While eating disorders are complex mental health conditions that derive from a mixture of biological, psychological, and environmental factors, a preoccupation with body image and body dissatisfaction are some of the most common risk factors for developing disordered eating behaviors. [1]

In fact, scientists have long proposed that chronic low self-esteem is a necessary prerequisite to developing an eating disorder, and some studies have gone as far as saying eating disorders can technically be viewed as symptoms of chronically low self-esteem. [2]

As such, addressing body image concerns and restoring self-esteem is a crucial aspect of eating disorder recovery. And while different treatment approaches have different ideas of how to accomplish this, acceptance and commitment therapy (ACT) has demonstrated effectiveness in helping individuals cope with and overcome poor body image.

What is Acceptance Commitment Therapy?

A famous quote from the theologian Reinhold Niebuhr, commonly called the serenity prayer, asks a higher power for “the strength to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Acceptance commitment therapy runs off a similar philosophy.

In the teachings of ACT, negative experiences are not necessarily things that need to be fixed, but rather experiences that should be put into the perspective of life as a whole, with all of its good, bad, and ugly. As such, the goal of this therapy is not to eliminate or avoid negative experiences but to develop a more flexible relationship with them. [3]

The therapeutic method shows patients how to better understand their disordered thoughts and behaviors and encourages them to make positive changes where needed, but to also practice acceptance around things that can not or do not necessarily have to change. [4]

The emphasis on acceptance is used to help someone move beyond the fixation on their disordered thoughts. Instead, patients are asked to channel this energy toward activities that they feel passionate about, and which align with their goals and morals. [4]

How Does ACT Work?

Acceptance commitment therapy is a combination of talk therapy and action-oriented therapy.

In early sessions, a patient and therapist will work together to identify unhelpful thought and behavioral patterns and how they may contribute to ongoing issues in the patient’s life. A therapist will then help a patient work out which issues should be addressed—and the changes needed to help resolve them—and those that may benefit more from practicing acceptance. [4]

Patients will also be asked early on to identify their morals, values and interests. As therapy goes on and a patient moves toward recovery, they’ll be encouraged to start participating more in these interests or other activities that align with their values and goals. [4]

Along the way, a patient will learn various tools and techniques to help them cultivate acceptance, clarify their values, develop a more flexible relationship with difficult thoughts, and commit to taking action that will help them feel a greater sense of purpose and fulfillment in life.

How ACT Can Help with Improving Body Image?

Body image issues stem from a number of sociocultural, psychological, and biological factors that lead to a fixation on physical appearance. In many ways, acceptance commitment therapy works to help people break out of a fixation mindset and focus on more positive experiences that help them feel fulfilled.

In general, this can help people move away from overly critical views of their own bodies and develop an overall more positive and balanced perspective. But ACT can also help combat negative body image—and cultivate positive body image—more directly.

Developing a Mindfulness Practice

The cultivation of mindfulness practice is a key aspect of ACT. [4] This involves being completely attentive to the present moment as an objective observer, without applying any type of criticism or evaluation.

By learning to observe their surroundings in this way, individuals can start learning how to experience their thoughts and emotions more objectively. [7] This can help them separate their negative ideas about their bodies from objective reality, or to understand that what they think is not the same thing as reality itself. [8]

Ideally, patients can use this newly created cognitive space to offer themselves the kind of self-compassion that encourages a healthier body image. And some studies have found the potential of mindfulness to do just that, with patients reporting a greater sense of positivity and purpose after practicing the technique. [9]

Building Cognitive Flexibility

Cognitive rigidity, or the inability or unwillingness to change thoughts or behaviors, even when they’re unhelpful, has been found to be one of the biggest psychological factors that works to uphold disordered eating behaviors. [6]

On the other hand, ACT has been specifically found to help promote cognitive flexibility. [5] This is a powerful mindset that can help people overcome all kinds of mental health issues, including eating disorders.

Accepting and adapting to situations allows someone to more easily move past so-called problems, to the point where they may no longer see them as problems at all, but rather just another part of life as a whole. This same type of mindset can be applied to body image: Where someone once saw a “flaw” in or problem with their body, they may learn to simply see a body.

Encouraging Self-Acceptance

In a similar vein, the acceptance cultivated by ACT can help bring about higher self-esteem and greater body positivity.

Self-acceptance has been tied to self-esteem, with studies showing the level of one generally having an impact on the level of the other. [10] Other studies have shown that, at a certain point, self-acceptance can even replace self-esteem as a measure of worth. [11]

Mindfulness has also been shown to raise levels of both self-acceptance and self-esteem. [11] And the positivity conjured by these mental health improvements can work to help someone develop a more positive relationship with themself and their own body.

