What Is Acceptance And Commitment Therapy For Binge Eating Disorder?

If you are reading this article then odds are you are looking into Binge Eating Disorder treatment. 

This article provides an overview of one therapy treatment option for Binge Eating Disorder, called Acceptance and Commitment Therapy (ACT).

Please note there are other Binge Eating treatments available. 

Cognitive Behavioral Therapy, Dialectical Behavior Therapy, and Intuitive Eating are other Binge Eating Disorder treatment options.

Here’s an overview of different Binge Eating treatment options.

However, in this article we will just focus on helping someone understand Acceptance and Commitment therapy who has never heard of this treatment before.

This article starts out with the 10,000 foot perspective.

What Is Acceptance and Commitment Therapy?

There are two keys to understanding Acceptance and Commitment therapy – not surprisingly, they are:

1. Acceptance
2. Commitment

Let’s talk about Acceptance first.  We’ll get to the Commitment portion in a while.

Acceptance means that you accept what is out of your control.

Acceptance does not mean passivity, however. A common misconception is that Acceptance means you roll over and let people walk all over you.

This common notion is incorrect. Acceptance simply means you actively choose to embrace and feel negative experiences. 

Basically you purposefully allow yourself to be uncomfortable.

This is a psychological skill that is incredibly beneficial for your mental health, and it’s integral to effective binge eating disorder treatment.

It turns out that humans have a natural instinct to avoid pain. Unfortunately avoiding pain is oftentimes the worst thing for our mental and psychological health! 

For example, sometimes food is used for emotional comfort, as a way to avoid or be distracted from negative feelings. That is, they are eating “emotionally.”  In these situations a person is trying to control their experiences to avoid negativity and pain. They are not accepting their thoughts and feelings.

But with purposeful acceptance, you make an effort to NOT change or alter your discomfort in any way.  

But why accept negative experiences?

Oftentimes people get themselves into big trouble because they try to control negative experiences that are actually outside of their control!

Let’s look at how a minor frustration like being late to work can lead to a binge eating episode.

First, being late to work provokes feelings of anxiety and stress.

Then, this person feels overwhelmed and may automatically try to make their negative feelings go away by eating food.

By binge eating or emotionally eating, a person temporarily ‘controls’ their negative experience:

• Their thoughts switch away from being late to ‘what am I going to eat?’
• While eating their frustration temporarily goes away
• After they finish eating they may feel blank or numb, instead of stressed and tense.

Do you see how trying binge eating and emotionally eating can really be an attempt to control an uncontrollable situation and to feel less stress?

But eating, unfortunately, gets this person into extra trouble:

• Feels guilty afterwards
• Loses self-esteem
• Gains weight
• Experiences worse mental health

Do you see how trying to control an uncontrollable experience can lead to negative long-term consequences? 

Some people will still contend that there are some positives.  And yes, controlling your experiences in the short term by binge eating can have positive effects. For example, becoming numb might be more pleasant than being overwhelmed and stressed.

However, in the long term, your instincts to control negative situations to avoid pain and discomfort will only lead to more suffering.

With “Acceptance” You Can Make Different Decisions In The Present Moment

With “Acceptance” you can gain an ability to prevent automatic and short-term decisions.

This is why “Acceptance” is so important!

With Acceptance, a person can face their difficulties head on instead of automatically going to food for comfort and suffering long-term consequences.

This is called “Psychological Flexibility”, another important principle in Acceptance and Commitment Therapy.  

Note that it was “Acceptance” that opened the doors to Psychological Flexibility, a new state of mind.

A person feels their negative experiences, but by actively practicing acceptance instead of reacting to avoid pain, a person now has a chance to make a different decision instead of automatically using food to cope with their feelings.

This state of Psychological Flexibility is crucial to mental health.

Instead of feeling like you are ‘addicted to food’ or losing control ….

You are now in a position to make a different decision because you have flexibility. Now you don’t automatically respond to negative feelings by trying to control or avoid. 

Instead you accept them, and that in turn gives you more flexibility.

