Acceptance and Commitment Therapy (ACT)
ACT helps clients with eating disorders distance themselves from harmful thoughts and urges without needing to eliminate them entirely. Rather than challenging every disordered thought, ACT focuses on reducing the power of those thoughts over behavior.
Dietitians may use metaphors like “passengers on the bus”, where the client is the driver and their thoughts and emotions are the passengers. Some may be loud or distressing (e.g., “I can’t eat this” or “I’ll gain weight”), but the driver ultimately decides the direction. This helps clients build psychological flexibility—acknowledging their thoughts while choosing to act in ways that align with recovery values.
ACT also teaches committed action, helping clients move toward values like nourishment, energy, or freedom from obsessive food thoughts—even when discomfort is present. Over time, clients learn to sit with anxiety or fear while still taking meaningful steps toward healing.
Cognitive Behavioral Therapy (CBT)
CBT is a cornerstone in eating disorder treatment, especially for those struggling with anorexia, binge eating disorder, or bulimia. It focuses on helping clients identify and challenge distorted thinking patterns related to food and body image.
In session, a dietitian might explore cognitive distortions such as:
- “If I eat carbs, I’ll lose control.”
- “One bad meal ruins everything.”
- “Only ‘clean’ foods are safe.”
Using fact-checking and cognitive restructuring, dietitians guide clients to examine these beliefs and replace them with more realistic, flexible thoughts. For example: “Eating one meal outside my plan doesn’t define my health,” or “Carbs fuel my brain and body.”
Behavioral strategies in CBT also include:
- Exposure therapy: Practicing eating feared or avoided foods in a safe, structured way.
- Routine disruption: Helping clients safely break rigid food routines that reinforce disordered behaviors.
- Meal support: Guiding clients through anxiety-provoking eating situations, like dining out or eating socially.
For individuals experiencing eating disorder symptoms such as food obsession, guilt after meals, or severe restriction, CBT helps build practical skills for change.
Dialectical Behavioral Therapy (DBT)
DBT is especially effective for clients who experience emotional dysregulation or who use food-related behaviors to manage distress. This includes individuals living with binge eating disorder, restrictive eating, or purging.
A key DBT strategy dietitians often teach is the STOP skill:
- S: Stop
- T: Take a breath
- O: Observe
- P: Proceed mindfully
For instance, when a client feels an urge to binge after a stressful day, the STOP skill helps create space between the urge and the behavior. Dietitians may also guide clients through a pros and cons list, comparing the short-term relief of the binge to the long-term consequences like guilt, discomfort, or worsening eating disorder symptoms.
Other DBT tools dietitians integrate into nutrition sessions include:
- Distress tolerance strategies to avoid impulsive eating behaviors
- Emotional regulation to manage triggers like body dissatisfaction
- Mindfulness to slow down and make intentional food choices
For those navigating the complexities of disordered eating or eating disorders, DBT helps foster self-awareness and emotional resilience.
Emotion-Focused Therapy (EFT)
Emotion-Focused Therapy (EFT) centers on the idea that eating disorders are often fueled by unresolved or suppressed emotions. Individuals may turn to food to escape from difficult feelings like shame, loneliness, or anxiety.
Dietitians trained in EFT use techniques to help clients reconnect with their emotions and understand how they influence eating patterns. A powerful tool in EFT is chair work.
In this exercise, a client might sit in one chair and speak from the voice of their inner critic—saying things like, “You’re disgusting. You shouldn’t eat that.” Then, they move to another chair and speak from a place of self-compassion: “That voice is hurting me. I deserve care and nourishment.” This interaction builds emotional awareness and helps shift internal dialogue from harsh judgment to kindness.
EFT is especially useful for clients experiencing:
- Body image distress
- Shame-based restriction
- Emotional eating
For example, a client with binge eating disorder who eats to cope with loneliness can learn through EFT to recognize and sit with the feeling of loneliness itself, rather than numbing it through food. This allows for deeper healing and behavioral change.
Finding the Right Support for Your Eating Disorder Recovery
Recovery from eating disorders is complex and highly individualized. Whether you’re dealing with anorexia, bulimia, binge eating disorder, or ARFID, therapeutic nutrition counseling led by experienced dietitians can be a key part of sustainable recovery.
Each of the approaches outlined—ACT, CBT, DBT, and EFT—can help clients:
- Reduce distressing eating disorder symptoms
- Improve emotional regulation
- Reframe unhelpful thoughts
- Build a peaceful relationship with food
If you’re unsure about whether your food behaviors qualify as disordered eating or an eating disorder, or you’re noticing signs like obsession with food, fear of eating, frequent restriction, or bingeing, know that compassionate help is available.
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.
