While ACT can help alleviate eating disorder symptoms, that’s not necessarily the immediate goal of the program. Instead, ACT works to help foster a mindset of acceptance, which can improve someone’s quality of life to the point where they no longer use eating disorder behaviors as a coping mechanism. This makes ACT a great choice for supporting long-term recovery and an overall sense of well-being.
What Is ACT?
Acceptance and commitment therapy is distinctive from popular therapeutic techniques based on cognitive behavioral therapy (CBT), which teaches patients how to recognize and redirect unhelpful thoughts. Instead, ACT operates on the philosophy that negative emotions and experiences are a natural part of life’s ebb and flow.2
Refocusing
According to ACT, it’s not the experiences themselves that are problematic, but rather the focus on them. Even attempting to avoid thinking about something is a form of spending energy on it in this teaching. Instead, patients are encouraged to let these feelings go and to use their energy to focus on committing to and creating positive change.2
To aid them in this transition, ACT teaches patients the tenets of mindfulness and other strategies to help them separate their sense of self and self-worth from their thoughts, feelings, and memories.2 The hope is to allow patients to be less defined by negative experiences and see and accept themselves as a whole.
Commitment
Equally important is the “commitment” aspect of ACT. At this stage of therapy, patients are encouraged to define their values—things like family, community, health, friendship, work, and spirituality—and develop patterns of behavior that are consistent with these values.2 The idea is to help them build a better, more fulfilling life that will help sustain a healthier perspective long-term.
When Is Acceptance and Commitment Therapy Used?
Acceptance and commitment therapy is a helpful tool for those who use emotional avoidance and/or controlling behaviors as maladaptive coping mechanisms.3 These issues can help power eating disorders and a number of other mental health conditions, such as anxiety, depression, and obsessive-compulsive disorder (OCD).
Avoidance generally refers to an unwillingness to address upsetting matters, usually through behaviors that temporarily relieve these feelings but eventually take a powerful and negative toll on the psyche.4 Controlling tendencies are also frequently problematic and can contribute to cognitive rigidity or trouble with or the inability to adapt to change.5
ACT helps combat both of these issues head-on. Encouraging patients to accept their troubling thoughts forces them to acknowledge them in a way that avoiding behaviors does not. Mindfulness and other strategies taught through acceptance commitment therapy help create cognitive flexibility, or the ability to change more adeptly to meet one’s needs.4
Still, ACT is not designed to address the specific symptoms of a mental health disorder. Though it’s been found to help reduce symptoms, it’s generally used alongside other types of therapy that more specifically target these issues, especially when dealing with something as complex as an eating disorder.4
Acceptance Commitment Therapy and Eating Disorders
In the case of helping someone with an eating disorder, ACT may be most helpful when the patient is using avoidance behaviors or exhibiting cognitive rigidity in their thoughts or actions. It may also be a good choice for patients who simultaneously struggle with anxiety or depression, as ACT has been found to help ease symptoms of these conditions.1
Mindfulness techniques, like the ones taught in ACT, have been found to help reduce eating disorder behaviors.6 Focusing on values like family, community, and friendship can help reduce self-isolating behaviors that can also maintain disordered eating. Overall, the approach can help instill thoughts and behavior that can help someone maintain long-term recovery.
Still, eating disorders are complex conditions that impact not only mental but physical and emotional well-being. It’s important for patients to have comprehensive treatment. ACT may help someone with certain aspects of recovery, but a patient may also benefit from nutritional therapy, group therapy, medication, or other psychotherapy techniques to help directly address their eating disorder behaviors.
How Does Acceptance Commitment Therapy Work?
Acceptance and commitment therapy is based on six core ACT processes. These tenets are central to the healing process promoted by this type of therapy.2
Disordered eating behaviors are often a coping mechanism people use to gain a sense of control over their lives after experiencing trauma or to avoid distressing thoughts, feelings, memories, or sensations. This is why ACT can be so helpful in combating eating disorder behaviors.
By learning to accept negative thoughts and feelings rather than avoid them, you can “let go” of the hold that these experiences have on you. This can, in turn, help you let go of the maladaptive coping mechanisms you’ve had in place to sustain your experiential avoidance.
Sometimes, separating our sense of self from our thoughts and experiences can be difficult. Cognitive defusion, which is one of the six core processes of ACT, attempts to help patients understand that thoughts are just thoughts and that they are separate from themselves.
People with eating disorders often bind their negative perceptions about their body, weight, and food to their sense of self. “My body is too big, and therefore I am bad,” a cognitively-fused thought might go.
On the other hand, cognitive defusion is a concept in which people view themselves as autonomous entities visited by thoughts of all kinds. This can help you start to view your unhelpful thoughts more objectively and begin the process of acceptance.
Through defusion, a mental health professional can help you start to examine or question self-destructive beliefs. In essence, the goal is for negative thoughts, when they do occur, to be seen for what they are: unhealthy ideas skewed by one’s own perception and separate things entirely from your self, value, or worth.
“Self-as-context” is an idea closely related to defusion.
People with eating disorders often closely tie their sense of self, as in who they believe they are, with their disordered eating behaviors. They may identify as their disorder, and some people may even view quitting disordered eating behaviors as giving up an important part of themselves, even if they are aware on some level that they need help.
