Tag Archives: Cognitive behavioral Therapy

A Change Anything Activity

12 Aug

here is an activity I was asked to do that I hope will help me get over the problems of snacking at night.  It is my biggest biggest danger area by FAR.

Take a minute and write down all the behaviors you do during this crucial moment that you know you shouldn’t

  • I eat sweet or salty snacks available in the house.
  • I go out and purchase sweet or salty snacks if they are not available in the house.
  • I ask family members to go out and purchase snacks for me.
  • I take the snacks upstairs to bed and play on the computer while I eat them.
  • Sometimes i don’t keep perfect track of how much of it I have eaten.

– Then next to each one, jot down why they make you feel good (or why you do them)

I eat sweet or salty snacks available in the house.

I am honestly not sure why I want to eat the snacks. I’m rarely hungry. It satisfies my sweet (or salty) tooth.  It calms me down and relaxes me.  It gives me something to do.

I go out and purchase sweet or salty snacks if they are not available in the house.

I like planning and purchasing snacks. It gives me something to do.

I ask family members to go out and purchase snacks for me.

I like it if I don’t have to go out and buy them, I can just sit and watch TV or play on the computer until they come back.  Sometimes my husband likes to get his snacks too and then we eat together.

I take the snacks upstairs to bed and play on the computer while I eat them.

Its sort of like a slumber party.  I do something I like and eat the snacks.  Sometimes my husband eats his snacks too and we watch TV together.

Successful changers find alternate activities that also make them feel good, but are more healthy such as “going for a 15 minute walk” instead of “watching TV.”

– For the last step, brainstorm a list of things that might be better alternatives. Then tonight, when you are tempted to do an unhealthy normal behavior, try a new one.

I could eat a healthier snack.

I could knit or crochet to keep myself busy.

I could go on a walk, but often its hard with all the kids to get away, and right now its really hot outside still at night.

I could blog or get on twitter and talk about it and get support.

I could read a book that will encourage me to do something different.

I could do an activity with one of my kids.

I could get something done around the house (cleaning, prep)

 

So, I have not actually DONE this yet, tried alternate behaviors.  I have in the past, but have again fallen into the trap of this behavior.  It is like a bone-deep, soul deep behavior that I don’t understand. I like to eat snacks at night.  I don’t like to do some of the things other people might say, like take a bath (not a fan) and its like there are all sorts of behaviors and barriers are all tied up in this situation.  I’m probably making it more difficult than it really is.  Maybe I need to just try it and see.  Its like I just get this “itch” about an hour or two after dinner to get my snack on.  And my mind won’t let it go until I scratch the itch, either with eating or with shopping, my two go-to behaviors.

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An open letter to Judith Beck :( #wls #CBT @beckdietsolution

16 Apr

Some of you may have seen this Huffington blog post from Judith Beck to Carnie Wilson about her repeat gastric band surgery.

I am really bummed out by this, as I have been a huge huge supporter of Beck Diet Solution and my copy of  the book is always close by and very dogeared. I have even paid for a coaching session with beck institute, and seen great value.

But, this open letter is  just….wow.

In the theory of CBT, how would you have Carnie reframe her reaction to this column?  Ouch. This would be enough to make me pissed off, defiant and trigger all my bad habits.  I don’t get the logic about this at all, unless it was just to sell books, in which case, not only am I disappointed, I think that it probably backfired.  The response by the weight loss surgery community has been swift.  The problem is, Dr. Beck, your work IS the foundation of what we all need to do to change the mental part of our struggle with food.  Your work is so good, and now this post totally drags you down and will make people question your credibility.

I’m not saying that most of your points aren’t correct–of course they are.  I think a large majority of people who have WLS have food issues; I certainly do.  And our surgeons encourage us to work the psychological part of this program — its a requirement to even get the surgery.  Its how, ultimately, I found your book, upon recommendation.