Yes, you may still have food cravings or overwhelming feelings. But now you have a different option. You can choose to accept and embrace those feelings instead of trying to control or avoid them.

Can you really embrace these feelings? Or because you are feeling uncomfortable, does this mean that you need to use food to cope?

When people lack this ability to accept their feelings, they feel that they have either one or two options:

1 – Feel miserable forever

2 – Eat food to make the pain go away

But “Acceptance” opens the doors to the new state of mind, Psychological Flexibility.

Psychological Flexibility, in turn, leads to Commitment

Interestingly, while Acceptance is incredibly positive and healing …

Acceptance is NOT the goal of Acceptance & Commitment Therapy. 

Acceptance is needed because it can help you to Commit to what is important to you.

Remember, Acceptance leads to Psychological Flexibility. Psychological Flexibility then gives you freedom and space to choose a different behavior or action when you feel overwhelmed or experience something negative.

Ultimately, Commitment and taking positive actions towards a personal value is the goal of Acceptance and Commitment therapy.

So Commitment comes after Acceptance! 

But Commitment to what? At some point by yourself or working with an Acceptance and Commitment Therapy (ACT) therapist, you may develop a list of potential things you would like to Commit to:

• Personal values
• Personal goals or visions
• Things that truly inspire you

Here are some examples of personal values or visions that you may want to take committed action towards:

• Family
• Career
• Spiritual purpose
• Mental health
• Not wanting to end up like a friend or family member who is in dire straits

The key is that you are moving towards a desired destination that you truly want.

This is one of the most important parts of Acceptance and Commitment therapy!

The important part here is just taking action towards a valued direction. You could pick anything to be your valued direction.

The key is to start moving in the right direction for you!

Otherwise,  humans often times can develop a sense of hopelessness because they are not making any progress.

This is why getting a sense of progress is very important.  With progress, a person can more easily tap into their inner resources such as courage or resiliency.

So another key here when contemplating committed action is to simply realize that any valued direction is better than none at all!

Many aspects of mental health begin to improve once you begin taking meaningful action and begin seeing progress.

Oftentimes a person is even more able to practice awareness and access their observing self as they start acting on their personal values.

For example, a person might feel overwhelming stress. But if they accept the feeling and in addition know their “why” behind it, then this becomes a positive feedback loop.

In fact, one of the main ways to understand Acceptance and Commitment therapy is simply accepting how you feel now, so that you can feel better later on.

Again, the key is having a direction to move in, so that you can become more willing to practice Acceptance!

At this point you probably have an understanding of how Acceptance And Commitment therapy works, at least generally speaking.

However, these concepts of “Acceptance” and “Commitment” can still be difficult to comprehend. 

This next section explores the meaning of Acceptance And Commitment therapy using a tug or war analogy.

Understanding ‘What ACT Therapy Means’ Using The Tug of War Rope Analogy

I got this metaphor from my podcast conversation with Dr. Solomon about body image.

Using this analogy, imagine you are holding a rope very tightly, next to a cliff.

On the opposite side of the rope, on the other side of the cliff, is your much stronger evil twin. 

And your evil twin is insulting you. Hurling horrible criticisms your way.

You are tugging on this rope with your incredibly strong evil twin, going back and forth. The cliff is between you and your twin.

You are getting exhausted. The harder you pull on the rope, the harder your twin pulls back. You try different angles and different hand grips. 

But nothing works. Your evil twin just pulls back as hard as you pull. And your evil twin is slowly pulling you closer to the edge of the cliff!

Eventually, you realize that your evil twin is even growing stronger the harder you try to tug on the rope.

The harder you try to pull, the more energy you give to your evil twin. The more you pull against your twin, the stronger your evil twin gets.

But what if you dropped the rope? What if you stopped pulling on the rope?

Your evil twin might still be there. Your evil twin might still be hurling insults your way.

However, you only get pulled towards the cliff if you choose to pick up the rope and pull on it.

What does it mean to let go of the rope? What would happen if you let your evil twin shout and you didn’t react?

