REBT techniques/coping with urges
 

I've found that many techniques from REBT (Rational Emotive Behavior Therapy) have been useful to me in keeping to a healthy food and exercise plan as well as making me a happier person overall.

The main REBT technique that has helped me is identifying and disputing irrational beliefs that make me very unhappy and result in behaviors I don't like. It uses an A-B-C framework. A=activating event, B=belief, C=consequence.

We usually think of events (A) causing results (C):

A: I'm at a cafe, see some delicious fresh-made pastry, and get an overwhelming craving for some with my coffee even though I've had plenty to eat and am not hungry.
C: I give in and get the pastry and eat it.

But did A really cause C? REBT says no, there is a B, an irrational belief that caused me not to do what I know I should and would prefer to do (not order the pastry). REBT encourages you to dig deep and figure out why. In my case there might be several irrational beliefs:

B1: I will feel terrible and awful if I don't eat the pastry and I won't be able to stand it!
B2: It's SO UNFAIR that I can't eat what I want when I want it and I can't stand it! Life SHOULDN'T be unfair!
B3: I SHOULDN'T crave food every time I see it! I'm a weak, pathetic person.

The next step of REBT is D="disupting". I then actively dispute the beliefs.

D1: Is it really true I wouldn't be able to stand it? Will I actually die if I don't have the pastry? Would I have even felt the urge if the coffeehouse had been out of pastry that day? Haven't I gone without food before and survived? I have zero evidence that "I couldn't stand it" (I'm still alive!), and lots of evidence that, yes, I CAN stand it. It might not be pleasant, but it's not terrible, horrible, and awful!
D2: Who am I to dictate how life should be, am I god? Don't I have lots of advantages that other people don't have? Is that fair?
D3: I am who I am. I can't be other than I am right now and the workings of the brain are poorly understood. Just because I get a desire for something doesn't make me weak or pathetic, it just makes me human.

If one is successful at finding the irrational belief that is really driving one's actions (and sometimes it's not obvious and takes several rounds of doing this technique) and successful in disputing the irrational belief and getting myself to see this, it gets replaced with a new E: effective belief.

Perhaps:

E: It's unpleasant to have to experience unsatisfied desires for the pastry and give up the short term pleasure, but it's not terrible, horrible, and awful and I CAN stand it. It would be nice not to be subject to such urges, but sometimes life isn't nice and I just have to deal with it. I'd also prefer that life was fairer, that I could eat whatever I want, or that I didn't get strong urges, but again, it's not terrible, horrible or awful, and I CAN stand it. That I get urges for such things doesn't say anything about my character, that would be silly.

By replacing the strong irrational beliefs which "awfulize" the urge with a gentler one that recognizes the reality of the urge and merely expresses my preference that things be otherwise, C need not happen even though the urge did. I wrote C above as "give in and eat the pastry", but it could also be "I don't order the pastry and get angry and upset", which is also not a good outcome. Disputing irrational beliefs also helps diffuse that "angry and upset" result in the cases where I am successful in not ordering unhealthy food for me. So the new outcome becomes "I don't order the pastry, and feel some disappointment at not getting to fulfill the urge, but don't feel angry and upset about it".


The ABC technique is the cornerstone of REBT, but there are many other coping with urges tools, including many for preventing them. And there is a site that has collected many of the tools together and worksheets for addressing them:

http://www.smartrecovery.org/resources/toolchest.htm

These were pulled together by SMART Recovery which is an alternative/adjunct to AA and mostly focused on helping people overcome substance and alcohol abuse, but is helpful for any chronic problem behavior.

One of the best books on REBT generally is by the psychologist who formalized the theory and is _A Guide To Rational Living_:
http://www.amazon.com/Guide-Rational.../dp/0879800429

atalanta,

It sounds a lot like cognitive behavioral therapy, which I find quite helpful. Do you know enough about them to compare? I'd be interested in your thoughts.

Anne

Anne -- atalanta may know more, but I do know that REBT was created by Albert Ellis in the 50s and was one of the early forms of cognitive behavior therapy.