What I am now left feeling like, is that the person who’s work has inspired me the most, may think that those of us who have weight loss surgery are copping out.  Maybe its only those of us who have had it twice? But now I would have to suspect that any WLS is seen as a copout.  Its just not true — the medical statistics speak to the fact that the likelihood of morbidly obese people being able to lose the weight and keep it off is less than 5%–and its not just the mental aspect.  There are mechanisms in our bodies that are simply “broke” when we are that overweight.  Our bodies physically and mentally fight against us to lose weight the “right” way.

I am not saying that I don’t question Carnie’s choices too….but the reality is, I get it.  I get her, I get the struggle.  I don’t like her trying to use it to make a career comeback.  I do think it takes a lot of courage to admit you’ve failed and have to try again.  I don’t understand how any doctor could suggest that getting a lap band again would be a good choice for her.  It didn’t work the first time, and definitely is not the surgery with the best track record out of the 4 primary WLS types.  But I do think a revision is appropriate, just not to repeat the band.  So why choose it again?  Why not pick a more permanent WLS?  Why take the way that didn’t work last time?  I don’t get that.  I’m not trying to dis the band, but the statistics seem to support a lower level of success with band than other procedures.

Anyway, so Dr. Beck, while I guess, as Carnie is a public figure and has made her weight loss issues public, its fair to talk about it, but wouldn’t a call or direct private reach out with an offer to share your considerable knowledge and approach have been more humane?  Imagine the long term payoff if your method could have been the reason carnie really kept it off this time? Now THAT would sell books.

Because I already know that the approach is best, I won’t be abandoning the principles of CBT for sustained weight loss but I am sad that this appears to be a judgement against weight loss surgery and I am sad that the WLS community will probably not dive into this important book because of this issue.

In one of the primary aspects of the beck diet solution, you’re supposed to give yourself credit for the good choices. Let’s find something to give Carnie Wilson credit for….

~11 weeks post ops and my first vomit

6 Mar

I really CANNOT believe I am posting about vomit, but this is the lengths I will go to in order to enlighten you, dear reader, into the life of being a post-op WLSer.  I have not had the “luck” of having a single episode of vomiting or nausea since surgery, but I learned tonight what happens if I push my sleeve too far.  yeah, well, I learned definitively that I cannot push my sleeve, because it will push right back.

We went out to dinner to a Japanese restaurant, and chose a Hibachi table for hubs, me and our two littlest, knowing they would enjoy the “show” of the hibachi cooking and knowing that since its basically pure protein and veggies, its the perfect WLS choice.  We split a dinner for two among the 4 of us, that included filet mignon, chicken, salmon, shrimp and scallops.  Even with 4 of us, it was a huge amount and we took a very large box full home.  I had 5 shrimp, 3 small cubes of filet mignon, and 3 scallops, and a few assorted pieces of veggies — zucchini, broccoli, mushrooms.  Ate everything slow and chewed well. Then the kids and hubs wanted to have dessert, so we ordered a fried banana and japanese fried ice cream. It did me in.  I ate a small portion and started to feel bad, crampy, like I needed to stand up or stretch out. I could feel stuff in my esophogus, I presume.

Paid for dinner, went out and got in the van, and was beyond thrilled that my overly puky/allergic 2 year old has caused me to store a supply of medical emesis ring/bag things in my glove box, because dessert came right back out.  ugh, and double ugh.  I now know why they call it “the slimes”.   Anyway, won’t do that again.  Shudder.

I am laying in bed, stretched out, typing this out while its still fresh.  What was curious is that I didn’t get my usual “tell” after the meat, which is hiccuping.  Usually as son as I am full, I get the hiccups, which is my clue to cut it out.  This time, I didn’t get the hiccups until after dessert, as we were walking out.

So my question to you — do you have a “tell” when you are full?  hiccups or sneezing?  Loved this episode of Bariatric TV that explains the hiccups and sneezing.