Part of ACT is helping to give you an identity outside of your eating disorder. A “contextual self” is built, where you start to develop other aspects of your personality that don’t involve food, eating, or disordered behaviors.
This can help someone understand that the thoughts and feelings related to their eating disorder don’t have to be important to who they are and that they can be a full, valuable individual outside their disorder.
Acceptance and commitment therapy helps people develop present-moment awareness, sometimes called present-moment focus.
Based on many of the tenets of mindfulness, this skill helps you stay open and aware of everything you’re experiencing in the present moment, including sensory experiences and thoughts.
By practicing present-moment focus, you can observe your own thinking patterns and see how all kinds of thoughts come and go over any given time. This can help you learn to perceive your thoughts from a distance, view them more objectively, and detangle your sense of self from them.
Even if unhealthy or illogical thoughts and feelings occur, by practicing present-moment awareness, you are more prepared to identify these thoughts and feelings as unhelpful or illogical. Once you have a better view of these patterns, you can begin to identify potential triggers and channel unhealthy thoughts and feelings in healthier, more productive ways.
One element of ACT is helping patients identify and develop a strong sense of personal values.
Many people with eating disorders center their value system on the ideas of body weight, shape, and size, eating (or not eating) a certain way, or successfully practicing other types of disordered behavior.
By working to disengage your sense of self from negative thoughts and eating disorders, acceptance and commitment therapy can help you see how your values may have become skewed. This then frees you up to create a new and healthier set of life values, which can revolve around causes or traits that are important to you.
Committed action is often the final step of acceptance commitment therapy.
This core tenet is about helping patients actively incorporate the lessons they learn in therapy into their lives. It asks you to commit to the positive changes you’re working on and to continue seeking more avenues for positive growth.
As a patient, you may be asked to think about causes or activities you identify with and then find ways to participate in them. Your therapist could coach you in setting healthy goals for the future or give other strategies for skill development.
When embraced in earnest, the committed action aspect of ACT can help you maintain long-term recovery by dedicating yourself to lasting positive changes.
What to Expect with ACT
When participating in acceptance and commitment therapy, you can expect to work with a mental health professional to start processing thoughts, feelings, and memories you may typically not want to think about.
This process can feel uncomfortable or stressful, but it’s an important aspect of how ACT works. The idea is not to bombard you with negative feelings but to go at a pace and intensity that will be helpful overall, giving you a safe way to process difficult things.
Mindfulness
You will likely also learn and practice tenets of mindfulness during these sessions. This could involve breathing techniques or other practices designed around tuning into the present moment and gaining a sense of separation from your thoughts.
Goals
Your therapist will likely also help you flesh out any goals or interests you may have, separate from those connected to your condition. They may encourage you to look into any activities or organizations that support these interests or goals and encourage you to start participating in these activities.
How Effective Is Acceptance & Commitment Therapy?
Research on the best ways to treat eating disorders is ongoing, and there have been few studies that look specifically at acceptance commitment therapy, especially over long periods of time.
One study measured ACT’s effectiveness against other types of treatment for a group of 77 women and found the method to be more helpful, with the results more pronounced in younger participants who had less previous treatment and lower ratings of depression.7
Other studies don’t look at ACT as a whole but may examine different tenets of acceptance commitment therapy. For example, mindfulness, which is taught as part of ACT, has been more heavily studied than ACT, and the concept is linked to reduced eating disorder behavior, especially in younger patients.6
Overall, acceptance and commitment therapy is generally thought to work best as a complementary therapy to more traditional eating disorder treatments, like cognitive behavioral therapy. Particularly, the focus on creating and enacting positive change may benefit someone later in their recovery journey.
Finding Help for an Eating Disorder
If you or a loved one are struggling with disordered eating behaviors, it’s important to seek help.
These conditions can be dangerous or even deadly if untreated. The sooner help is sought, the more long-term physical and emotional damage can be avoided.
If you don’t know where to look for help, you can talk to your physician, therapist, or another trusted medical professional. They can point you in the direction of a program or offer other advice on the next steps.
A number of eating disorder hotlines can also help provide you with further information or resources.
Eating disorders can be difficult to overcome, but recovery is always possible. Taking the time to look for help can be the first step on the journey to recovery.
Resources
- Onnink CM, Konstantinidou Y, Moskovich AA, Karekla MK, Merwin RM. (2022). Acceptance and commitment therapy (ACT) for eating disorders: A systematic review of intervention studies and call to action. Journal of Contextual & Behavioral Science; 26:11-28.
- Fung K. (2014). Acceptance and Commitment Therapy: Western adoption of Buddhist tenets? Sage Journals; 52(4).
- Manlick CF, Cochran SV, Koon J. (2012). Acceptance and Commitment Therapy for Eating Disorders: Rationale and Literature Review. Journal of Contemporary Psychotherapy; 43:115-122.
- Dindo L, Van Liew JR, Arch JJ. (2017). Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. Neurotherapeutics; 14(3):546–553.
- Gabrys RL, Tabri N, Anisman H, Matheson K. (2018). Cognitive Control and Flexibility in the Context of Stress and Depressive Symptoms: The Cognitive Control and Flexibility Questionnaire. Frontiers in Psychology; 9:2219.