Background: Presenters will discuss the application of Acceptance and Commitment Therapy (ACT) in the treatment of eating disorders and present strategies for the integration of ACT principles with traditional CBT. Comparisons and contrasts will be drawn between ACT and CBT. Strategies for practitioner self-care, consistent with values-based living, will be identified.
The development of third-wave cognitive psychology, such as Acceptance and Commitment Therapy, is a marriage of the cognitive and behavioral, as well as mindfulness components which offers increased potential for enduring change (Hayes, Stroshal, & Wilson, 1999). Research and clinical practice suggest that traditional second-wave cognitive therapies such as CBT and ERP may fall short in delivering long-term results (Abramowitz, Taylor, & McKay, 2009).
This presentation will feature the innovative use of ACT in the treatment of eating disorders. Basic tenets of ACT (with the target of increasing psychological flexibility ) will be set forth. Consideration in integrating ACT into CBT practices will be discussed. We will explore basic barriers to psychological flexibility, some of which may actually be reinforced by a traditional CBT approach.
While outcome data on ACT for eating disorders is growing and research efforts continue (Juarascio, Foreman, & Herbert, 2010), there is much yet to be explored. Additionally, the research foundation for ACT as an efficacious treatment for related mental health conditions including anxiety and mood disorders is currently quite substantial (Twohig, Hayes, Plumb, et. al, 2010; Zettle, 2007). The presenters will touch on relevant studies within these patient populations as it relates to eating disorder treatment.
A foundational treatment target in ACT is the reduction of psychological inflexibility including experiential avoidance of thoughts, feelings and internal experiences, a frequent and debilitating behavior among disordered eaters (Merwin, Timko, Moskovich, et. al., 2011). The use of ACT in eating disorder treatment helps facilitate acceptability of interventions by enhancing willingness to engage in necessary, yet painful experiences. This is in contrast to a CBT approach, which would suggest attempting to alter thoughts in an effort to increase the desirability of any given event. This presentation will include specifics that clinicians can use in their respective treatment settings across levels of care, to help their patients move past ineffective behaviors.
Finally, we will examine the role of the practitioner in meeting the client mindfully as a means of improving outcomes. We will explore how the use of ACT can contribute to practitioner’s well-being through appropriate role-modeling of a values-driven life.
This presentation is designed to help practitioners integrate mindfulness components of Acceptance and Commitment Therapy (ACT) into Cognitive-Behavioral Therapy (CBT) practices. While CBT is considered second-wave Cognitive Psychology, a more integrated, mindfulness-based, third-wave of Cognitive Psychology (ACT), may offer additional tools in working with the rigid behavior patterns that often accompanies eating disorders. The emerging data for ACT in the treatment of eating disorders will be discussed.
A CBT approach to therapeutic change attempts to control the actual emotions and thoughts. Conversely, ACT focuses on one’s attempts to control the consequences of an emotion or thought, with the understanding that neither the emotion or thought, nor the subsequent emotional responses, can be either controlled or eliminated.
From an ACT perspective, ineffective practices (such as those behaviors inherent in an eating disorder), result from a lack of psychological flexibility and relational abilities. This theory will be discussed and the six core processes of ACT will be presented utilizing practitioner and client-friendly themes of “Letting go,” “Showing Up” and “Taking Action” as a means of increasing psychological flexibility.
We will draw comparisons between the two therapeutic approaches (e.g., working to change the thought vs. accepting the thought) and discuss how concepts from ACT can assist clients in increasing cognitive flexibility and decreasing unnecessary control.
Principles and methods will be experientially demonstrated with the intention that participants will leave with new ideas and techniques to utilize immediately. Practical applications in all levels of care (outpatient, IOP/PHP, RTC) will be discussed. Additionally we will discuss strategies for practitioner self-care, consistent with the ACT model.
Jennifer Tolman, Ph.D. is clinically trained as a Psychologist and works as Director of Specialty Services at Avalon Hills Residential Treatment Facility. She works with patients, families and outpatient treatment teams, to ensure seamless care as patients move from residential care to lower-levels of care. She directs patient follow-up and provider relations related to the Avalon Hills Treat to Outcome Philosophy. She also oversees the legal advocacy at Avalon Hills, in an effort to ensure patients receive the benefits of Mental Health Parity laws and insurance coverage. She serves as a Board Co-Chair for the Columbia River Eating Disorder Network.
Tera Lensegrav-Benson, PhD is the Director of Patient Services at Avalon Hills Eating Disorders Program. Dr. Lensegrav-Benson is a licensed clinical psychologist and has presented at numerous national conferences on various health psychology topics and the use of Acceptance and Commitment Therapy for the treatment of eating disorders. For the past 6 years, her clinical practice has focused exclusively in the area of disordered eating. Additionally, she is engaged in teaching doctoral psychology students and holds adjunct faculty status at Utah State University in the Department of Psychology. Dr. Lensegrav-Benson can be contacted via email drtera@avalonhills.org or by phone 435-245-4537