I can really see how something like that would help me. In fact, when I'm "on my game" I think I do this ... just more informally and more haphazardly. :)

It's really an interesting approach! And so useful to get to those "B" statements that are operating behind the scenes and see them for what they are.

Jay

Atalanta, wow, thanks for sharing this. I've actually done this a few times haphazardly as well, wyllenn. But I think it is helpful that this mental process is "formalized" into a more logical situation because I tend to take a more emotional approach towards eating. Transforming my eating approach from emotional to cognitive could be extremely beneficial!!! I am going to try and use this when those urges come along. Thanks again :)

Yup, Wyllenn has it exactly -- REBT is one branch of cognitive behavior therapy. Albert Ellis passed away last month. He was a prolific writer, mostly saying the same thing over and over (another of his books is : How to Absolutely Refuse to Make Yourself Miserable About Anything, Yes, Anything -- but note that some people find his style to be very annoying. Another good book on the subject is Michael Edelstein's "Three Minute Therapy" which is arguably better written). But it really does help to see lots and lots of examples: it's motivating and it helps one to better figure out what the irrational beliefs are. And it's a bit comforting to know we all deal with them.

And also I think that a lot of it is just formalized common sense. However, I personally find the framework very helpful.

I definitely need to keep that method in mind, I'm sure it can be really helpful. So far, all I've been doing was to ask myself "why" questions (such as, "why do I want that pastry? What will it bring me?", etc), but it's nothing really structured. I guess I'll try that next time I get such a craving.

atalanta -- Did you stumble on REBT, or have someone recommend it specifically for weight loss? (or was it something else?)

And I so agree its' helpful to see how we all deal with the same kinds of issues! That's why I love this place so much!!

About 8 years ago I went to a vegetarian potluck that had a speaker, Michael Edelstein. He gave a quick summary of REBT, the ABC technique and suggested that irrational beliefs generally fall into 3 categories: believing that we should be other than we are, believing that others should be other than they are, or that life should be other than it is. And that making these things be AWFUL rather than preferences can make us miserable.

I thought about the things in life that made me miserable and sure enough ... I was unhappy because so-and-so shouldn't act the way they did, or because I thought I should be more perfect, etc. I was intrigued, read his book and then lots of Ellis. Using the techniques really made a positive difference in my life. It wasn't until 3 years after that that I successfully applied it to weight loss.

Interesting, I haven't yet found a good book with a strong focus on REBT/cognitive techniques wrt to weight loss. Ellis had one decades ago, but I didn't think it was very good. I had high hopes for the "Beck Diet Solution", which promised to be a cognitive behavior therapy (CBT) approach, but that too was a disappointment.

One of the things I really like about REBT and cognitive techniques is that they recognize our individuality -- encouraging you to work on the specific behaviors you decide you want to change, to find your own specific irrational beliefs and to find your own, specific new effective rational beliefs. There is a lot of focus on you figuring out things for yourself and designing your specific plan of action.

The Beck book was a disappointment because it didn't do this. It seemed to assume that the challenges the author faced were the ones you do and to repeatedly asserted that it was important you do ALL the things she said (despite some token words in the other direction about not viewing things as all-or-nothing). I'm sorry Dr. Beck, one of your challenges may have been eating while standing but that isn't something that is a contributor to my overeating. And while I do need to journal my food, I don't need to do it a day in advance. And no, I'm not in denial about this. It was also annoying the number of times it refered to itself, continually asserting that you were on the "Beck Diet". To me this the antithesis of self-driven, self-designed cognitive behavior change. Give me the tools, give me examples, and I'll fly on my own, you don't need to chart the flight path.

Oops, that got a little ranty. There are some good things in the book. I guess my strong disappointment comes partly from wishing that one of the few CBT-centered weight loss books were better.

I think it's a great technique to incorporate into ones life. And I'm definitely going to try it myself.

I've actually started reading the Beck Diet Solution. I'm not up to the journaling portion and at this stage of my game, I don't think I'll need to follow it. But I had heard about it and was curious. I'm only about 50 pages in, from what I can see it does teach some useful tools. Perhaps a bit watered down though from REBT.

atalanta -- Thanks for the background and the info. You know... there could be a market for a book yourself! You seem to have the writing skills for it!

