Applying Acceptance and Commitment Therapy to Body Image Issues

Pretty young woman with flowers

Body image issues and preoccupation are a proven risk factor for disordered eating thoughts and behaviors.

In fact, many professionals in the field acknowledge that disordered eating behaviors such as binging, purging, food restriction or avoidance, and compulsive exercise are driven by patient’s preoccupation with eating weight, and shape, and their control [1].

These body image issues tend to also be related to low self-esteem, and both play a huge role in disordered thoughts and behaviors surrounding food and exercise. The fact that all of these aspects are tied together may seem unsurprising to you. For some time now, it has generally been accepted as fact, and the biggest question is, “okay, what do we do about it?”

85% of individuals in the United States report experiencing low self-esteem, creating a large pool of vulnerability to a disorder. Many psychological viewpoints aim to treat these aspects of disordered thoughts and behaviors in order to cut them out at the root, so-to-speak.

Acceptance and Commitment Therapy

One such treatment that is showing promising effects is Acceptance and Commitment Therapy, also known as ACT.

ACT is based out of the assumption that mental illnesses stem from individuals engaging in inflexible and harmful thoughts, behaviors, and emotions to avoid aversive internal experiences [1].

These responses are known as “experiential avoidance” and professionals that work from an ACT perspective aim to treat individuals through broadening their “psychological flexibility. [1].”

Psychological flexibility is the opposite of experiential avoidance in that individuals with psychological flexibility can engage authentically in the present moment of any situation or emotion, even uncomfortable ones, without behaving in a manner that is ineffective or contrary to their values.

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ACT and Disordered Eating

It is understandable that ACT is considered for treating disordered eating, as many studies have indicated that disordered behaviors are ineffective coping skills that arise out of avoidance of unwanted or uncomfortable feelings or circumstances.

One study aptly points out, “restrictions of food intake and the onset of a binge-eating episode have both been described as methods for controlling unwanted and intrusive thoughts and feelings [1].”

ACT also focuses on a concept known as “cognitive fusion,” or, “the propensity to adhere to thoughts as literal truths that directly guide behavior [1].”

For those with disordered body image, it is likely they consider their negative thoughts bout themselves, their appearance, or their value as fact and that rigidly adhering to these beliefs guides their disordered eating and exercising behaviors.

Individuals in ACT are encouraged to clarify their values so that they can adjust their beliefs and behaviors to align with these.

“Working with mindfulness, acceptance, and willingness for inner experiences helps the individual to change behaviors aimed at avoiding or controlling painful inner states [1].”


Girl laying grass with flowers working a positive Body ImageACT has been effective in treating depression and anxiety, and researchers have reason to believe it will also successfully treat disordered body image and eating thoughts, beliefs, and behaviors.

A recent study that occurred over a 16-week period found that “ACT group intervention focusing on body image was effective in reducing residual ED symptoms and body image problems in an ED sample [1].”

The study found that those that underwent ACT treatment during this time had a larger symptom reduction than those that received treatment as usual [1].

The treatment compared in this study was Cognitive Behavioral Therapy, the most common treatment of choice for eating disorders.

The study notes that CBT and ACT are similar, and this is, perhaps, why ACT is so effective. However, in this study, it is interesting that ACT was not only similarly effective; it was more effective.

So much of eating disorder symptomatology and development involves underlying thoughts and beliefs. Therefore, the more therapeutic interventions that address these areas, the better the likelihood of increased recovery rates.


[1] Fogelkvist, M., et al. (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, 155-166.

About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

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 April 30, 2020, on
Reviewed & Approved on April 30, 2020, by Jacquelyn Ekern MS, LPC

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