Now, back to the regularly scheduled update (well, painfully late update).  As time passes, everything settles into a new normal.  I’m about 11 weeks post op now, and I’ve lost close to 70 lbs.  I have about 60 lbs more to go. Its cool being on the “downhill” side, but there is still a loooong way to go.

In my accountability group via Tracy at mytinytank.net,(if you want to join the next accountability, group, which begins on 3/12, please contact Tracy via her website–I highly recommend it!)   I spent six weeks with a couple of great WLSers focused on my goal of getting more consistently active.  My goal was to be consistently averaging 6500 steps at least five days a week, tracking using my fitbit, by March 5th.  And I did it!  I have gradually moved into a place where exercise is now feeling more like part of my routine.  I have been able to do this at least once before, so part of me is still scared I’ll fall off the wagon, so its likely in the next six week curcuit for accountability I’ll still be focusing on exercise consistency and increase in some fashion again. Actually, by the last couple of weeks, I’ve been closer to 7-8k steps, which is still less than the 10k a day gold standard, but for someone who used to walk less than 2k a day most days, this is pretty good!

What benefits have i seen?  Definitely have more cardio endurance.  I’ve gone to zumba a few times in the last month, and enjoyed it, and could actually make it an hour each time without dying.  Sometimes I had to slow down and just march/move in place while sucking down water, but I always restarted again and got back to it.  I’ve traveled and been able to cruise through the airport without getting all sweaty and gross, and even decide to walk extra to get more steps in.  Crazy!

Overall I just feel better and like i have more pep in my step.  Some days, its hard to get myself going, but I always (always) feel better after I’ve done it.  I’ve made a habit of scheduling it into my day during weekdays, and planning for generally to be going to the YMCA and working out before i have to be there anyway to pick up my little ones who attend daycare at the Y, so its a good reason to combine the two.  That behavior is called “anchoring” in the behavior change world, I’d say, basically attaching a new behavior you want to do to something you already do regularly and have to do, so that it is easier to make the new behavior a habit.  i used to try to do things like try to get up early and exercise, and for me, that is complete and utter bullshit.  I hate the morning with a passion, and that just makes it worse.

So I do the opposite of what most people do, I go at the end of the work day, and its working out pretty good.  However, on the other hand, if I got in my exercise early in the day, I could get my step count even higher through the course of the day.  (because i would shoot to get 6-7k in via planned exercise, and then my normal steps would add on….as it is, I arrive at the Y at end of day, and tend to quit when I get to 6-7k, rather than do a planned 6-7k.

Anyway, change is happening.  You can see it in my face, which now sports a pointy chin with a cleft in it (who knew?).  I still hate what has happened to my nose, which I swear I attribute to CPAP.  my nose is way bigger than it used to be.  So rude. I used to have a cute nose.  Oh well.  i’m excited to have bought a top that was simply an “XL” and I fit into the first pair of Levis I have worn since I was a freshman in college.  So that is pretty crazy.  Granted, i think they make levis in larger sizes than they did when i was in college 🙂 🙂  So its not like I’m down THAT small yet.  Some day!!

6 week post op, Groundhog day, awash in behavior change options

2 Feb

Well, yesterday I was officially six weeks post-op. I am really surprised how fast the time went. The time sure CRAWLED to get to the surgery date and through the liquids phases of the post-op diet. At this point, I basically feel like me again. I don’t have any tenderness in my tummy, my energy level is pretty much back to normal, and I am allowed to have a full range of diet options. What does all that mean? It means I feel like I am teetering on the edge of my own personal possibility of groundhog day, of either spring coming early, or an interminable stretch of time ahead of me where I continue to battle darkness, personal choices and challenges. I want spring to come early for myself, and with it the possibility of change, new behaviors and new hope. I want spring to come and bring me new confidence, increased self-esteem and higher belief in myself that I can change my behaviors, tiny steps at at time, to develop a new normal.

