HFO Announcements New Courses: Optimizing Personal Control in Health and Aging Contexts Recently Updated Courses: Acceptance and Commitment Therapy (ACT) in the Treatment of Individuals with Eating Disorders An Innovative Model of Group Therapy for Patients with Eating Disorders: Acceptance and Commitment Therapy (ACT) Preparing Young Patients and Their Parents For Medical Procedures: Strategies To Reduce Distress And Promote Coping Call for Authors HFO is seeking competent and qualified academics/healthcare professionals to provide CE courses on topics relevant to behavioral medicine and health psychology. In particular, courses on Asthma, Autism, cultural competence, ethics, Fibromyalgia, healthcare disparities, and organ transplant are desired. Click here for more information about authorship opportunities and how to grow with HFO. Related Announcements HFO is pleased to announce a new alliance with Vericare, a national provider of mental health care services. HFO will be Vericare's new resident recommended CE provider, offering their service providers a discount and the ability to track and file their CE progress for Vericare's accreditation. Click here for more information. Buy "Acceptance and Commitment Therapy (ACT) in the Treatment of Individuals with Eating Disorders" now and save $10 off the purchase price. Use promo code HFOACT at checkout to receive your discount.

Addressing Experiential Avoidance in Patients with Eating Disorders with ACT Experiential avoidance, defined as deliberately avoiding or escaping the experience of unwanted thoughts, feelings, or bodily sensations, may underlie eating disorder behavior1. The strategy has been documented with anorectic2 and bulimic clients3, 4 and associated with binge eating5. In fact, the literature suggests that experiential avoidance is even more influential than body/weight concerns in maintenance of eating disorder behaviors6. Recent surveys of eating disorder providers indicate that while trained in Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), specialists do not consistently ascribe to one of these orientations, relying instead on a combination of treatment techniques7, 8. One new therapeutic approach, namely Acceptance and Commitment Therapy (ACT), may represent another important tool for clinicians as ACT targets experiential avoidance9. ACT appears to be a promising treatment approach for disorders associated with experiential avoidance, such as substance abuse, anxiety disorders, chronic pain, and eating disorders; with some data suggesting that ACT is more effective than other treatment approaches, including cognitive-behavior therapy (CBT), psychoeducation, and psychopharmacology10 (http://www.contextualpsychology.org/empirical_readings). Unlike other therapeutic approaches to eating disorders that focus on reducing unwanted thoughts and feelings, ACT helps each client to mindfully observe and accept all thoughts and feelings, while maintaining commitment to her core values9. The six primary components of ACT are presented below. The 6 Components of ACT Control is the Problem - recognizing the problem of attempting to suppress thoughts and feelings; Self as Context - separating themselves from the thoughts and feelings that occur in the course of the eating disorder; Mindfulness – promoting awareness of, rather than dissociation from, thoughts, feelings, and bodily sensations; Acceptance – the active process of willingness to experience all thoughts and feelings that occur; Values Identification - declaring core values for life; Commitment to Valued Living - goal setting and movement toward valued directions. Featured Course Acceptance and Commitment Therapy (ACT) in the Treatment of Individuals with Eating Disorders (4 CEs) by Michelle Macera, Ph.D. ACT is considered to be a “third wave” of CBT11. The first wave (behavior therapy) focused on reinforcement, punishment, and other conditioning techniques to change overt behavior. The second wave (CBT) recognized cognition in addition to behavior, and therapists supplemented behavioral techniques with cognitive restructuring to change irrational thoughts to more rational ones. The third wave marks a shift from evaluating and changing “irrational” thoughts to treating all thoughts with acceptance and mindfulness (i.e., Dialectical Behavior Therapy, Functional Analytic Psychotherapy, Mindfulness-Based Cognitive Therapy12-14. While there are no definitive recommendations for the treatment of anorexia nervosa, ACT has been applied successfully to treat anorexia15 and a client workbook utilizing the basic principles of ACT has been developed16. Cognitive-behavior therapy (CBT) is presently recommended for bulimia treatment. However, as clients with bulimia engage in binge-purge behavior to escape or avoid unwanted thoughts and feelings, interfering with long-term quality of life, ACT may be useful in addressing this maladaptive experiential avoidant behavior among bulimic clients who fail to respond to CBT. Thus, ACT may prove to be a worthwhile endeavor in cases where other approaches have stalled or failed. In addition, ACT can be successfully translated into both individual and group modalities. This is especially important when designing high level care. The featured course reviews the theoretical and empirical underpinnings of ACT and presents ACT-relevant assessment and treatment techniques for use with eating disordered patients, focusing on individual treatment. Specifically, ACT-based techniques such as mindfulness activities, exposure-based exercises, and commitment to core values are discussed.

About the Author Michelle Heffner Macera, PhD – Author of The Anorexia Workbook. Research Coordinator and Therapist at Center for Hope of the Sierras, a residential eating disorder treatment center in Reno, NV. Interests: Application of Acceptance and Commitment Therapy (ACT) to treat eating disorders.

References

1. 1. Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152-1168.

2. Cockell, S.J., Geller, S., & Linden W. (2002). The development of a decisional balance scale for anorexia nervosa. European Eating Disorders Review, 10, 359-375.

3. Mizes, J.S. & Arbitell, M.R. (1991). Bulimics’ perceptions of emotionalresponding during binge-purge episodes. Psychological Reports, 69, 527-532.

4. Rasmussen-Hall, M.L. (2007). Distress intolerance, experiential avoidance, and alexithymia: Assessing aspects of emotion dysregulation in undergraduate women with and without histories of deliberate self-harm and binge/purge behavior. Dissertation Abstracts International: Section B: The Sciences and Engineering, 67 (9-B), 5420.
   

5. Telch, C.F. & Agras, W.S. (1993). The effects of a very low calorie diet on binge eating. Behavior Therapy, 24, 177-193.

6. Schmidt, U. & Treasure, J. (2006). Anorexia nervosa: Valued and visible. A
   cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology, 45, 343-366.

7. Tobin, D.L, Banker, J.D., Weisberg, L., & Bowers, W. (2007). I know what you did last summer (and it was not CBT): A factor analytic model of international psychotherapeutic practice in the eating disorders. International Journal of Eating Disorders, 40, 754-757.

8. Simmons, A.M., Milnes, S.M., Anderson, & D.A. (2008). Factors influencing the utilization of empirically supported treatments for eating disorders. Eating Disorders, 16, 342-354.

9. Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2003). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: The Guilford Press.

10. Hayes, S.C. & Strosahl, K.D. (2005). A practical guide to acceptance and commitment therapy. New York:  Springer Science and Business Media, Inc.

11. Heffner, M., Sperry, J.A., Eifert, G.H., & Detweiler, M. (2002). Acceptance and Commitment Therapy in the treatment of Anorexia Nervosa:  A case example. Cognitive and Behavioral Practice, 9, 232-236

12. Heffner, M., & Eifert, G.H. (2004). The anorexia workbook. Oakland, CA:  New Harbinger Publications.

13. Hayes, S.C. (2004). Acceptanceand commitment therapy, relational frame theory, and the thirdwave of behavioral and cognitive therapies. Behavior Therapy, 35, 639-665.

14. Linehan, M. M. & Dimeff, L. (2001). Dialectical Behavior Therapy in a nutshell. The California Psychologist, 34, 10-13.

15. Kohlenberg, R.J. & Tsai, M. (1991). Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Relationships. New York: Springer Science and Business Media, Inc.

16. Segal, Z.V., Williams, .M.G. & Teasdale, J.D. (2002). Mindfulness-based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. New York:Guilford Press.

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