Using Mindfulness and Using Mindfulness and Acceptance-based Therapy Acceptance-based Therapy for Treating Binge Eating for Treating Binge Eating DisorderDisorder

Joyce D. Nash, Ph.D.Joyce D. Nash, Ph.D.info.drnash@comcast.netinfo.drnash@comcast.netwww.joycenashphd.comwww.joycenashphd.com

For Presentation HandoutsFor Presentation Handouts

• http://loseweightlivehealthyguide.cohttp://loseweightlivehealthyguide.com/m/

ANAD_bed_presentationANAD_bed_presentation

ResourcesResources• Russ Harris. (2009). Russ Harris. (2009). Act Made SimpleAct Made Simple• http://www.thehappinesstrap.com/upimages/ACT_Made_Simhttp://www.thehappinesstrap.com/upimages/ACT_Made_Simple_Introduction_and_first_two_chapters.pdfple_Introduction_and_first_two_chapters.pdf

• Russ Harris. (2006). “Embracing Your Demons: An Overview Russ Harris. (2006). “Embracing Your Demons: An Overview of Acceptance and Commitment Therapy”of Acceptance and Commitment Therapy”

• http://www.actmindfully.com.au/upimages/Dr_Russ_Harris_-http://www.actmindfully.com.au/upimages/Dr_Russ_Harris_-_A_Non-technical_Overview_of_ACT.pdf_A_Non-technical_Overview_of_ACT.pdf

• Steven Hayes, Kirk Strosahl, Kelly Wilson. (1999). Steven Hayes, Kirk Strosahl, Kelly Wilson. (1999). Acceptance and Commitment Therapy: An Experiential Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change.Approach to Behavior Change.

• http://www.contextualpsychology.orghttp://www.contextualpsychology.org

Resources (continued)Resources (continued)• J. B. Luoma, S. C. Hayes, R. D. Walser (2007) J. B. Luoma, S. C. Hayes, R. D. Walser (2007)

Learning ACT: An Acceptance & Learning ACT: An Acceptance & Commitment Therapy Skills-Training Manual Commitment Therapy Skills-Training Manual for Therapists.for Therapists.

• J. Nash. (2011) J. Nash. (2011) Lose Weight, Live Healthy: Lose Weight, Live Healthy: A Complete Guide to Designing Your Own A Complete Guide to Designing Your Own Weight Loss Program.Weight Loss Program.

• http://loseweightlivehealthyguide.comhttp://loseweightlivehealthyguide.com

Proposed DSM-V Criteria for Proposed DSM-V Criteria for BEDBED• A. Recurrent episodes of binge eating. An A. Recurrent episodes of binge eating. An

episode is characterized by both of the episode is characterized by both of the following:following:

• 1. eating, in a discrete period of time (e.g., 1. eating, in a discrete period of time (e.g., an amount of food that is definitely larger an amount of food that is definitely larger than most people would eat in a similar than most people would eat in a similar period of time under similar circumstancesperiod of time under similar circumstances

• 2. a sense of lack of control over eating 2. a sense of lack of control over eating during the episode (e.g., a feeling that one during the episode (e.g., a feeling that one cannot stop eating or control what or how cannot stop eating or control what or how much one is eating)much one is eating)

DSM Criteria (continued)DSM Criteria (continued)• B. The binge-eating episodes are associated B. The binge-eating episodes are associated

with three (or more) of the following:with three (or more) of the following:• 1.1. eating much more rapidly than normaleating much more rapidly than normal• 2.2. eating until uncomfortably fulleating until uncomfortably full• 3.3. eating large amounts of food when not eating large amounts of food when not

feeling physically hungryfeeling physically hungry• 4.4. eating alone because of being eating alone because of being

embarrassed by how much one is eatingembarrassed by how much one is eating• 5.5. feeling disgusted with oneself, feeling disgusted with oneself,

depressed, or very guilty after overeatingdepressed, or very guilty after overeating

DSM Criteria (continued)DSM Criteria (continued)• C.C. Marked distress regarding binge eating is Marked distress regarding binge eating is

presentpresent

• D.D. The binge eating occurs, on average, at least The binge eating occurs, on average, at least once a week for three monthsonce a week for three months

