to engage in the selected counseling approach. Practitioners should have the appropriate qualifications for the selected approach, as qualifications differ by modality. For example, CBT and ABT for weight management involve a variety of techniques and often require specialized skills and training for their proper implementation. Thus, these modalities are often delivered or supervised by a clinical psychologist or other mental health practitioner. However, other specialized providers (eg, registered dietitian nutritionists) can be taught to deliver many elements of these interventions with thorough training, experi- ence, and supervision. Because CBT is more established and widespread than ABT, more practitioners are trained in the former than in the latter. Although ABT-based interventions share many common elements with CBT, practitioners require additional formal training in ABT for these interventions to be effective. Motivational interviewing can be effectively delivered by a wide range of health care providers, many of whom participate in a full day of training (or more) in this modality prior to its implementation. Like CBT and ABT, motivational interviewing is most effective when the practitioner has sufficient “hands-on” experience in using the approach and the associated counseling techniques. Across all counseling strategies, developing and maintaining a strong rapport and trust with the patient or client is crucial to treatment engagement and suc- cessful outcomes, and a patient or client-centered stance should be maintained throughout treatment. In some instances, this may require making adaptations to counseling strategies and specific behavior-change techniques used in treat- ment. For instance, if a patient or client is particularly ambivalent about behavior change, more motivational interviewing may be needed to increase treatment buy-in, bolster motivation, and facilitate change talk. A patient or client who responds to major life challenges with impulsive or mindless eating may benefit from placing greater emphasis on these topics in treatment and incorporating more attuned-eating exercises into treatment sessions. In many respects, the different counseling approaches described in this


chapter there are substantial and complementarity. Thus, integration of different approaches and techniques is appropriate and even expected in some cases. In particular, as ABT builds on CBT, it is not difficult to incorporate ABT-informed strategies into CBT interventions and vice versa. For example, a discussion of values-congruent behavior could be a valuable addition to a CBT intervention and result in better treatment adherence. Although ABT and CBT share many common features, there are important distinctions as well. Perhaps one of the biggest differ- ences lies in the specific tools used in each (eg, distress tolerance in ABT vs cogni- tive restructuring in CBT). Acceptance and defusion strategies in ABT are forms of cognitive restructuring that are well suited to patients or clients with cognitive disinhibition or cognitive inflexibility. ABT and CBT also differ in their strategies for dealing with environmental stimuli. A CBT practitioner might encourage a patient or client to remove energy-dense foods from the home so that the stimulus can be avoided. In contrast, an ABT practitioner might encourage urge surfing as a tool for distress tolerance in the presence of energy-dense, highly palatable foods. However, stimulus control could be used in ABT, as long as it is value-congruent and does not foster avoidance on the patient or client’s part. Similarities between ABT, mindful eating, and intuitive eating are also appar-


ent, and these approaches are complementary in some respects. Yet, like CBT and ABT, they differ in important ways. Both mindful eating and intuitive eating emphasize minimizing distractions while eating and paying attention to hunger and satiety cues. However, intuitive eating does not restrict the type of food eaten and gives patients or clients unconditional permission to eat. Intuitive eating may


244 SECTION 3: Interventions for the Treatment of Overweight and Obesity


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