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

After insertion, if the fingers pull out, the tube catches and tightens and the only way to
escape is to push the fingers in, then slide them out. The finger trap demonstrates that
attempts to control an uncontrollable event (e.g., body weight) are futile, whereas efforts
to push in and accept one's body are more beneficial. The control agenda (i.e., not eating)
was discussed and its counterproductive consequences named (e.g. fatigue and hunger).
The person was then encouraged to discriminate between oneself and one's problem
behaviour, providing context in which acceptance is possible and avoidance is
unnecessary.
Another metaphor was demonstrated by using chess pieces that are thought of as being at
war with one another, while the board is merely an observer. The board never loses, but
the pieces are constantly being attacked and knocked off the board. The patient was
encouraged to see that she was functioning as a chess piece by fighting off the "fat
thoughts," and she was losing at the game. Instead the patient was encouraged to play the
game in a new way by serving as the board and observing the fight rather than
participating in it. The patient was then asked to specify her valued life directions and
these were referred to throughout. The map highlighted how eating would move her
towards those directions (e.g., eating would give her more energy to succeed at
swimming which was important to her). This paper concluded that with parental support,
rapport, and other standard cognitive-behavioural techniques ACT techniques were
successfully incorporated into a behavioural treatment for AN.
Interestingly, Heffner et al (2002) reported that although the treatment was considered
successful, body dissatisfaction remained. It was emphasised that the treatment goal was
not to eliminate body dissatisfaction, but to accept thoughts and feelings of body
dissatisfaction and refocus her energy toward achieving chosen goals. Thus, although the
patient was not satisfied with her body, she was able to resume a healthy lifestyle in spite
of weight-related thoughts and feelings. This is an important difference between the CBT
perspective and ACT. This point will be taken up further under consideration of body
image in relation to acceptance and mood disorders which follows.
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