Imagine a kind of eating disorder treatment where how many times you binged or purged, or how much weight you gained this week, or how well you stuck to your meal plan was not important.
Imagine that instead, what mattered is how well your actions throughout the week were in service to your true values. Those could include improving family relationships, imagining yourself in a committed, loving relationship, or getting back to school or work. Imagine what it would be like if your primary focus was to reject actions that serve your eating disorder: engaging in “fat talk” avoiding social events involving food, or keeping your eating habits secretive, for example.
This, in a nutshell, is the heart of a therapeutic approach called ACT, which stands for Acceptance and Commitment Therapy. I’ve written about it before, but it’s been gaining new supporters in the eating disorders world. ACT can be an especially helpful tool for the long-term patient, or for someone who feels stuck and unable to progress.
ACT was one of the workshop topics at the last annual Renfrew Foundation Center conference in Philadelphia. Although sessions are aimed mostly at professionals, I’m continuing what I’ve done in the past, culling practical takeaways both for those battling an eating disorder and the people who care about them.
ACT, as speaker Danielle Doucette, PsyD, a Chicago-based psychologist, explained, challenges the DSM (Diagnostic and Statistical Manual of Mental Disorders)-based approach to treating eating disorders, “in which you check off a list of symptoms, and have to eliminate them” so that a patient is symptom-free and can be declared “recovered.”
Dr. Doucette explained that ACT doesn’t make eating-disordered symptoms or behaviors the enemy. Instead it encourages patients to identify the values they most would like to live by, and helps them actively pursue those. Whether symptoms abate or disappear is not the issue; a patient can become much happier and engaged in life while still purging two or three times a week, for example. It's a battle between values: those of your own true self and those of the eating disorder, or as Jenni Schaefer famously named hers, “Ed.”
Patients come in, Dr. Doucette explained, wanting to fix their problems, whether they involve panic attacks, overeating, or body image issues. “At some point, we made pain a problem to be solved, like a math problem.” Only pain can’t be solved, she adds, “any more than a sunset can be solved.” According to ACT, pain “just is.” Dr. Doucette exhorted her audience of practitioners to “bear witness to that pain, don’t try to problem solve it.”
ACT, Dr. Doucette, said, also “challenges the notion that treatment gains can only be made in an outpatient setting,” and described a number of practical exercises anyone can try to employ:
“Creative Hopelessness,” for example, asks the question, “How did I get to be in this place that’s so far from where I want to be?” Eating disorder patients are skilled at being able to “problem solve themselves out of difficult or painful feelings,” Dr. Doucette explained. Want to stop feeling fat, or stop the anxiety you feel around food? Solutions might include compulsively exercising, cutting, or bingeing and then purging.
In the Creative Hopelessness exercise, which is designed to make clear how destructive those strategies are, Dr. Doucette will ask the patient three questions:
1. What have you tried to do to get rid of the thoughts and anxieties about feeling fat?
2. What makes those values unworkable?
3. When you engage in these behaviors are you moving toward your values or away from them?
Another approach illustrates the value of moving from “fusion” with powerful eating-disordered values (“I feel fat therefore I must starve today”) toward “diffusion,” or the ability to see those thoughts as mere thoughts, tricks of the mind that might or might not be true, thoughts that are cutting you off from the life you want to live.
The exercise, which Dr. Doucette calls “The Hands as Thoughts Metaphor,” asks patients to put their open hands in front of them like a book. The hands are the eating-disordered thoughts that they are rigidly fused with and compelled to follow. Then the therapist asked them to slowly bring their hands up to their faces, almost touching their nose. Notice how the room looks different. What’s it like to talk to someone when you can’t see their emotional response, or gesture back to them? Can you play with your children with those thoughts right in front of your face? Now, can you bring your thoughts down to your lap? You’re not throwing them away, but you are gaining distance from them. Do you notice how you can see what’s going on around you, how it changes what you are able to see, do and say?
The idea is to imagine being able to distance yourself from the negative loop of self-talk and behaviors and to see more clearly what your strengths are, where you want to be going in life, and what actions you need to take to get there.
I hope post has helped you begin understand what ACT is and how you might be able to employ it in your own life, or keep it in mind when you are talking to a loved one who is locked in battle with an eating disorder. For more information, here’s a link to some of Dr. Doucette’s graphic presentation on ACT and eating disorders. Here, you’ll find an interesting Q&A with author and psychologist Emily Sandoz, PhD, who has written books on ACT and eating disorders and body image.