Therapeutic Relationships – Part 2 Sylvia Kench
Obesity in the UK is a common problem and it is estimated that it affects 1 in 4 adults in the country (NHS, 2016).
The cause of obesity is usually excess calorie consumption and a lack of physical exercise and can cause potentially life-threatening illnesses. It can also affect quality of life and cause psychological problems such as depression and low self esteem. The factors that contribute to obesity are complex and varied but it can be as much of a psychological problem as a physical problem.
Food is often used as a coping mechanism when dealing with negative emotions such as anxiety, stress, sadness, loneliness and frustration. In individuals suffering obesity, there appears to be a perpetual cycle of negative mood disturbance, over- eating and weight gain followed by guilt. The gain in weight can then lead to distressed mood due to inability to control eating urges and guilt, triggering the eating cycle one again. This can result in using food to cope with emotions (Collins and Bentz, 2009).
Dr. Aaron T. Beck (1921) developed cognitive therapy in the 1960s and followed on from Albert Ellis’s rational emotive behaviour therapy (REBT). Beck’s (1967) system of therapy has been widely used in cases of negative thinking where therapists guide clients to challenge their negative thoughts and behaviours.

He developed the cognitive triad which are three forms of negative thinking that are typical in clients suffering negative feelings. The three components of the triad are negative view of the self, negative view of the future and negative view of the world (Mcleod, 2015).
Understanding and explaining the behaviour and thought processes of a client with obesity is important as this ultimately can help treat the condition.
The cycle of eating and negative emotions often associated with obesity, can be explored using Beck’s cognitive triad.
Beck (1976) states that negative automatic thoughts (NATS) are thoughts that are activated in certain situations and centre on themes of negativity such as low self- esteem and uselessness. He believed that people may not try, rather than risk failure. In obese clients, this can be seen as them not attempting to diet or participate in physical exercise, as they know they are not going to succeed. Low self esteem in obese people will result in them having a negative view on themselves and in turn may have a negative view of the future.
Society often views obese individuals negatively and believe that these people are ‘lazy’ or ‘weak-willed’. Obese individuals are often aware of these negative stereotypes and internalise them. This could then put themselves again at risk of low mood and anxiety and entering a negative eating cycle again for comfort. This would relate to Beck’s theory of them having a negative view of the world.

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