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Acceptance and Commitment Therapy for Eating Disorders: A Process-Focused Guide to Treating Anorexia and Bulimia
A Process-Focused Guide to Treating Eating Disorders with ACT At some point in clinical practice, most therapists will encounter a client suffering with an eating disorder, but many are uncertain of how to treat these issues. Because eating disorders are rooted in secrecy and reinforced by our culture's dangerous obsession with thinness, sufferers are likely to experience significant health complications before they receive the help they need. Acceptance and Commitment Therapy for Eating Disorders presents a thorough conceptual foundation along with a complete protocol therapists can use to target the rigidity and perfectionism at the core of most eating disorders. Using this protocol, therapists can help clients overcome anorexia, bulimia, binge eating disorder, and other types of disordered eating. This professional guide offers a review of acceptance and commitment therapy (ACT) as a theoretical orientation and presents case conceptualizations that illuminate the ACT process. Then, it provides session-by-session guidance for training and tracking present-moment focus, cognitive defusion, experiential acceptance, transcendent self-awareness, chosen values, and committed action-the six behavioral components that underlie ACT and allow clients to radically change their relationship to food and to their bodies. Both clinicians who already use ACT in their practices and those who have no prior familiarity with this revolutionary approach will find this resource essential to the effective assessment and treatment of all types of eating disorders.
- GenresPsychology
312 pages, Hardcover
First published February 3, 2011
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Displaying 1 - 3 of 3 reviews
November 7, 2012
**ACT now!**
While traditional eating disorder therapy approaches focus on alleviating the symptomatic behaviors, ACT (Acceptance and Commitment Therapy) takes a refreshing alternative approach. The primary focus of ACT is to help the client understand the purpose of their eating disorder behaviors, and then help create ways to shift their life to be more in line with their chosen values:
"The goal in ACT for eating disorders is psychological flexibility with the purpose of facilitating valued living. ACT targets broad behavior change, not in the sense of reducing eating disorder symptoms but in the sense of changing the dominant functions of the behavioral repertoire. ACT is about shifting life towards the things an individual cares about. The therapeutic stance in act is about making a place for that shift to occur.... ACT therapists help clients to interact more effectively with the things in their lives that hurt the worst and the things that mean the most." (pp. 59-61).
The crux of making this shift is to help the client develop psychological flexibility--the ability to "actively and openly contact their ongoing experiences in the present moment as fully conscious human beings, without defense and as it serves their chosen values." (p. 17). In other words, "ACT focuses on building valued living in the present, without the world of the individual having to change." (p. 117)
With clear explanations and illustrative clinical applications, the book masterfully teaches the six clinical components involved in helping eating-disordered clients develop this psychological flexibility:
1. Present moment focus--employing flexible and focused attention to ongoing events
2. Cognitive defusion--experiencing an event fully in its complexity without emotions or cognitions about the event dominating the experience
3. Experiential acceptance--openly embracing one's experiences, both good and bad, without attempting to change them
4. Transcendent self-awareness--developing flexibility in contacting different ways of experiencing one's self, such that a sense of self that is separate from any particular experience emerges
5. Valued living--living in such a way so as to facilitate contact with chosen values
6. Committed action--noticing when actions are not consistent with values and then gently turning back to valued living
This is one of those books that is so well-written, that just a few sentences can succinctly capture the complexity of essential aspects of eating disorder experience. Case in point:
"Eating and other interactions with food come to be organized almost exclusively around avoidance, either of body image or other aversive experiences that are more salient, intense, or otherwise dominant in the moment. In this way, an individual might be highly likely to binge in one moment as self-doubts, anxiety, and painful memories are present, and far more likely to purge and restrict in the next moment as sensations of fullness, evaluations of her appearance, shame, and guilt become more salient and more intense...And as we sit with this individual, we are left with this question: what kind of learning history would account for this kind of narrowing from a full, rich experience of the self and the world to a life dominated by the aversive control exerted by food and the body?" (pp. 48-49)
So many passages of this book resonated deeply with me, and the respectful way that I like to practice therapy. This section, on viewing clients as sunsets to be witnessed and not math problems to be solved is my absolute favorite:
"Often, we clinicians buy into the problem-solving agenda our clients present with...We focus on the fusion problem or the avoidance problem...And, in doing so, no matter how true or effective our analysis is, no matter how much coherence or compassion it's founded in, we make our clients like a row of math problems. What if in treating someone like a math problem we offer little different than what the world has offered them or what they have offered themselves? The chance for behavior change becomes smaller and smaller as the context we create becomes more and more like the world they know, a world in which they are the problems to be solved.
There is an alternative position we find ourselves in from time to time. Sometimes we let go of the problem-solving agenda. We're compelled by something a client says or does and suddenly we take a step back from our conceptualization and plan. We notice the human being in front of us. Without any effort to assess or intervene, we lean in and simply witness. In these moments, the client is less like a math problem than a sunset.
Take a moment and imagine what would happen if we tried to experience a sunset by measuring the angle of the light refraction off the water molecules in the air. We gaze out at the horizon with our refractometer and our laptop and let the numbers crunch. We might end up with a correct analysis, but something would be lost. What if it is the same with our clients? What if we have something precious to gain by treating them as sunsets instead of math problems? What if we have something precious to gain by treating ourselves as witness instead of problem solvers?
