Utilizing Acceptance and Commitment Therapy for Eating Disorders

Acceptance and commitment therapy (ACT) is a type of psychotherapy commonly used to help people struggling with eating disorders of all types, including bulimia nervosa (BN), binge eating disorder (BED), and more.

Acceptance and commitment therapy

The practice involves learning to recognize, confront, and accept negative thoughts, feelings, and memories, as opposed to suppressing or redirecting them, which is taught in other types of therapy. Patients are then taught to separate their sense of self and self-worth from these thoughts, feelings, and memories, which hopefully allows them to be less defined by negative experiences and see and accept themselves as a whole.

While ACT can help alleviate eating disorder symptoms, that’s not necessarily the immediate goal of the program. Rather, 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 operates on the philosophy that negative emotions and experiences are just another part of life. And it’s not the experiences themselves that are problematic, per se, as much as the focus on them.

Patients are guided on how to stop struggling against or actively ignoring unpleasant thoughts and feelings. Even attempting to avoid thinking about something is a form of spending energy on it, ACT advises.

Instead, patients are encouraged to let these feelings go, accepting that they are part of the good, bad, and ugly of life, and to use that energy instead to focus on committing to and creating positive change.

This type of therapy isn’t just helpful for treating eating disorders. As ACT can help a person come to terms with difficult feelings, it can also help someone with processing trauma.

Even if their unpleasant feelings still occur, patients can learn how to live with them and still live a meaningful life with the help of acceptance and commitment therapy.

When Is ACT Used?

Acceptance and commitment therapy is generally a helpful tool for people who have experienced trauma or other negative events and for those who may fixate on unhelpful thoughts. It can be used to help with anxiety, depression, and OCD, as well as eating disorders. [1]

A relatively common response to difficult feelings or experiences is to essentially “deaden” oneself to them, trying to act as though they don’t exist and just generally growing more emotionally numb.

This unwillingness to address the matter is sometimes called experiential avoidance, and it can have a powerful and negative toll on the psyche, preventing someone from processing how they feel and making it more difficult for them to experience positive emotions.

ACT works to help someone fully realize these emotions instead, work through their pain, and then let it go while redirecting their focus on building healthier routines that reflect their life values.

Body image

Acceptance Commitment Therapy for Eating Disorders

In the case of helping someone with an eating disorder, ACT may be recommended if the patient’s disordered eating behavior seems to stem from trauma or if they fixate on negative body image or other unhelpful thoughts.

A mental health professional, in these cases, won’t ignore the fact that some experiences and thoughts can be harmful. But they also won’t encourage a patient to act as though these feelings or experiences didn’t or don’t exist. 

Indeed, addressing—and then working on accepting—these thoughts and situations is the key to stopping these painful feelings, ACT advises. By processing feelings, a patient can break the negative cycle.

How Does It 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 for avoiding 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, a patient can “let go” of the hold these experiences have on them. This can, in turn, help them let go of the maladaptive coping mechanisms they’ve had in place to sustain their experiential avoidance.

Sometimes, it can be difficult to separate our sense of self from our thoughts and experiences. 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, food, and their inability to achieve a certain weight 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 which are visited by thoughts of all kinds. This can help them start to view their unhelpful thoughts more objectively and begin the process of acceptance.

Through defusion, a mental health professional can help a person 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 one’s 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 someone an identity outside of their eating disorder. A “contextual self” is built, where a person starts to develop other aspects of their personalities that don’t involve food, eating, or their 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 a person develop present-moment awareness, sometimes also called present-moment focus.

Based on many of the tenets of mindfulness, this skill helps people stay open and aware of all the things they’re experiencing in the present moment, including sensory experiences and thoughts.

By practicing present moment focus, someone can start to observe their own thinking patterns and see how all kinds of thoughts come and go over any given time. This can help them learn to perceive their thoughts from a distance, view them more objectively, and start to detangle their sense of self from them.

Even if unhealthy or illogical thoughts and feelings occur, someone practicing present moment awareness is more prepared to identify these thoughts and feelings as unhelpful or illogical. Once someone has a better view of these patterns, they 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 someone’s sense of self from their negative thoughts and eating disorder, acceptance and commitment therapy can help someone see the ways in which their values may have become skewed. This then frees them up to create a new and healthier set of life values, which can revolve around causes or traits that are important to the person.

Committed action is often the final step of acceptance commitment therapy.

This core tenet is about helping a patient actively incorporate the lessons they learn in therapy into their life. Put another way, it asks the patient to commit to the positive changes they’re working on and to continue seeking more avenues for positive growth.

A patient may be asked to identify causes or activities they identify with, then find ways to participate in them. They could be coached by their therapist in how to set healthy goals for the future or given other strategies for skill development.

When embraced in earnest, the committed action aspect of ACT can help people maintain a long-term recovery by dedicating themselves to lasting positive changes.

What to Expect

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 normally 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.


You will likely also learn and practice tenets of mindfulness during these sessions. This could involve breathing techniques or other practices designed around tuning in to the present moment and gaining a sense of separation from your thoughts.


Your therapist will likely also help you flesh out any goals or interests you may have separate from 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?

While research is ongoing, there have been some studies conducted on acceptance and commitment therapy’s effectiveness in treating eating disorders.

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. [3]

Still, authors noted the promise of ACT, despite the complicating factors involved in the study.

Overall, acceptance and commitment therapy is regarded as most effective when used after an initial, more traditional form of eating disorder treatment, such as cognitive behavioral therapy (CBT). The focus ACT has on mindfulness and positive change may complement the later part of someone’s 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. And the sooner help is found, 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 may be able to 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.


  1. Acceptance and Commitment Therapy. Psychology Today. Retrieved February 8, 2023.
  2. Applying ACT to Eating Disorders: Why It Works. PraxisCET. Retrieved February 8, 2023.
  3. Fogelkvist, M., Aila Gustafsson, S., Kjellin, L. et al.  (2022). Predictors of outcome following a body image treatment based on acceptance and commitment therapy for patients with an eating disorder. Journal of Eating Disorders; 10(90).

Last Update | 03 - 10 - 2023

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