This surgery is sooo not about the physical and mechanical aspects of all of this. I keep thinking of other analogies in life and none of them quite work but have parts that resonate. At first I thought, its like declaring bankruptcy. But that is long before I realized the truth of the matter about weight loss surgery, about how the day of surgery is really just the beginning of hard work. Up until the last while, I realized that even a part of me felt I was taking “the easy way” out. But this is not the easy way out. Just because my stomach is smaller doesn’t change my personality, my habits, my behaviors. It is easier to stick to the post-op diet in the early phases, ironically. Honest to god, I do think its like the “rehab” equivalent for a drug or alcohol addict. The radical change in behavior, supervised medically, to ensure you don’t hurt yourself and have a chance at a do over. You don’t feel like yourself, you feel very “medical”, you fear complications if you choose the wrong behavior. But I can see that as the medicalness fades, and the risk of complications decreases over time, its just me out there. Me and the things I choose to do next to make my life different than it was before.

I started with a therapist locally last week, and I was given two homework assignments. “Stay in Today” and think about what triggers me to eat. The first assignment is better for me right now, because I can do that. I know that I have the tendency to spend my life thinking about everything but the day in front of me, and making today the best day I can make it. Imagine what the world would be like if you lived each day just focused on today? Trying to do what I can, just in the day, to make it good. After many of those days, the past starts to become easier to look back on, and the future starts to potentially become something less to worry about, if you’re taking care of each day, one at a time. I know this cognitively, but it is hard to change the behavior of daydreaming about tomorrow, in particular. When I pay off this bill I can….when I get my tax refund I can….when I weigh 199 I will….when I am a size 14 I will….What a shame that I have been living my life in suspended animation, always holding off the good stuff for later. What is going to be good about today? What is going to be good about today for you? Think about that. Because that is at the core of this thing, I think.

The thinking about what triggers me to eat is much harder, particularly because I’m post-op and everything just feels kind of different right now, if that makes any sense. I think because i have gone through my six week rehab, whatever triggers there are aren’t working the same way on me, so its hard to pinpoint what they are. I did identify the ones about travel back in October or whenever that was, for sure. So that was good, but in day to day life, I’m not necessarily seeing it. I know that at the end of a work day, I can feel pretty mentally wiped out and lazy, and that its easy just to succumb to going out. That is still true, and we eat out a lot, even now, post-op, but I am able to make good choices still when I am out. It is easier now that I have a wider choice on the menu. When i was in liquids or softs, I felt pretty pissy about eating only what I could eat. Now I feel pretty happy that I can eat a good portion of protein and try some tastes of other things. My worry is, its a slippery slope? Do I valiantly NOT have any tastes of other things, to avoid sliding down the slope, or is it better to have the tastes and get some joy out of it, so that I don’t take a nosedive off the top of the slope at some point? My guess is, that answer is different for everyone, and we have to find that truth within ourselves. Shit, I hate that answer. 🙂

Another thing we talked about was fear being at the base of a lot of behaviors like addictions (and i consider that I have a food addiction) And she mentioned that for a lot of people with issues with food and money, that fear of lack is at the core of it. I haven’t been magically been able to put my finger on the reasons I am the way I am. Its like an elephant in the room that I truly can’t see. I know certain truths about my past that I can logically see have probably influenced my life, but I haven’t had that big “a-ha” moment that I feel like I should have.

I am working so hard right now on amassing my knowledge around behavior change. I am a researcher my nature, I love to know about stuff, and why it works. So that is pretty time consuming. I can’t blindly follow one methodology either, so I am in the midst of learning about several, including The Beck Diet Solution, Change Anything, and Tiny Habits. Honestly they all support each other, and have different steps to approaching the same thing, which is behavior change. I like comparing them and taking different ideas from them, but at the moment I’m feeling a little overwhelmed by it all. I wish God would just knock on my head and say, “here, this is the way, you’re making this way too complicated.” But honestly, I feel that I have to practice some critical new skills that come out of these methods to get to the other side and see it get easier. One of the things I liked hearing about in Change Anything is this idea of “being a scientist” — to try different approaches and after you try them, look at them to see why they worked or did not work. This is something that honestly happens in my work life all the time, so why this should be so novel to me in my personal life is kind of ridiculous, but I like the idea of framing that way. Because again, it takes out the “that was a failure, therefore, I am a failure.” thought process. It makes all of this an experiment to see what works and what doesn’t, and then a matter of assembling those things that work and figuring out how to hang them together to make a total program of change.

