Using Mindfulness & Acceptance Based Therapy for Treating BED


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Using Mindfulness & Acceptance Based Therapy for Treating BED

  1. 1. Using Mindfulness & Acceptance-Based Therapy for Treating BED Joyce D. Nash, Ph.D. [email_address] @drjnash
  2. 2. Book & Blog <ul><li>“ Lose Weight, Live Healthy: A Complete Guide to Designing Your Own Weight Loss Program” </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li>For a copy of this powerpoint presentation, go to: NEDA_ 2011_ACT_BED_Nash </li></ul>
  3. 3. Agenda <ul><li>How ACT differs from CBT </li></ul><ul><li>Mindfulness </li></ul><ul><li>BED essentials </li></ul><ul><li>Introduction of an actual BED client </li></ul><ul><li>Basics of ACT </li></ul><ul><li>Research and readings at the end of handouts </li></ul>
  4. 4. How ACT Differs from Other CBT Approaches <ul><li>Does not strive to change negatively perceived thoughts and feelings, but rather emphasizes acceptance of these private events </li></ul><ul><li>Does not dispute evidence for thoughts </li></ul><ul><li>Is context -focused (not content-focused) </li></ul><ul><li>Is not symptom-focused </li></ul>
  5. 5. What ACT Does in Session <ul><li>Uses experiential exercises </li></ul><ul><li>Makes extensive use of metaphors </li></ul><ul><li>Targets experiential avoidance and cognitive fusion </li></ul>
  6. 6. ACT is like a New Concept Car <ul><li>ACT has both theoretical and empirical support </li></ul><ul><li>Based on Relational Frame Theory (RFT) </li></ul><ul><li>Developed by Steven Hayes, Ph.D., at University of Nevada at Reno, and his associates </li></ul>
  7. 7. Acceptance and Commitment Therapy (ACT) <ul><li>A – Accept your thoughts, feelings, memories, and other private events as they occur moment to moment, without judgment </li></ul><ul><li>C – Clarify and connect with personally defined values that give direction to your life, and set goals that support these values </li></ul><ul><li>T – Take effective action in accordance with your goals and values </li></ul>
  8. 8. Aim of ACT <ul><li>To help us create a rich, full, and meaningful life, while accepting the pain that life inevitably brings </li></ul>
  9. 9. Sources of Pain and Discomfort <ul><li>Clean Discomfort </li></ul><ul><li>Dirty Discomfort </li></ul>
  10. 10. ACT and Mindfulness <ul><li>ACT is not just mindfulness </li></ul><ul><li>ACT uses mindfulness as a means of accessing the observing self in the present moment </li></ul><ul><li>The observing self has no words but the thinking self is chattering continuously </li></ul>
  11. 11. What is Mindfulness? <ul><li>A mental state of awareness, focus, curiosity, openness, and receptiveness that allows you to engage fully in your here-and-now experience </li></ul>
  12. 13. Essentials of BED Diagnostic Criteria <ul><li>Recurrent episodes </li></ul><ul><li>Larger than normal amount of calories </li></ul><ul><li>Sense of lack of control </li></ul><ul><li>No regular use of compensatory behaviors </li></ul>
  13. 14. Agenda of Control <ul><li>Lack of control implies the need for more control </li></ul><ul><li>Works in the external world </li></ul><ul><li>Doesn’t work for thoughts and feelings </li></ul><ul><li>Binge is an attempt to stop thinking and feeling, that is, it is an experiential avoidance strategy </li></ul>
  14. 15. Introducing Tina <ul><li>Presenting complaints </li></ul><ul><li>History </li></ul><ul><li>Eating triggers </li></ul><ul><ul><li>Family dynamics </li></ul></ul><ul><ul><li>Emotions </li></ul></ul><ul><ul><li>Unstructured time </li></ul></ul><ul><ul><li>Feeling of not fitting in </li></ul></ul><ul><ul><li>Social situations </li></ul></ul><ul><ul><li>Hunger, fatigue </li></ul></ul>
