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Acceptance and Commitment Therapy for Eating Disorders
Eating disorders are serious mental health conditions that affect millions of people around the world. Yet the stigma of mental illness, high cost of treatment, and general lack of understanding about these conditions may cause many individuals to forgo seeking help.
But there are a number of therapies that can help someone successfully reduce eating disorder symptoms and work past the misguided—and potentially dangerous—thoughts that drive them.
Among these methods, acceptance commitment therapy (ACT) has been found to be particularly helpful for not only reducing eating disorder behaviors, but preventing people from relapsing after primary treatment is over. [1]
What is Acceptance Commitment Therapy?
Acceptance commitment therapy, sometimes called acceptance and commitment therapy, is a type of talk therapy aimed at helping people accept difficult thoughts and emotions while simultaneously making proactive, positive changes in their life.
The concept is based on the idea that distress is not caused by negative thoughts or experiences in and of themselves, but rather the fixation on or attachment to these thoughts and emotions. Instead of something that needs to be “fixed,” negative thoughts are presented in ACT as part of the greater life experience.
Aside from helping alleviate mental anguish, learning to view the world and one’s experiences of it in this way has been shown to help create greater psychological flexibility. [2] This trait is considered crucial in helping people better manage and eventually overcome disordered thoughts and behaviors of all kinds.
Principles of Acceptance and Commitment Therapy
In order to help patients make these important perspective shifts and start committing to healthier hobbies and habits, ACT utilizes six major principles, sometimes called core ACT processes.
Acceptance
The idea of acceptance is truly at the heart of acceptance and commitment therapy.
This principle is all about understanding that all thoughts and feelings are a natural part of life, even when they are negative or uncomfortable. It emphasizes that no thoughts or emotions are inherently “good” or “bad.”
Rather than attempt to filter out or avoid “bad” thoughts, acceptance, as taught through ACT, invites patients to let their mind run with minimal interference, welcoming the full array of thoughts and letting them ebb and flow naturally, without fixating on or following any one.
Defusion
Defusion is a key component of ACT that helps underscore the idea of thoughts as their own separate, and ultimately benign, entities.
This principle asks patients to distance themselves from their thoughts, in order to get a more objective view of them. The hope is that patients will learn to see their thoughts not as absolute truths or sources of distress, but rather as the fleeting bits of imagery or language that they truly are.
This kind of separation gives someone more mental space to consider not just their thoughts, but the reactions they may have to them. This can serve to further reinforce the idea that these reactions are a choice, and the true source of distress or acceptance.
The Observing Self
This concept goes one step further than defusion, teaching patients to understand themselves as separate entities from their thoughts, feelings, or even experiences.
During ACT sessions, a patient may be asked to draw a distinction between the thoughts they’re experiencing as their “thinking self,” and the “self” that is observing these thoughts – the observing self.
Rather than become consumed or defined by the thoughts and emotions that arise, the observing self allows them to more passively flow, without judgment or attachment. Embodying this perspective can help patients start to dislodge their sense of self from their thoughts about themselves.
Mindfulness
Mindfulness is the practice that ties many of these concepts together, allowing patients to let their thoughts flow naturally while tapping into their observing self.
The concept hinges on staying present in the moment, without attaching judgment or direction to the thoughts and sensations that arise. This helps to once again reinforce the differences between thoughts and feelings, self, and reality.
A state of mindfulness is often achieved by utilizing breathing techniques and other meditative practices, which patients are taught during a course of ACT.
Personal Values
The focus on values comes into play during the “commitment” aspect of acceptance and commitment therapy.
This principle involves establishing someone’s core morals and values, or beliefs that are strong enough to inspire action. Once these traits have been and identified, a patient and their therapist will think of positive causes, hobbies, or jobs that align with these ideals.
A patient is then encouraged to pursue these new interests, or make causes that promote these values and morals a higher priority in their life.
The concept is intended to have a twofold effect: Drawing someone’s focus toward interests and actions that make them feel good, and helping them build an identity that isn’t centered around disordered thoughts or behaviors.
Committed Action
Committed action asks patients to continue practicing what they’ve learned, even after therapy is over. Essentially, it’s a strategy to help patients maintain their new perspectives and healthier interests.
