Eating disorders pose significant challenges for athletes, impacting their physical health, mental well-being, and overall performance. The development of these disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, can stem from a variety of genetic and environmental factors, one of which being the unique pressures athletes face regarding body image, weight management, and performance expectations. Recovery from such disorders requires a multifaceted approach, integrating nutritional guidance, psychological support, and behavioral strategies. One effective therapeutic approach for athletes is Acceptance and Commitment Therapy (ACT). This blog explores how ACT can support athletes in recovering from eating disorders by focusing on its core principles and techniques, tailored to the needs of those in the sports community.
What is Acceptance and Commitment Therapy (ACT)?
Acceptance and Commitment Therapy (ACT) is an evidence-based therapeutic model designed to enhance psychological flexibility. Developed by Steven C. Hayes and his colleagues, ACT helps individuals understand and navigate their experiences, identify their core values, and direct their actions towards a meaningful and fulfilling life. The therapy emphasizes accepting difficult emotions and thoughts, cultivating mindfulness, and committing to values-based actions.
For athletes recovering from eating disorders, ACT offers a framework that addresses both the psychological and behavioral aspects of their challenges. By promoting acceptance of internal experiences, fostering mindfulness, and encouraging commitment to personal values, ACT supports athletes in overcoming the challenges associated with eating disorders and achieving long-term recovery.
Core Principles of ACT in the Context of Sports and Eating Disorders
1. Cognitive Defusion: Observing Thoughts and Emotions Without Being Controlled By Them
In the context of eating disorders, athletes often grapple with distressing thoughts and emotions related to body image, food intake, and performance. These thoughts can become overwhelming and negatively impact behavior. Cognitive defusion, a key principle of ACT, involves learning to observe these thoughts and emotions without being controlled by them.
For athletes, defusion means recognizing that thoughts about weight, body shape, or food restrictions are just thoughts, not absolute truths. By practicing defusion, athletes can separate themselves from these thoughts and reduce their impact on decision-making and behavior. For example, an athlete might experience a thought like, “I need to restrict calories to perform better,” and through defusion, understand that this is merely a thought rather than a directive.
Techniques for Defusion:
- Mindful Observation: Practice observing thoughts and emotions without judgment, noting them as they arise and pass.
- Defusion Exercises: Engage in exercises such as labeling thoughts (“I’m having the thought that I’m not good enough”) to create distance between the thought and the self.
2. Acceptance: Embracing Discomfort and Challenging Avoidance
Acceptance involves leaning into discomfort rather than avoiding it. Athletes with eating disorders may engage in avoidance behaviors, such as skipping meals or excessive exercising, to escape unpleasant emotions or thoughts. ACT encourages athletes to confront these discomforts directly.
For example, an athlete with body dysmorphia might avoid wearing form-fitting clothing due to fear of negative body judgment. ACT would encourage them to gradually challenge this avoidance by experimenting with slightly tighter clothing, helping them confront and accept their discomfort.
Techniques for Acceptance:
- Acceptance Hierarchy: Create a list of uncomfortable thoughts or situations, starting with less challenging ones and gradually working up to more difficult ones. This helps build tolerance to discomfort in a structured manner.
- Journaling: Keep a journal to track and reflect on emotions and thoughts as they arise during the process of acceptance.
3. Mindfulness: Being Present and Observant
Mindfulness is a central component of ACT, involving being fully present in the current moment and observing thoughts, emotions, and behaviors with curiosity and openness. For athletes, mindfulness helps in managing stress, reducing obsessive thinking about food or body image, and making informed decisions aligned with their values.
Mindfulness practices, such as meditation and mindful eating, can help athletes tune into their physical sensations and emotional states, promoting a healthier relationship with food and body image. For instance, mindful eating encourages athletes to focus on the sensory experience of eating, rather than being preoccupied with calorie counts or body weight.
Techniques for Mindfulness:
- Mindfulness Meditation: Regularly practice mindfulness meditation to enhance present-moment awareness and emotional regulation.
- Mindful Eating: Focus on the sensory aspects of eating, such as taste, texture, and smell, to build a more intuitive and less restrictive approach to nutrition.
4. Values Clarification: Identifying and Committing to Personal Values
ACT emphasizes the importance of identifying and committing to personal values—guiding principles that provide meaning and direction in life. For athletes recovering from eating disorders, clarifying values can shift focus away from body image and performance pressures towards actions that reflect their true goals and aspirations.
For example, an athlete might value health, personal growth, and enjoyment of their sport. By identifying these values, they can set goals and take actions that align with these values, such as adopting balanced nutrition, focusing on skill development, or fostering positive relationships with teammates.
