ACT & Eating Disorder Treatment: What You Need to Know

Woman getting therapy

Working with a therapist can help reduce eating disorder behaviors and symptoms, and get you moving toward recovery. One way therapists work on reducing symptoms is through Acceptance Commitment Therapy (ACT).

What It Is

ACT helps individuals to reduce eating disordered thoughts, feelings, and symptoms. The focus is typically on what the person can control, which is one’s thoughts, feelings, and behaviors [1].  ACT is a therapy which has roots in Cognitive Behavioral Therapy (CBT) and many therapists who were solely using CBT, have moved into using ACT with eating disordered patients.

Acceptance Commitment Therapy uses metaphors to teach and emphasize strategies that help cope with and manage eating disorder symptoms. The focus is on identifying one’s values and then to consciously act in a way that is in-line with those values and purposes.

One metaphor used is called Passengers on the Bus. In this technique, you visualize traveling through life as the driver of a bus. The passengers are noisy and distracting, and each passenger represents an eating disorder thought.

Through the use of this metaphor, clients learn that as the driver, they can still work toward their goals and purpose even with the ‘noise’ by not engaging the passengers.

Research to Support ACT

Empirical support for ACT has shown that it is a positive therapy for individuals with an

.0eating disorder [1]. First, individuals who have utilized ACT, have demonstrated improved functioning and decreased disordered eating behaviors.

Secondly, with the use of ACT, individuals have stated greater satisfaction in one’s self-esteem and appearance when practicing therapeutic skills, and they reported a significant reduction in eating disorder thoughts and behaviors.

The Process

ACT works to decrease maladaptive coping mechanisms, such as restriction, binge-purge cycles, binge eating, over-exercising, and body checking. It also works to move a person from rigid behaviors and thoughts to ones that are more flexible.

Six different processes are used to accomplish these goals. These are Defusion, Acceptance, Mindfulness, Detaching, Clarity, and Action-Focused.

1. Fusion to Defusion

Using defusion, a person learns to defuse from unhealthy eating disorder thinking. With fusion, the eating disorder thoughts seem like the absolute truth that need to be followed.

friends celebratingThe clinician and patient can work to find alternate ways to reframe these unhealthy thoughts, feelings, or behaviors.

Defusion works to let the individual see their thoughts as sensations, streams of words, sounds, and images [1].

Some techniques may be taking a thought and saying it out loud in a funny voice or accent or song to disempower the significance of the thought. These tools help increase a person’s flexibility to their thoughts and feelings.

2. Acceptance

ACT works to help a person move from experiential avoidance to acceptance of thoughts and feelings. Typically eating disorder behaviors are a way to escape or avoid painful emotions. Metaphors are used to show how avoidance is not a long-term solution.

Through acceptance, the individual learns that they create internal and emotional space for recovery [1]. This is done through exposure work conducted in and outside of sessions to practice acceptance and tolerance of behaviors and emotions.

3. Mindfulness

Mindfulness is the third process used in ACT. This allows a person to be invested in the present moment with their thoughts, sensations, emotions, and environment. The eating disorder is an expert at taking away mindfulness, and individuals learn to pay attention to the present moment without judgment.

4. Detaching

Fourth, the disorder will have their own story of who they are which is typically unhealthy and unlovable. This therapy uses the idea of the “observing-self” to teach individuals that they are not their thoughts nor are they defined by them. The goal is to change the beliefs and create new, healthy ones.

5. Clarity

Fifth is the clarification of values. Individuals typically get stuck in eating disorder values, and many feel that their disorder is their core identity. ACT works to help each person identify and clarify who and what they would like to be. They work on developing their own set of values and standards for self.

6. Action-Focused

Lastly, ACT focuses on taking action to stay committed to one’s values. Many individuals will put all of their energy toward the eating disorder and cease engaging in behaviors that lead to a meaningful life.

Friends supporting each otherWith ACT this process works to empower clients to take specific steps to achieve their values. This final stage helps individuals practice what they have learned and developed in their sessions.

Regardless of how you define ACT, whether as processes or areas of fusion, the goal is to be presently focused in the moment, aware of your core values and goals, and take committed action to achieve them.

It is about cognitively and behaviorally making a change to let go of the eating disorder and working to create a meaningful and purposeful life.

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] Acceptance and Commitment Therapy (ACT) in the Treatment of Eating Disorders. (n.d.). Retrieved December 27, 2017, from
[2] Acceptance Commitment Therapy in Eating Disorders. (2017, November 24). Retrieved December 27, 2017, from

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on February 13, 2018.

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