Using Mindfulness & Acceptance-Based Therapy for

Treating BED

Joyce D. Nash, Ph.D.drjnash@comcast.netwww.drjoycenash.com

@drjnash

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Book & Blog

• “Lose Weight, Live Healthy: A Complete Guide to Designing Your Own Weight Loss Program”

• www.loseweightlivehealthyguide.com

• www.loseweightlivehealthyguide.com/blog/

• For a copy of this powerpoint presentation, go to: www.loseweighlivehealthyguide.com/NEDA_ 2011_ACT_BED_Nash

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Agenda

• How ACT differs from CBT

• Mindfulness• BED essentials• Introduction of an

actual BED client• Basics of ACT• Research and

readings at the end of handouts

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How ACT Differs from Other CBT Approaches

• Does not strive to change negatively perceived thoughts and feelings, but rather emphasizes acceptance of these private events

• Does not dispute evidence for thoughts

• Is context-focused (not content-focused)

• Is not symptom-focused

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What ACT Does in Session

• Uses experiential exercises

• Makes extensive use of metaphors

• Targets experiential avoidance and cognitive fusion

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ACT is like a New Concept Car

• ACT has both theoretical and empirical support• Based on Relational Frame Theory (RFT)• Developed by Steven Hayes, Ph.D., at University of

Nevada at Reno, and his associates

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Acceptance and Commitment Therapy (ACT)

• A – Accept your thoughts, feelings, memories, and other private events as they occur moment to moment, without judgment

• C – Clarify and connect with personally defined values that give direction to your life, and set goals that support these values

• T – Take effective action in accordance with your goals and values

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Aim of ACT

• To help us create a rich, full, and meaningful life, while accepting the pain that life inevitably brings

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Sources of Pain and Discomfort

• Clean Discomfort

• Dirty Discomfort

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ACT and Mindfulness

• ACT is not just mindfulness

• ACT uses mindfulness as a means of accessing the observing self in the present moment

• The observing self has no words but the thinking self is chattering continuously

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What is Mindfulness?

• A mental state of awareness, focus, curiosity, openness, and receptiveness that allows you to engage fully in your here-and-now experience

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Essentials of BED Diagnostic Criteria

• Recurrent episodes

• Larger than normal amount of calories

• Sense of lack of control

• No regular use of compensatory behaviors

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Agenda of Control

• Lack of control implies the need for more control• Works in the external world• Doesn’t work for thoughts and feelings• Binge is an attempt to stop thinking and feeling, that is, it

is an experiential avoidance strategy

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Introducing Tina

• Presenting complaints• History• Eating triggers

– Family dynamics– Emotions – Unstructured time– Feeling of not fitting in– Social situations– Hunger, fatigue

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Triggers for Binges and Overeating

• Negative emotions• Positive social experiences• Low distress tolerance• Restrictive eating/dieting• Unstructured time/transitional times• Readily available, high-energy, palatable food

(food cues in the environment)• Evolutionary motivational system to ensure

survival

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Mindful Questions to Ask

• What is triggering me to eat this food right now?

• What are my other options for food to eat or behavior in which I can engage?

• Is eating this food in line with my values and the option I choose at this time?

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Core Messages of ACT

• Accept what is out of your personal control

• Commit to taking actions that enrich your life because they are based on your values

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ACT and Values

• Values are statements about– What you want to be doing with your life– What you want to stand for– How you want to behave on an ongoing basis

• Values clarify what gives your life a sense of meaning or purpose

• Values are chosen life directions

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Processes that Keep Us Stuck

• Cognitive Fusion– You become fused with, melded with, and inseparable

from your thoughts– Thoughts dominate behavior– Leads to unworkability

• Experiential Avoidance– Trying to avoid, get rid of, suppress, or escape from

unwanted thoughts, feelings, memories, fears

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Processes That Work

• Defusion– Wherein thoughts, feelings, and urges come to be

experienced from a psychological distance, i.e., the observing self

– Being able to have a thought, feeling, craving, or urge without trying to suppress, believe, or act on it

• Acceptance– Learning to tolerate or be willing to have aversive

internal experiences in the service of goal-related behavior

– Alternative to control strategies

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Choosing Based on Values

• Some ideas are worth considering• Ask yourself, “Does this contemplated action

move me toward something I value?”• A good thing overdone undermines the value of

health and well-being

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ACT in a Nutshell

Present focused

Experiential/metaphor

Between session work

Applicable to a variety of problems

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Some Obesity-related Research• Lillis, J., Hayes, S. C., Bunting, K., & Masauda, A. (2009).

Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model. Annals of Behavioral Medicine, 37:58-69.

• Tapper, K., Chaw, C., Ilsley, J., Hill, A. J., Bond, F. W., Moore, L. (2009). Exploratory randomized controlled trial of a mindfulness-based weight loss intervention for women. Appetite, 52:396-404.

• Forman, E. M., Hoffman, K. L., McGrath, K. B., Herbert, J. D., Brandsman, L. L., Lowe, M. R. (2007). A comparison of acceptance- and control-based strategies for coping with food cravings: an analog study. Behavior Research and Therapy, 45:2372-2386.

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More Obesity-Related Research• Lillis, J., Hayes, S. C., & Levin, M. E. (2011). Binge eating and

weight control: the role of experiential avoidance. Behavior Modification, 35:252-264.

• Forman, E. M., Butryn, M. L., Hoffman, K. L., & Herbert, J. D. (2009). An open trial of an acceptance-based behavioral intervention for weight loss. Cognitive and Behavioral Practice, 16:223-235.

• Lillis, J., Levin, M. E., & Hayes, S. C. (2011). Exploring the relationship between body mass index and health-related quality of life. Journal of Health Psychology, 16(5):722-727.

• Weineland, S., Arvidsson, K., Kakoulidis, T., & Dahl, J. (2011). Acceptance and commitment therapy for bariatric surgery patients: a pilot RCT. Obesity Research and Clinical Practice, e-1 to e-10. Published online 18 May 2011.

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Reading Recommendations

• Russ Harris. (2006). “Embracing Your Demons: An Overview of Acceptance and Commitment Therapy”. www.actmindfully.com.au/upimages/Dr_Russ_

Harris-a_non-technical_overview_of_act.pdf • Russ Harris. (2009). ACT Made Simple.• J. B. Luoma, S. C. Hayes, R. D. Walser (2007). Learning

ACT.• Steven Hayes, Kirk Strosahl, Kelly Wilson. (1999).

Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change.

• Steven Hayes. (2007). ACT in Action, DVD Series.