought: I’m afraid I won’t know who I am after losing so much weight.
Response: It’s true, things will look and feel very differently. It may require some renegotiation on my part to figure out where I fit in, and renegotiations with others to figure out our relationships, but that doesn’t mean it can’t be done. It’s better than the alternative of staying overweight, feeling miserable, and continuing to be stuck in an unhappy and unhealthy place.
Sabotaging Thought: I’m sad I won’t be able to binge anymore.
Response: By having this surgery done, I am giving some things up and there are definitely disadvantages. It’s okay to be sad about what I’m losing, but it’s also important to think about how much I’m gaining, and how all-encompassingly great those things are, like better health, self-pride, and confidence. I’ll be giving some things up, but in many ways, I’ll be getting my life back in return.
Sabotaging Thought: I’m afraid that I won’t be able to handle so much change.
Response: Thank goodness things will change! I need change to keep moving forward and to improve my life. Change can initially be scary, but that doesn’t mean I can’t handle it, and that doesn’t mean it won’t be 100% worth it.
I recently had a session with my dieter, Kara, who is a busy stay-at-home mom to her four boys. In earlier sessions, Kara and I worked on all of the foundational dieting skills and she got very adept at consistently instituting good eating habits. Because of this, we then started talking about having Kara make a food plan in advance and stick to it. Kara was initially resistant to this idea and stated that her lifestyle just wouldn’t work with a strict eating plan because she was always on the go and she often didn’t know ahead of time what her next meal would be. Kara also said that she didn’t want to give up spontaneous eating and liked being able to eat something if it was offered to her unexpectedly. I discussed with Kara the fact that making a food plan and sticking to it would likely make her life a lot easier because she wouldn’t have to rely on willpower at any one given moment to resist unplanned treats. I also pointed out that it might actually be very helpful for Kara to have a food plan, because she was often scrambling around at the last moment to make sure that she had dinner on the table for her family.
Despite these compelling reasons for why it might be worth it to try making a plan and sticking to it, Kara still resisted the idea and so we agreed to try it her way first – she’d work on staying in control of her eating and resist cravings, but without having a formal plan. Over that week, Kara tried hard to reign in her eating without a food plan and without violating her rule: no junk food until after dinner. However, when Kara came in to see me the following week, she dejectedly told me that something had thrown her off almost every single day, like when she was offered licorice at the park, cookies at a PTA meeting, or a dinner out with her husband.
Kara and I discussed what had happened over the week and she realized that, right now, she faces too many temptations each day to be able to resist all of them easily enough, and therefore making a plan and sticking might be very helpful in overcoming this obstacle. I reminded Kara that she probably tried very hard each day to resist the temptations and to reason herself out of eating food she knew she shouldn’t, and therefore likely had a much harder week than if she had just known ahead of time whether or not she was going to have something. Kara decided that she was willing to try and stick to a food plan for at least one week and see if it made a difference in her overall day.
Before she set out to do this, Kara and I spent some time in session thinking about when it would be hardest for her to stick to her plan and what sabotaging thoughts might get in the way of her doing so. Kara thought that the hardest times would be, as it had been, when she was offered or saw food she didn’t expect, and to not give in in that moment. I asked Kara what thoughts she might have in those moments, and then she made Response Cards with responses that we formulated together. Here are some of Kara’s sabotaging thoughts and then the responses we formulated:
Sabotaging Thought: I really want to eat that right now even though it’s not on my plan. Just this one time won’t matter.
Sabotaging Thought: It’s not fair that I can’t eat this treat right now.
Sabotaging Thought: I really don’t like having to make a food plan.
When Kara came in to see me earlier this week, she reported that she had had a much better week. As we predicted, once Kara made a food plan and worked on sticking to it, it made several aspects of her life easier. First of all, Kara struggled a lot less about whether or not to eat something that was offered to her because she knew that if it wasn’t on her plan, she shouldn’t convince herself that it was okay to eat it. Second, Kara also found that she really enjoyed having meal plans for the day (and even for the week) because it allowed her more time with her boys in the afternoon because she was spending less time trying to figure out what to prepare for dinner. Once Kara decided to try making a food plan, she realized that it wasn’t nearly as bad as she thought it was going to be and, in many ways, it actually made her day better, not worse.
The Beck Institute Weight Management 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.
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