Therapeutic Approaches that are Evidence-Based in Eating Disorder Treatment
Acceptance and Commitment Therapy (ACT) for Eating Disorders
ACT is helpful for preventing relapse as well as reducing eating disorder behaviors. A common myth about eating disorder treatment is that the goal is simply to ‘’get rid of’’ disordered thoughts. It is more complicated than that. ACT teaches clients skills for living a mindful and meaningful life by making space for uncomfortable thoughts without letting them dictate their behavior. Instead of fighting negative self-talk or food fears, clients learn to accept them. ACT focuses on workability, so rather than focusing on whether a thought is true or false, it helps you evaluate whether the thought is helpful. Does it move you towards your values and desired outcomes or pull you away?
ACT is grounded in 6 core skills:
Hexaflex model: This framework helps you build psychological flexibility through six skills:
- Contact with the present moment: Staying mindful of your current experiences rather than getting caught up in your thoughts.
- Values: Identifying what matters to you around food, body image, and physical activity and using them to guide recovery.
- Committed action: Taking consistent steps aligned with your values even when it’s difficult.
- Self as context: Viewing yourself beyond your thoughts and feelings, focusing on your identity as a whole (e.g ‘’I’m having the thought that I’m unlovable’’ VS ‘’I’m unlovable’’).
- Defusion: Separating yourself from your thoughts.
- Acceptance: Allowing difficult thoughts and feelings without trying to escape them, because it’s much easier to let them exist.
Cognitive Behavioral Therapy (CBT) for Eating Disorders
CBT helps you recognize how your thoughts, feelings, and behaviors are interconnected. With an eating disorder, it is common to experience black-and-white thought patterns like ‘’I ate dessert, so I’ve failed’’, ‘’I’ll never be healthy unless I restrict’’ or food labeling (‘’good’’ vs ‘’bad’’ foods). CBT helps you identify and challenge these cognitive distortions and encourages you to explore more flexible thinking patterns. Dietitians might also use tools like food logs and thought records to help you spot harmful patterns, build awareness, and reframe automatic negative thoughts. The goal is not just changing how you eat; it is changing how you think about eating, helping you build healthier, more flexible habits. It uses both cognitive and behavioral techniques.
CBT involves 2 key components:
- Cognitive techniques: These focused on identifying and restructuring distorted thoughts and beliefs, helping you reduce food-related anxiety and guilt.
- Behavioral techniques: This often involves exposure therapy, where you identify and slowly reintroduce avoided foods with the support of a dietitian or a therapist. It also includes problem-solving strategies to help you navigate food-related challenges (e.g., finding alternative coping skills outside of restriction or binge eating when stressed).
Dialectical Behavioral Therapy (DBT) for Eating Disorders
DBT focuses on emotional regulation, which can be specifically helpful if your eating disorder behaviors are tied to coping with overwhelming emotions. When stress, sadness, or anger feels unbearable, behaviors like binge eating, purging, or restricting can become a way to self-soothe. DBT helps by teaching skills to manage intense emotions. The balance of acceptance and change makes DBT effective. It validates the pain you’re in while also guiding you toward new skills to reduce suffering.
DBT’s goals are to :
- Improve the client’s motivation.
- Enhance their capabilities.
- Ensure that the skills they learn are put into action in the real world.
DBT teaches four core skills:
- Mindfulness: increasing awareness of your thoughts, emotions, and physical sensations without judgment. This helps you recognize eating disorder behavior triggers and respond with intention rather than impulsivity.
- Distress tolerance: Building coping skills to ‘’ride the wave’’ of intense emotions without turning to harmful behaviors. For instance, if you feel the urge to binge when stressed, DBT encourages grounding techniques to calm your nervous system.
- Emotional regulation: learning to identify and manage intense emotions, helping you respond to emotional triggers with healthier coping mechanisms.
- Interpersonal effectiveness: Strengthening communication and boundary-setting skills to reduce conflict to build relationships that bring joy.
Emotion-Focused Therapy (EFT) for Eating Disorders
EFT helps you heal your relationship with your emotions and, in turn, with food. Eating disorders often mask emotional pain, with food becoming a way to numb or control feelings. EFT encourages you to name, feel, and cope with feelings rather than avoiding them.
For example, if you find yourself emotionally eating when lonely, EFT supports you in exploring the underlying loneliness rather than simply stopping the behavior. This therapy is especially helpful for self-criticism and unresolved emotional wounds.
EFT works in 3 stages:
- Emotional awareness: Increases your ability to recognize and name emotions.
- Validation and acceptance: validating and processing emotions with compassion. Healthcare professionals use emotion coaching to help clients process feelings through compassionate guidance.
- Consolidating healthier emotional responses: Strengthening your ability to respond to emotions with healthier coping strategies to avoid engaging in eating disorder behaviors.
EFT works by activating distressing relationship dynamics to develop your emotional intelligence. This involves exploring emotional splits, two competing perspectives in the brain. The splits could come from unfinished business, critical inner voice, and the protector – a part of the self that suppresses emotions as a defense mechanism.
Finding the right therapeutic approach for your eating disorder recovery:
Recovering from an eating disorder is not a one-size-fits-all process. Each of these therapies provides unique tools to help you navigate emotions and thoughts and help you build a better relationship with food.
If you or someone you love is struggling with an eating disorder, seeking support from a qualified eating disorder team that has a therapist and a dietitian can be a valuable step toward recovery. Please visit part two of this blog to learn about how dietitians use techniques from these therapeutic approaches in their nutrition counseling. .
Need Eating Disorder Help?
Our team is here to support you. Whether you’re seeking eating disorder treatment, or just want to talk to someone who understands, we’re here to help. Call us at 202-738-4726 or email us at: info@fuelingforrecovery.com.
