Navigating Body Image and Eating Disorders with Acceptance and Commitment Therapy

Navigating Body Image and Eating Disorders with Acceptance and Commitment Therapy

Written By: Tory Krone AM, LCSW

Proactive Therapy

In a society where diet culture, TikTok influencers, and contradictory messages about food and bodies prevail, many individuals find themselves struggling with negative body image and disordered eating patterns. Acceptance and Commitment Therapy (ACT) offers a refreshing, evidence-based approach to treating these struggles. Research has shown ACT to be an effective treatment to help people overcome body image issues and reduce disordered eating behaviors, and also as a proven way to avoid relapse. One study found that people who engaged in Acceptance and Commitment Therapy for eating disorders showed significantly decreased eating disorder symptoms and much less need for specialized care even up to two years after leaving treatment.

Understanding Acceptance and Commitment Therapy (ACT)

ACT is a form of therapy that teaches people to learn to live with their thoughts and feelings rather than suppressing or avoiding them, while also committing to actions aligned with their values. Central to ACT is the concept of psychological flexibility, which involves being open to experiences and acting in accordance with one’s values even in the presence of difficult experiences, thoughts and emotions.

As a therapist and founder of a therapy practice that specializes in eating disorders, my team and I most often turn to an ACT framework to help our clients with eating and body image struggles.  We often use the following interventions to help our clients create meaningful change: 

1. Body Image Exposures:  Exposure therapy is commonly used in treating anxiety disorders, and a similar approach can be applied when working with body image. In ACT, individuals might engage in gradual exposure to situations that trigger body image concerns. In therapy sessions, clients may be guided through exposure exercises that involve looking at or scanning specific body parts or one’s whole body via a mirror, using photos or the “self view” when engaged in teletherapy. This technique involves bringing awareness to different parts of the body– without judgment. By observing our bodies without trying to change them, we can learn to cultivate a more compassionate relationship to our bodies.

2. Values Clarification: Identifying and clarifying personal values is a fundamental aspect of ACT. Therapists help clients explore what truly matters to them, such as relationships, creativity, or personal growth. By connecting with their values, clients learn to prioritize values over more fleeting urges or thoughts in the moment.  
3. Defusion Techniques: ACT teaches defusion techniques to help individuals distance themselves from unhelpful thoughts. One exercise involves prefixing thoughts with “I’m having the thought that…” For example, instead of “I am ugly,” one might say, “I’m having the thought that I am ugly.” This simple linguistic shift can reduce the impact of negative self-talk.
4. Values-Based Goal Setting: Setting goals based on personal values is central to ACT. Therapists assist individuals in setting realistic, meaningful goals related to their values. A common example of this process is when working with clients who value having an intimate relationship, but have been unwilling to put themselves out there due to insecurities around their body shape or size. 
5. Workability of Thoughts: Rather than focusing on whether thoughts are true or false, ACT emphasizes their workability. Clients examine whether their thoughts are helpful in moving them towards their valued goals. If a thought or belief is not conducive to well-being or aligned with values, they learn to watch it from a neutral stance or take action in spite of it. An example of this in a body image context might be for a client to say to themselves ‘I notice I’m having the thought that I can’t date unless I lose weight.’ Then we would evaluate that thought to see where buying into that thought or allowing it to dictate the client’s actions would get them. 
6. Committed Action: ACT encourages individuals to take meaningful action consistent with their values, even in the presence of discomfort. Therapists help clients develop specific, achievable action plans to improve their relationship with their bodies and their eating habits. This might involve incorporating joyful movement, practicing mindful eating, or seeking social support. 

Acceptance and Commitment Therapy is both an empowering approach and research backed method to address body image issues and eating disorders. By cultivating mindfulness, clarifying values, and taking committed action, individuals can develop a healthier relationship with their bodies and nourish themselves both mentally and physically. ACT provides the tools and support needed to embrace self-image with acceptance and resilience. To begin therapy for eating or body image concerns, please visit our website www.proactive-therapy.com and reach out via our contact form. 

Resources:

1. Fogelkvist M, Gustafsson SA., Kjellin L, & Parling T. (2020). Acceptance and commitment therapy to reduce eating disorder symptoms and body image problems in patients with residual eating disorder symptoms: A randomized controlled trial. Body Image; 32:155–166.