Hmmm, it seems like I was reading a CBT-based weight loss book, when I became pregnant last time and subsequently put it away. Lemme go look...

Here it is: The Rules of "Normal" Eating by Karen Koenig. I didn't get far enough in it to see if it was helpful. I'll pick it up and try again, well, just as soon as I finish the latest vampire murder mystery I'm reading. It looked like CBT, talking about irrational beliefs, with the though/response column format, with some ideas about what beliefs people have about food. It seemed to be one of those books where you have to actually think and find your own answers, so isn't likely to go flying off the shelves in our quick-fix world.

Anne

Taming the Feast Beast by Jack Trimpey is an REBT-based weight-loss-oriented book. I read it years ago but I don't remember if I thought it was good.

I HAVE utilized REBT successfully in the past for other things, though.

Doh! I'm not a maintainer and I keep posting in the forum! Darn these interesting topics. Sorry, I hope you guys don't mind!

Silly, Amy! Everyone is welcome here!! In fact, I think it's important everyone think about maintenance early on!!!!

Luminous - as soon as you lose 1 lb you are a maintainer. You never want to gain that 1 lb back. I know that if I had started thinking about maintenance earlier in previous weight loss attempts, I actually might have maintained :)

I actually don't like the term maintenance at all, because weight is never static. I think of myself as actively managing my weight, and prefer the term weight management, which doesn't place an artificial distinction between losing weight and maintaining.

Anne

Anne - I love it - weight management! Much nicer. Just that sometimes I manage better than others. :lol:

Pat, management is indeed a day-to-day thing! :)

Anne

Make that hour to hour. ;)

Anyone for minute to minute??? :lol:

I guess I can't argue that. :)

Minute to minute? No arguments here as well. *sigh*

Light-bulb moment. Somehow, I was always feeling like some sort of fraud, posting here when I'm not at my professed goal yet... but drats, you're right! I'm already doing my best to envision what I do like a lifestyle and not a diet, so why not worry about maintenance NOW rather than wait until the end and then find myself clueless.? It kind of contradicts my 'philosophy'! So I guess you're definitely stuck with me then, because what's for sure is that even if I were to never lose those last 10 lbs, I'd still do what it takes to maintain to where I am now. :)

I feel the same way, Kery! While I've pretty much maintained a 30 pound loss for over a year now, I'm still working on losing those last 10 pounds.

Exactly right. :) Maintenance starts on Day One of your diet/lifestyle change. That's why everyone - regardless of where they are and where they want to end up in their weight loss journey - is part of Maintainers and welcome to post here. :hug:

Losing weight is the warm-up; it's the easy part. We've all done it a hundred times, right? :lol: Keeping it off forever is the rest of the story. Every single pound we lose is precious and we want to keep it off -- forever. Who cares how long it takes to get to your goal? That's not what's important. Never, ever, ever gaining it back is the only thing that counts in the end.

While I agree strongly with the main idea here, for me, weight loss/not ever gaining back a single pound is not my goal. The goal for me is a consistent healthy lifestyle. Now, that will mean that my body will lose weight and maintain a healthier weight, but that is only a side effect and a usually good (but not perfect) metric for whether I am being honest with myself about my lifestyle.

To have a healthy lifestyle I have to consciously choose the right amounts of food day-to-day (choosing healthy kinds of food was never much of a problem for me, I really can do that part almost unconsciously, I'm very lucky in that) and exercise. When I do this, if my body is above its healthy weight it will lose weight, if it is below, it will gain, and if it is at a healthy weight it will maintain. Thus I also fall into the there is no difference between the weight loss phase and maintenance camp.

Not even caloric intake?

My maintenance looks nearly exactly like my weight loss, with the exception of more calories per day, the addition of 1 weekly treat meal and the occasional glass of red wine.