  15. 16. Triggers for Binges and Overeating <ul><li>Negative emotions </li></ul><ul><li>Positive social experiences </li></ul><ul><li>Low distress tolerance </li></ul><ul><li>Restrictive eating/dieting </li></ul><ul><li>Unstructured time/transitional times </li></ul><ul><li>Readily available, high-energy, palatable food (food cues in the environment) </li></ul><ul><li>Evolutionary motivational system to ensure survival </li></ul>
  16. 18. Mindful Questions to Ask <ul><li>What is triggering me to eat this food right now? </li></ul><ul><li>What are my other options for food to eat or behavior in which I can engage? </li></ul><ul><li>Is eating this food in line with my values and the option I choose at this time? </li></ul>
  17. 19. Core Messages of ACT <ul><li>Accept what is out of your personal control </li></ul><ul><li>Commit to taking actions that enrich your life because they are based on your values </li></ul>
  18. 20. ACT and Values <ul><li>Values are statements about </li></ul><ul><ul><li>What you want to be doing with your life </li></ul></ul><ul><ul><li>What you want to stand for </li></ul></ul><ul><ul><li>How you want to behave on an ongoing basis </li></ul></ul><ul><li>Values clarify what gives your life a sense of meaning or purpose </li></ul><ul><li>Values are chosen life directions </li></ul>
  19. 21. Processes that Keep Us Stuck <ul><li>Cognitive Fusion </li></ul><ul><ul><li>You become fused with, melded with, and inseparable from your thoughts </li></ul></ul><ul><ul><li>Thoughts dominate behavior </li></ul></ul><ul><ul><li>Leads to unworkability </li></ul></ul><ul><li>Experiential Avoidance </li></ul><ul><ul><li>Trying to avoid, get rid of, suppress, or escape from unwanted thoughts, feelings, memories, fears </li></ul></ul>
  20. 22. Processes That Work <ul><li>Defusion </li></ul><ul><ul><li>Wherein thoughts, feelings, and urges come to be experienced from a psychological distance, i.e., the observing self </li></ul></ul><ul><ul><li>Being able to have a thought, feeling, craving, or urge without trying to suppress, believe, or act on it </li></ul></ul><ul><li>Acceptance </li></ul><ul><ul><li>Learning to tolerate or be willing to have aversive internal experiences in the service of goal-related behavior </li></ul></ul><ul><ul><li>Alternative to control strategies </li></ul></ul>
  21. 23. Choosing Based on Values <ul><li>Some ideas are worth considering </li></ul><ul><li>Ask yourself, “Does this contemplated action move me toward something I value?” </li></ul><ul><li>A good thing overdone undermines the value of health and well-being </li></ul>
  22. 26. ACT in a Nutshell <ul><li>Present focused </li></ul><ul><li>Experiential/metaphor </li></ul><ul><li>Between session work </li></ul><ul><li>Applicable to a variety of problems </li></ul>
  23. 27. Some Obesity-related Research <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>
  24. 28. More Obesity-Related Research <ul><li>Lillis, J., Hayes, S. C., & Levin, M. E. (2011). Binge eating and weight control: the role of experiential avoidance. Behavior Modification, 35: 252-264. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>
  25. 29. Reading Recommendations <ul><li>Russ Harris. (2006). “Embracing Your Demons: An Overview of Acceptance and Commitment Therapy”. </li></ul><ul><li> Harris-a_non-technical_overview_of_act.pdf </li></ul><ul><li>Russ Harris. (2009). ACT Made Simple . </li></ul><ul><li>J. B. Luoma, S. C. Hayes, R. D. Walser (2007). Learning ACT . </li></ul><ul><li>Steven Hayes, Kirk Strosahl, Kelly Wilson. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change . </li></ul><ul><li>Steven Hayes. (2007). ACT in Action , DVD Series. </li></ul>