I keep encountering misconceptions about what behavioral counseling is, particularly when it comes to health conditions. As psychologists, we don’t just chat w/ patients or tell them what to do. Behavioral counseling is a collaborative learning process. Let me explain… #scicomm
Let’s say a patient comes to me wanting to lose weight. My first step is to assess how much they want to lose, why they want to lose weight, medical or psych issues that might be affecting their weight, and what they have tried in the past (and how that went). 2/n
If issues emerge that should be treated first, I will do so or refer. For ex, if the patient has uncontrolled diabetes, we would address this. If they have depression, weight loss will be difficult, so we will need to tackle this via counseling and/or meds. 3/n
When we're ready to develop a weight loss plan, the first step will be to set some goals for weight loss, diet, and exercise. Both long- and near-term. We discuss the science of goal setting and agree on intervals in which to check in on progress toward goals. 4/n
When setting short-term goals I ask patients to anticipate problems that could get in the way. For ex, if the plan is to exercise 3 x/week after work, we will play out scenarios where this plan gets stymied and then brainstorm how to handle. Good goals have contingency plans! 5/n
Next we set up a plan for self-monitoring, which might include daily weighing, diet journaling, and an exercise calendar. We discuss the science of self-monitoring. I agree to review their self-monitoring records regularly and give feedback. 6/n
I do not prescribe any particular diet but instead we review a week or so of diet diaries together and identify areas where healthier choices can be made. Often we end up with a healthier version of their usual diet. I always say, “don’t start a diet you don’t want to marry!” 7/n
For exercise, I ask the patient which exercises they like most (or hate the least!) and come up with a plan together to slowly increase physical activity. We often set steadily increasing goals rather than one big goal right off the bat. 8/n
Once a patient has a plan, we end up doing a lot of problem solving when things go wrong or if the scale isn’t budging. We also do a lot of tweaking goals and plans. Everyone is different so this process is all about personalizing to the patient and his/her situation. 9/n
I then spend some time talking about how stress can disrupt weight loss, both physiologically & behaviorally. I teach stress reduction skills. Some patients love mindfulness, others prefer cognitive or behavioral strategies (e.g., delegation, assertiveness skills training). 10/n
I also teach patients how cues affect behavior. We discuss the science around this and then do some fun exercises to identify all the cues that affect our eating and exercise in a week. I then teach strategies for disrupting cue-driven eating. 11/n
I also discuss how to manage hunger. We discuss the neurobiology of appetite. I teach patients to track hunger before and after meals and to be aware of how much their eating is cued by hunger vs external things (e.g., candy bowl). 12/n
I also discuss how beliefs affect behavior. For example, a patient might say “I’m just not the exercising type” and then this can set a negative tone about exercise. We work on strategies to challenge negative thinking. 13/n
I also help patients come up with ways they can leverage their social networks (and buffer themselves from unhealthy social influences). They learn to negotiate with loved ones, ask for what they need, find a buddy, etc. 14/n
Usually every session ends with “next steps” that map onto the topic we discussed. Deciding on next steps is a very collaborative process. We make sure to write down next steps since that strengthens commitment (and memory!). 15/n
I like to think of behavioral counseling as “scaffolding” for behavior change. It provides a framework to guide the behavior change process and to keep it moving and in the right direction. Lots of learning, problem solving, and course correction. 16/n
It is a lot to cover (and I have oversimplified it here), but to be effective, you usually need several contacts (often weekly) over months to have plenty of opportunity to iterate goals, feedback, strategies, and problem solving. 17/n
