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Acceptance and Commitment Therapy

Though acceptance and commitment therapy is a relatively new psychological therapy, numerous studies and evidence-based research have now highlighted the effectiveness of this treatment method for patients with a range of disorders and psychological problems.

Acceptance Commitment Therapy (ACT) is a mindfulness-based therapy that incorporates elements of Buddhist mindfulness meditation and newer behavioral therapy techniques. ACT differs significantly from CBT interventions in that rather than correcting negative thoughts, emotions and sensations, it teaches you to embrace and control them. This rationale is based on accepting feelings such as fear, frustration and anxiety that are a vitally necessary part of life and that allow you to be more involved in the things going on around you. By embracing these feelings so that you can more effectively reach and achieve your goals, the negativity can be reduced significantly. By trying to avoid negative feelings, the more they can persist in your life and influence it in unwanted ways. The goal is to control your reaction to these feelings in order to allow you to participate in life in an easier way. Research has shown that acceptance commitment therapy can have a dramatic impact on a whole host of problems, from anxiety and depression to chronic pain and a variety of other conditions.

There are six core principles involved in acceptance and commitment therapy that have been developed to improve psychological flexibility:

  • Cognitive defusion: These are specific learning methods that allow you to reduce your habit of ‘buying into’ ineffective or harmful thoughts, emotions, images and memories. Changing the way we think about things can be ineffective, so this method offers you the choice of simply not buying into or engaging with thoughts that could be harmful to you.
  • Acceptance: Here, you learn how to make space for your thoughts instead of spending energy trying to change them. This principle is applied to physical sensations and emotions as well as thoughts. Learning how to tolerate these thoughts allows patients to more actively pursue the things they want in life.
  • Mindfulness: By making contact with the present moment, your experience becomes clearer so that you can take interest without judgment. Mindfulness teaches you to positively interpret things that happen around you in a more grounded way without painful interpretations that can be catastrophic to your experience.
  • Self-observation: Transcendence allows you to experience an arena where positive and negative events occur but have no actual power to harm you. When we have anxiety or other painful internal experiences, it feels as though it is harmful to us if we allow it to be there. Unfortunately this results in trying to suppress or avoid these feelings, resulting in them getting more intense and unpleasant. By recognizing that these painful experiences do not actually harm us, but are just some of many internal experiences we have, it can help us to act in meaningful and not get too embroiled in managing our emotions.
  • Values: By identifying the things that are most important to your true self, you can develop values that become the compass of your life without expectation of positive experiences. Every goal that you face will have unpleasant components but by making your values clear and acting in accordance with them, you will reduce avoidance and rather create more helpful strategies to handle them.
  • Commitment: Your value-based goals can be more effectively committed to. Here, you make an effort to realize your values no matter how difficult they may be. Your life will become more meaningful when you are able to make a consistent effort towards your value-based goals.

Cognitive Behavioral Therapy for Eating Disorders

Cognitive Behavioral Therapy, or “CBT” is a method of treatment therapy that focuses on examining the relationships between a patient’s thoughts, feelings, and behaviors. The key is to uncover the thoughts and feelings that lead to self-destructive or otherwise harmful behavior. In doing so, work in therapy can center on addressing these core beliefs so that the outcome, or end behavior, is modified. For example, if a person feels depressed and thinks “I am worthless” then he or she might engage in cutting, bingeing and purging, or isolative behavior as a result. Work in therapy will start with the feelings and thoughts instead of simply trying to put a stop to the harmful action. If the therapist and patient cbt3together can alter the thought from “I am worthless” to “I am worthwhile” then a chain reaction is created that encourages the patient to participate in positive, healing behaviors as opposed to self-destructive ones.

A person who seeks help from a CBT therapist can expect a very active experience both in and out of a session. This means being pushed to challenge the core thoughts and beliefs, or “automatic thoughts,” practicing acting based on alternative thought patterns, and completing homework assignments between appointments.

Cognitive behavioral therapy has been shown to be as effective as anti-depressants for some individuals, and even changes brain activity in people with mental illness. This suggests that the brain itself will actually improve as a result of participating in CBT. It is used to treat a wide range of issues, including depression, anxiety, and phobias.

