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Three ACT Concepts to Integrate into Therapy for Clients with Eating Disorders

Posted on May 05, 2016 by StayConnected

Giulia Suro_PhD_Primary TherapistPrimary Therapist Giulia Suro, PhD shares three specific strategies that can be integrated into the therapy process. In her post, she explains how Acceptance and Commitment Therapy (ACT) can be a useful approach to help clients with eating disorders.

Acceptance and Commitment Therapy (ACT) is a creative, mindfulness-based therapy that hinges on acceptance and values-driven action. You do not need to be well-versed in the theory of ACT to integrate ACT techniques in to every day sessions. Below are three core concepts to ACT that can be brought in to therapy when you might feel like changing things up.

Functional Contexualism, or, “How did this serve you?” Imagine a chair that has a leg that gives out every time you sit on it. What words would you use to describe this chair? Broken? Faulty? Garbage? What if this chair was being used as an educational tool in a furniture-making class? Or as prop in a circus act? In these contexts, the chair would be serving its purpose, or function, perfectly well. Eating disorders also serve a function in the specific context each individuals’ life. This may be to provide a sense of control, safety or distraction. Yet, our clients are very quick to label their own behavior as dysfunctional or wrong. Focusing on the function of behaviors given their context can shift clients to examine their eating disorder from a more compassionate stance and help them move away from guilt and self-blame.

Experiential Avoidance, or, “Feelings won’t kill you.” Eating disorders, like most mental disorders, are characterized by avoidance. This may be avoidance of specific foods, settings, people and often life in general. From an ACT perspective, it’s truly not the external stimuli that are being avoided. Instead, it is how these things make us feel internally. Family therapy would not be difficult if it did not bring up feelings of anger or guilt. Fear foods would not be threatening if they did not incite terror or disgust. In this way, acts of avoidance are really an attempt to escape some internal experience. From this framework, discussions about exposure can center on the emotions that are truly at the heart of avoidance.

Defusion, or, “You are not your thoughts.”A common frustration in the recovery process is that eating disorder thoughts continue to persist despite progress being made. This can be scary and discouraging. When this comes up, ACT offers the skill of defusion. When we defuse from our thoughts, we see them from an objective stance and are better able to hold them lightly. A quick exercise in defusion entails identifying a powerful thought such as “I’m worthless,” and noticing how it feels to buy in to it. Adding the phrase “I’m having the thought that..” to the beginning of the sentence (“I’m having the thought that I am worthless”) immediately provides some space and allows us to and observe the thought from a distance. While the thought itself doesn’t change, we decrease its power and increase our clarity.

 

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