• E.E. The binge eating is not associated with the The binge eating is not associated with the recurrent use of inappropriate compensatory recurrent use of inappropriate compensatory behavior (i.e., purging) and does not occur behavior (i.e., purging) and does not occur exclusively during the course of bulimia nervosa or exclusively during the course of bulimia nervosa or anorexia nervosaanorexia nervosa

Triggering SituationsTriggering Situations• Social situationsSocial situations (e.g., eating out with (e.g., eating out with

friends, parties, holidays with family)friends, parties, holidays with family)

• EmotionsEmotions (e.g., anger, anxiety, sadness, (e.g., anger, anxiety, sadness, depression, loneliness, boredom)depression, loneliness, boredom)

• Low Arousal/Transition TimesLow Arousal/Transition Times (i.e., between (i.e., between tasks, after finishing a task)tasks, after finishing a task)

• PhysiologicalPhysiological (e.g., hunger, fatigue, pain) (e.g., hunger, fatigue, pain)

Aim of ACTAim of ACT

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

Acceptance and Commitment Acceptance and Commitment Therapy (ACT)Therapy (ACT)

• A – Accept your thoughts and feelings and be A – Accept your thoughts and feelings and be present.present.

• C – Connect with values that give direction to C – Connect with values that give direction to your life and set goals that support these your life and set goals that support these valuesvalues

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

Assumptions Underlying Assumptions Underlying ACTACT

• 1.1. Quality of life is primarily dependent Quality of life is primarily dependent upon mindful, values-guided action.upon mindful, values-guided action.

• 2.2. This is possible regardless of how This is possible regardless of how many symptoms a person has—provided many symptoms a person has—provided that the person responds to the symptoms that the person responds to the symptoms with mindfulness.with mindfulness.

Core Messages of ACTCore Messages of ACT

• 1.1. Accept what is out of your personal Accept what is out of your personal control—i.e., your thoughts, feelings, control—i.e., your thoughts, feelings, memories, or other private events.memories, or other private events.

• 2.2. Commit to taking effective action Commit to taking effective action that enriches your life because it is that enriches your life because it is based on your values.based on your values.

How ACT Implements How ACT Implements Core MessagesCore Messages

• 1.1. Mindfulness skillsMindfulness skills

• 2.2. Values clarificationValues clarification

What Is Mindfulness?What Is Mindfulness?

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

More About MindfulnessMore About Mindfulness• 1.1. It is an awareness, not a thinking It is an awareness, not a thinking

process.process.

• 2.2. It involves flexibility of attention.It involves flexibility of attention.

• 3.3. It involves being able to observe It involves being able to observe without becoming engaged or entangled.without becoming engaged or entangled.

ACT and ValuesACT and Values• ACT is more than mindfulness.ACT is more than mindfulness.

• It’s about valued living, taking effective It’s about valued living, taking effective action on an ongoing basis that is guided action on an ongoing basis that is guided by and aligned with core chosen values. by and aligned with core chosen values.

• Mindfulness is a way of facilitating valued Mindfulness is a way of facilitating valued action.action.

Values in Plain LanguageValues in Plain Language• Values are statements about: Values are statements about:

– what you want to be doing with your lifewhat you want to be doing with your life– what you want to stand for, andwhat you want to stand for, and– how you want to behave on an ongoing basishow you want to behave on an ongoing basis

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

• Values are chosen life directionsValues are chosen life directions

Processes that Get Us StuckProcesses that Get Us Stuck

• Cognitive FusionCognitive Fusion– Means you are inseparable from your thoughtsMeans you are inseparable from your thoughts– Means thoughts dominate behaviorMeans thoughts dominate behavior– Leads to Leads to unworkabilityunworkability

• Experiential AvoidanceExperiential Avoidance– Means trying to avoid, get rid of, suppress, or Means trying to avoid, get rid of, suppress, or

escape from unwanted thoughts or feelingsescape from unwanted thoughts or feelings– Facilitates behavioral addictionsFacilitates behavioral addictions