Studies have shown CBT to be quite effective when used with eating disorder patients, particularly those with bulimia nervosa or binge eating disorder. In fact, cognitive behavioral therapy is said to be more effective for these disorders than any other form of talk therapy. In one study, 37% of people completely abstained from bingeing after receiving CBT that focused on the disorder. Other therapies show less promising results. One alternative, dubbed interpersonal therapy, did demonstrate similar results, but it took a much longer time to get there. Cynthia Bulik, PhD., director of the University of North Carolina Eating Disorder Program at Chapel Hill, said, “CBT is associated with the best outcome for bulimia nervosa.”

Because this type of therapy was initially formulated to treat depression, eating disorder patients who participate in CBT tend to experience a marked improvement in mood. This finding is especially important considering the number of patients who suffer from eating disorders and mood disorders, such as depression. Sometimes the eating disorder can cbt2cause problems in mood as well. It is not uncommon for people who binge and purge to feel guilty or anxious about the behavior, so the potential for CBT to improve these feelings is particularly helpful. CBT can also help the patient to implement positive actions that can help break the cycle of eating disordered behaviors, such as avoiding skipping meals or talking to others about triggering topics, such as weight or food.

One study measured outcomes among patients with either bulimia nervosa or eating disorder not otherwise specified (ED-NOS). Both groups showed clinically significant improvement at both the 20 week and 60 week follow up. Specifically, 39% of participants reported NO episodes of bingeing or purging over the previous 28 days, and at the 60 week follow up that number was 46%. Furthermore, an exploratory analysis showed a correlation between the psychopathology of the patient and the type of CBT employed. For patients with co-morbid disorders or more complex cases, a broader form of cognitive behavioral therapy that also addressed these other issues was more successful, while utilizing this broad method with patients who only had eating disorders had the opposite effect. For these patients, a more focused form of CBT was found to have the best results. For the therapist, the obvious recommendation is to understand the full extent of a patient’s profile before making a decision about how to execute the therapy. For patients, this means that regardless of complexity or psychiatric diagnosis, cognitive behavioral therapy can have promising results, more so than any other type of talk therapy.


Advice for Families

Are you a family member of a therapy patient? Whether your child, spouse, sibling, or other family member is attending therapy, chances are you have some questions. When one person in a family is struggling with an eating disorder, depression, anxiety, or other mental health issue, it affects everyone in the household. Unfortunately, a lot of family members don’t know how to act around the patient and so sometimes do more harm than good. Of course, we all have good intentions, and it makes sense to want to be involved. However, there are certain guidelines that people would do well to follow in order to best support the therapy patient.

Stop trying to “fix” them.

This seems to hold especially true for men, including fathers, brothers, therapycartoonhusbands, and boyfriends. For whatever reason (genetics, social factors, etc.) men like to look at a problem, analyze it, and decide upon the best approach for solving the problem and making it go away. Unfortunately, this often means looking at the family member in therapy as “the problem” and setting about trying to “fix” the person. The best thing you can do is recognize that their therapy is out of your control and that there is nothing you can do to make this so-called problem go away. This is often a particularly touchy subject for parents, who feel responsible for their child’s health and (understandably) think they should have a say in the treatment approach. Contrary to what people sometimes think, the best thing you can do for your family member is let go of the reins and put some trust in the therapist. After all, they are the trained professional who best knows how to deal with mental health! If there is something you can do, they or your family member will let you know. Second of all, looking at the person as “a problem” won’t help the situation. It will only damage the relationship and make the person feel shame and guilt. Everyone has their shortcomings and needs a little help. In this case, your family member will be helped by attending therapy, not, in most cases, by your input.

Patience, patience, patience. Did I mention patience?

Rome wasn’t built in a day, and you might not see improvement or change in your family member attending therapy for a while. If the patient just started seeing a therapist, drop any expectation that they are going to come home from the appointment a new person. It can take weeks or months before you start to notice anything different. Respect the process. Try not to put pressure on your family member or ask a lot of probing questions about their progress. As the therapist and patient build a relationship they will begin to accomplish more and more, but this can only be done as work over a series of appointments builds on itself. If you have patience, your family member attending therapy will undoubtedly share with you what they feel comfortable and allow you to celebrate successes with them when such milestones are reached.

Expect resistance.

