When I sit down with an individual to do an eating disorder assessment, many of their thoughts and feelings are similar. “I am so anxious.” “I cannot eat carbohydrates.” “I feel so gross.” “The eating disorder is worse when I am alone.” Eating disordered thought patterns and “rules” are often rigid. The purpose of Acceptance and Commitment Therapy (ACT) is to increase an individual’s ability to be flexible in the way they think so that they are better able to live a full and meaningful life. ACT has six main principles that work together to increase an individual’s ability to be adaptable in the way that they react to challenging thoughts and emotions.
- Present-Moment Focus is about being able to notice experiences in the moment in order to decide what may be important to the individual. It is the opposite of having a specific or “rigid” focus. For example, an individual with an eating disorder may be at dinner with friends and are so consumed by thoughts about what they will order or how they can avoid the meal that they are completely unaware of the important conversation going on between their friends. This step of ACT would help the individual notice their thoughts and emotions about the meal and the conversation so they can decide what is the most important focus in that moment.
- Cognitive Defusion centers on an individual’s ability to have an experience without their thoughts and feelings dominating the event. An example may be, someone living with an eating disorder is being urged by a family member to seek professional help. Perhaps they feel ashamed because the eating disorder has thrived in secrecy. Their initial reaction may be to only focus on their sense of shame. Cognitive defusion, in this case, would be the ability to acknowledge their own emotions and thoughts, their family member’s concern, and the treatment options their family member is providing for them.
- Experiential Acceptance is the ability to experience positive and negative emotions, thoughts, and events without trying to avoid or change them. Instead of distracting from a painful emotion, an individual practicing experiential acceptance would let the feeling come without doing something to avoid or distract themselves from it. It does not mean enjoying the difficult parts of life, rather it is not allowing behavior to be driven by one’s own thoughts, emotions, or the actions of others. For someone with an eating disorder, this may look like the ability to acknowledge that they are experiencing self-doubt or negative body image without using an eating disorder behavior to cope with or avoid these thoughts.
- Self-As-Context is about increasing an individual’s self-awareness. It is the ability to take cues from one’s own values, desires, and thoughts rather than conforming to what they feel they “should” be doing, saying, or thinking. In a world that consistently provides messages on what is and is not considered attractive, this principle can be incredibly important – and difficult – in the recovery process. It is the ability to make food choices based on one’s true taste preferences rather than what an eating disorder is telling someone they “should” be eating. It is the ability to wear clothes that an individual finds fun and comfortable as opposed to what their eating disorder says is “acceptable” for their body type.
- Valued Living is the ability to choose actions that align with an individual’s values (perhaps family, education, friends, health). It is taking a long-term rather than a short-term view in terms of how one’s actions today will impact the things that are important to them down the road. In eating disorder recovery, this may be showing up to treatment every day in order to be well enough to attend college in the fall
- Committed Action is being able to identify when actions are not consistent with one’s values and make a change. It is not about governing oneself with specific rules about the way they will behave for the rest of time. It is being open to exploring how the way one behaves supports or undermines their values. This may look like helping an individual who values being a parent to explore how eating disorder symptoms are impacting their ability to be present with their children.
There are several excellent resources for providers seeking to integrate ACT into their work with clients living with eating disorders like anorexia nervosa. I recommend this text which provides insight in detail about how ACT can be utilized in eating disorder treatment.
If you are concerned that you or someone you love is experiencing symptoms associated with eating disorders, we are here for you.
Kara Foye, MS, is an adolescent clinician providing individual, family, and group counseling within Walden’s partial hospitalization and intensive outpatient levels of care at the Peabody clinic. She received her Master’s Degree from Salem State University in 2016. She incorporates ACT, motivational interviewing, and humor into her work with clients and families whenever possible. In her free time she enjoys reading, true crime documentaries, and hiking with her Boston Terrier, Sam.