Change Your Thinking to Help Manage Your Weight Weight Management Program Endocrinology and Metabolism Program Richmond Road Diagnostic and Treatment Centre 1820 Richmond Road S.W. Calgary, AB T2T 5C7

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This  material  is  designed  for  informa1on  purposes  only.  It  should  not  be  used  in  place  of  medical  advise,  instruc1on  and/or  treatment.  If  you  have  specific  ques1ons  please  consult  your  doctor  or  appropriate  healthcare   professional.  ©  2013-­‐2014  Alberta  Health  Services.  All  rights  reserved  in  rela1on  to  this  material.    Without  limita1on  to  the  foregoing  reserva1on  of  copyright,  this  publica1on  shall  not  in  whole  or  in  part  be  reproduced,   stored  in  a  retrieval  system,  or  transmiJed  in  any  form  or  by  any  means  (electronic,  mechanical,  photocopying,  recording  or  otherwise)  without  the  prior  wriJen  permission  of  Alberta  Health  Services.    AHS  provides  this   policy  and/or  procedure  (the  “Material”)  on  an  “as-­‐is,  where-­‐is”  basis,  and  hereby  expressly  disclaims  any  other  representa1on  or  warranty,  express  or  implied,  oral  or  wriJen,  statutory  or  otherwise,  including  without   limita1on,  warran1es  of  fitness  for  a  par1cular  purpose,  implied  warran1es,  and  warran1es  of  non-­‐infringement  or  merchantability.    AHS  has  made  reasonable  efforts  to  ensure  the  accuracy  of  the  informa1on  included   in  the  Material.    However,  AHS  expressly  disclaims  all  liability  for  the  use  of  the  Material  and  for  any  claims,  ac1ons,  demands  or  suits  arising  from  such  use.      

April 16, 2013

Key Message

Manage your thinking and you Manage your weight! 2

Objectives To know: 1.  What Cognitive Behavioural Therapy (CBT) is; 2.  How your thoughts, feelings and behaviours are related; 3.  How your unhelpful thinking leads to weight management problems; 4.  How to manage your thinking to help you manage your weight.

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Contents 1. Introduction to CBT 2. CBT Skill 1 - Motivation for Weight Management 3. CBT Skill 2 - Give Yourself Credit 4. CBT Skill 3 - Change Distorted Thinking 13 Cognitive Distortions managed by 13 CBT Skills

5. CBT Skill 4 - Good Thinking 6. In Review

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How to use this program Please take your time!! You may want to break your learning into 3 or 4 lessons and take some time to practice the CBT skills between sessions.

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Men are disturbed not by things, but by the view which they take of them. Epictetus

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X If you say… “I can’t go on a vacation. I always gain weight on vacations!” ….It is not the vacation that is the problem, but the view you take of vacations. ü  CBT helps you to change your thinking so you learn to say to yourself… On this vacation I may not lose weight, but I have the skills to stay within my calorie budget and maintain my weight! I will focus on having fun!”

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What we think we become. All that we are is the result of what we have thought. Buddha

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X If you say - I will never lose all this weight – your thoughts are likely to come true.

Canadian Obesity Network, used with permission

ü  Cognitive Behavioural Therapy helps you learn to say – It will take time but I will lose some weight!

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CBT and Weight Management

The way you think about food, your body, and your health affects your feelings, your behaviour and therefore your weight. 10

Thoughts

Behaviours

Feelings

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CBT is a learned skill that takes practice so that means doing homework! We have attached worksheets to help you with the homework. Or you can use your own notebook. To download a worksheet, click on the paperclip image BELOW that looks like this one. 12

4 CBT Skills

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CBT Skill 1 Motivation for Weight Management Poor weight management motivation might come from unhelpful thoughts such as: X X X X

Resisting food is too hard. It’s not worth it. Nothing works. I can just take pills to control my diabetes and high blood pressure.

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CBT Skill 1 Motivation for Weight Management The first step in weight management is to list all the reasons weight loss and weight maintenance are good ideas. Here are some examples: ü  I’ll have more energy! ü  I’ll be able to take the stairs! ü  I will take less medication! ü  I’ll have fewer medical appointments! ü  I’ll be proud of myself!

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CBT Skill 1 Motivation for Weight Management

Read your motivations for losing weight everyday! Read them many times a day! These motivations will become stronger the more times you read and hear them! Remember – you are what you think! 16

CBT Skill 2

Give Yourself Credit

Poor weight management often leads to self criticism. You may also focus on everything you do wrong. For example you might say… X I don’t deserve credit – look at my size. X I won’t say anything good to myself until I’ve lost all this weight.

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CBT Skill 2

Give Yourself Credit

Learning to speak well of yourself is an important part of weight management. Every time you make a healthy food choice, resist a bag of chips, or add a bit more movement to your day, be kind to yourself and say… ü  Way to go – a small step in the right direction! ü  I deserve to lose weight! ü  It’s been a long time since I said no to chips so good for me!

