Initially, many dieters report automatic thoughts such as: "The only thing I can do to make this craving go away is to eat," "This craving will just get worse until I can't tolerate it, so I may as well give in now," and "I have no willpower against cravings."

Psychoeducation is one of our first interventions. We teach dieters that cravings arise from a number of different triggers: environmental (dieters see or smell a particular food), social (others around them are eating or drinking), mental (they are just thinking about a particular food or meal), or emotional (they feel tired, stressed, sad, happy, etc.). They may think about how wonderful a particular food will taste; they may visualize themselves eating the food and receiving great satisfaction; they may even get a sensory image, almost tasting the food in their mouths. They may also have memories in which the physiological tension that accompanies cravings dissipates as they take the first bite of the food they are craving.    

We explain to dieters that when they experience a craving, they likely experience some emotional discomfort related to that craving also. The discomfort is usually anxiety or irritability. When dieters experience a craving for something they know they have not planned to eat, they may have anxious or irritable thoughts and argue with themselves about whether or not they are going to allow themselves to give in and eat the unplanned food. We discuss with dieters a concept that is new for most of them. That is, there are actually two ways to make this discomfort go away- either by firmly deciding they are going to eat the food they are thinking about, or by firmly deciding they are not going to eat the food they are thinking about, then turning their attention to a compelling activity. We frequently have dieters do experiments to demonstrate this point. They find that as soon as they decide to give into a craving, their discomfort starts to diminish-even before the food is in their mouths because their decision has been made. What often surprises dieters is that their discomfort also starts to diminish as soon as they make the definite decision not to eat, even before they turn their attention outward to an activity. To facilitate the latter, we help dieters create a list of activities they could choose to turn their attention to when they begin to experience a craving (e.g., taking a walk, playing a game on their phone, looking at an entertaining website, calling a friend, cleaning or organizing a room, or listening to music, to name a few).    

A technique to motivate dieters to overcome cravings is having them remind themselves exactly why it is worth it to them to resist their urges. We reinforce this skill by having them read, twice or more daily, a long list of reasons why they want to lose weight. When dieters find that their attention has been captured by how uncomfortable they feel (which tends to lead to more discomfort), we coach them on how to correctly label their feelings and to remind themselves that the craving is temporary: "This is just a craving. It may be mildly uncomfortable now, but pretty soon it will go away." They also learn to motivate themselves: "If I stand firm and don't give in, I will be SO GLAD that I did; I will feel proud of myself once the craving has passed. But if I do give in, I will feel bad about myself; I will feel guilty and weak." (They also read coping statements like this at least twice a day, even in the absence of cravings.)    

By using these techniques -- labeling feelings, deciding firmly that they are not going to give in to cravings, and getting immediately distracted -- (and other techniques as well), dieters prove to themselves that cravings DO decrease, that they DON'T just get worse and worse, that they DO have willpower to withstand them, and that they CAN make them go away without ever putting a single bite of food in their mouths. Dieters often have to deliberately practice this skill over and over again, and give themselves credit for each success, before they really start to gain confidence that they can overcome cravings. Once they start to build a memory bank of successful experiences, it gets easier and easier for them because they are more firmly able to just say "No, I'm not giving in," and move on.

Through all of these methods, dieters are able to change their thinking about cravings:

• The idea "If I'm having a craving, the only thing I can do to make it go away is eat," changes to, "I don't need to eat to make this craving go away. The moment I decide that I'm definitely not giving in to it, the craving will start to diminish. And as soon as I fully turn my attention to something else, I won't be thinking about it at all."   

• "This craving will just get worse until I can't tolerate it, so I may as well give in now," changes to, "Cravings don't get worse and worse. Even if I do nothing, the craving will start to go away on its own, once my attention is turned elsewhere. At worse this craving is mildly uncomfortable, especially compared to other discomforts I've experienced in my life; I can certainly tolerate it, and it is so worth it to me to do so."    

• "I have no willpower against cravings," changes to, "I can withstand cravings without giving in, and there are things I can do to make them go away faster. I have withstood cravings many times before and I know I can keep doing it. Besides, it feels so good when I do."

Ultimately, we teach dieters to take a short-cut. Instead of distraction, we have dieters label their experience ("This is just a craving," or "This is just discomfort,"), tolerate it, and go about their business. They soon notice that they experience cravings less and less -- and they are prepared and able to stand strong when cravings do arise.

For more information about a CBT approach to weight loss and maintenance, visit http://www.beckinstitute.org/cbt-training/diet-workshops.