Acceptance and Commitment Therapy for Eating Disorders: A Process-Focused Guide to Treating Anorexia and Bulimia (Professional) [Hardcover]

Emily K. Sandoz PhD (Author), Kelly G. Wilson PhD (Author), Troy DuFrene (Author)

Book Description

Publication Date: February 3, 2011 | Series: Professional

A Process-Focused Guide to Treating Eating Disorders with ACT

At some point in clinical practice, most therapists will encounter a client suffering with an eating disorder, but many are uncertain of how to treat these issues. Because eating disorders are rooted in secrecy and reinforced by our culture's dangerous obsession with thinness, sufferers are likely to experience significant health complications before they receive the help they need. Acceptance and Commitment Therapy for Eating Disorders presents a thorough conceptual foundation along with a complete protocol therapists can use to target the rigidity and perfectionism at the core of most eating disorders. Using this protocol, therapists can help clients overcome anorexia, bulimia, binge eating disorder, and other types of disordered eating.

This professional guide offers a review of acceptance and commitment therapy (ACT) as a theoretical orientation and presents case conceptualizations that illuminate the ACT process. Then, it provides session-by-session guidance for training and tracking present-moment focus, cognitive defusion, experiential acceptance, transcendent self-awareness, chosen values, and committed action-the six behavioral components that underlie ACT and allow clients to radically change their relationship to food and to their bodies. Both clinicians who already use ACT in their practices and those who have no prior familiarity with this revolutionary approach will find this resource essential to the effective assessment and treatment of all types of eating disorders.

Editorial Reviews

Review

About the Author

Emily K. Sandoz, PhD, is assistant professor of psychology at University of Louisiana at Lafayette. She is a clinical psychologist and behavior analyst who specializes in treating clients using acceptance and commitment therapy. Emily is coauthor of Acceptance and Commitment Therapy for Eating Disorders, The Mindfulness and Acceptance Workbook for Bulimia, and Living with Your Body and Other Things You Hate.

Kelly G. Wilson, PhD, is associate professor of psychology at the University of Mississippi. He is a central figure in acceptance and commitment therapy (ACT), and was one of the authors of the landmark Acceptance and Commitment Therapy (Guilford Press, first edition 1999, second edition 2011). Wilson is among the most sought-after ACT trainers. His popular experiential workshops touch thousands of clinicians and students each year. www.onelifellc.com

Troy DuFrene is a writer in the San Francisco Bay Area who specializes in psychology and blueberries. He is coauthor of Coping with OCD, Mindfulness for Two, Things Might Go Terribly, Horribly Wrong, Acceptance and Commitment Therapy for Eating Disorders, Mindfulness and Acceptance for Bulimia, and Living with Your Body and Other Things You Hate. www.troydufrene.com

Product Details

• Hardcover: 312 pages
• Publisher: New Harbinger Publications; 1 edition (February 3, 2011)
• Language: English
• ISBN-10: 1572247339
• ISBN-13: 978-1572247338
• Product Dimensions: 6 x 1.1 x 9 inches
• Shipping Weight: 1 pounds (View shipping rates and policies)
• Average Customer Review: 4.0 out of 5 stars  See all reviews (5 customer reviews)
• Amazon Best Sellers Rank: #180,355 in Books (See Top 100 in Books)

Most Helpful Customer Reviews

4 of 4 people found the following review helpful

5.0 out of 5 stars a must read for anybody working with eating-related problems October 18, 2011

By Joseph Ciarrochi

Format:Hardcover

Working with eating-related problems is extremely tricky. Folks who struggle with eating are often very self-critical and feel stigmatized by society. They often do not want your help. They are invalidated by insensitive therapist remarks.

What's great about this book is that it is compassionate and client-centered. it shows you how to stay mindfully present with the client and how to understand the situation that gave rise to their problematic pattern of eating. It also allows you to focus on the clients values, rather than on having to enforce values from outside ("You must eat").

