DClinPsy Portfolio Volume 1 of 3 - University of Hertfordshire ...

Heffner et al, (2002) assert that the cognitive-behavioural treatment they put forward
targets the core problems of ineffective control strategies and the unwillingness to remain
in contact with negative emotions or thoughts (experiential avoidance), in AN.
ACT holds that excessive control strategies are problems, not solutions, in common with
the cognitive-behavioural theory of AN, where a problematic need for control maintains
AN (Fairburn, Shafran, & Cooper, 1999) and that dietary restriction is reinforced by the
sense of being in control. This is particularly apparent if the individual has failed at
controlling other areas of life. Another feature of AN is the avoidance of thoughts or
feelings related to weight and body image, (Meyer, Waller and Watson, 2000). An ACT
treatment plan seeks to undermine ineffective control and avoidance strategies by helping
the client see how these are inhibiting, discriminating between themselves and their
problem behaviour so that acceptance becomes possible and avoidance unnecessary. The
client then identifies valued life directions and is provided with support to achieve these.
In Heffner et al’s (2002) example a concrete, visual map of valued directions was drawn
with one road, representing AN, leading to a dead end and the other roads, representing
valued directions, were interconnected and never ending. The values specified were
achieving a goal regarding swimming, and the therapist explained how eating would
move the client toward the direction (e.g., eating would give the client more energy to
succeed at swimming). Thus, negative emotions and thoughts are not considered
obstacles but an expected part of goal directed behaviour. So the individual is not
expected to increase their body image satisfaction but to get on with achieving valued
goals irrespective of their level of body image satisfaction (Heffner et al, 2002).
Treatment effectiveness for Eating Disorders and Obesity
Cognitive Behavioural Therapy for Bulimia Nervosa (CBT-BN) has been compared with
a wide range of psychological treatments (Wilson & Fairburn, 2002). It has been found to
be as effective as or more effective than all the treatments it was compared to.
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