I have joined an accountability group for six weeks with Tracy from mytinytank.net and some other lovely ladies that hopefully will join us as we go along. The idea is to commit to a single thing we want to make a change around and be accountable to each other to report our progress, our successes and our challenges. We have a once a week brief call to report on this, and are free to reach out to the other members durign the week to ask for support at crucial moments or victories. I like this! I think two elements I’ve avoided in past attempts to change behavior is social support and exercise. So therefore, these are two areas I am focusing on the most right now to help with setting in new habits.

Phew. That was soapboxy. Thanks for reading.

4 weeks post op, travel next week, another book review

21 Jan

Well, I can’t believe I’m already 4 weeks post op.  I have 4 more days of softs and then I get to move onto regular bariatric diet.  Which is just in time, because it is looking like I will be traveling for a quick trip for work leaving on Wednesday to go to Franklin, TN. Not sure yet though.  I am kind of looking forward to it happening, not for the stressful situation that I will head into down in Franklin, but rather to see the seatbelt fit (I hope) without an extender.  I have to think with the pounds and inches I’ve measured away that I should be a bit more comfortable in an airplane seat now.  That’s cool to think about.  My incisions all look good, the one that was problematic still has a large scab that isn’t letting go, but no further issues from it.  This was my first almost full week back at work, monday was a holiday.  I have the flexibility to work from whereever, but on Tuesday I actually went in to my local office and tried to get back in the work mindset.  The last time I was in the office was pre-op, and I found it interesting that I felt like I could walk a lot faster than I used to–at lunch I walked all around the inside hallways (its a very large office) and felt energized afterwards.  Weird!

I am finding myself falling into a habit with breakfast being a premier protein drink.  I hope that is ok.  I’m not much of a breakfast person, I know its important though.  It seems like the premier protein gives me a really good start with 30 g of protein and a lot of other vitamins and minerals.  Is it really terrible if I continue to do this long term?

I also worried myself with a meal that I feel I was able to eat way too much.  I took a 5 oz can of canned chicken breast, a T of light mayo and pureed it in the bullet, and also had about 2 oz of cottage cheese.  I was able to eat ALL of this.  Folks on VST seemed to think that since it was pureed (and it was quite liquidy) that even though it was chicken it might not have been that far off of liquid so was able to pass through rapidly.  I hope so.  This evening though seemed better, we went out to a chinese buffet (what a waste of money for me, but everyone else wanted it) and I had about 2 oz of really soft cooked honey chicken, 2 oz of cottage cheese and half a hard boiled egg.

I really am able to drink very well and don’t have issues with eating anything. Nothign has upset my sleeve so far.   I do feel when I start to get full, and that is wild to me.  Preop I would have had to have the mother of all binges to feel anything close to physically full.

last week I was doing a good job of getting my steps in and this week I’ve just sucked it, other than that one day I was in the office.  Exercise really is a mental block for me.  I can give myself every excuse in the world for not doing it.

As many people seem to experience, I hit the three week stall right on time, with the scale not moving (except for up, as  the days went on without poop…LOL) this week.  It did gradually at least get back to where I was, but I am hoping now that the movement will continue on down.

The book I started this week is Beck Diet Solution, which I think is finally the nirvana I was looking for in terms of an eating focused cognitive behavioral approach.  Its a six week plan compatible with any eating plan to retrain the way we approach, think and feel about food, and hopefully then impact our actions related to food.  It has a nice format in breaking down each day into something to do to take a step forward.