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CBT Skill 2

Give Yourself Credit

The CBT part is to say good things to yourself again and again. It may be difficult to believe these encouraging statements at first! Be patient! Over time your thoughts will be less negative. Soon you will see yourself in a more positive light.

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CBT Skill 3

Change Distorted Thinking

Cognitive Behavioural Therapy is replacing unhelpful or distorted thinking with more helpful and realistic thinking! Following are 13 examples of distorted thinking. These are called Cognitive Distortions. For each Cognitive Distortion we describe a CBT Skill to help. The CBT skills will help you change your unhelpful thinking to helpful weight management self talk! 20

CBT Skill 3

Change Distorted Thinking

Each cognitive distortion is presented in 2 slides. The first slide explains the distortion and gives a few examples. The second slide explains a CBT skill and a few examples of how to use the skill.

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1) All or Nothing (Black & White) Thinking If you use this distorted way of thinking, you look at life and weight loss in absolute black-andwhite categories. You might be saying: X I have to lose all this extra weight, it’s no use losing just some! X What’s the use of walking for 10 minutes – I need to get sweaty and exercise for 2 hours for it to count!

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1) All or Nothing (Black & White) Thinking Not too many things in life are purely black and white. Try thinking in Shades of Gray, which means thinking somewhere in between. For example, you could change the All or Nothing statements on the previous slide to: ü  Even if I lose 5-10% of my excess body weight, my medication will likely decrease! ü  A long gym workout would be great, but walking around the block is better than nothing! Besides, exercise is really about improving my health and my mood! 23

2) Dwelling on the Negatives Just as the name says, this cognitive distortion is all about negative thinking. Some negative thinking examples are… X I am overwhelmed – I give up! X I didn’t lose weight this week – it’s not fair. X This is too hard.

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2) Dwelling on the Negatives Sometimes the answer to negative thinking is to flip the thought to a more positive or more realistic thought. You might say… ü  I am overwhelmed, but I know this is all worth it, so there is no use giving up. With practice I can do this! ü  I didn’t lose weight this week but I stayed on my food plan so it’s likely my weight loss will show next week. ü  This is hard but I want to live longer to be with my family. 25

3) Overly Positive Fortune Telling Hope of a better future is important to our overall health, but overly positive fortune telling may lead to weight gain. Statements such as the following will sabotage weight management… X It doesn’t matter if I eat this, I’ll make up for it later. X I’ll just have one more square of chocolate and then I’ll stop.

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3) Overly Positive Fortune Telling A good way to counteract overly positive fortune telling is to conduct a small personal experiment. Or, you can recall how things really turned out in the past. ü  I will eat this desert now and then watch myself to see if I really do make up for it later. If I don’t cut out calories later in the day then I know this is a distorted way of thinking! ü  How many times have I ever stopped at one square of chocolate? Never, so what makes me think this time is different? Today I just won’t start! 27

4) Negative Forecasting You might be in the habit of making negative guesses about the future. The following statements will likely lead to weight gain; X I’ll never be able to give up my two double double’s in the morning. X I will fail, I always fail at everything.

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4) Negative Forecasting Try a Thought Record. It will help you use more balanced and helpful weight management self talk. Automatic Thought

Supporting Evidence for Automatic Thought

Evidence Not Alternative and/ Supporting or Balanced Automatic Thought Thought

I will fail, I always fail at everything

I have failed every diet – look at me!

I am successful at work when I have knowledge and work hard.

I have failed before but with new knowledge, support and hard work I will manage my weight. 29

5) Random Rules Sometimes our distorted ways of thinking create some interesting random rules such as… X X X X

Calories eaten standing up don’t count! Weight loss has to be fast! Don’t leave food on your plate – eat it all up! Weekends and vacations don’t count!

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5) Random Rules Challenge those rules by looking up the scientific evidence. ü  Every calorie counts!! ü  Rapid weight loss often leads to rapid weight gain back. ü  The evidence is in – its either waste or waist!! ü  No scientific evidence suggests that the human body metabolizes calories differently on the weekends or vacations!

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6) Emotional Reasoning We often take our feelings and emotions to be truths about ourselves, and these emotions can lead to overeating, poor food choices and weight gain. X I am so angry – I have to have ice cream. X I’m lonely! I want chocolate right now. X I feel so stressed – I need chips.

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6) Emotional Reasoning Ask yourself some questions about those feelings. This is called the Socratic Method named after the philosopher Socrates who taught his students by posing questions. ü  What am I angry about? How will ice cream help? Will I be angry about eating ice cream? Could I go for a walk or talk to somebody? ü  Just because I want chocolate does that mean I have to eat it? Could I want a piece of fruit instead? What can I do about my loneliness? What healthy hobby can I do tonight? ü  What relaxation technique can I use? How can I change this stressor? How will chips help? 33

7) Mind Reading At times you may think you know exactly what someone else is thinking, but really, none of us are mind-readers. If you try to mind read, it can certainly lead to over eating. A common example is when you are a guest and think X My friend won’t like me if I say no to her brownies, and people will think it strange if I just ask for water.

