Presentation Packet to be handed in on day of presentation

Checklist:
1._____Lesson Plan (with learning objectives, methods and role play description)
2._____Strategies Handout for class
3._____PowerPoint presentation
4._____Presentation Milestone Check Record
5._____Grading Sheet below

Shannon Boguth
Cheyenne Tate
Mariah Tabar

HNF 471 Counseling and Education Skills Project Lesson Plan

Obesity and the Cognitive Behavioral Theory

Strategies: Cognitive Restructuring, Relapse Prevention, Stimulus Control

1. Target audience: HNF 471 Students

2. Group size: ~20+ people
3. Performance objectives:
a. Participants will be able to explain what negative self- talk is to a partner.
b. Participants will be able to demonstrate their knowledge of stimulus control by
identifying negative and positive cues with 80% accuracy.
c. Participants will be able to design a relapse prevention plan when provided a
high-risk scenario.
4. Time allotted: 25 minutes
5. Pre-assessment: Students will take a quiz prior to instruction to assess where they are
in their understanding of the cognitive behavioral theory and the assigned strategies.
The quiz will consist of four questions, one for the theory and one about each strategy.
6. Content and sequence:
a. Pre-assessment conducted on class to determine their understanding of the
theory and assigned strategies
b. Strategies handout provided to the audience regarding important information
about the topic
c. Overview of the cognitive behavioral theory
d. Overview of key points about cognitive restructuring
e. Overview of key points about stimulus control
f. Overview of key points about relapse prevention
g. Role play conducted in the setting of a consultation with the patient.
i. Role play addresses cognitive behavioral theory
ii. Role play addresses a situation in which cognitive restructuring arises
iii. Role play addresses a situation in which stimulus control arises
iv. Role play addresses a situation in which relapse prevention arises
h. Studies provided to confirm information portrayed to the class
 i. Students participate in quiz to determine their understanding of the theory and
assigned strategies following instruction
j. Questions from the audience taken
7. Learning activities:
a. Pre and post quiz
b. Interpretation of the theory and assigned strategies in the role play
c. Display of important information in PowerPoint
8. Teaching methods:
a. PowerPoint that displays messages to students we want to convey
b. Handout that provides important information regarding the topic
c. Role play that demonstrates how to apply this theory and assigned strategies in
the patient setting
9. Materials:
a. Handout that provides important information regarding the topic
b. PowerPoint displaying information to students
c. Potential props to aid in role play
10. Evaluation:
a. Quiz on students to determine their understanding of the theory and assigned
strategies following instruction
11. Role play script:
Dietitian: So what brings you in today?
TS: Well, since as far back as I can remember I have been fighting to keep my weight
down. Back in high school school were the dream days..I was 120 pounds! Right now
though I just have been feeling tired all the time and just have no motivation to do
anything after work. I saw this pill on the internet that can help you lose weight and I was
curious if Im qualified for gastric bypass? I really want to get this weight off.

Narrator: This represents the concept of negative self talk. TS sees herself and her
weight (body) as opposing forces. She also associates lower weight with happiness
(high school described as dream days solely based on weight). She also is showing a
clear lack of belief in her self-efficacy by initially jumping to pharmacological and surgical
methods of weight reduction. This does not show a strong desire to change her overall
health, but instead just her appearance.

Dietitian: Im confident that after I figure out a bit more about you, I can help you realize
you have the power to get to a healthy weight and feel better! So, can you tell me about
your typical eating routine?
TS: I usually wake up, grab a quick breakfast sandwich and go to work. Most of my
eating occurs when I finally get off work. I just grab whatever I see first, I usually have
some chips in the pantry and will have those as I cook my meals. Then I just get to
unwind and watch some TV. I always enjoy my favorite show with a big bowl of buttery
popcorn and a pepsi! Oh yeah, and then cake before bed of course.
Dietitian: Great, do you think that maybe instead of having chips around, if instead you
had some fresh grapes on the counter you would snack on those instead while cooking
your meals?
TS: Actually, yeah I mean I do like chips but I definitely am just eating them to pass the
time while my meal cooks, so grapes would be just as good. Or could veggie
straws.chips be a good swap? I know Ive seen those in the store.
Dietitian: Great! And Im sure I could find some recommendations and example labels of
healthy swaps and show you how to read the label to find out if a product youre
interested is a good fit! Also, how do you feel about separating eating and watching
television, in some cases watching TV can distract us from exactly how much food were
consuming and lead to over eating.
TS: I guess I never thought about it that way. This makes sense though, because I
swear I start a show and by the time its over ill have finished a whole entire bag of
whatever Im snacking on.
Dietitian: Also, if popcorn and TV is something you truly enjoy, I can show you some
visual models of how much would be a good amount to portion out before, and that way
you can snack and watch TV and not overeat!

Narrator: The dietitian here is working with the client to identify the stimulus in the
environment that are causing the unhealthy eating patterns. In this case, the availability
of the chips in the pantry and the television. They would work together to implement
healthy alternatives, positive cues, or eliminate negative cues. This is also a great
opportunity to use modeling (food modes) and label education.

TS: I just know that after I eat dinner, I am always craving something sweet!
Dietitian: Well, you can still have your dessert. Fruit and yogurt can satisfy a sweet
tooth and provide health benefits.
TS: Okay, but I also have a big halloween party coming up and I know there will be
unhealthy choices around, what should I do?
Dietitian: How would you feel about eating a meal before? You could also pack gum, or
mints to keep you from choosing unhealthy options.