Techniques for Values Clarification:
- Values Exploration Exercises: Engage in exercises to explore and articulate core values, such as reflecting on what is most important in life and how these values can guide behavior.
- Goal Setting: Set specific, values-based goals that reflect personal priorities and aspirations, such as improving performance through balanced training and nutrition.
5. Committed Action: Taking Purposeful Steps Towards Recovery
Committed action involves taking deliberate and purposeful steps towards achieving values-based goals, despite any internal or external obstacles. For athletes with eating disorders, committed action means making choices and taking actions that align with their values, even when faced with difficulties or cravings.
For instance, if an athlete values health and well-being, they might commit to a balanced eating plan and regular physical activity that supports their overall health rather than focusing solely on weight loss or appearance.
Techniques for Committed Action:
- Action Planning: Develop a concrete action plan with specific, measurable steps that align with personal values and recovery goals.
- Behavioral Experiments: Test out new behaviors and monitor their impact on well-being, adjusting as needed to stay aligned with values and goals.
6. Self as Context: We Are More Than Our Experiences
Self as context is the idea that we are more than our thoughts, feelings, or even physical experiences. Rather than identifying with them (e.g., “I am anxious” or “I am struggling with my diet”), athletes can learn to view themselves from a broader, more compassionate perspective. This principle allows athletes to observe their emotions, physical sensations, and thoughts without being consumed or defined by them.
Self as context also encourages athletes to focus on their core values, such as health and performance, rather than fears or external pressures. By doing so, they can make more conscious, value-driven choices that support long-term recovery while still pursuing their athletic goals.
Techniques for Self As Context
- Role Play Perspectives: Act out different parts of yourself (athlete, critic, nurturer), then step back as the observer to see how these parts interact.
- Leaves on a Stream: Imagine placing thoughts on leaves floating down a stream to reinforce that thoughts are temporary and separate from your true self.
Practical Application of ACT for Athletes
1. Individual Therapy Sessions
ACT can be delivered through individual therapy sessions with a trained therapist who specializes in eating disorders and sports psychology. In these sessions, athletes can explore their thoughts, emotions, and values, as well as the core principles of ACT. Personalized support helps athletes address their unique challenges and make progress at their own pace.
2. Integration with Nutritional Support
ACT can be integrated with nutritional counseling to provide a well-rounded and holistic approach to eating disorder recovery. Collaborating with a registered dietitian, athletes can develop strategies to support them with their fueling in a way that aligns with their values and goals. By offering ACT-informed approaches, registered dietitians can dive deeper into exploring the unique psychosocial challenges that athletes face, and support them with strategies in line with their goals for eating disorder recovery.
3. Group Therapy
Group therapy settings provide a supportive environment where athletes can share their experiences and learn from others facing similar struggles. Group ACT sessions foster a sense of community, encourage peer support, and reinforce ACT principles through shared learning and interaction.
4. Mindfulness Practices
Incorporating mindfulness practices into daily routines can support the principles of ACT. Techniques such as mindfulness meditation, deep breathing exercises, and mindful movement can help athletes manage stress, improve emotional regulation, and enhance their overall well-being to bring them closer to the lives they want to lead without their eating disorder.
Conclusion
Acceptance and Commitment Therapy (ACT) offers a valuable approach for athletes recovering from eating disorders. By focusing on defusion, acceptance, mindfulness, values clarification, and committed action, ACT addresses both the psychological and behavioral aspects of eating disorders. ACT-informed treatment helps athletes build psychological flexibility, manage difficult emotions, and align their actions with personal values, supporting a healthier relationship with food and body image.
For athletes, integrating ACT into a comprehensive treatment plan provides the tools and support needed to navigate the recovery process. By fostering acceptance, mindfulness, and commitment to values-based actions, ACT empowers athletes to work through and overcome the challenges of eating disorders and achieve long-term recovery and well-being.
If you are interested in exploring how ACT can support you in your eating disorder recovery, contact our team at info@fuelingforrecovery.com or by phone at (202) 738-4726. You can also book an appointment with one of our professionals directly by clicking this link.
References
- Fogelkvist, M., Gustafsson, S. A., 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. https://doi.org/10.1016/j.bodyim.2020.01.002
- Eating Disorder Hope. (2023). Acceptance and Commitment Therapy for Eating Disorders. Retrieved from https://www.eatingdisorderhope.com/treatment-for-eating-disorders/therapies/acceptance-commitment-therapy-act
- Udelf, D. (2022). How ACT Is Revolutionizing Sport Psychology. Psychology Today. Retrieved from https://www.psychologytoday.com/ca/blog/sport-between-the-ears/202203/how-act-is-revolutionizing-sport-psychology