Therapy is a tough process and not always fun! As your family member processes their emotions and faces difficult obstacles, there may be times when they bad mouth therapy, insist on quitting, or reject the therapist’s advice. It’s not helpful to get into an argument about it with them, but show your support for their commitment in any way you can. Whether it’s prompting a dialogue about the reasons they are struggling, sharing a story with them about a time you wanted to give up on something but persevered, or ask if there is anything you can do to help them with an assignment or make the task more bearable.

You don’t have to understand what they’re going through, just try to understand they’re going through something.

It can often be hard for families of therapy patients to deal with the depression, anxiety, eating disorder, grief, or trauma that their loved one is experiencing. Many times this is because the family member has no direct experience with the mental illness or life experience. It’s OK to not understand, and in fact you may be met with frustration if you try to act like you “get it” or know exactly what they’re going through. Faking it won’t help anything. All that’s really required of you is that you understand your child, sibling, or significant other is struggling and dealing with something very difficult for them. Don’t feel pressured to relate or tap into their exact emotions. Sometimes a simple acceptance of their struggle and a shoulder to lean on is all that is required.

Establish appropriate boundaries.

This one looks a little different for everyone and takes significant communication to agree upon limitations. Sometimes this means taking a step back if you are a person who is typically overly involved in their loved one’s life. There’s no need to attend every session or know every detail of what was discussed! On the other hand, this can also mean boundariesrelaxing the boundaries. If you are skeptical of therapy, distance yourself because it’s “not your problem,” or are frustrated with your loved one for needing help, you have probably built a brick wall between yourself and your family member attending therapy. Try to keep an open mind and participate in sessions if and when necessary. Spark a discussion regarding the boundaries that will work best for both parties.

I hope this helps! Do you have any other questions regarding this topic? If so, leave them in the comments and I’ll do my best to answer them.

Willingness Vs. Willfulness in Therapy

Willfulness: obstinately bent on having one’s own way. Said or done on purpose, deliberate.

Willingness: ready to do something without being forced. Helpful, cooperative and enthusiastic. Offered voluntarily.

In therapy for mental illness or other struggles, there will undoubtedly be times when the patient has one idea about how he or she should proceed, and the therapist has another. Sometimes the patient might truly think that their plan will be more fruitful, and other times they might simply be resistant to the therapist’s suggestion. When someone is willful, they are taking deliberate actions to further their own plans and designs. In therapy, this could play out in a number of ways. For example, a patient might refuse to take medications that have been prescribed by a psychiatrist because they think they don’t need them. A depressed patient might continue to engage in self-harm behaviors because they are convinced the healthy coping skills their therapist has suggested won’t work. They might decide it’s a good idea to argue with their loved ones about their condition instead of listening to their parents’, spouse’s, friends’, etc. concern because they are focused on what these other people have done wrong. All of these examples demonstrate a patient’s willfulness. The patient has made a conscious choice to carry out such actions because they think they know better.

Consider the question: If you (the patient) know better, then why even attend therapy for mental illness, grief, or life transitions? Isn’t it true that you (the patient) would not have sought out the help of a professional if your life, feelings, thoughts, etc. were going exactly as you had planned or desired?

On the other side of willfulness is willingness. Willingness comes with the same degree of action and purposefulness but has an additional component – cooperation. Willfulness is close-minded, while willingness is open-minded. Willfulness accepts only one plan, while willingness considers many. A depressed patient, if willing, listens to the suggestions of the therapist and opts to try something different. This could mean trying out a new medication, with the knowledge that if it doesn’t work, the treatment team can consider an alternative. This could mean going for a walk, calling a friend, a writing in a journal instead of engaging in self-harm behaviors. It could mean sticking to the meal plan decided upon in therapy for eating disorders even when it is uncomfortable. It could mean trying to see an issue from a loved one’s point of view instead of resolutely insisting that they are wrong.

It can be quite disconcerting to try something new and be willing. Willfulness seems so much easier, as it often means sticking to what is known or what you (the patient) have done in the past. It often means trusting your own mind, even though your mind has been contributing to the problem. It makes sense, however, to realize that problems can’t be solved with the same thinking that created them. Being willing means letting go and trusting someone else to help and offer solutions. The therapist, psychiatrist, or whoever else makes up the treatment team really does have your (the patient’s) best interest in mind.

Let go of willfulness and embrace willingness!

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