On January 29, 2025, Beck Institute conducted a live virtual Q&A with Dr. Judith Beck. Members of the public, including both mental health professionals and non-professionals, submitted over 400 questions. Did you submit a question for Dr. Beck? She will continue to respond to audience questions in our blog, on social media, and in our newsletter, so be sure to check back to see if she answers yours.
Question: How have your views on dieting and providing cognitive-behavioral assistance to clients for dieting changed since the publication of the Beck Diet Solution? What should a cognitive-behavioral approach be with clients that want to lose weight and want help with removing the cognitive and behavioral barriers in the way of losing weight?
Answer (provided by Dr. Beck and Deborah Beck Busis, LCSW): Many of our views on providing CBT to assist clients in gaining control of their eating, getting healthier, and losing weight have remained the same. We have always known that anyone can make short term changes in their behavior (virtually every client we’ve worked with has lost weight in the past!) but to make lasting changes, they need to change their thinking. We help clients figure out what thoughts they are likely to have once they’re triggered to eat something unplanned and help them come up with compelling responses to those thoughts.
For example, if a client has a bad day at work and comes home and has the thought, “I had such a bad day; I deserve to treat myself with a big dinner to help myself feel better,” we would help them examine the evidence of how having a big, unplanned dinner has made them feel in the past. Based on that evidence, they may craft a response along the lines of, “It’s true I did have a bad day at work, and I do deserve something to help me feel better, but I know from past experiences that having a big, unplanned meal will only make me feel worse. It will make me feel out of control and overstuffed, both of which are very uncomfortable. I deserve something that is truly a treat, not a trick.”
We still try to figure out what habits and systems, both in terms of eating and exercise, are reasonable and maintainable for our clients. If a behavior change isn’t maintainable, clients will stop doing it and regain weight.
We teach our clients specific cognitive and behavioral skills in a very deliberate sequence. Our goal is to help our clients build their mental muscle layer by layer so they get stronger and gain a greater sense of self-efficacy as they go. We start out with the easiest (but not necessarily easy!) skill first.
We help clients figure out what challenges may arise as they implement their new skill and how to overcome them. Once they’ve mastered the skill, we move on to the next easiest skill, and then the next, and so on. By the time we’re working on very challenging skills, such as planning and tracking their eating, our clients are well trained for it and able to follow through consistently. This is the equivalent of beginning a physical weight training program by starting with the five-pound weight, then moving up to the ten-pound weight, then the 15, and so on. By the time they’re up to the 50-pound weight, they are ready for it because they already mastered the 45-pound weight and everything that came before.
Although our approach remains largely the same, the language that we use to describe some of the techniques and skills has evolved. For example, we used to call clients’ mental muscles their “giving-in muscle” and their “resistance muscle.” Their “giving-in muscle” is the muscle that gets strengthened when clients plan to have one cookie, want a second, and end up having a second. Their “resistance muscle” is the one we help them strengthen. It’s the muscle they use when they’re tempted to have the second cookie but instead make a decision that’s in line with their health goals. Over the years, we realized that “giving in muscle” sounds judgmental or implies weakness—and our clients are anything but weak. Making changes to habits that have been engrained over decades is incredibly hard work. On the other side, “resistance muscle” implies that clients are denying themselves something they really want. The CBT approach to weight management isn’t about denying yourself the opportunity to eat foods that make you happy. It’s about finding ways to incorporate those foods in moderation into a balanced eating plan. Language matters! We now call these muscles clients’ “on track muscle” and “off track muscle.”
We also place much less emphasis on the number on the scale and instead focus mostly on implementing healthy daily habits and actions. We help clients implement changes that can have an immediate positive impact on their overall health and wellness regardless of their current weight. Although seeing the number on the scale go down is a major goal for most of our clients, we focus primarily on the process of getting there, not on the number itself.
While we focus far less on the scale, we focus far more on helping our clients recognize and gather evidence of what actually makes them feel good, and what does not. Frequently, what our clients think will make them feel good actually doesn’t (like treating themselves to a big meal after a bad day) and what they think won’t make them feel good actually does (like having a healthy dinner and feeling in control and not overstuffed). We call this the “belief-reality disconnect.” The more evidence our clients gather of what makes them feel good, and what doesn’t, the easier it becomes for them to consistently act in line with their goals. Over time, they stop buying into the unhelpful belief and start living in reality.
Do you need help achieving your personal health goals, improving your diet, losing weight, or beginning and sticking to an exercise program? Our Wellness Coaching program can help you with this and much more! Not only do we offer one-on-one coaching like what Lucy described, we also offer live and recorded workshops and webinars, group coaching, and online resources to help support your wellness journey. Learn more and get started today!