CBC Intervention Techniques — Questions and Answers

Question 1: A bariatric client says, "I know I should stop late-night snacking, but it's the only time I relax." Which motivational interviewing technique best responds to this ambivalence?

Prescribing a strict no-eating-after-8pm rule
Confronting the client about denial
Referring the client back to the surgeon
Developing discrepancy between current behavior and personal goals (Correct answer)

Correct answer: Developing discrepancy between current behavior and personal goals

Developing discrepancy helps the client see the gap between their behavior and their weight-loss goals without confrontation.

Question 2: In cognitive behavioral therapy for post-surgical bariatric patients, which tool is most commonly used to identify triggers for emotional eating?

A serum vitamin panel
A resting metabolic rate test
A self-monitoring food and mood diary (Correct answer)
A body composition scan

Correct answer: A self-monitoring food and mood diary

Self-monitoring diaries link eating episodes to emotions and situations, revealing behavioral triggers.

Question 3: A counselor asks a pre-surgical client, "On a scale of 0 to 10, how confident are you that you can follow the post-op diet?" This is an example of which technique?

Administering a standardized depression screen
Conducting a structured clinical interview
Applying aversive conditioning
Using a confidence ruler to assess self-efficacy (Correct answer)

Correct answer: Using a confidence ruler to assess self-efficacy

Scaling questions, or confidence rulers, gauge self-efficacy and open discussion about strengthening confidence.

Question 4: Which intervention is most appropriate when a client repeatedly engages in "grazing" behavior six months after gastric sleeve surgery?

Encouraging longer fasting windows of 24 hours
Recommending liquid meal replacements indefinitely
Structured meal planning with scheduled eating times and stimulus control (Correct answer)
Advising the client to weigh themselves hourly

Correct answer: Structured meal planning with scheduled eating times and stimulus control

Grazing responds best to structured, scheduled eating combined with stimulus-control strategies that limit food cues.

Question 5: During a session, a client becomes defensive when the counselor suggests reducing sugary drinks. According to motivational interviewing, the counselor should first do what?

Repeat the recommendation more firmly
End the session early
Warn the client about surgical failure
Roll with resistance by reflecting the client's concerns (Correct answer)

Correct answer: Roll with resistance by reflecting the client's concerns

Rolling with resistance through reflective listening defuses defensiveness and preserves the therapeutic alliance.

Question 6: Which behavioral technique involves removing tempting foods from the home and avoiding eating while watching television?

Cognitive restructuring
Flooding
Systematic desensitization
Stimulus control (Correct answer)

Correct answer: Stimulus control

Stimulus control modifies the environment to reduce cues that trigger unwanted eating behaviors.

Question 7: A client states, "I ate one cookie, so my whole diet is ruined." Which cognitive distortion should the counselor target?

Displacement
Projection
All-or-nothing thinking (Correct answer)
Reaction formation

Correct answer: All-or-nothing thinking

Viewing one lapse as total failure is classic all-or-nothing (dichotomous) thinking addressed in CBT.

Question 8: According to the Transtheoretical Model, a client who says "I'm planning to start tracking my meals next month" is in which stage of change?

Precontemplation
Action
Preparation (Correct answer)
Maintenance

Correct answer: Preparation

Intending to take action within the next month defines the preparation stage.

Question 9: Which intervention is most effective for a bariatric client in the precontemplation stage?

Raising awareness with nonjudgmental information and exploring the client's perspective (Correct answer)
Creating a relapse prevention plan
Setting detailed weekly weight-loss goals
Assigning daily calorie-counting homework

Correct answer: Raising awareness with nonjudgmental information and exploring the client's perspective

Precontemplators are not ready for action, so awareness-raising and empathic exploration fit the stage.

Question 10: A counselor helps a post-op client rehearse ordering a bariatric-friendly meal before attending a wedding. This technique is best described as what?

Paradoxical intention
Dream analysis
Behavioral rehearsal (role-playing) (Correct answer)
Free association

Correct answer: Behavioral rehearsal (role-playing)

Practicing a challenging situation in session is behavioral rehearsal, which builds skills and confidence.

Question 11: Which statement by a counselor best demonstrates a complex reflection during motivational interviewing?

"Why didn't you follow the meal plan?"
"So you didn't exercise this week."
"You need to try harder next week."
"You're frustrated because the scale isn't moving, and you're wondering if all this effort is worth it." (Correct answer)

Correct answer: "You're frustrated because the scale isn't moving, and you're wondering if all this effort is worth it."

A complex reflection adds inferred meaning or emotion beyond the client's literal words.

