1. Identify counseling skills needed for behavior change
2. Recognize behavioral, cognitive, and psychoeducational  treatment strategies
Course outcome assessed/addressed in this assignment:
NS420-1: Apply professional nutritional counseling skills to a client session
Instructions
Imagine yourself in the role of a Nutrition Counselor and Josephine in your client. Josephine is a 20-year-old female who is present for an eating disorder not otherwise specified. She currently teaches salsa lessons at the community college and is in her last semester of college. She reports she is living at home and the food her mom prepares is not the healthiest because her mom is from Honduras and her father is from Guatemala, so the food is prepared differently. She indicates she has been thin all her life, but she began struggling with her weight as soon as she went through puberty. Since she is a salsa instructor, she has to remain fit. She reports she feels very guilty if she has consumed fried foods during the day, but since that is the way her mom primarily cooks, she feels awful to tell her mom to stop cooking that way. She reports if she does consume too much fried foods or junk food, she will run at least 2-3 miles that day or else force herself to vomit, but all the food does not come out. She reports sometimes if she has a later class, she will not eat dinner or only eat 1 meal per day. She has tried counting calories, but then she gets so mad at herself for having more than 1200 calories it causes her to exercise more, which then leads her to feeling exhausted. She indicates she is on no medication, but does take a multivitamin when she remembers. She indicates she has gone from 110 pounds to 125 pounds over 5 years and wants to be back down to 110 or even less. She also had gone to the doctor and he was quite concerned with her lab values. She has provided you a 24 hour meal record:
Breakfast:
1-6” corn tortilla
½ cup fried beans cooked with peppers, onions and oil
½ cup rice
1 cup no sugar added orange juice
Lunch:
1 slice of whole wheat bread
2 slices turkey
1 small apple
Dinner:
2- 6” tortillas
Beef with onions, peppers cooked in oil
Tomato, onion, pepper salad (made with oil and lime juice)
2 cups of rice
Height: 5’2” Weight: 117 pounds (based on your scale in the office)
Labs:
Test Result Reference Units
Albumin (visceral protein stores) 3.3 g/dL 3.5-4.8 g/dL
Sodium 133 mEq/L 136-145 mEq/L
Potassium 3.8 mEq/L 3.5-5.2 mEq/L
Iron 0.4 mg/dL 0.6-1.1 mg/dL
Vitamin B12 185 pg/mL 200-835 pg/mL
Questions for Unit 6:
• According to the Stages of Change Model, what stage of change do you believe Josephine is in? Explain how you determined that stage of change? How does this affect her readiness to learn?
• For this situation, how would you establish a rapport with the client?
• Identify and discuss 3 counseling skills you would use to encourage behavior change for the client
• Identify and discuss 2 cognitive-behavioral therapy techniques you would use with this client.
• How do you educate the client on what is considered normal exercising and excessive exercising?

• Requirements This assignment needs to be at least two pages in length and include at least two references.
• This Assignment should be in APA format and follow the conventions of Standard American English (correct grammar, punctuation, etc.). Your writing should be well ordered, logical, and unified, as well as original and insightful. Your work should display superior content, organization, style, and mechanics. Be sure to use APA in-text citations and a reference page to attribute each source.

Answer all questions for study guide you’ll find the answers in the slides attached. Study guide is also attached

Study Outline for Exam III Exam Date: Saturday Dec 5th Exam Topics: Mood Disorders, Somatic Disorders, Dissociative  Disorders, Schizophrenia, Eating Disorders, Sexual Disorders, Personality Disorders, Substance Related Disorders Specific Strategies: A. Utilize this guide to provide a list of key topics that may be included in the exam. Some students like to use this guide as a key to looking up materials in the notes and chapters. B. Review the lecture slides -as these will reflect emphasis—it is most likely that these topics will be on your exam C. Review the text; you should pay close attention to materials that converge with lecture topics. D. DSM: While you are not expected to memorize diagnostic criteria you should know the key features of each disorder and you should be able to differentiate the disorders (you might find the use of flash cards especially helpful here). Mood Disorders: characterized by mood episodes that are discrete periods of time in which a number of specific mood related symptoms are present and they represent a change from previous functioning. Key Concepts: o Mania o Depression o Mixed Episode Major Depressive Disorder and Dysthymic Disorder o Key differences between MDD and Persistent Depressive Disorder (Dysthymic Disorder) o MDD: Key criteria for diagnosis o Double Depression o Specifiers i.e., Severity and Subtypes for MDD o Depression, the life cycle and prognosis o Causal factors: • Biological • Personality Traits, Interpersonal, Environmental: Social supports, childhood adversity (Cinderella) • Cognitive and behavioral – general factors and Beck’s Cognitive Triad and Learned Helplessness (The Tornado Study) Bipolar Disorders: Characterized by the presence of one or more manic, mixed (mania and depression) or hypomanic episodes. o Bipolar I: one or more manic or mixed episode that swings to normal or depressive symptoms (emphasis on Manic) o Bipolar II: one or more depressive episodes combined with swings to hypomania (emphasis