Identifying Personal Values

While practicing ACT, patients are asked to identify their values, morals, and goals and work toward achieving them or participating in activities that align with these ideals.

This type of focus on bigger picture ideas can help shift someone’s perspective away from negative body image and other intimate issues and toward broader views of life, meaning, and purpose.

Finding and pursuing these lofty ideals can realign someone’s idea of what is significant or what truly matters in life. It can also help someone put more energy toward—and, hopefully, derive purpose and passion from—things not tied to their diet or physical appearance.

How Effective is Acceptance Commitment Therapy for Body Image Issues?

While acceptance commitment therapy is relatively new, a number of studies have already been done to prove its effectiveness on combating mental health conditions of all kinds, including eating disorders. Results have consistently shown the therapeutic method as helpful for decreasing body dissatisfaction and increasing body positivity and acceptance.

One study showed that, compared to groups receiving a general psychiatric education and those receiving medication for mental health issues, those who underwent ACT reported significantly improved body image acceptance and awareness. [12]

Another study, examining women struggling with polycystic ovary syndrome (POCS), found acceptance commitment therapy greatly improved a patient’s body image, self-esteem, quality of life, eating problems, anxiety, and depression. [13]

And ACT wasn’t just found to help people reconcile body image issues and reduce disordered eating behaviors, but to help them avoid relapse or backsliding, with one study finding patients who practiced ACT showing significantly decreased eating disorder symptoms and much less need for specialized care up to two years after leaving treatment. [3]

Finding Help for Eating Disorders

Seeking professional help can be crucial in healing and recovery from an eating disorder and its comorbidities. Here are some tips for finding a therapist who can offer ACT or other forms of help.

Talking to your primary care physician or a mental health professional can be a good first step. These professionals can not only offer their own opinion on the matter but give you referrals to therapists who treat eating disorders or body image issues. It may be possible to specifically request a meeting with a therapist who specializes in ACT.

A number of eating disorder hotlines can also help provide additional information and resources. These services are usually free of charge and allow callers to remain anonymous.

But regardless of where you look for help, the most important thing you can do is start looking. It very well may be the first step on the road to recovery.

Resources

Kapoor A, Upadhyay MK, & Saini NK. (2022). Relationship of eating behavior and self-esteem with body image perception and other factors among female college students of University of Delhi. Journal of Education and Health Promotion; 11:80.
Silverstone PH. (1992). Is chronic low self-esteem the cause of eating disorders? Medical Hypotheses; 39(4):311–315.
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.
Acceptance and Commitment Therapy. Psychology Today. Accessed August 2023.
Valizadeh S, Makvandi B, Bakhtiarpour S, Hafezi F. (2020). The Effectiveness of “Acceptance and Commitment Therapy” (ACT) on resilience and cognitive flexibility in prisoners. Journal of Health Promotion Management; 9(4):78-89.
Wang S, Gray E, Coniglio K, Murray H, Stone M, Becker K, et al. (2019). Cognitive rigidity and heightened attention to detail occur transdiagnostically in adolescents with eating disorders. The Journal of Treating and Prevention; 29(4):408-420.
Mindfulness. (n.d.). Psychology Today. Accessed August 2023.
Ito D, Watanabe A, Osawa K. (2023). Mindful attention awareness and cognitive defusion are indirectly associated with less PTSD-like symptoms via reduced maladaptive posttraumatic cognitions and avoidance coping. Current Psychology; 42:1182-1192.
Garland EL, Farb NA, Goldin P, & Fredrickson BL. (2015). Mindfulness Broadens Awareness and Builds Eudaimonic Meaning: A Process Model of Mindful Positive Emotion Regulation. Psychological Inquiry; 26(4):293–314.
MacInnes DL. (2006). Self-esteem and self-acceptance: an examination into their relationship and their effect on psychological health. Journal of Psychiatric and Mental Health Nursing; 13(5):483-489.
Thompson B, Waltz J. (2007). Mindfulness, Self-Esteem, and Unconditional Self-Acceptance. Journal of Rational-Emotive & Cognitive-Behavior Therapy; 26:119-126.
Givehki R, Afshar H, Goli F, Scheidt CE, Omidi A, & Davoudi M. (2018). Effect of acceptance and commitment therapy on body image flexibility and body awareness in patients with psychosomatic disorders: a randomized clinical trial. Electronic Physician; 10(7):7008–7016.
Moradi F, Ghadiri-Anari A, Dehghani A, Reza Vaziri S, & Enjezab B. (2020). The effectiveness of counseling based on acceptance and commitment therapy on body image and self-esteem in polycystic ovary syndrome: An RCT. International Journal of Reproductive Biomedicine; 18(4):243–252.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a 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 March 6, 2024 on EatingDisorderHope.com

Acceptance and Commitment Therapy for Help with Body Image Issues