In ACT, we assume that every client has something as lovely to share as a sunset, just waiting to be witnessed. We assume that if we take the posture of a problem solver, the client is likely to show up as a problem. If we take the posture of a witness, however, the client is more likely to show up as a sunset. We also assume that the more our clients are witnessed, the more likely they are to witness others in their lives. It may even be that the more sunsets we witness, the more likely we are to show up as a sunset in our own lives." (p. 62)
Refreshing, huh?
My recommendation for this book can be summarized in two words: ACT now!
While traditional eating disorder therapy approaches focus on alleviating the symptomatic behaviors, ACT (Acceptance and Commitment Therapy) takes a refreshing alternative approach. The primary focus of ACT is to help the client understand the purpose of their eating disorder behaviors, and then help create ways to shift their life to be more in line with their chosen values:
"The goal in ACT for eating disorders is psychological flexibility with the purpose of facilitating valued living. ACT targets broad behavior change, not in the sense of reducing eating disorder symptoms but in the sense of changing the dominant functions of the behavioral repertoire. ACT is about shifting life towards the things an individual cares about. The therapeutic stance in act is about making a place for that shift to occur.... ACT therapists help clients to interact more effectively with the things in their lives that hurt the worst and the things that mean the most." (pp. 59-61).
The crux of making this shift is to help the client develop psychological flexibility--the ability to "actively and openly contact their ongoing experiences in the present moment as fully conscious human beings, without defense and as it serves their chosen values." (p. 17). In other words, "ACT focuses on building valued living in the present, without the world of the individual having to change." (p. 117)
With clear explanations and illustrative clinical applications, the book masterfully teaches the six clinical components involved in helping eating-disordered clients develop this psychological flexibility:
1. Present moment focus--employing flexible and focused attention to ongoing events
2. Cognitive defusion--experiencing an event fully in its complexity without emotions or cognitions about the event dominating the experience
3. Experiential acceptance--openly embracing one's experiences, both good and bad, without attempting to change them
4. Transcendent self-awareness--developing flexibility in contacting different ways of experiencing one's self, such that a sense of self that is separate from any particular experience emerges
5. Valued living--living in such a way so as to facilitate contact with chosen values
6. Committed action--noticing when actions are not consistent with values and then gently turning back to valued living
This is one of those books that is so well-written, that just a few sentences can succinctly capture the complexity of essential aspects of eating disorder experience. Case in point:
"Eating and other interactions with food come to be organized almost exclusively around avoidance, either of body image or other aversive experiences that are more salient, intense, or otherwise dominant in the moment. In this way, an individual might be highly likely to binge in one moment as self-doubts, anxiety, and painful memories are present, and far more likely to purge and restrict in the next moment as sensations of fullness, evaluations of her appearance, shame, and guilt become more salient and more intense...And as we sit with this individual, we are left with this question: what kind of learning history would account for this kind of narrowing from a full, rich experience of the self and the world to a life dominated by the aversive control exerted by food and the body?" (pp. 48-49)
So many passages of this book resonated deeply with me, and the respectful way that I like to practice therapy. This section, on viewing clients as sunsets to be witnessed and not math problems to be solved is my absolute favorite:
"Often, we clinicians buy into the problem-solving agenda our clients present with...We focus on the fusion problem or the avoidance problem...And, in doing so, no matter how true or effective our analysis is, no matter how much coherence or compassion it's founded in, we make our clients like a row of math problems. What if in treating someone like a math problem we offer little different than what the world has offered them or what they have offered themselves? The chance for behavior change becomes smaller and smaller as the context we create becomes more and more like the world they know, a world in which they are the problems to be solved.
There is an alternative position we find ourselves in from time to time. Sometimes we let go of the problem-solving agenda. We're compelled by something a client says or does and suddenly we take a step back from our conceptualization and plan. We notice the human being in front of us. Without any effort to assess or intervene, we lean in and simply witness. In these moments, the client is less like a math problem than a sunset.
Take a moment and imagine what would happen if we tried to experience a sunset by measuring the angle of the light refraction off the water molecules in the air. We gaze out at the horizon with our refractometer and our laptop and let the numbers crunch. We might end up with a correct analysis, but something would be lost. What if it is the same with our clients? What if we have something precious to gain by treating them as sunsets instead of math problems? What if we have something precious to gain by treating ourselves as witness instead of problem solvers?
In ACT, we assume that every client has something as lovely to share as a sunset, just waiting to be witnessed. We assume that if we take the posture of a problem solver, the client is likely to show up as a problem. If we take the posture of a witness, however, the client is more likely to show up as a sunset. We also assume that the more our clients are witnessed, the more likely they are to witness others in their lives. It may even be that the more sunsets we witness, the more likely we are to show up as a sunset in our own lives." (p. 62)
Refreshing, huh?
My recommendation for this book can be summarized in two words: ACT now!
June 6, 2017
A must read for therapists!
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April 30, 2025bueno, sin más
Displaying 1 - 3 of 3 reviews