Acceptance and Commitment Therapy (ACT)
ACT is part of what is considered a “third generation” of behavioral therapies designed to help clients commit to behavioral change and manage emotions. Coming on the heels of Cognitive Behavioral (CBT) and Dialectical Behavior (DBT, also part of the third generation) therapies that focus on behavior change as an eventual catalyst for attitude change, ACT challenges clients to choose different behaviors DESPITE distressing emotions that may be present. ACT stands for Accept, Choose, Take action. According to Marcia Herrin EdD, MPH, RD, LD (2012), ACT functions on the guiding principle of “Change what you do, not what you think or feel.” Research has shown that ACT therapy can be beneficial for clients who struggle with substance abuse, mood disorders, history of abuse, trauma, and obsessive compulsive disorder. While research on how ACT would benefit eating disorder treatment is less plentiful, it can be helpful for teaching clients how to reduce avoidant behaviors and begin to live fully again.
Acceptance
This is probably one of the most difficult things to do when things are going awry in life. We want to be treated fairly, to not suffer, and to get what we want. Unfortunately, we will not always move through life unscathed. Eating disorders can develop out of a need to cope with what is too overwhelming to process. In the absence of resources to manage distressing situations or emotions, the eating disorder can become more entrenched as time goes on.
Claudia Dewane, LCSW, DEd (2008) describes accepting and facing situations as “creative hopelessness.” In other words, clients can take what they’ve tried in the past and evaluate it while leaving space for new ideas and techniques. This may leave the client floundering a bit, wondering what to do now when previous attempts have been deemed fruitless. Accepting the situation and also accepting the feelings and thoughts that accompany it, rather than avoiding feelings or refusing to accept, the client can move toward creative solutions.
Changing Direction
With the guidance of identifying values and cognitive restructuring techniques, clients can begin to CHOOSE what approach they will take to a situation. For example, clinicians can work with their clients on cognitive defusion, which helps to demonstrate that the thoughts and emotions that come up when faced with a situation are just that- thoughts and emotions- and not necessarily the reality. Identifying values helps the client further with ACT tasks by helping to tailor behavior changes to the values that govern the client’s live and give it meaning. Actions based in values are meaningful and can create lasting change.
The Truth About Acceptance and Commitment Therapy
With acceptance of the situation and a plan for change based on values and steeped in newfound clarity of thought, action can take place. In eating disorder recovery, action can be challenging. It involves letting go of the eating disorder and taking action using newfound skills. This is going to feel strange and likely produce anxiety. Avoiding this anxiety, avoiding change, will delay recovery and potentially compound the eating disorder.
ACT therapy is not meant to be a long-term therapy, but with a comprehensive treatment approach that includes therapy, nutrition, medical care, and even group work, it can be a helpful behavioral intervention for clients who need help moving beyond their challenging situations.
Sources
Herrin, M. (2012). The New Alphabet Soup of Eating Disorder Treatment. Psychology Today;
Dewane, C. (2008). The ABCs of ACT: Acceptance and Commitment Therapy. Social Work Today;