Acceptance and commitment therapy for eating disorders

What is acceptance and commitment therapy?

Acceptance and commitment therapy (ACT) is a multi-faceted approach to mental health treatment. It incorporates aspects of both mindfulness and proactive planning to help someone move past harmful thoughts and behavioral patterns.

Rather than focus on changing the way someone thinks, acceptance commitment therapy works to help someone manage what already is. It frames uncomfortable experiences such as pain, anxiety, grief, and disappointment as normal parts of the human condition—in line with the natural ups and downs and ebbs and flows of life.¹

Patients are taught strategies for better managing—and accepting—these difficulties. This frees up energy that would otherwise be directed at changing, negating, or avoiding uncomfortable emotions. Instead, patients are asked to use that energy toward proactively pursuing activities that make them feel good and are in line with their values and overall life goals.¹

The hope is that acceptance techniques can help someone build the mental flexibility to better manage uncomfortable emotions, and involvement in meaningful activities can help them resist the tendency to avoid or otherwise escape uncomfortable feelings, including through maladaptive coping mechanisms like disordered eating behaviors.¹

Core ACT processes

ACT for eating disorders or any other type of mental health condition generally uses six core principles to guide therapy.

ACT and eating disorders

Acceptance and commitment therapy is increasingly being tested for treating eating disorders. Over the course of this research, the method has been found to help with certain issues that haven't been well addressed with other types of therapy for eating disorders, including:²

• Addressing harmful avoidance tendencies
• Helping increase present-moment awareness
• Addressing low levels of motivation to seek out or enact meaningful change

The mental flexibility encouraged by ACT can also work to directly counteract cognitive rigidity, a very fixed way of thinking that makes it difficult for someone to adapt to new thoughts or situations, which is a major aspect of many eating disorders.^1,3

Acceptance and commitment therapy can also help patients disentangle their idea of self-worth from their appearance through the application of committed action, defusion, and self-as-context techniques.⁵ The pursuit of valued pastimes taught by the therapy can help encourage greater senses of self-acceptance, self-esteem, and self-compassion.

ACT for eating disorders: How does it work?

Each eating disorder case is as unique as the individual going through it, and treatment plans are adjusted to address each individual's needs accordingly. However, when using acceptance and commitment therapy for eating disorder treatment, there are some general techniques and goals that may be applied.

Usually, at the start of treatment, a therapist will work with a patient to clarify their goals and values.⁵ This can help a patient cultivate clarity around what they want and help them begin to understand how their thoughts or behaviors may interfere with the pursuit of these goals.¹

Patients will also be asked to describe themselves and the specific challenges they may be facing. With ACT for eating disorders, these conversations may be particularly focused on someone's ideas of body image and self-worth.⁵ The therapist will then use the patient's own words to help them understand how they talk to and about themselves—often the building blocks of both defusion and self-as-context.

Mindfulness techniques are another essential aspect of ACT. Acceptance and commitment therapy for eating disorders incorporates mindfulness training as well, but modules may be targeted toward more specific experiences, such as how to be mindful of one's body and physical needs to cultivate deeper respect and appreciation for one's body.⁵

ACT and eating disorders: How effective is it?

ACT for eating disorders can be an effective tool for both reducing harmful behaviors and increasing positive experiences. In empirical studies, the therapeutic method has been shown to help people reduce eating disorder behaviors on both a short- and long-term basis.

One study compared those attending ACT sessions in addition to their regular therapy at a residential treatment center to those who were not given the additional sessions. The patients who received acceptance commitment therapy showed a larger reduction of eating disorder symptoms in the immediate term and were less likely to be rehospitalized 6 months after release.²

Another examination of ACT and eating disorders found that the method not only led to "large reductions" of eating disorder behavior but overall better cognitive functioning when compared with cognitive behavioral therapy (CBT), another popular treatment for eating disorders.⁴

Other research has indicated that those with more severe eating disorder symptoms showed a greater reduction of disordered behaviors when participating in acceptance and commitment therapy.⁵

Other therapies for eating disorders

Eating disorder symptoms are varied and specific to each individual. While ACT for eating disorders may be effective for some, it may not work as well for others—or work better when used alongside other approaches or treatment methods.

Some people may also benefit from participating in more than one of these therapies or pairing therapy of any kind with additional help from support groups and other programs. Nearly all of these approaches can also be applied to group or individual therapy environments and conducted in person or virtually.

Acceptance and commitment therapy at Within

At Within, we understand and appreciate that different people will benefit from different therapeutic approaches. That is why we bring together a team of experts with experience in several therapy techniques, including acceptance and commitment therapy for eating disorders.

Our virtual program allows patients from across the country to participate, and levels of care range from day programs to outpatient treatment, depending on patient needs. We can also provide additional help, such as specialized medical equipment sent through the mail and meal deliveries, to help make the road to recovery as smooth as possible.