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7) Mind Reading Try a cost/benefit exercise to help with mind reading. Cost of my thinking I will eat extra calories I will feel badly about myself when I go home I will feel guilty I will be angry when I weigh myself ? /10

Benefit of my thinking I will make my host happy I will get to eat yummy food and drink my favourite pop I won’t feel different Fun food and drink will make me happy ?/10 35

8) Self-Deluded Thinking Self deluded thinking is believing for a moment what you know not to be true. X I cheated this morning so I might as well keep cheating because today is a write-off! X Right now I don’t care about my weight, so I will eat what I want!

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8) Self-Deluded Thinking Sometimes just identifying the cognitive distortion can help to make changes. So say to yourself.. ü  I am deluding myself if I think I can just write off today and eat whatever I want. This thinking got me here and won’t get me out of trouble!! I will go right back to my food plan this minute! ü  I am deluding myself if I think I don’t care about my weight because I do. Every time I put food in my mouth it matters! I want to be healthier and not gain any more weight! 37

9) Justifications We can justify a lot of overeating!! Have you ever said… X I can eat this because it is my birthday. X It’s okay to eat this because it was free. X It has been a busy day! It’s okay to eat out because I don’t have time to cook!

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9) Justifications Try using humour to change some of these justifications. ü  Of course I can eat this because there are no rules on birthday days! I can also run a red light, jump the line at the bank, whatever I want – It’s my birthday!!! ü  Yes I will eat all the free food I can find including all the free samples in the store today, all the leftovers in the lunchroom, and I will order big when it’s on the boss!

ü  Of course we can eat out because it doesn’t take any time to drive to the restaurant, order the food, wait for the food to cook, eat the food, wait for the bill, earn the money to pay the bill… 39

10) Exaggerated Thinking We can certainly make weight management situations seem much worse than they are with exaggerated or catastrophic thinking such as… X I can’t stand being hungry, I have to eat now. X The only thing that reduces my stress is food – I need ice cream!! X My ideal weight is 160lbs and I need to get there no matter how hard it is!

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10) Exaggerated Thinking Exaggerated thinking can be softened by the ‘what if’ technique. ü  ‘What if’ I tried to go hungry for an hour? ‘What if’ I distracted myself with something that makes me think less about the hunger? ‘What if ‘I said “It’s just hunger – I can wait for my meal!” ü  ‘What if’ I tried something else to reduce stress? ‘What if’ I tried a walk just this once to see if it helps? ü  ‘What if’ this is my best weight? ‘What’ if this is the lowest number of calories I can consume and still be healthy? 41

11) Should Statements Should statements are full of pressure, guilt and do not change unhealthy weight management behaviours. X I should be able to manage my food intake. X My family should understand my weight problem and should not push food on me. X I should like to go to the gym.

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11) Should Statements Replace the word ‘should’ with a more realistic word. This is called the Semantic or Replace the Word technique. ü  I will learn to manage my food intake! ü  My family do not understand my weight problems and will push food on me until I firmly say NO! ü  I do not like to go to the gym. I will find some type of movement that I do like!

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12) The Reward Fallacy Do you expect your sacrifice and hard work to be rewarded, and feel bitter if you are not rewarded? Have food rewards been a part of your life for so long it is hard to think of any other kind of reward? You may be saying… X I did so well – today I deserve a fast food treat. X I have lost 25 pounds– I deserve something sweet.

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12) The Reward Fallacy Surveying what others do to reward themselves may give you some new ideas. ü  I do deserve a treat, but I also deserve to be thinner! My friend treats herself with a visit to the library. Maybe I will go pick up a new book. ü  Weight loss does deserve credit, but it does not have to be sweets! My sister treats herself to a massage or a manicure – I will try that!

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13) Wishful Thinking Wishful thinking is magical thinking and is not positive or productive. Maybe you say X I wish I was a calorie millionaire. X I wish I wasn’t diabetic. X I wish I could just wake up thin.

