Cognitive-Behavioral Theory

Cognitive-behavioral theory is based on the assumption that all behavior is learned and is directly related to internal factors (e.g., thoughts and thinking patterns) and external factors (e.g., environmental stimuli and feedback) that are related to the problem behavior. Patients are taught to utilize a variety of behavioral and cognitive strategies to recognize behaviors that lead to inappropriate eating and replace them with more rational thoughts and actions. The behavioral strategies most suited to minimal contact interventions are outlined in Table 31.3 and include self-monitoring, goal setting, and problem solving.

Incorporation of Behavioral Theory Tenets to the 5As Model

The 5As model provides specific guidance on how to integrate motivational interviewing, the transtheoretical model, and cognitive-behavioral therapy principles into a minimal contact dietary intervention. A quick assessment allows for tailoring of counseling goals. For those patients not ready to make dietary changes, the goal of the intervention is to enhance readiness/motivation. The

Table 31.3 Behavioral strategies useful to support dietary change




Cornerstone of therapy, used in goal setting/progress assessment Provide rationale and instruction for self-monitoring Assist patient in reviewing log and identifying patterns Assist with goal setting and problem solving Celebrate successes

Goal setting

Collaborative activity

Identify goal that client is willing to expend effort to achieve Discuss pros and cons of goal

Document and track progress toward long- and short-term goal May need to provide information/skill development Encourage strategies to build confidence Celebrate successes

Problem solving

Define the problem Brainstorm solutions

Weigh pros and cons of potential solutions Patient selects/implements strategy Evaluate outcomes/adjust strategy

intervention addresses the client’s ambivalence about change; motivational interviewing is an appropriate strategy. Clients ready to change will be more open to utilize behavior therapy strategies such as self-monitoring, goal setting, and problem solving. The 5As model outlined in Table 31.4 guides the content of the brief nutrition encounter.

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