Various psychotherapeutic approaches are used in the treatment of eating disorders. Since these disorders are so complex and multifaceted, there is no one-size-fits-all approach. One of the newer theoretical approaches that can be implemented in treating eating disorders is Acceptance and Commitment Therapy, or ACT. Just as the name suggests, ACT, developed by Steven Hayes, is an intervention in which clients are guided to compassionately find acceptance around themselves, their circumstances, and their internal experiences, while also taking steps towards a meaningful life better suited to their wellbeing and values.
I recently attended a presentation about ACT and watched a live demonstration of this approach implemented in a mock therapy session. I’ve used bits and pieces of this style with clients who struggle with eating disorders, and this event helped me further evaluate ways I can integrate this intervention with clients trying to recover. I feel inclined to share some of these ACT techniques, in hopes that someone who is struggling could find some solace in these tools.
ACT is based on six core processes that make up what’s known as the hexaflex model. All of these components are an integral part of the therapy overall and in relation to treating eating disorders, specifically. I will elaborate on two of these components and how they can be applied as recovery tools.
This is a core process in which the individual who is experiencing thoughts, feelings, images, or memories becomes a witness or observer to them, rather than becoming entangled in them. It’s a way to approach your internal experiencing by noticing, rather than being, your thoughts or feelings. The goal of this process is to both experience the thought or feeling, while also giving yourself some space to be aware of them, rather than engulfed or consumed by them. Defusion helps you stay present in what you’re experiencing and also allows you a more detached or objective standpoint where challenging cognitions or emotions are not so impairing.
Some common components of an eating disorder are the ruminations, obsessions, and consuming thoughts that one might experience. These can be debilitating and may plunge the person into acting out an eating disorder behavior (restricting, binging, purging, etc.) in order to find some relief from these internal processes. For instance, some common eating disorder thoughts are the following:
- “I need to lose weight.”
- “I’m so stressed and need to binge.”
- “I’m disgusting.”
Using cognitive defusion can help address these painful experiences and the impact they may have. One way to do this is to employ the “I notice” technique, where you reframe your thought, feeling, or memory to state that you are noticing it, rather than identifying with it, or becoming it. For instance:
- “I’m noticing an urge to lose weight.”
- “I’m noticing feelings of stress and an urge to binge.”
- “I notice feelings of self-disgust.”
This manipulation in words and meaning helps the individual observe and become aware of their process, rather than succumb to it.
Another foundational process in ACT is acceptance – the act of being vulnerable and allowing your experience of uncomfortable feelings, thoughts, sensations, urges, and memories. Through this practice, you give permission to these types of discomfort to run their course, rather than try to resist, avoid, defend against, or succumb to them. When we accept, we don’t have to want, like, desire, or agree with whatever we are giving space to, but are just providing time and room for them to show up and be as they are.
Acceptance is an inevitable and transformational component for someone who wants recovery from an eating disorder. Many refuse or have a hard time with treatment because they are rebelling against the idea of acceptance. Instead, the individual’s time and energy is poured into fighting, resisting, changing, or avoiding, whether this involves lacking acceptance around certain emotions, cognitions, sensations, behaviors, imperfections, body changes, traumas, or other types of distress. Practicing acceptance is a gradual skill and takes time and patience to develop. Learning to integrate this earlier on in recovery can be monumental. Here are some ways you can implement acceptance during your path of eating disorder recovery:
- Accept that although your eating disorder behaviors initially served a function for you, that they are no longer serving or working for you.
- Accept that body changes are a natural process of living.
- Accept the anxiety you might feel when trying various fear foods.
- Accept that you need help.
- Accept that you, and all other human beings, are imperfect.
- Accept feelings of sadness that you are experiencing (or whatever emotion is coming up for you).
The resistance and defensiveness against the circumstances, memories, thoughts, and feelings in one’s life can be some of the most painful parts of an eating disorder or other mental disorder. Allowing these painful processes the space to show up and working through them can ultimately bring you relief and loosen the reigns of an eating disorder.
Bahar Moheban, M.A. is a clinical psychology doctoral candidate and registered psychological assistant in Torrance under the supervision of Dr. Nazanin Moali. She provides individual therapy and facilitates a Body Image Group for adults and adolescents with disordered eating, body dissatisfaction, and comorbid disorders. If you are struggling with compulsive exercise or any other type of disordered eating, contact Bahar for a counseling appointment to repair your relationship with food, body image, and movement.