Not necessarily. Generally speaking, a heavier body requires more calories to maintain its weight and it requires more calories to do the same exercises than a lighter weight body does. (Although LBM is the primary consumer of at-rest calories, it's not the only consumer -- and hauling a 200 lb body up a hill (or even just out of bed) takes more calories than a 120lb body, whether or not those lbs are muscle or fat).

Thus, if you consume maintenance level calories and do maintenance level exercise and are above maintenance weight, you will lose weight -- although, very, very slowly if you are near maintenance weight. Because most people aren't happy with a such a slow rate of weight loss, they choose to eat less than maintenance levels and then increase calories when they hit maintenance weight. This, however, is not required (but is hard to do -- everyone's body is different and changes as we age, acquire health conditions, etc, so it's difficult to know exactly what the maintenance level is if you're not there), you could live a 'maintenance' lifestyle from day 1 and your body will eventually get there.

That said, do I sometimes choose to eat less than what maintenance is when I weigh more so that I get even faster weight loss? Yeah. I'm human. Also, since determining exact maintenance level is hard (or impossible since it is a moving target), doing so makes it take less time to get feedback on whether the calorie level is in an appropriate range.

Actually, there is one big exception: if one is very overweight, the body's calorie needs could be so high just to perform daily living tasks, that eating at maintenance level calories would be too low to be healthful without medical supervision. In that case, a slow decrease over time to maintenance level calories as one loses weight is advised.

I think I agree with that last part....although I think it is very hard for most people to do. Not just because of the speed of weight loss, but I think for most people it is almost necessary to shake things up and change things so radically to be able to make a permanent change.

I think what is hard about management is that it is such a learning process and we dont get it right every single time. If you have pounds to lose it is easier to be radical and have a margin for error. But the bigger you make the margin, the more there is a drive, either from hunger, or denial or whatever to compensate.

Not to pick on Glory here :hug: but I was reading your thing about the donut in the other thread. At a rational level we all know that a donut (and not even a whole one;)) or a slice of pizza doesnt make us failures or ruin everything, but it is so much EASIER to say "no donuts ever" then to learn to beat our demons back. Because donuts have come to REPRESENT something more than what they are.

I think that is at some level why this time around I have been almost MAKING myself eat some amount of "forbidden foods" regularly. Pizza, chocolate and ice cream to be specific. Because I want so desperately to be able to treat ALL food as just food. Some is better than others but none of it should control ME.

I, also, have no forbidden foods, but then I never really had a problem with binging to excess on any one food, so it's hard for me to relate. But such restrictions can be used as a method for dealing with cravings.

I should post a list of curbing craving strategies, but one of them absolutely is 'avoidance'. Avoiding putting yourself in situations or engaging in behaviors that contribute to making bad choices. Having rules like "no buffets", "no cookies", or "no open candy dishes" are examples of this strategy.

A related strategy is 'substitution', doing something else when the craving occurs. Eating a healthy food instead, chewing gum, shop for clothes.

These are very valid and useful strategies, however there are downsides to these two strategies.

Overuse of avoidance can impair living a life you'd like to (e.g. if you had a strict rule about eating every 2 hours and never eating out, it might limit you having a healthy-for-you social life or make you rebellious by making it difficult to come to peace with your diet choices).

Overuse of substitution, especially when the craving is emotional just reinforces the craving: you get a craving and then you reward yourself by indulging in something pleasurable (shopping instead of eating, say). You never learn to just be with the craving and feel your feelings.

When you make yourself eat some of your forbidden foods, you are actually using an advanced, and very valid, strategy for handling cravings -- teaching yourself how to live with the urge in moderation. When done well, this is very powerful -- you learn to handle problem food/situations rather than avoid them and this means you are better able to keep to your behavior change when you are confronted with situations beyond your control. The downside of this is that if done poorly, you could slide back in to bad behaviors. The key is knowing yourself and being honest with yourself.

