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Introduction

Poor emotional regulation is related to increased risk of obesity (Lumeng et. al, 2018). Specifically, impulsivity, a characteristic of emotional regulation, is linked to negative eating behaviors, such as the consumption of  greater high-calorie food, and sedentary behaviors, which both lead to increased risk of obesity. Therefore, by improving an individual’s emotional regulation, one may thereby decrease negative behaviors associated with weight gain and obesity (Lumeng et. al, 2018).

Theory

Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy). CBT helps clients become aware of inaccurate or negative thinking in the midst of challenging situations and respond or cope in a more effective way. CBT is a helpful tool in treating mental health disorders, such as depression, post-traumatic stress disorder (PTSD) or an eating disorder. Cognitive behavioral therapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope with your situation in a healthy way and to feel better about yourself and your life (Mayo Clinic Staff, 2017).

In CBT, individuals learn to be their own therapists. Through exercises in/outside of sessions, clients can practice coping skills to change their own thinking, problematic emotions and behavior. CBT takes into consideration what is going on in the person’s current life, rather than what has led up to their difficulties. A certain amount of information about one’s history is needed, but the focus is primarily on moving forward in time to develop more effective ways of coping with life (American Psychological Association).

Case Study

Rosa is a 52-year-old woman with type II diabetes who weighs 265 lbs (Cypress, 1999). She describes difficulty losing weight, and does not know what to do about it. She reports binge eating every evening due to difficulty coping with life stressors such as work, losing weight, and caring for her children. She reports feeling stressed and depressed and wants to gain control over her life.

Evidence

There is mixed evidence regarding the effectiveness of self-regulation and coping skills strategies to promote weight loss. One study targeted at increasing self-regulation in children living with obesity to promote healthier eating behaviors concluded that although self-regulation interventions were efficient at improving  children’s general emotional and behavioral self-regulation, did not necessarily helped them regulate their obesity related behaviors (Lumeg, et al., 2016).  Another study that used proactive coping skills strategies as an intervention to improve healthy self-care behaviors in people with diabetes type 2, and reduce their weight showed improved behaviors in regards to diet and physical activity resulting in significant weight loss (Thoolen, et. al., 2009).

Intervention Plan

Problem Statement:      Client displays unhealthy eating habits secondary to poor distress tolerance skills.

2 Long Term Goals

• Client will identify the pros and cons of current coping strategies for life stressors to reduce binge eating frequency from five times per week to two times per week in order to increase healthy eating habits in two weeks.
• Client will independently demonstrate mindful eating techniques to improve distress tolerance skills for healthy eating habits during the last four treatment sessions.

3 Short Term Goals

• Client will demonstrate distress tolerance strategies when role playing a stressful situation with the therapist to increase healthy eating habits in two weeks.
• Client will report two distraction techniques to decrease over-eating and improve distress tolerance to increase healthy eating habits in two weeks.
• Client will independently identify three self-soothing strategies to promote impulse control in stress eating in one week.

Intervention format: Individual

Setting: Outpatient setting

Supplies: None

Agenda

• Greet client and build rapport (5 min)
• Client will take the Beck’s Anxiety Inventory (15 min)
• Client will identify the pros and cons of current coping strategies for life stressors to reduce binge eating (15 min)
• Summarize session (5 min)

Documentation

S: Client reports that she overeats because she feels stressed, depressed and has no control over her life.

O: Client participated in a one hour OT session. She was given the Beck’s Anxiety Inventory and scored a 40. Client engaged in a mindfulness exercise as she ate a snack.  She was educated and trained in EFT techniques for impulse control.

A: The score from the Beck’s Anxiety Inventory indicates high levels of anxiety which correlates to poor impulse control and overeating as a result. Her disposition and performance when engaging in mindfulness and EFT techniques to modulate her anxiety indicates a potential to increase her distress tolerance.

P: Client will resume therapy sessions twice a week for one hour each day. Sessions will focus on increasing awareness of anxiety triggers, and developing a repertoire of self-soothing techniques to promote impulse control. Client will be provided with an Adult Sensory Profile at next session to determine sensory integration techniques to incorporate into the client’s treatment.

References

American Psychological Association. What Is Cognitive Behavioral Therapy? http://www. apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.aspx

Lumeng, J.C., Miller, A.L., Horodynski, M.A., Brophy-Herb, H.B., Contreras, D., Lee, H., Sturza, J., Kaciroti, N., & Peterson, K.E. (2017). Improving self-regulation for obesity prevention in head start: a randomized controlled trial. Pediatrics, 139(5), 1-10. doi:10.1542/peds.2016-2047

Thoolen, B., De Ridder, D., Bensing, J., Gorter, K., & Rutten, G. (2009). Beyond good intentions: the role of proactive coping in achieving sustained behavioural change in the context of diabetes management. Psychology & Health, 24(3), 237-254. doi:10.1080/08870440701864504

Mayo Clinic Staff. (2017).Cognitive Behavioral Theory.https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610