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Acceptance and Commitment Therapy Is an Important Component of Eating Disorder Treatment

Eating disorders are relatively widespread forms of mental health conditions that affect millions of people. Even though the usual perception of these disorders is that they are rare and only afflict certain demographics, they are present in every race, gender, and age group. They also tend to be more common than is normally expected.

For example, bulimia nervosa affects  almost two percent of adult women in the United States at some point in their lives. The most common kind of eating disorder, binge eating disorder affects 3.5 percent of women, 2 percent of men, and 1.6 percent of all adolescents. As with any kind f mental health disorder, eating disorders have no quick fix or easy cure. Each of these disorders can become deeply ingrained in their sufferers’ states of mind and day-to-day routine, requiring special methods of treatment to correct behaviors and rehabilitate the person’s relationships with food and eating.

What Does Eating Disorder Treatment Look Like?

In general,treatment for eating disorders consists of medical stabilization (if necessary) for physical symptoms caused by the eating disorder, followed by psychiatric/psychological treatment and nutrition training. For this article, we’ll focus on the psychological techniques used to help individuals rediscover their recovered selves, but each segment of treatment is essential to a full recovery. Among the primary components of a well-balanced recovery program are evidence-based eating disorder treatment methodologies.

The most well-established technique (aside from standard talk therapy) used in eating disorder treatment is cognitive behavioral therapy (CBT). Most traditional talk therapy explores the individual’s past experiences, emotions, and reactions to these, but CBT and its offshoots are more focused on identifying and altering behavioral responses. The core of CBT is understanding that thinking patterns can become distorted and unhelpful – and that these thinking patterns can be corrected through practice and mindfulness. The client and therapist first work to identify which thoughts are disordered or otherwise hurting the client, then learn to accept those thoughts without acting on them. Better coping strategies can then be learned and applied to a variety of situations.

Another form of behavioral therapy specifically applied to eating disorder patients is dialectical behavioral therapy (DBT). An offshoot of CBT, DBT was developed in the 1970s to help individuals cope with intense emotions, particularly negative ones. “Dialectical” refers to the concept of combining opposite ideas. This makes it especially effective in rehabilitating negative/distorted thinking about body image and food intake. Body image distortions are prime contributing factors in anorexia nervosa, bulimia nervosa, and binge eating disorder, making DBT a commonplace treatment strategy for these disorders. Both DBT and CBT involve structured sessions and “homework” designed to help the individual focus on awareness of their unhelpful thinking and replace it with healthier patterns.

The Role of Acceptance and Commitment Therapy in Eating Disorder Recovery

As established forms of therapy such as dialectical behavioral therapy and cognitive behavioral therapy have been accepted into the mainstream of treatment, acceptance and commitment therapy (ACT) has become one of eating disorder therapists’ most prominent tools. A focused psychotherapeutic technique, ACT helps participants learn to rationally evaluate and accept negative or flawed emotions, without acting on them. Being able to feel emotions and accept them without acting on them is part of mindfulness training, one of the core components of serious mental health treatment.

When u in treating eating disorders (and many other kinds of psychiatric illnesses), ACT introduces treatment clients to the concept of “creative hopelessness,” which is the act of stepping back rationally and seeing that the disordered behaviors like binge eating episodes or food restriction do not alleviate feelings of anxiety, but instead keep them going in a continuing pattern.

For example, a therapist using ACT might point out that despite their client’s distorted thinking that they areoverweight, by medical definitions they are underweight – and it’s beginning to affect their health (this is commonly seen in cases of anorexia nervosa). They then progress to identifying the reasons they are attempting to lose weight. ACT  is geared toward understanding how distorted thinking perpetuates itself; by showing a client that struggling to control or repress distressing emotions, they, in reality, continue those emotions.

Inducing “creative hopelessness” helps the individual in treatment rationally assess their actions and thoughts. As a form of behavioral therapy, acceptance and commitment therapy also integrates well with self-monitoring like guided meditation, journaling, and art/music therapy. Anything that helps an individual gain a new perspective and understanding of their emotions and thought patterns can be part of this discipline.

ACT can also inspire individuals to more actively take part in their recovery program. People with eating disorders often become emotionally attached and dependent on their behaviors as a coping mechanism for negative thoughts and emotions.They must overcome a certain resistance to change. For many people with eating disorders, the disordered behaviors, n matter how harmful, are a method of dealing with anxiety, depression, and particularly PTSD. By applying a rational look at these factors, ACT can break this cycle of resistance to change.

How Mindfulness Is Used in Acceptance and Commitment Therapy

Mindfulness bridges the gap between therapy and spirituality for millions of practitioners. It is the act of maintaining a focused awareness of the moment, ignoring the distracting thoughts that run through the mind at all times, and simply experiencing emotions. Recovery programs often teach their clients how to be mindful by using evidence-based techniques that help increase awareness of the senses while staying in touch with “in the moment” emotions.

Mindfulness training can be done in therapy sessions – CBT and DBTboth foreground being able to experience and understand emotions without acting on them – or on your own. Meditation, guided or solo, as well as practices like yoga and tai chi, can facilitate mindfulness. Yoga in particular promotes awareness and connectivity between the body, mind, and spirit. ACT uses the clarity and detachedness regarding our feelings that come from mindfulness techniques to help isolate disordered behaviors and replace them with more healthful ones.

Mindful awareness is an important part of replacing harmful thoughts and behaviors that result from, any mental health condition including the majority of eating disorders. For example, individuals are taught to recognize negative thoughts like “Everyone thinks I am too fat” and alter them to something more detached like “I am having a thought that people think I am fat.”

This cognitive exercise separates the individual from the self-focused aspect of negative thoughts and allows them to re-center the reactions to more healthful alternatives. Therapists might use mindful meditation techniques when anxiety arises during treatment – to breathe deeply and use mindfulness techniques to be aware of the anxiety without succumbing to it.

Seeking Treatment That Works for You

Eating disorder treatment programs available in residential or day treatment not “settings as well as virtual programs conducted entirely online (provided there is no need for concurrent medical treatment). Modern treatment programs are not “cookie-cutter.” Instead, they will contain individualized treatment plans, including ACT, to match each client’s unique needs for recovery. If you or someone you know is suffering from an eating disorder, call today to learn more about getting help for bulimia nervosa, anorexia nervosa, binge eating disorder, and all other types of eating disorders.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.