The book gives an excellent grounding in basic behavioral theory. It is process oriented, which means it teaches you what processes to target, rather than requiring you to do particular techniques. Not every technique is going to be appropriate to every client. The great thing about a process focus is that you can use techniques or flexibly invent your own, depending on what the client needs. For example, there are probably a thousand ways to help clients become more mindful and flexible with their body image. This book shows you how.

I love that the book has a sample protocol to show you how ACT might look with your client. I also found the additional resources at the end of the book to be most helpful. These include client questionnaires and handouts, and therapist tools

This is a must-buy for anybody who wants to use ACT, mindfulness, or intuitive eating principles with their clients.

2 of 2 people found the following review helpful

4.0 out of 5 stars About so much more than "just" eating disorders... March 18, 2012

By M. Aalberse

Format:Hardcover|Amazon Verified Purchase

Yes, there are some typos in the book, and that's really too bad (but not conducive to misunderstanding, IMO), which is why I don't give it the 5 stars this gem deserves.
However, and much more importantly, I find, it also presents a badly needed alternative to DSM classification, and one that I have found clinically hig relevant - as well as respectful for the client.
And... there's so much dedication and compassion oozing out from the pages, mixed with high quality theorizing.
It may take some slow reading and "chewing" for those not familiar with the ACT model, but then readers will find this rich and wholesome "food for thought" and for feeling and action.
Those working with this stigmatized group will appreciate how important all this is, and feel challenged maybe and surely inspired.

2 of 2 people found the following review helpful

5.0 out of 5 stars Review from an eating disorder therapist April 22, 2011

By Alice

Format:Hardcover|Amazon Verified Purchase

This is a great book for therapists who treat people with anorexia and bulimia, and I would add that it can also be helpful for treating binge eating disorder. It will be most helpful if you already have some fairly solid knowledge of eating disorders, as well as some guidelines about the appropriate level of care (residential, intensive outpatient, outpatient). Because a person who is malnourished or has other medical complications may not be cognitively ready to do the mental processing involved in ACT, I would caution not to use ACT until a client is re-fed. However, I would highly recommend this book for any clinician!

If you've used DBT in treating eating disorders, but haven't seen the best outcomes, try ACT! It has some similar elements, including mindfulness, but it adds much more in terms of examining values and adding value to life. There are other books about ACT for other diagnoses, but I like the way this one is organized and written.

1 of 1 people found the following review helpful

5.0 out of 5 stars ACT now! October 9, 2012

By Deb

Format:Hardcover

While traditional eating disorder therapy approaches focus on alleviating the symptomatic behaviors, ACT (Acceptance and Commitment Therapy) takes a refreshing alternative approach. The primary focus of ACT is to help the client understand the purpose of their eating disorder behaviors, and then help create ways to shift their life to be more in line with their chosen values:

"The goal in ACT for eating disorders is psychological flexibility with the purpose of facilitating valued living. ACT targets broad behavior change, not in the sense of reducing eating disorder symptoms but in the sense of changing the dominant functions of the behavioral repertoire. ACT is about shifting life towards the things an individual cares about. The therapeutic stance in act is about making a place for that shift to occur.... ACT therapists help clients to interact more effectively with the things in their lives that hurt the worst and the things that mean the most." (pp. 59-61).

The crux of making this shift is to help the client develop psychological flexibility--the ability to "actively and openly contact their ongoing experiences in the present moment as fully conscious human beings, without defense and as it serves their chosen values." (p. 17). In other words, "ACT focuses on building valued living in the present, without the world of the individual having to change." (p. 117)

With clear explanations and illustrative clinical applications, the book masterfully teaches the six clinical components involved in helping eating-disordered clients develop this psychological flexibility:
1. Present moment focus--employing flexible and focused attention to ongoing events
2.... Cognitive defusion--experiencing an event fully in its complexity without emotions or cognitions about the event dominating the experience
3. Experiential acceptance--openly embracing one's experiences, both good and bad, without attempting to change them
4. Transcendent self-awareness--developing flexibility in contacting different ways of experiencing one's self, such that a sense of self that is separate from any particular experience emerges
5. Valued living--living in such a way so as to facilitate contact with chosen values
6. Committed action--noticing when actions are not consistent with values and then gently turning back to valued living