Question 12: When teaching relapse prevention, the counselor explains the "abstinence violation effect." What does this concept describe?

Weight regain caused by pouch stretching
Withdrawal symptoms from sugar cessation
The body's metabolic slowdown after dieting
A lapse spiraling into full relapse because the client interprets it as personal failure (Correct answer)

Correct answer: A lapse spiraling into full relapse because the client interprets it as personal failure

The abstinence violation effect occurs when guilt and self-blame after a lapse trigger complete abandonment of the behavior change.

Question 13: A counselor uses SMART goals with a bariatric client. Which goal best meets SMART criteria?

"Lose as much weight as I can"
"Get healthier soon"
"Walk 20 minutes after dinner, five days a week, for the next month" (Correct answer)
"Exercise more whenever possible"

Correct answer: "Walk 20 minutes after dinner, five days a week, for the next month"

The walking goal is specific, measurable, achievable, relevant, and time-bound.

Question 14: Which technique involves the counselor intentionally summarizing both sides of a client's ambivalence about surgery?

Progressive muscle relaxation
Contingency contracting
Thought stopping
A double-sided reflection (Correct answer)

Correct answer: A double-sided reflection

Double-sided reflections capture both the client's reasons for and against change in one statement.

Question 15: A post-op client reports drinking alcohol to cope with stress now that food is restricted. What phenomenon should the counselor assess for?

Addiction transfer (cross-addiction) (Correct answer)
Dumping syndrome
Band slippage
Nutrient malabsorption

Correct answer: Addiction transfer (cross-addiction)

Replacing food with alcohol or another substance after bariatric surgery suggests addiction transfer, which requires targeted intervention.

Question 16: Which group intervention format is most supported for improving long-term adherence after bariatric surgery?

Annual individual check-ins with no group contact
Ongoing structured support groups with psychoeducation and peer accountability (Correct answer)
Unmoderated online forums only
A single pre-surgical information lecture

Correct answer: Ongoing structured support groups with psychoeducation and peer accountability

Regular structured support groups combining education and peer support are linked to better adherence and weight outcomes.

Question 17: A client eats rapidly and stops only when experiencing pain and vomiting. Which mindful-eating intervention directly targets this pattern?

Prescribing appetite suppressants
Restricting the client to two meals per day
Recommending high-intensity exercise before meals
Teaching the client to slow down, chew thoroughly, and notice satiety cues before discomfort (Correct answer)

Correct answer: Teaching the client to slow down, chew thoroughly, and notice satiety cues before discomfort

Mindful eating trains the client to recognize early satiety signals, preventing overfilling of the surgical pouch.

Question 18: When a client expresses shame about weight regain, which counselor response best reflects self-compassion-based intervention?

"You should have followed the plan we made."
"Shame can be a good motivator to do better."
"Regain is a common part of this journey; let's look at it with curiosity rather than judgment." (Correct answer)
"Let's not talk about it and focus on the positive."

Correct answer: "Regain is a common part of this journey; let's look at it with curiosity rather than judgment."

Self-compassion approaches normalize setbacks and replace judgment with curiosity, reducing shame-driven eating.

Question 19: A counselor and client sign a written agreement stating the client will earn a non-food reward after completing 12 food logs. This illustrates which technique?

Motivational rulers
Exposure and response prevention
Cognitive defusion
Contingency contracting (Correct answer)

Correct answer: Contingency contracting

Contingency contracting formalizes behavior-reward agreements to reinforce adherence.

Question 20: Which is the most appropriate first-line counseling intervention for a client with mild pre-surgical binge eating symptoms?

Cognitive behavioral therapy focused on regular eating patterns and trigger management (Correct answer)
Immediate psychiatric hospitalization
Postponing all counseling until after surgery
Long-term psychodynamic analysis of childhood

Correct answer: Cognitive behavioral therapy focused on regular eating patterns and trigger management

CBT is the evidence-based first-line treatment for binge eating and can be delivered before surgery.

Question 21: A client says, "There's no point logging food; I always fail anyway." Which cognitive restructuring step should the counselor take first?

Help the client examine the evidence for and against the belief (Correct answer)
Assign double the logging homework
Switch the topic to exercise
Agree that logging may not suit everyone

Correct answer: Help the client examine the evidence for and against the belief

Cognitive restructuring begins with collaboratively testing the accuracy of the automatic thought against real evidence.

CBC Intervention Techniques

A bariatric client says, "I know I should stop late-night snacking, but it's the only time I relax." Which motivational interviewing technique best responds to this ambivalence?

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