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Introduction

Individuals with eating disorders and obesity have been found to experience harmful behaviors and attitude patterns that infiltrate into their daily functioning. These maladaptive behavior patterns involve distorted thinking. A comprehensive approach is recommended when dealing with these individuals, as disordered eating permeates them as an individual, their home, and social environments. One of the greatest challenges with these individuals is breaking them out of vicious cycles. Cognitive behavioral therapy (CBT) can support the patient when making a change in their habits and attitudes that are influencing their psychological disorders. CBT can be exactly what these individuals need as it aims to break negative behavior cycles. In this way, clients will be in a better state to lead a healthier lifestyle (Wilfley et al., 2011).

Theory

Cognitive behavioral therapy (CBT) was developed by Aaron Beck. It assumes the following: cognition affects behavior, cognition can be monitored, and altered, and that behavior change is mediated by cognitive change. In essence, these assumptions imply that our thoughts direct our behavior (Beck, 2011). According to Beck 2011, individuals adapt to positive or negative self-concepts that translate as behavior patterns, and the goal of CBT is to redirect individual’s negative thoughts to positive ones that will result in positive behavior.

Case Study

This client came to an initial occupational therapy session. Rosa is a 52-year-old woman with type II diabetes who weighs 265 lbs (Cypress, 1999). She describes difficulty losing weight due to low self-esteem and depression. She reports binge eating at restaurants and at home, especially during the evening when she is overwhelmed with negative and pessimistic thoughts. She thinks that she is worthless and is not capable of losing weight (Cypress, 1999).

Evidence

There is evidence that CBT is an effective intervention to control weight. A systematic review by Brennan 2014, indicates that psychological interventions like CBT facilitate weight loss, particularly when combined with dietary and exercise strategies. Also, according to Calugi et al., 2016, CBT has a weight reduction effect of up to 5 years as evident on their case control study.

Intervention Plan

Problem Statement

• Client has difficulty managing her health and losing weight secondary to cognitive distortion.

Long-Term Goal

• Client will identify and use a technique to redirect her cognitive distortions to manage her health and lose weight in 4 months.

Short-Term Goals

• Client will list 5 thoughts in a journal every day and identify whether they are positive or negative to decrease cognitive distortions and manage her health in 2 months.
• Client will create a list of affirmations to refer to when she has negative thoughts to redirect cognitive distortion and improve health management in 2 months.
• Client will record positive modifications to the previously identified negative thoughts to redirect cognitive distortions to manage her health and lose weight, in 2 months.

Intervention format: Individual

Setting: Outpatient setting

Supplies: None

Agenda

• Greet client and build rapport (5 min)
• Administer the occupational profile. Identify problems, goals, environments, and diagnoses. Identify what the client believes in guided discovery (10 min)
• Create a problem list with the COPM (15 min)
• Create goal/s (5 min)
• Educate client on the cognitive model, the process of CBT, and the effectiveness of CBT (10 min)
• Assign homework (5 min)
• Summarize and elicit feedback (5 min)

Documentation

S:  Client stated:  “I can’t lose weight because I’m a worthless pig. I feel like I will always be a fat cow. Nothing I can do will ever change that. After the occupational therapist explained what CBT is and asked her if she was willing to try it, the client stated: “Why not? Nothing else is working”.

O:  In today’s initial session, the client identified five problem areas in the COPM that she wants to work on during therapy, the most important activity being weight loss, followed by being confident in her own skin, eating healthily, exercising, and the finally participating in social activities, such as eating at restaurants with friends. The occupational therapist and the client created the following goals:  “I can and I will lose weight, eat healthily, exercise, and be confident in my own skin” and “I can and I will go to restaurants to spend time with friends and not be afraid of binge eating.” Furthermore, the client was educated on the cognitive model, the process of CBT, and the effectiveness of CBT on depression and low self-esteem for obesity.

A: The client’s ability to identify five problem areas and goals shows increased insight into core beliefs. Client’s abilities to identify goals shows increased motivation for cognitive restructuring towards more positive thoughts and increased weight loss

P: Client will resume therapy sessions once a week for one hour each day. Sessions will focus on cognitive restructuring for negative thoughts towards weight and self-esteem. The client will be assigned the WRAP as homework in order for the client to self-identify strengths, triggers, self-care maintenance, and action plan for the next treatment session.

References

Beck, J. (2011), Cognitive behavior therapy: Basics and beyond (2nd ed.), New York, NY: The Guilford Press, pp. 19–20.

Brennan, L. (2014). Psychological interventions for overweight or obesity. Cochrane Database Of Systematic Reviews, (5), doi:10.1002/14651858.CD003818.pub3

Calugi, S., Ruocco, A., El Ghoch, M., Andrea, C., Geccherle, E., Sartori, F., & Dalle Grave, R. (2016). Residential cognitive-behavioral weight-loss intervention for obesity with and without binge-eating disorder: A prospective case-control study with five-year follow-up. International Journal Of Eating Disorders, 49(7), 723-730. doi:10.1002/eat.2254

Wilfley, D. E., Kolko, R. P., & Kass, A. E. (2011). Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents. Child and Adolescent Psychiatric Clinics of North America, 20(2), 271–285.http://doi.org/10.1016/

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