What an honor it is to introduce you to one of my mental health heroes. Meet Dr. Steven Hayes as well as his new book, A Liberated Mind. I am reading this incredible book right now; it looks like Dr. Hayes is changing my life yet again. The first time I met his work firsthand was when I entered treatment for posttraumatic stress disorder, PTSD. In treatment, I participated in a group each week based around Acceptance and Commitment Therapy (ACT), a therapeutic approach originated by Dr. Hayes. In ACT group, I was able to spend time thinking about my authentic values and begin taking steps in that direction. Little by little, step by step, it happened: my life began to reflect my values rather than the imprint of trauma. Thanks to Dr. Hayes and his team for donating two signed copies of A Liberated Mind.
For a chance to win a signed book, see information at the bottom of this post. Be sure to check out Dr. Steven C. Hayes’ website to learn more.
A Liberated Mind: How to Pivot Toward What Matters
One of the toughest aspects of treatment is that people with eating disorders are so often ambivalent about, or outright opposed to, getting treatment. ACT values work helps them see how they have subverted other life aspirations in their pursuit of weight control and then make an authentic commitment of their own to realigning their lives with their values.
In addition, extreme allegiance to elaborate food-related rules is a major feature of eating disorder behavior, and a relatively high number of people with eating disorders also struggle with OCD. Defusion helps them break the grip of those rules.
Self work can help people with eating disorders to find a place where they are OK even with thoughts like I’m too fat or My body is disgusting. A transcendent sense of self gives people with eating disorders a foundation for wholeness.
ACT also helps with the anxiety that is a common problem for people with eating disorders. Psychiatrist Emmett Bishop, who has developed an ACT-based eating disorder treatment program, explained to me that eating disorders are so hard to treat in part because food restriction gives people significant relief from negative emotions that have tormented them, with anxiety being core to that turmoil. Research shows that about two-thirds of people with eating disorders also have an anxiety disorder. Emmett says that they attain “an adaptive peak of experiential avoidance” and compares the effect to that of anti-anxiety medications, known as anxiolytics. ACT, he says, helps people “get off the peak and deal with the resultant anxiety.” He says, “Our patients are lost in a tangle of anxious details.” Flexibility training helps them create a healthy coherence in their minds focused on their values instead of on preoccupation with moment-to-moment monitoring of how well they’re following their elaborate eating rules.
CBT is still the gold standard for psychological treatment of eating disorders, so perhaps the wisest course is to add ACT skills to support traditional CBT approaches. A recent study did just that with an Internet program that combined CBT with ACT. The CBT elements focused on achieving early change and stabilizing healthy eating patterns, noticing over evaluation of body shape and weight, and working on such core issues as interpersonal difficulties or perfectionism. ACT values work was added to motivate change, and acceptance and mindfulness work was used to help let go of perfectionism and rigid thinking. The study found that nearly 40 percent of those who used the website were helped, versus only 7 percent for those who were not given access to the site.
The power of adding ACT training to a program for treating eating disorders was also empirically assessed in a study at the Renfrew Center in 2013. One group of people with eating disorders were given the center’s standard treatment, which involves common methods like regular weighing, exposure to feared foods, and the normalization of eating habits. Another group was given the standard treatment as well as the choice of attending eight nighttime group training sessions, each of which combined instruction in a number of the ACT skills. Anyone who attended at least three was counted as having completed the training, so engagement with the practices was sometimes limited. Nonetheless, the study showed that those who got some ACT training showed significantly less concern about their weight and greater intake of food—by almost twice as much—as the non-ACT group. At a six-month follow-up, fewer of those in the ACT group had been re-hospitalized.
Successes like this have led a number of eating disorder treatment programs around the United States to use ACT as a main approach. Emmett Bishop’s program is one example. He founded the Eating Recovery Center, which has locations in a number of states. One of the things I like about Emmett’s program is that he carefully collects data from all of the patients he treats, and he periodically publishes it. That is as rare as it is honorable. He recently published results from six hundred of his patients and found that about 60 percent were significantly helped by his largely ACT-based treatment program, and that changes in psychological flexibility strongly predicted the improvement.
The measure of eating-related psychological flexibility Emmett uses is a modification of one that a former student, Jason Lillis, and I published years ago. It asks people to rate statements such as the following:
- I need to feel better about how I look in order to live the life I want.
- Other people make it hard for me to accept myself.
- If I feel unattractive, there is no point in trying to be intimate.
- If I gain weight, that means I have failed.
- My eating urges control me.
- I need to get rid of my eating urges to eat better.
- If I eat something bad, the whole day is a waste.
- I should be ashamed of my body.
- I need to avoid social situations where people might judge me.
Win a Signed Book! To enter to win a copy of A Liberated Mind, please post a comment below, answering: What is one core value that motivates you in recovery? (e.g., I want to recover in order to go to school; I want to travel the world; I want to recover in order to be more present for my family.) Two winners will be randomly selected from all who comment. (Winners must be US residents.)