As you start accepting  instead of resisting or fighting the evil twin, the evil twin grows less powerful.

Of course in this instance, your evil twin is really your own inner demon and inner critic. You, on the other side of the cliff from your twin, are your “observing self.”

Your observing self is the person you are when you practice Acceptance! You just observe everything. Instead, you just observe the rope on the ground.

You just notice the insults your evil twin is throwing at you. But you, your observing self, are still and nonreactive.

With your observing self you are able to witness thoughts, feelings and everything in between.

Your evil twin may be thinking negative things about yourself, about your life, about your body that you don’t like.

But what if you just stay in the present moment and stay aware of your thoughts and feelings?

You start to realize that you are not controlled by your thoughts. You have thoughts, but you don’t have to act in response.  That is, you are not your thoughts.

Instead of becoming defensive and reactive about negative thoughts, now your negative thoughts are just there, just like a bully on the other side of a cliff hurling insults at you.

But these insults only hurt you if you get reactive and pick up the rope!

What if you didn’t have to agree with the insults? Would anything bad happen if you could just accept the insults? What if you could just let them fly by your head?

Eventually you would actually become curious about this evil twin. Why is this evil twin so angry at you?

This is what happens in Acceptance and Commitment therapy. As you start to accept, instead of resisting and fighting against reality, you start to turn towards your enemies and demons.

And this inner shift then paves the way toward behavioral shifts as well.

What Is Acceptance and Commitment Therapy Used For?

Acceptance and Commitment Therapy first was recognized for pain management. 

Pain management is for some conditions of chronic pain that do not go away no matter what. No medication or anything can alleviate some people’s chronic pain.

In these situations, the principles of Acceptance and Commitment were taught with great effectiveness!

It turns out that if you don’t resist the pain, then you can still move towards your goals.

Previously people resisted their pain. They spent hours upon hours each day resentful that they were in pain.

As they learned to accept their pain, they had less resistance. Instead of thinking about how terrible their life was, they began to accept some level of pain.

With this Acceptance, they gained the key state of “Psychological Flexibility”. 

Now they could pursue their goals even though they still had physical pain in the present moment.

Want more examples? Here is a TedX talk that explores how Acceptance and Commitment Therapy was used successfully with pain management and other behavior change.

These Acceptance and Commitment Principles Also Apply to Binge Eating Disorder 

While food cravings are not the same as chronic pain, in the beginning of treatment for binge eating disorder, a person needs to learn Acceptance as well.

A person needs to accept, for example, that they have binge eating habits and not be ashamed about these habits.

A person can accept the sensations of food cravings, can accept their emotional turmoil.

Here are a few specific examples of how Acceptance is useful in terms of treating Binge Eating Disorder:

• Accepting your food cravings instead of acting on them
• Accepting you have a binge eating episode without falling into guilt
• Not falling back into dieting patterns after a binge episode
• Accepting and embracing difficult emotions instead of using food to feel better

Instead of food being a bandaid to cover up emotional pain, Acceptance can slowly help people lean into the pain and become stronger.

Anxiety, depression, OCD and other types of addiction and abuse can all benefit from Acceptance and Commitment Therapy as well!

How Does Acceptance and Commitment Therapy Work?

Acceptance and Commitment Therapy is all about leaning in.

It’s about embracing the painfuI instead of feeling guilty, trying to control, or fighting your thoughts or emotions.

Now that you know the general pattern of Acceptance and Commitment Therapy, let’s go more into detail.

Here are four specific Acceptance strategies: 

• Allow your impulses or food cravings to rise up like a wave. Just like a wave, there will be a peak. This is when the feelings or cravings are most intense. But just like a wave these feelings will fade away. If you fight the feelings you’ll get frustrated and turn to food, but if you choose to accept, you’ll in time be able to stand in the wave and let it pass through you.
• Know your triggers without judgment. Know that you get vulnerable when you are stressed. The key is to accept your vulnerability. Accept that you need rest and relaxation. Be sure to also notice the positives and things that are going well and that you are grateful for.
• Acknowledge that life is difficult for everyone. Just because things are difficult does not mean that you are doing things wrong or have failed.
• Always try to think about how you have some degree of control over how you respond to thoughts and feelings. The overall intention is to respond with relaxation and openness instead of tightness, control and anxiety.