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13) Wishful Thinking Wishful or miracle thinking can be fun but it can also be a waste of time and interfere with weight management. Use the “That’s Life” or “Oh well” technique to help you deal with reality. ü  That’s life; I am not a calorie millionaire so I have to live on a calorie budget if I want to be healthy! ü  Well that’s life – I have diabetes and I can’t wish it away. I will learn to eat better. ü  Oh well, I cannot wake up thin, that is childish and magical thinking. I am going to distract myself in my sewing room! 47

Cognitive Distortions 1.  All or Nothing Thinking 2.  Dwelling on the Negatives 3.  Overly Positive Fortune Telling 4.  Negative Forecasting 5.  Random Rules 6.  Emotional Reasoning 7.  Mind Reading 8.  Self-Deluded Thinking 9.  Justifications 10. Exaggerated Thinking 11. Should Statements 12. The Reward Fallacy 13. Wishful Thinking

CBT Skills 1.  Thinking in Shades of Grey 2.  Flip to positive or realistic 3.  Conduct a small experiment 4.  Thought records 5.  Find the evidence 6.  Socratic method – ask some questions 7.  Cost / Benefit analysis 8.  Name the cognitive distortion 9.  Humour 10.  “What if” questioning 11.  Replace the Word 12.  Survey method – ask others 13.  “O well” technique (acceptance therapy) 48

CBT Skill 3

Change Distorted Thinking

To manage your weight you must identify and change distorted thinking. But not all in one day! Give yourself permission to work on these unhelpful ways of thinking slowly!

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CBT Skill 4

Good Thinking

Reading and repeating the good thinking or affirmations written by others is another way to practice Weight Management CBT. Here are some examples of what others have said: ü  ü  ü  ü  ü  ü 

Movement is Medicine! I am careful about my food choices, I keep to my food plan! I live on a calorie budget! I do not comfort myself with food! The momentary pleasure is not worth the weight gain! My Best Weight is where I am healthy and like my life! 50

CBT Skill 4

Good Thinking

Two websites for ‘Good Thinking” examples WMP News, Nuggets and Nudges: http://wcmprod2.ucalgary.ca/cdm/node/17 Daily CBT motivational tips: http://www.beckdietsolution.com/daily-diet-solutions/

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CBT Skill 4

Good Thinking

Write down good thinking or affirmations you find helpful. Read them everyday!

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Thoughts

Behaviours

Feelings

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In Review Write down your motivations for losing weight and read them daily!

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In Review Give yourself credit for the right things you do to manage your weight – no matter how small. Write them down, review daily, and celebrate your successes!!

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In Review Learn how you distort your thinking. Then practice changing those distorted thoughts to more realistic and helpful thinking.

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In Review Be patient – all new skills take time to learn.

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In Review Practice, practice, practice the good thinking you have learned, and soon it will just be the way you think!

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For more information 1.  View more online health education sessions to help with weight and other chronic illnesses at http://wcmprod2.ucalgary.ca/cdm/ 2.  In the Calgary area, ask your doctor about referring you to the Weight Management Program at Richmond Road Diagnostic and Treatment Centre,1820 Richmond Road S.W. Calgary, AB T2T 5C7 403-955-8088 3.  Call Health-Link for other weight management resources in Alberta Toll-free: 1-866-408-5465 (LINK) Edmonton: 780-408-5465 (LINK) Calgary: 403-943-5465 (LINK)

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Please answer a few questions to help us evaluate this session. We appreciate your help!

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Please choose the statement that best describes you. A) A person with obesity or other chronic disease B) A friend or family member of a person with obesity or other chronic disease C) A healthcare provider D) Other

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How did you find out about this presentation?

A) The Calgary Weight Management Program B) Your family doctor or a healthcare provider from your family doctor's office C) A health care provider not from your family doctor's office D) A friend E) Other

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What did you find most useful about this online presentation? Please type in your answer.

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What comments or suggestions do you wish to share? Please type in your answer:

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The objectives of this session were to know: 1.  How your thoughts and feelings affect your behavior 2.  How your unhelpful thinking leads to weight problems 3.  How to manage your thinking to help manage your weight

The session objectives were clear to me

I accomplished the objectives of this session

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Please rate how the following have changed since you've watched this session. My belief that CBT skills (changing how I think) can help me manage my weight has... My confidence that I can use CBT skills (changing how I think) to help manage my weight has...

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Please rate how the following have changed since you’ve watched this session.

My understanding of the link between my thinking and weight management has… My understanding of how to use CBT skills to change my thinking about weight management has… Submit 67

Indicate how strongly you agree or disagree with the following statements about this session.

I was interested in what I was learning. There were enough practice exercises. I was happy with the level of difficulty. Submit

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Indicate how strongly you agree or disagree with the following statements about this session.

I will be able to use what I learned in this workshop. Watching this online was a good way to learn about CBT. Submit

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Finding your motivation, or reasons for wanting to manage your weight, is not important for CBT (changing your thinking). A) True B) False

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All or nothing thinking can help people manage their weight because it keeps their goals set high. A) True B) False

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Giving myself credit for small changes will lead to weight gain because I am being too easy on myself. A) True B) False

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Distorted thinking gets in the way of managing weight. A) True B) False

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"Should" statements get in the way of weight management because they increase pressure and guilt. A) True B) False

Thank You!

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