Committed action involves helping patients recognize when their actions no longer align with their personal values, and gives them the necessary tools to recalibrate and refocus.
Rather than setting strict rules for lifelong behavior, committed action is about being open to the evolution of one’s behavior, and paying attention to how this either supports or undermines one’s values.
ACT as Eating Disorder Treatment
ACT has become a widely-recommended treatment option for many eating disorders, including bulimia nervosa (BN), binge eating disorder (BED), and anorexia nervosa (AN), thanks to its ability to promote psychological flexibility, acceptance, and the development of meaningful interests.
Further, acceptance commitment therapy has been found to have a number of other benefits for patients struggling with eating disorders.
Addressing Root Causes
Perfectionism and rigid thinking are common drivers of disordered eating behavior. These ways of thinking are predicated on the idea that there are “right” and “wrong” ways to do things.
ACT helps break the illusion of that false dichotomy, introducing the idea of thoughts as fluid, with no attachment to “good” and “bad” or “right” and “wrong.” Embodying this concept can help alleviate disordered eating behaviors.
Improving Quality of Life
ACT has been shown in clinical studies to help improve someone’s quality of life. [3]
The result likely comes from the therapy’s dual focuses: Creating greater acceptance of thoughts and feelings, and developing new interests to help build a meaningful life.
That the therapy can lead to easing residual eating disorder symptoms likely also contributes to patients’ positive experiences, helping them achieve not just mental peace but greater physical health.
Promoting Self-Compassion
Many individuals with eating disorders struggle with self-criticism and chronically low self-esteem. Frequently, this is connected to their distorted body image, and its conflation with their sense of self and self-worth.
Acceptance and commitment therapy helps a patient separate their sense of self from their thoughts about themselves, which can help them gain clarity and learn to value themselves, as well as their body.
The psychological flexibility promoted by ACT, particularly through its use of defusion, also works as body image treatment, which can help promote self-love. [4]
Building Resilience
Eating disorders can be incredibly challenging to overcome. However, ACT can help someone struggling with these conditions develop the resilience and coping skills necessary to manage the difficult emotions that often come with recovery.
Traditional therapies focus on reducing or eliminating negative thoughts and emotions, but this could inadvertently lead to a sensitivity around these types of thoughts. Rather, ACT teaches individuals to welcome all thoughts, and not fear or judge any of them.
By learning to accept and tolerate negative experiences as just another part of life, patients may develop a sense of emotional resilience that can help them navigate future challenges.
ACT and Eating Disorder Recovery
Acceptance commitment therapy has not only been shown to help treat eating disorders, but help patients sustain their recovery efforts. [1]
This may be thanks, in part, to the final principle of committed action, which arms patients with strategies for preserving their new perspective and adjusting in a healthy way to any changes down the road.
It’s also possible for individuals to incorporate the principles of ACT in their daily lives, in order to help them continue to cope with disordered thoughts and behaviors, and continue to work on improving their overall well-being.
Mindfulness, meditation, or breathing techniques are strategies many ACT patients find helpful long after their course of therapy ends. And the prioritization of interests that align with one’s values can help keep someone’s focus trained on positive change.
These concepts may seem strange or difficult at first, but with enough practice, they can become second nature, and help guide someone to the path of long-term recovery.
Resources
- Juarascio A, Shaw J, Forman E, Timko CA, Herbert J, Butryn M, Bunnell D, Matteucci A, & Lowe M. (2013). Acceptance and commitment therapy as a novel treatment for eating disorders: an initial test of efficacy and mediation. Behavior modification; 37(4):459–489.
- Wetherell J, Liu L, Patterson TL, Afari N, Ayers CR, Thorp SR, Stoddard JA, Ruberg J, Kraft A, Sorrell JT, Petkus AJ. (2011). Acceptance and Commitment Therapy for Generalized Anxiety Disorder in Older Adults: A Preliminary Report. Behavior Therapy; 42(1):127-134.
- Gloster AT, Walder N, Levin ME, Twohig ME, Karekla M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science; 18:181-192.
- Fang S, Ding D, Ji P, Huang M, & Hu K. (2022). Cognitive Defusion and Psychological Flexibility Predict Negative Body Image in the Chinese College Students: Evidence from Acceptance and Commitment Therapy. International journal of environmental research and public health; 19(24):16519.
