ACT for eating disorders and body image: A mindful approach

Acceptance and commitment therapy (ACT) is a powerful, evidence-based approach gaining recognition for its effectiveness in treating psychological difficulties, especially eating disorders and body image dissatisfaction. Unlike traditional therapies, ACT focuses on mindfulness and behavioural changes, emphasising acceptance, cognitive defusion, and committed action.

Understanding eating disorders and body image dissatisfaction

Eating disorders like anorexia nervosa, bulimia nervosa, and binge-eating disorder involve unhealthy eating habits and intense anxiety about body weight and shape. Body image dissatisfaction, a common feature of these disorders, means having persistent negative thoughts and feelings about one’s appearance. This can lead to harmful behaviours and a lower quality of life.

Traditional treatments aim to change negative thoughts and behaviours, but they don't always work for everyone. That’s where ACT comes in, offering a new way to achieve psychological flexibility and live according to one’s values.

Core principles of ACT

Acceptance and commitment therapy is based on six key processes designed to help individuals develop psychological flexibility – staying present despite unpleasant thoughts and feelings, and taking actions that align with personal values.

Acceptance

In ACT, acceptance means embracing unwanted thoughts and feelings about body image without trying to change them. It doesn’t mean liking these thoughts or feelings but rather stopping the resistance against them and acknowledging their presence.

Cognitive defusion

This helps individuals distance themselves from their thoughts and reduce their impact. For example, instead of thinking “I am fat,” one can reframe it as “I am having the thought that I am fat,” which weakens the thought’s power.

Being present

Mindfulness techniques help individuals stay connected to the present moment, breaking the cycle of rumination and worry common in eating disorders and body image issues.

Self-as-context

This principle helps individuals see themselves as separate from their thoughts and feelings, fostering a consistent sense of self despite changing internal experiences. Individuals with eating disorders often struggle to know who they are outside of their disorder. This approach helps them recognise that their identity is more than their eating disorder and promotes a more stable sense of self.

Values

Identifying and connecting with deeply held values helps create a meaningful life. For someone with an eating disorder, this might mean recognising values related to health, relationships, and personal growth.

Committed action

This involves taking steps toward valued goals despite obstacles, encouraging behaviours that align with personal values, leading to a more fulfilling and healthier lifestyle.

How ACT helps with eating disorders and body image

ACT helps individuals move away from trying to control or eliminate negative thoughts and emotions. Instead, it promotes accepting these internal experiences and committing to actions aligned with one’s values.

For example, someone with bulimia nervosa might feel intense shame and guilt after bingeing and purging. ACT teaches them to accept these feelings without letting them dictate behaviour. By identifying values like health and well-being, they can take action toward these values, such as seeking support from a therapist or nutritionist, rather than engaging in self-destructive behaviours.

Research and effectiveness

Research shows ACT is effective in treating eating disorders and body image dissatisfaction. A 2020 meta-analysis in behaviour therapy found ACT significantly improved eating disorder symptoms and body image compared to other traditional treatments. The acceptance-based approach is particularly effective in reducing internal struggles and fostering healthier relationships with food and body image.

Acceptance and commitment therapy offers a promising alternative to traditional treatments for eating disorders and body image dissatisfaction. By fostering acceptance, mindfulness, and values-driven behaviour, ACT helps individuals develop a more flexible and compassionate relationship with their thoughts and feelings. This, in turn, can lead to significant improvements in mental health and quality of life. As research continues to support its effectiveness, ACT stands out as a valuable tool in the therapeutic landscape for these challenging conditions.