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APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
In Weight Loss and Control, Dr. Ann Mary Kearney-Cooke demonstrates her approach to helping clients with issues about weight. Clients who have concerns about weight typically go through a cycle of dieting and bingeing. Dr. Kearney-Cooke works with clients to stop this unhealthy pattern by teaching them self-regulatory skills as well as forming realistic weight loss goals. She uses a cognitive–behavioral approach combined with interpersonal therapy, as oftentimes, clients overeat in part because of relationship issues.
In this session, Dr. Kearney-Cooke works with a client who has struggled with losing weight for many years. Following the birth of her child almost 1 year ago, the client reports that she lost a lot of weight; however, she has been unable to keep the weight off and is now interested in developing healthy eating habits and learning how to maintain weight loss. Dr. Kearney-Cooke takes an inventory of the client's history, her strengths, and her daily demands and resources. Dr. Kearney-Cooke then teaches her strategies for portion control as well as ways to set boundaries around mealtime that will result in more mindful eating.
Approach
The multiple demands facing individuals today make the treatment for weight loss and overcoming binge eating a challenging one for clients and therapists.
In this video, the therapist takes the role of a "coach," predominantly using cognitive–behavioral techniques and interpersonal psychotherapy methods to help the client overcome overeating and lose weight. The initial focus is on methods to overcome binge eating. Once a client is no longer engaging in binge eating, methods to lose weight can be introduced.
Interpersonal Psychotherapy
Interpersonal psychotherapy focuses on the role that interpersonal problems in relationships play in overeating. The assumption is that there is an interaction between negative mood, interpersonal functioning, and eating problems. Listening skills, negotiation skills, assertiveness skills, and strategies to set appropriate boundaries with others are taught so that clients can learn how to meet their needs with people instead of food.
Example of Tool: Relationship Questionnaire
Clients are asked to fill out the relationship questionnaire to help identify interpersonal triggers that lead to negative mood and overeating. Questions include the following:
Who are the five people in your life you are closest to?
How frequent is your contact with each of them?
What is your eating like before, during, and after you see them?
What are two expectations you have for each of these people? When they are not fulfilled, what do you do?
What roles do you tend to play in relationships with others? Do certain roles leave you "hungrier" than others?
What are the satisfying and unsatisfying aspects of these relationships? How can you be deliberate about making your relationships more satisfying?
Cognitive–Behavioral Therapy
Cognitive–behavioral therapy focuses on changing thoughts and behavior patterns that contribute to disordered eating, as well as developing alternative coping strategies. The dietary restraint model demands versus resources model, and self-talk model are also taught to help clients decrease overeating and lose weight.
Example of Tool: Self-Monitoring Form
Clients are asked to fill out a self-monitoring form to clarify eating habits. They are asked to report the following information:
type and quantity of food and liquid consumed
calories
time of each eating episode
place where food was consumed
situation: events that influenced eating
type and duration of exercise each day
each eating episode considered by client to be a binge (these should be underlined with a colored marker)
After reviewing self-monitoring sheets and identifying patterns to symptoms, therapists should encourage clients to
identify specific cues and consequences associated with binge eating episodes
develop strategies for rearranging cues (avoiding stimuli, restructuring the stimulus field, strengthening cues for desired behavior)
change response to cues, including building in a pause (e.g., when you want to binge, look at watch, wait 20 minutes, then binge); all food you are going to binge on must be on table before you start to binge
develop a list of alternative pleasurable activities to replace binge eating
identify thoughts that trigger binge eating and challenge or test distorted thinking
develop a relapse prevention plan
About the Therapist
Ann Mary Kearney-Cooke, PhD, is the director of the Cincinnati Psychotherapy Institute. She has been named a distinguished scholar for the Partnership for Women's Health at Columbia University in New York, where she developed the curriculum for the Helping Girls Become Strong Women Project. She has lectured at more than 150 conferences and written on the treatment of eating disorders, body image, and self-esteem.
She was honored as a fellow by the American Psychological Association for her outstanding contributions to the psychology of women. She is the psychological expert for the "Weight Loss Diary" column of Shape magazine. Her work has been featured on shows such as NBC's Today, CBS's The Morning Show, and Oprah.
Suggested Readings
Agras, W. S. (1993). Short-term psychological treatments for binge eating. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment (pp. 270–286). New York: Guilford Press.
Agras, W. S., & Apple, R. F. (1997). Overcoming eating disorders: A cognitive-behavioral treatment for bulimia nervosa and binge-eating disorder. San Diego, CA: Harcourt.
Allison, D., & Heshka, S. (1993). Emotion and eating in obesity? A critical analysis. International Journal of Eating Disorders, 13, 289–295.
Bulik, C. M., Sullivan, P. F., & Kendler, K. S. (2002). Medical and psychiatric morbidity in obese women with and without binge eating. International Journal of Eating Disorders, 32, 72–78.
Fairburn, C. G., & Wilson, G. T. (Eds.). (1993). Binge eating: Nature, assessment, and treatment. New York: Guilford Press.
Ganley, R. (1992). Family patterns in obesity with consideration of emotional eating and restraint. Family Systems Medicine, 10, 181–199.
Kearney-Cooke, A. (in press). Overcoming overeating. In A. Kearney-Cooke (Ed.), Power surge: Coming to terms with your body and self in midlife. New York: Simon & Schuster.
Klerman, G., Weissman, M., Rounsaville, B. J., & Chevron, E. S. (1984). Interpersonal psychotherapy of depression. New York: Basic Books.
Levine, M. D., Marcus, M., & Moulton, P. (1996). Exercise in the treatment of binge eating disorder. International Journal of Eating Disorders, 19, 171–177.
Marcus, M., Wing, R., & Hopkins, J. (1988). Obese binge eaters: Affect, cognitions, and response to behavioral weight control. Journal of Consulting and Clinical Psychology, 56, 433–439.
Mufson, L., Moreau, D., Weissman, M., & Klerman, G. (1993). Interpersonal psychotherapy for depressed adolescents. New York: Guilford Press.
Sorbara, M., & Geliebter, A. (2002). Body image disturbance in obese outpatients before and after weight loss in relation to race, gender, binge eating, and age of onset of obesity. International Journal of Eating Disorders, 31, 416–423.
Striegel-Moore, R. H. (1993). Etiology of binge eating: A developmental perspective. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment (pp. 144–172). New York: Guilford Press.
Vitaliano, P., Scanlan, J., Krenz, C., & Fujimoto, W. (1996). Insulin and glucose: Relationships with hassles, anger, and hostility in non-diabetic older adults. Psychosomatic Medicine, 58, 489–499.
Wifley, D. E., & Cohen, L. R. (1997). Psychological treatment of bulimia nervosa and binge eating disorder. Psychopharmacology Bulletin, 33, 437–454.