on depression) o Bipolar I and II usually cycle 2 or 3 times a year; “rapid cycler” has mood swings 4 or more times a year. o Cyclothmic disorder: Two or more years with hypomania or hypomania with depressive swings o Causal Factors: biological, psychological Treatments for Mood Disorders o Medications o Antidepressants (know specific classes o Mood Stablizers (know specific examples – Lithium, etc) o ECT and Sunlamps o Psychotherapy – treatment(s) of choice Test your knowledge: True or False • If Cinderella had been real she would have been at risk for the development of major depressive disorder. • Adopting a pessimistic way of living can contribute to the development of mood disorders. • A depressed individual who experiences delusions would be diagnosed with major depressive disorder with atypical features. • The relationship between severe stress and depression is strongest for first time episodes. • According to your text, Beck’s negative cognitive triad includes thoughts about self, significant others and relationships. • If a person has had a manic episode, the diagnosis must be bipolar I. • Depressive episodes in Unipolar Major Depression are the same as those found in Bipolar Disorders. Somatic Symptom Disorders: Presence of physical symptoms for which no organic cause can be determined Illness anxiety disorder: Believes has or will develop a serious medical illness despite contrary evidence. • Comorbidity, Age of Onset • Differentiate from Somatic Symptom Disorder Somatic symptom disorder: Presence of somatic symptoms with no physical cause can be determined • Demographics, Comorbidity, Course • Diagnostic criteria Functional Neurological Symptom Disorder AKA Conversion disorder: loss of bodily function, sudden onset, situations of duress (stress) • History and etiology from a Freud’s perspective, primary and secondary gains • Behavioral perspective: etiology and sustaining variables • Prevalence, Demographics, Culture Factitious Disorder And Factitious Disorder by Proxy o Key Characteristics Test your knowledge: • Factitious disorder by proxy is when a person inflicts medical or physical illness in themselves. True or false? • Compare and contrast illness anxiety disorder and conversion disorder. • Compare and contrast functional neurological symptom/conversion disorder and somatic symptom disorder. • How did Freud explain the presence of physical symptoms caused by psychological stress? How do Freud’s beliefs differ from cognitivists and behaviorists? • What is the relationship between culture and somatic symptoms disorders such as functional neurological symptom disorder? Dissociative Disorders: Characterized by change(s) in the normal, integrated functions of a person’s identity, memory, or consciousness • Casual factors: environmental, biological Depersonalization/Derealization Disorder: Subjective sense of being outside of one’s own body and/or environment. Feels like you lose control of actions; however, reality testing stays in tact • Depersonalization vs. Realization – definitions and respective subjective experiences • Risk and Casual Factors: environmental, biological Dissociative Amnesia/Dissociative Amnesia with Fugue: Sudden loss of memory for important personal information; non-organic • Localized amnesia, Selective amnesia • Characteristics of fugue • Dateline NBC story on Dissociative Fugue (featuring David Earle) Dissociative Identity Disorder (DID), formerly called Multiple Personality Disorder: Person possesses two or more distinct personalities. Personalities take turns controlling one’s actions, results in gaps regarding important personal information (activities) • Prevalence over time • Causes • Intervention, Risks (hypnosis, memory) Test your knowledge: • How did Freud dissociative phenomena i.e., etiology and intervention? Are Freud’s views still accepted today? • Compare and contrast depersonalization vs. derealization. • Malingering is a type of somatoform disorder. True or False? • What is the role of stress as a causative factor for various dissociative disorders? • What are the challenges associated with diagnosing DID? Schizophrenia: Thought disorder characterized by the presence of severe hallucinations and delusions Key Terms: • Hallucinations (including common types) • Delusions • Symptom patterns: positive symptoms, negative symptoms, specific subtypes Etiology: • Diathesis stress • Dopamine Hypothesis • Glutamate • Enlarged ventricles • Hypofrontality • Prevalence Phases: Prodromal, Active, Residual Subtypes (Key Characteristics) • Catatonic • Disorganized • Paranoid • Undifferentiated • Residual Prognosis and Treatment • Prognosis: Rule of Thirds • Medications: Antipsychotics • Interventions (types, effectiveness, most desired approaches) Test your knowledge: • A hallucination refers to a false belief. True or False • What biological and environmental diatheses are associated with development of schizophrenia? • In reference to schizophrenia, name and define several positive symptoms. Name and define several negative symptoms. • How have we come to understand the presence of seemingly enlarged ventricles in schizophrenia? • What is the “Rule of Thirds”? • Which neurotransmitters play a key role in schizophrenia? Explain. Substance Abuse and Addiction • Key Concepts o Substance use • Impaired control • Social impairment • Risky use • Pharmacological (tolerance, withdrawal) • Most commonly abused substances • DSM IV vs DSM 5 o Substance abuse vs dependence → Substance Use Disorder and specifiers o maladaptive pattern o tolerance and withdrawal • Alcohol o Biochemical Perspectives (consumption and addiction): GABA, dopamine