This is one of those books that is so well-written, that just a few sentences can succinctly capture the complexity of essential aspects of eating disorder experience. Case in point:
"Eating and other interactions with food come to be organized almost exclusively around avoidance, either of body image or other aversive experiences that are more salient, intense, or otherwise dominant in the moment. In this way, an individual might be highly likely to binge in one moment as self-doubts, anxiety, and painful memories are present, and far more likely to purge and restrict in the next moment as sensations of fullness, evaluations of her appearance, shame, and guilt become more salient and more intense...And as we sit with this individual, we are left with this question: what kind of learning history would account for this kind of narrowing from a full, rich experience of the self and the world to a life dominated by the aversive control exerted by food and the body?" (pp. 48-49)

So many passages of this book resonated deeply with me, and the respectful way that I like to practice therapy. This section, on viewing clients as sunsets to be witnessed and not math problems to be solved is my absolute favorite:
"Often, we clinicians buy into the problem-solving agenda our clients present with...We focus on the fusion problem or the avoidance problem...And, in doing so, no matter how true or effective our analysis is, no matter how much coherence or compassion it's founded in, we make our clients like a row of math problems. What if in treating someone like a math problem we offer little different than what the world has offered them or what they have offered themselves? The chance for behavior change becomes smaller and smaller as the context we create becomes more and more like the world they know, a world in which they are the problems to be solved.

There is an alternative position we find ourselves in from time to time. Sometimes we let go of the problem-solving agenda. We're compelled by something a client says or does and suddenly we take a step back from our conceptualization and plan. We notice the human being in front of us. Without any effort to assess or intervene, we lean in and simply witness. In these moments, the client is less like a math problem than a sunset.

Take a moment and imagine what would happen if we tried to experience a sunset by measuring the angle of the light refraction off the water molecules in the air. We gaze out at the horizon with our refractometer and our laptop and let the numbers crunch. We might end up with a correct analysis, but something would be lost. What if it is the same with our clients? What if we have something precious to gain by treating them as sunsets instead of math problems? What if we have something precious to gain by treating ourselves as witness instead of problem solvers?

In ACT, we assume that every client has something as lovely to share as a sunset, just waiting to be witnessed. We assume that if we take the posture of a problem solver, the client is likely to show up as a problem. If we take the posture of a witness, however, the client is more likely to show up as a sunset. We also assume that the more our clients are witnessed, the more likely they are to witness others in their lives. It may even be that the more sunsets we witness, the more likely we are to show up as a sunset in our own lives." (p. 62)

Refreshing, huh?

My recommendation for this book can be summarized in two words: ACT now! Read more ›

9 of 16 people found the following review helpful

1.0 out of 5 stars Big Disappointment June 8, 2011

By DRJ

Format:Hardcover|Amazon Verified Purchase

As an ACT therapist specializing in treating eating disorders, I was really looking forward to getting and reading this book. I have never before rated a book so badly as this one. Where do I begin. As a subscriber to the scientist-practitioner model, I appreciate references to research in the text--not just a short, general list of references at the end of the book. Admittedly the authors represented this book as a "process-focused guide", but the experiential processes included did not have enough context to understand what the process being quoted was supposed to accomplish or why and how to generalize it to a therapist's actual practice. Furthermore, the context that was given hinted at these processes being used in a residential program and not in private practice. I believe the text should have clarified where the process was being implemented. Part I covered the "Foundations of ACT", which as a therapist familiary with ACT I could understand, but I can't imagine that anyone without adequate knowledge and experience with ACT would find this section anything more than mystifying. Part II was titled "Delving into ACT." I pushed myself through this section thinking that surely I would begin to understand the processes presented; I rarely was able to delve into what the authors were trying to communicate. Seven appendices were included, one of which included a template for an assessment plan. However, I could not find any explanation in the text of how to use this hexaflex diagram, even though I know and understand the hexaflex model. The other appendices were also unhelpful. And it may sound petty, but I was horrified to find five typos in the first 40 pages of text.... This book was just not up to the standard that most professionals expect from New Harbinger Publications or their authors (of which I am one). Read more ›