What if there was a way to break free from the negative self talk loop?
While the medical consequences of an eating disorder can be life-threatening, the harsh unrelenting internal dialogue and the compulsion to follow rules and rituals can cause most of the suffering. The endless stream of fear-based judgments, rigid demands, and threats can take over an individual’s mind and sometimes drive them into despair.
It is as you face these “intrusive eating disorder thoughts”, and the difficult emotions and impulses they provoke, that you can begin the long road to recovery. Even those who have triumphed over disordered eating behaviours for months or even years, remain vulnerable to a re-arising of these powerful mental formations that may trigger a relapse.
This is where Acceptance and Commitment Therapy (ACT) can have a role in creating and maintaining long term success in the battle against eating disorders.
Acceptance and Commitment Therapy
ACT does not attempt to change the content of irrational or negative thoughts and difficult emotions, even if they are false and destructive.
Instead, the goal is to help people face these thoughts, see them from a different perspective, and in turn respond in a way that is more helpful – in short, changing the way the individual interacts with their thoughts.
As Kathy Kater, LICSW psychotherapist in St Paul, Minnesota explains, research has demonstrated that ACT is highly effective with disorders that are driven by experiential avoidance: a compelling urge to avoid or control difficult internal states, such as unpleasant or painful thoughts, emotions, or sensations.
For example, eating disorders sufferers routinely deal with thoughts such as “I”m too fat” (and therefore, out of control, unacceptable or unloveable), or body states like a full stomach, by using eating disorder behaviours to temporarily reduce distress or feel in control.
What most eating disorder patients do not recognise is that the very act of trying to avoid internal distress keeps them trapped in a self-perpetuating cycle. Like a Chinese finger trap, the harder they try to escape, the more they are locked in. Repeatedly running away from difficult emotions, whether by not eating, purging, drinking alcohol, or any other “fix,” only creates more problems by creating a dependency on avoidance behaviors. Meanwhile, the individual is learning nothing about coping with the inevitable difficulties and pressures of life.
Helping patients become willing to face their difficult thoughts is the “acceptance” part of this therapeutic approach.
ACT uses mindfulness and cognitive defusion methods to help people mentally “step back” and see each thought for what it is: just a thought, i.e. the firing of certain synapses in the brain that may or may not be helpful.
Eating disorder thoughts are mental constructions that have formed as a result of separate thoughts and events that have become linked, and are now triggered involuntarily and as if they were one. For example, therapists often hear how associations between feeling bad, not eating, and in some way feeling better or “in control” can be traced to an event such as this one:
“Right after he broke up with me he started dating the skinniest girl in our class. I felt so bad, I could hardly eat. When I started to lose weight it felt good when people complimented me. That”s when I started to restrict on purpose, and the more weight I lost the better I felt. It was like the one thing I could do to feel in control.”
When thoughts are associated, separate thoughts and the impulses they bring up can become fused, as if they were one and the same. Thereafter, whenever any part of this thought is triggered, the entire ‘”fused thought” arises. For example, once eating behaviors have been associated with stress relief, any experience of angst may trigger an eating disorder thought like this: feeling anxious, can’t stand it, don’t eat, feel better. At this point, the world as coloured by this thought seems so real, it’s as if the person is no longer interacting with their thoughts at all. Instead, eating/not eating has become a life or death reality.
Treating Eating Disorders in Teens
Mindfulness makes it possible to become aware that in any present moment there is a “me” that is thinking and a “me” that can “watch myself think.”
When patients first experience this, I often ask them, “Who is watching?” When they become curious about this observing self—a self that transcends their thinking mind—they can see that it is possible to view both their self and their thoughts within a bigger context than they previously knew, creating a space in which new possibilities can arise.
Research has documented that the perspective from which thoughts are viewed can significantly alter their impact. For example, a patient told me, “I can’t stand to feel full—it makes me feel like I will blow up!” When fused with this thought, it seemed literally true to her. From her perspective, eating until full was akin to annihilation! Using mindfulness she was able to learn to observe this thought instead of being caught in it, and it became possible for her to say “I”m having the thought that if I feel full I will explode.”
In the space that opened she had room to feel sad and grief about the years of eating only morsels in order to obey this thought, and how it had cost her many of her dreams. In her case, being a slave to eating disorder rules had forced her to withdraw from training as a potential Olympic skater. From this new vantage point she could begin to consider whether she might be willing to have this thought, and even tolerate and manage the anxiety it evoked, if it meant she could begin to follow new dreams, such as becoming a skating teacher. It’s a “feel the fear and do it anyway” concept.
Connecting with an Ultimate Purpose/ Values
In line with this, another goal of ACT is helping patients to connect with their deepest values and ultimate purpose in life. What else could generate a willingness to face what torments us, and to let go of behaviours that provide an illusion of control?
By connecting with values, patients become aware of what they would want to be able to say about their life if their eating disorder thoughts and impulses were not controlling their actions: “In a world where you could choose to have your life be about something, what would you choose?” When patients feel immobilized on the difficult road to recovery, values clarification shines a compelling light on why they must go on.
ACT’s overall therapeutic goal is to help patients ride out the waves of emotionally-provocative thoughts and impulses, while committing to actions that align with what really matters most in their lives.
ACT is challenging because it conflicts with some of the basic tenets of Western thought, such as that “pain is bad,” “happiness depends on feeling good (“feel-goodism”)”, and “if you just work hard enough you can get whatever you want.” Therapists can be hooked by these beliefs in ways that are not all that different from our patients—I know I have been. It has taken me time and practice to integrate ACT into my work and personal life, but it continues to allow me to live an enriched life in both regards.
Author: Linda Thomson, B Arts, Social Science, Human Services, Masters of Counselling, Master Social Work Studies, Social Work, Member – AASW.
Linda Thomson has many years of experience in different fields of counselling, and has also managed counselling services in the not-for-profit sector. She has been involved in training and mentoring counsellors, and providing professional supervision. Linda finds it very rewarding to help young people overcome disordered eating behaviours.
Please call 1800 877 924 or book online to make a confidential appointment with Linda.