Narrator: Here the dietitian is helping the client sort out areas of possible relapse. The
client admits that she has a weakness for having something sweet after her last meal of
the day. So instead of telling her she cant do this anymore, the dietitian can work by
suggesting healthier options. Also, when the client states that they have a halloween
party coming up, this is an area where relapse could occur. The dietitian and the client
are making a game plan and goal for the client to follow in preparation.
Presentation Outline:

Target audience: Dietetics Students

Time Allotted: 25 minutes

Performance Based Learning Objectives:

Participants will be able to explain what negative self- talk is to a partner.

Participants will be able to demonstrate their knowledge of stimulus control by identifying

negative and positive cues with 80% accuracy.

Participants will be able to design a relapse prevention plan when provided a high-risk scenario.

Pre-Assessment:
Content and Sequence:
Presentation on Cognitive Restructuring
Activity
Presentation on relapse prevention
Activity + share out
Presentation on stimulus control
Activity + share out
Materials:
Cognitive restructuring thought pattern activity on powerpoint
Relapse prevention activity- groups assigned a letter, scenario on slides, they share
response
Stimulus control activity: will show a scenario on a slide, poll share of hands whether it is
a positive or negative stimulus.

Report of three primary articles of use of theory and strategies

Early BP, Grady MD. Embracing the Contribution of Both Behavioral and Cognitive Theories
to Cognitive Behavioral Therapy: Maximizing the Richness. Clinical Social Work. 2016;1-10.

Henrickson S, Anclair M, Hiltunen A. Effectiveness of cognitive behavioral therapy on health-

related quality of life: An evaluation of therapies provided by trainee therapists. Scandinavian
Journal of Psychology. 2016;57(3):215-222.

Larsson A, Hooper N, Osborne L, et al. Using Brief Cognitive Restructuring and Cognitive
Defusion Techniques to Cope with Negative Thoughts. Sage Journals. 2016;40(3):452-482.

Schuz B, Bower J, Ferguson S. Stimulus control and affect in dietary behaviours. An intensive
longitudinal study. Appetite. 2015;87:310-317.

Learning Activities/Teaching Methods:

1. Cognitive restructuring
a. Identify negative thought patterns
b. - activity given a negative self talk, make a positive
 c. I cant believe I feel tired after walking up one flight of stairs, I should skip lunch
d. I do feel tired walking up those stairs but if I keep making healthy changes, itll
only get easier
2. Relapse prevention
a. Explanation of high risk scenarios
-Fluctuating emotions
-Fluctuating environments- traveling, social events
-Holidays/Events
Activity get a partner and get assigned a relapse scenario, come up with a way to alter the
scenario to prevent relapse.
Example: You were just on a long flight and are starving while waiting for your baggage.
You decide to grab a huge combo meal from a fast food restaurant because its the first thing
you see) *could prevent by packing healthy snacks for the plane
You are attending a large family tailgate and know there will be tempting unhealthy food
items around *eat before, choose a smaller plate size, spend time away from food table
You are super upset after a bad day at work, you already had dinner and are full, but
just know a bar of chocolate will make everything better *Drink two glasses of water and
then re-evaluate if you want the chocolate bar

Teaching Methods:
Demonstrating: through the process of teaching through examples or experiments.
Partner activity
Collaborating: peers work together and discuss
Peers work together to arrive at a solution
classroom discussion: discuss together with class, ask questions and answer
Discuss the activity and further items, allowing room for a q&a

3. Stimulus control
b. Identify cues that trigger eating
c. Ask for volunteers to share common cues to eating
d. Share less noticeable cues (do you often need a snack while watching TV, do
you walk past a vending machine every day?)
e. Give a scenario and have clients identify the stimulus as negative or
positive
Example: Every day you walk in through the backdoor to work you pass a candy machine and
grab a Snickers *The stimulus is negative, the candy machine
If you get off the highway an exit early, you pass a bakery on your way home from work and
snag a cupcake *Stimulus is the bakery and negative
You are waiting for your dinner to cook and pass some grapes out on your counter, so grab a
handful *Stimulus is grapes and positive

Strategies Handout Description:

Relapse prevention
 Identify threats for relapses in behavior and develop both cognitive and
behavioral strategies to avoid them
Describe and introduce relapsing, identify high risk situations, develop behavioral
and cognitive strategies to deal with high risk situations, develop strategies to
minimize occurrence of high risk situations, enhance self-efficacy, work on lapse
management, work on cognitive restructuring, and urge management techniques
What relapsing is and how to avoid it
Cognitive restructuring
Increase awareness of self perceptions, beliefs related to diet, beliefs related to
weight, weight-loss expectations
Identify irrational thinking patterns and change them
Stimulus control
Modify cues that trigger undesirable behaviors
Identify cues and determine how to manage cues

References:
1. Bauer K, Liou,D. Medline Nutrition Counseling and Education Skill Development, 3rd ed.
Brooks Cole Co; 2016
1. Academy of Nutrition and Dietetics Evidence Analysis Library. NC: BEHAVIOR
CHANGE STRATEGIES (2007-2008)
http://andeal.org/topic.cfm?conclusion_statement_id=250877&cat=3946. Accessed September
24, 2016.