The first day had me writing an “Advantage Response Card” — a card to remind me of all the advantages of losing weight.  I’m not much for paper any more, so I am using the flashcardlet app on my phone instead.  I am also supposed to write it down in one other place, so that will be here.  I used a lot of what I wrote down pre-op but here are the things I am looking forward to (and one or two already there)

1. I can fit in an airplane seat comfortably without an extender.

2. I won’t feel like I need to use the big stall in the restroom to feel like I have enough room.

3. It will be easier to be clean, shower, shave and etc.

4. I will hurt less during and after being active.

5. I might be able to try new activities or sports.

6. I will be able to enjoy amusement park rides more again (an old favorite)

7. I will fit in restaurant booths easily.

8. Maybe I can ditch the CPAP.

9. My diabetes will improve or resolve.

10. I can tie my shoes easily.

11. I can easily paint my toenails.

12. I will have energy to play with my kids.

13. I can buy pretty clothes and even <gasp> lingerie.

14. My wedding rings fit (already!)

15. I can kneel at church without leaning back.

16. My bed and furniture won’t sag permanently where I sit and lay.

QOTW=Cognitive Behavioral Therapy for Weight Issues; Study on Sleeve shows it comparable to RNY

26 Sep

Well, first off, my research and topic exploration of the week for me is the use and role of Cognitive Behavioral Therapy to assist in changing behavior around eating and exercise to help in achieving a normal weight.  I’m very familiar with the concepts of Cognitive Behavioral Therapy, due to some of my past projects at a past employer.  I have the intellectual concepts down pretty cold.  However, I have a hard time putting it into practice.  I’ll be looking at this week how therapists might be working with wls patients using cognitive behavioral therapy to learn new ways to respond to the typical negative tapes and stressors that come up in our lives, and seeing if there are any cool tools for CBT for weight loss out there.  To the crickets out there reading this, if you have great suggestions for resources, I’m all ears and will include your suggestions in my summary post at the end of the week.

For now, if you want to play along at home….*

Think of a typical situation that might make you feel bad about your weight loss efforts.  Take a moment to write out that situation right now. What happened to make you feel badly? What was your reaction?  What did you do?  How did it affect your weight loss progress?

Now, ask yourself whether your thoughts about the situation were completely true and accurate.  how else might you think about/frame what happened?

Finally, rescript the situation.  What could you have told yourself that would have been more supportive and accurate, when the bad situation occurred?  Try it now, how does this new response make you feel about your weight loss progress?

Ok, now a quick poll regarding head hunger and how you approach it.

Okay, topic #2.  I am very interested in this study that WLSHelp has on their site about a 3 year study comparing vertical sleeve gastrectomy with roux-n-y bypass.  I have been flopping back and forth on which procedure to choose, and have been lacking the evidence-based data my mind desires to spell out some of the outcomes.  What is still missing is long term outcomes.  As in, does something creepy happen 10 years out to sleeve patients that no one expected? How long have sleeves been done in other countries, and what are the outcomes there?  This is the knowledge my brain seeks.  Ultimately, I think I would like the sleeve first, in the hopes that I can reprogram myself in portion size and feelings about eating effectively, but still occasionally be able to have a tiny portion of something without worrying about dumping.  I know many feel dumping is overrated, but I think about the little things, being able to have a little tiny piece of cake at a birthday party.  I know its a slippery slope though, so that is where I wrestle.  Do i need the RNY to keep me honest?  Surgeon said I could always revise to RNY later, but I’d just as soon only have to do this once.  And I would like my life after the initial weight loss to have the opportunity to be normal relative to other normal people.  I also think the appeal of losing all the grehlin production is awesome to me. if it would long term eliminate hunger signals, how awesome is that?

* I am not a doctor nor do I play one on twitter.  Check with your therapist for the best interpretation of CBT.

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