This discussion actually reminds me of Cesar Millan, the dog whisperer. He has this thing he does when he's trying to rid a dog of a fixation or obsession: basically just making the dog lie down and stay calm in very close proximity to the object of its obsession. The dog will lie there and because it can't chase the cat/chicken/hose, it looks away and practices avoidance--the dog will just refuse even to look at the temptation. Cesar is pleased that the dog is practicing avoidance, but keeps on with the exercises until the dog moves beyond avoidance into just being able to be around cats/chickens/hoses without freaking out, ie, into calm acceptance.

I think that makes sense for long-term healthy eating goals--or at least, for MY long-term healthy eating goals. I want to be able to eat like a regular, healthy, balanced human being without any fixations. I have to be careful not to overdo it, or to eat fattening things too often, but I think donuts or pasta or whatever can be part of a balanced diet. The trick, I think, is to eat really well and really healthily most of the time. That way if I feel like going out to dinner and getting red meat or cheese, or getting a kouign aman (best pastry ever!) from my local patisserie, I can, without having to worry that my life is ruined or that I'm a failure or that, secretly, I DESERVE to be fat. I want to be a balanced eater, healthy physically and psychologically.

I have a moderate but persistant binge history. Not on a particular food but on a cascading list of foods starting with triggers.

I do still have some forbidden foods...I guess. I should say I have some foods that SHOULD be avoided absolutely. Whipped cream I have no control. But ....well whipped cream isnt that hard to avoid either. Homemade cookies are another.....welll....2 more months til the holidays. Plan B C and D for them.

But these 3 are foods that I find too painful to give up. They are the foods that avoidance can trigger a binge just as much as having them. (I want pizza and deny myself pizza and eat an entire loaf of whole grain bread with hummus and STILL want freaking pizza) I have varying success. All are best done outside the home. Pizza I have been very successful at because I go to my favorite pizza place once a week which happens to be a "by the slice" place so it is easy to get one slice. I find that inferior pizza I still binge on. Ice cream and chocolate I have at times been able to have in the house and at times I struggle. Chocolate oddly enough is less of a problem. Even a bad chocolate binge tends to be in the 2-300 calorie range and I am faced with all my little wrappers. (I only buy the individually wrapped bite size dark chocolates) Ice cream I have less failure on, but when I do fail it tends to be monumental. But I keep on battling. One demon at a time. One strategy at a time.

I dont tend to binge on the foods I truly love. Dark chocolate is savored, snickers (ick) are devoured. Good pizza is enjoyed, cheap pizza is inhaled.

I think a big part of weight management IS failure. I used to work for 3M. They had a philosophy that if you didnt fail occasionally then you werent really growing. I could sit back and deny deny deny my demons or each failure I could say "I suck" and feed my demons or I can add to my arsenal of knowledge of how to fight and how to reprogram and how to make weight management more reflexive response and less deliberate response. Failure is opportunity.

This time around (since I'm back on track and all in a general way, not only for a day or two), I don't have any 'forbidden foods', precisely for that reason. I was very worried about that at first, thinking I'd fail, but surprisingly, it works for me, and better than if I were 'on a specific plan'. I do have pizza or chocolate occasionally, knowing it's not forbidden; I just have less of it (no 1-lb pizza for j00 alone, K!), and, well, it works. I don't crave it, and I'm able to keep control, sort of. I really want to learn eating with moderation, and good relationships with food--not guilt, shame, whatever (the only moral value food has is the moral value I give it, right?). And if I lose uber-slowly, then so be it, it's not a race after all, it's a lifestyle.

'Course, it's really not easy to get into that mindset. Somehow, it looks to me like society, the media etc. 'program' us to go the all-or-nothing way. Am I paranoid?: ?:

I've found that emphasizing quality rather than quantity helps too. I buy expensive, high quality dark chocolate that I want to savor, rather than shovel down my throat. If I want ice cream, there's a bakery in town that makes the most amazing stuff in the most incredible flavors (passionfruit! bittersweet chocolate! cassis!) and the servings are perfect: one small scoop (around a half cup. Yay!). The flavors are so intense and the quality so high that I really, really enjoy my one small scoop and feel satisfied when I've finished it. If I eat something calorific I want it to be really, really worth the calories.