These are some practical examples of how you can begin to use acceptance behavior change strategies.

You can find other practical strategies in this article here.

This concludes our main body of discussion about Acceptance and Commitment Therapy.

We’ve talked about the main principles and shown how these go together alongside Psychological Flexibility.

These last four behavior strategies are as in depth as we’ll go today.

However, one last topic:

Is Acceptance and Commitment Therapy a Form of CBT?

No, ACT is distinctly different from Cognitive Behavioral Therapy (CBT). 

True, our talk of reducing the inner critic and diminishing the power of negative self talk might seem similar to Cognitive Behavioral Therapy.

But The Association for Contextual Behavioral Science states that:

“Buttressed by an extensive basic research program on an associated theory of language and cognition, Relational Frame Theory (RFT), ACT takes the view that trying to change difficult thoughts and feelings as a means of coping can be counter productive, but new, powerful alternatives are available, including acceptance, mindfulness, cognitive defusion, values, and committed action.”

Now this sounds very fancy.

But what the Association for Contextual Behavioral Science is saying is actually pretty simple, just focus on this one piece here:

Trying to change difficult thoughts and feelings as a means of coping can be counter productive.

Now I am a huge fan of Cognitive Behavioral Therapy. However, in Cognitive Behavioral Therapy a person tries to change or correct one’s thoughts to alleviate suffering.

For example, a person might think, “I keep binge eating. I am worthless.”

In CBT, this person would question if they are really worthless just because they binge eat, even though this person may have a family or skill that is valuable.

A person can see that it is not “correct” to say that they are worthless because that factually isn’t true.

However, in Acceptance and Commitment Therapy, instead of trying to change or correct one’s thoughts …

A person instead tries to accept the thoughts without believing them. The extensive body of contextual behavioral science research has found this actually works!

A person working with an ACT therapist simply tries to notice their thoughts, feelings, memories and embrace what comes up in the present moment, without taking it personally.

Basically, Acceptance and Commitment therapists try to use mindfulness, psychological, and other behavioral strategies to help their clients relate entirely differently to negative thoughts and sensations.

ACT does incorporate psychological strategies from CBT where appropriate, but overall, the emphasis is on “accepting” instead of “changing”. 

With that being said, that is what Acceptance and Commitment Therapy is!

The quiz questions are based on medical criteria used in treatment settings to diagnose Binge Eating Disorder.

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Binge Eating Disorder (BED) is a type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.

Binge Eating Disorder is characterized by:

• Frequent episodes of eating large quantities of food in short periods of time.
• Feeling out of control over eating behavior.
• Feeling ashamed or disgusted by the behavior.
• There are also several behavioral indicators of BED including eating when not hungry and eating in secret.

Health Consequences of Binge Eating Disorder:

The health risks of BED are most commonly those associated with clinical obesity. Some of the potential health consequences of binge eating disorder include:

• High blood pressure  
• High cholesterol levels  
• Heart disease  
• Diabetes mellitus  
• Gallbladder disease

About Binge Eating Disorder:

• The prevalence of BED is estimated to be approximately 1-5% of the general population.
• Binge eating disorder affects women slightly more often than men--estimates indicate that about 60% of people struggling with binge eating disorder are female, 40% are male (Smith et al., 1998).
• People who struggle with binge eating disorder can be of normal or heavier than average weight.
• BED is often associated with symptoms of depression.
• People struggling with binge eating disorder often express distress, shame, and guilt over their eating behaviors.

 

References:

Smith, D.E., Marcus, M.D., Lewis, C.E., Fitzgibbon, M., Schreiner, P. (1998) Prevalence of binge eating disorder, obesity and depression in a biracial cohort of young adults. Annuls of Behavioral Medicine, 20, 227-232.