o Dose – risk relationships (“high” achieved, paradoxical effect, consumption rate vs absorption rate/BAL vs biological risks, mitigating factors) o Short-term and long-term risks of consumption o Lecture slide: common misconceptions regarding alcohol o Type I vs Type II alcoholism o Detox (process and risks) o Treatment • Meds • 12 step programs/self-help • Role of the environment and relapse prevention o Alcohol vs. other CNS depressants • Behavioral Addictions o Gambling Disorder o Key Characteristics o Rationale for inclusion in DSM Test your knowledge • How do DSM IV vs DSM 5 differ in conceptualizing sexual disorders, severity of dysfunction? • What is tolerance? What is withdrawal? • What are the risks of binge drinking? • What are the similarities and differences between gambling disorder and other addictive disorders? • What is the paradoxical effect of alcohol? • What is Atabuse? How is it used? Personality Disorders: An enduring pattern of inner experience and behaviors that deviates markedly from the expectations of the individual’s culture. Emphasis is on rigid, pervasive clusters of traits that cause difficulty in many different realms of functioning and/or the presence of distress See lecture slides for each personality disorder; know the key characteristics of each. • Be able to differentiate between disorders o OCD vs Obsessive Compulsive PD o Schizoid PD vs Schizotypal PD o Antisocial PD and Borderline PD o Histrionic PD vs Narcissistic PD o Diathesis stress and Borderline PD (see lecture slides for specific diagram) o Diathesis Stress and Antisocial PD (see lecture slides for specific diagram) o Dependent PD Etiology • Role of environmental variables i.e., stressors, parenting styles • Biological diatheses Treatment • Role of medications • Role and types of psychotherapy • Treatment and prevention of Antisocial PD Test your knowledge • What are the key characteristics of each personality disorder? • What is the etiology of Borderline PD? Antisocial PD? Narcissistic PD? • What is the role of stress in the development of personality disorders? • What differentiates personality disorders from Axis I disorders? • What is a treatment of choice for most personality disorders? Antisocial PD? Eating Disorders: Severe disturbances in eating behaviors that are maladaptive and include unhealthy efforts to control body weight, and abnormal attitudes about body weight and shape. Key Concepts: Binge Eating, Purging, Restricting, BMI (Body Mass Index) What is “normal” weight? • BMI: uses, problems Anorexia Nervosa: Types: • binge eating/purging • restricting type • differentiation from bulimia (% of body weight) Bulimia Nervosa: Types • Purging • Nonpurging Binge Eating Disorder • Characteristics of a Binge Etiological factors for eating disorders: • Diathesis-stress o Familial and individual dysfunction Bulimics, Anorexics o common precursor: dieting o genetic influences: higher co-occurrence among biological relatives o social/societal emphasis on thinness o age of onset for each eating disorder • comorbid disorders Treatment • medical risks and complications associated with anorexia and bulimia • family systems and individual approaches • role of medications Test your knowledge • What distinguishes a person suffering from anorexia from a person suffering from bulimia? • What problems are associated with using the BMI to determine healthy body weight? • Dieting in common precipitant of eating disorders. True or False • What physiological/medical problems are associated with anorexia? Bulimia? • Why is it often essential to combine psychological and medical care in the treatment of anorexia? Sexual disorders Subcategories: Gender, Sexual Dysfunction, Paraphilias Gender Dysphoria: A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). Treatment: • Challenges: early onset, biological (disorder of sex development) • Role of psychotherapy • Gradual gender changes (cross dressing, hormone therapy) • Sex reassignment Disorders that are related to the Act of Having Sex Risk factors: Early environment, past experiences, Desire Disorder—persistent absence of sexual fantasies and desire Differentiating between “normative” lack of sexual desire vs. diagnosable condition Female Sexual Interest/Arousal disorder Male Hypoactive Desire Disorder • Key characteristics of each Erectile Disorder • Key characteristics • Causes • Variables that must be ruled out: vascular disease, diabetes, etc. • Treatments: Viagra, Cialis, penile implants, etc. Premature Ejaculation • Key characteristics • Causes • Treatment Delayed Ejaculation Female Orgasmic Disorder • Key characteristics • Causes • Treatment Genito-Pelvic Pain/Penetration Disorder • Key Characteristics • Treatment: Desensitization involving vaginal dilators, address psychological conflicts, address any trauma history Paraphilias: Sexual stimulation from odd or unconventional objects. • Types (Fetishism, Frotterusim, Sexual Sadism, etc.) • Sadism: casual factors, subculture, variations in extremities • Pedophilia o Common demographic characteristics of individuals meeting the criteria for pedophilia o Treatment, challenges with treating pedophilia Test your knowledge • How does DSM determine if a difficulty the act of having sex is of clinical significance across relevant disorders? • What sort of gratification are sexual sadists most typically seeking? • What are the roles of vaginal dilators and penile implants in the treatment of sexual disorders? • When might someone desire the use of Viagra or Cialis? • What is considered the most common effective intervention in the treatment of gender identity disorder? • What are the key characteristics of each subtype of paraphilia? • What challenges are associated with treating pedophilia?