So I was thinking last night about the "never gain a single pound back" and is that really my goal? I am in an intentional weight loss hiatus for another month. Then I hope to lose probably 5-10 more lbs.

But I'd also like to gain some muscle so maybe less

Anyway. Right now I am 37 and marathoning. I think ~120 while marathoning (or at least distance running even if I go down to 1/2s) will be maintainable. And frankly being lighter is just easier on the body when running this much.

But what if I get to ....67... and I decide that I am DONE with this marathon/HTC crap. That my body just doesnt want to run 40 miles a week or more. You know, I may be ok with gaining back a few pounds at that point. I will always exercise, always be active. But if I get to the point where the desire for distance running is gone, then I wont be replacing that calorie burn with other exercise. While I am sure my appetite would decrease some, if it became painfully restrictive to maintain 120, I think I would be ok with maintaining 130-135 at that point in my life. Its still healthy, its still ok.

And I think I am young enough right now that 120 would look good on me, I am not sure if I think 120 would look as good at 67. Sometimes I think too thin is very aging.

Ahhh who knows... I am still playing around with my fantasy (which started before I lost weight) of being a independant (not with a gym) personal trainer/running coach for the overweight and new runners. Maybe by the time I am 67 I'll be running 40 mpw with clients!

This is my argument with WW. The high end of the goal range for someone my height (5'4" when I really try!) is 140. Losing I got to 160, and looked older than my age (I'm 62) and decided that there was nooo way I was going lower. At the time I was running probably 20+ miles a week, and doing 5K races, and weight training (still doing that, it's the running I've quit due to my knee problems) and frankly I looked good. It's where I'm aiming to get back to. I may never be a WW Lifetime member unless I get a doc's note that this is my goal weight, but it's one that works for me.

But off topic. I find that I too do much better with a good quality of whatever I'm craving, and eating it outside the home is much safer. :) Even though I ate stuff I seldom eat at the State Fair earlier this week, it was good quality stuff, and not the fried dough stuff or supersweet stuff (though mostly I don't even crave that). It was "real" food - crab cakes, scallops, and a "to die for" homemade tamale with homemade rice and beans. :)

I can see how that is frustrating, although I also think this is is reasonable compromise for WW. You should be seeing your doctor from time to time, every few years, say. Just ask for a note next time you go.

The WW range is based on standard BMI range, which does have its flaws, but is likely appropriate for about 90% of people. I do think they made the right decision to not allow folks to attend if they are below the lower range without a doctor's note so as to avoid supporting eating disorders. Since they offer free attendance when you make lifetime, having the upper end be too high will allow people to game the system (lose 10 pounds, set it as goal and then attend free for the support to lose the other 100 lbs). That would make it hard to be able to pay their staff researchers, nutritionists, web designers, and rent at building locations. Since a Dr's note is easy to get, I think this is a reasonable trade-off.

As a cancer survivor I would hope that everyone is getting a pap smear once a year - even after menopause or a hysterectomy - and a physical breast exam every year - unless you are of age in your state/province to get a mammogram. Early detection is crutial.

Not to forget EZ or any other man, I believe a prostate check is just as important.

Take the time - don't worry about the embarassment - it could save your life. ;)

I have to say, I've just gotten health insurance for the first time in two years and I am unreasonably excited about going to the doctor and getting a pap smear and a general check up. Hooray health insurance! It's been more than 3 years since I had a pap smear and I want to know that everything is aok. I had conjunctivitis last year and after trying all the over-the-counter options to no avail, I finally had to go to the college health center and beg for samples from the kind nurses. They gave them to me, but really, it shouldn't have to come to that.

(Tangent: right before my last insurance ended I went to the gyno for all the tests because I knew it would be a while before I had insurance again. I submitted to the exam, she took all the swabs, etc, etc. A few days later, literally minutes before we climb into our moving truck to drive 3000 miles to our new home, the doctor's office calls me to tell me that they've buggered up my sample and can't do the tests on it and could I please come in to have another exam. I couldn't, of course, so its been ages and ages since I was given a clean bill of health.....Grrrr!)