Practice Consideration
COUNSELING STRATEGIES
As a dietitian be aware that you can use and combine one or more theories to support your patients learning about dietary change. Cognitive Behavioral Theory (CBT) and Social Learning Theory (SLT) work hand in hand to expand the patient's learning and cognition.
(See Tool Kit, Counselling Strategies that identifies strategies commonly used with each approach.)
Cognitive Behavioral Theory (C-1.1)(1,2)
Cognitive Behavioral Theory is based on the premise that behavior is learned and is directly related to internal factors (e.g., thoughts and thinking patterns) and external factors (e.g., environmental stimulus and reinforcement) that are lead to the problem behaviors. Both cognitive and behavioral change strategies to effect behavior change are used.
Cognitive Restructuring (C-2.8)(1,2)
Dietitians may help clients identify the first, or automatic, thoughts that aren't supportive of optimal lifestyle choices; then identify which of the following common cognitive distortions exist, and finally construct an alternative thought to be substituted whenever the distorted thought starts to occur. This may be the framework that the dietitian uses to discuss the faulty logic of the initial thought without specifically naming it or the dietitian may educate clients on the following distortions so they may self manage cognitive distortions.
"My misery will go on and on and I'm absolutely convinced that this or any treatment will be doomed to failure."
Mind-reading — An assumption that people are looking down on you or criticizing you and the belief you know what others are thinking
"The dietitian thinks I'll never lose weight."
All-or-nothing thinking, e.g. seeing things in black and white
"I'm a complete failure"
Over generalization
"This always happens to me. Things never work out as I want them to."
Magnification or blowing things out of proportion
"Oh no, I ate a whole bar of chocolate. My diet is ruined and I'll never get back on track."
Social Learning Theory (C-1.3)(1,2)
A second approach which the dietitian may find useful iis Social Learning Theory (SLT). This combines a framework for understanding, predicting, and changing behavior based on the dynamic, reciprocal relationship between environment, the person, and behavior. It emphasizes the importance of observing and modeling behaviors, attitudes and emotional reactions of others. Determinants of behavior include goals, outcome expectations, and self-efficacy. Reinforcements increase or decrease the likelihood that the behavior will be repeated The tenant of Social Learning Theory is that the patient learns through interaction with other people and their environment. Bandura states,
| "Learning is a cognitive process that takes place in a social context and can occur purely through observation or direct instruction."(3) |
Basic Concepts of SLT
We learn through observations and imitation of other people and through direct teaching: through watching, listening and talking and through interaction with our environment. The reinforcement for the patient occurs from the learning. The patient feels good for having learned. There is no guarantee of change after the learning!!
The stages of the learning process according to SLT follow.
"Listen carefully. Pay attention"
Retention — Assess how much patient has retained
"What can you remember about ...?"
Reproduction — Can the patient do the learning? Is the patient up to the learning?
"Are you ready to start?"
Additional Reading
Snetselaar, L Nutrition Counseling Skills for the Nutrition Care Process. Burlington, MA: Jones and Bartlett Learning: 2009
Bandura, A. Social foundations of thought and action: A social cognitive theory. Prentice-Hall, Inc; 1986.
Bandura, A. Social learning theory. Englewood Cliffs, NJ: Prentice Hall; 1977.
References
1. From eNCPT, electronic Nutrition Terminology Reference Manual, 2023. https://www.ncpro.org. Accessed 17 August 2024..
2. Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. Intervention. 2023; Accessed 17 August 2024. Available from: https://www.ncpro.org/pubs/2023-encpt-en/page-055
3. Bandura A. Social learning and personality development. New York: Holt, Rinehart, and Winston; 1963.