Committed Action
ACT, at its core, is a behavioral psychology. What that means is that we often look at the behaviors which become a daily pattern as the client does them and reinforces them with their values, repeating them over time and building the life they want. These habits will help them grow their connections and values, and shape them as the person they most wish to be. This is known in ACT as committed action, and is the final process being presented here.
Appetite Awareness Training
This is a cognitive behavioral approach developed by Linda Craighead, used with clients who struggle with binge eating, overeating, and restricted eating. The idea behind it is for clients to begin to self-monitor their hunger and fullness cues so they can use those to guide their eating, as opposed to external cues like cravings, food rules, or trying to control emotions.
One of the committed action skills worked on with this client was creating a monitoring form. There are plenty of apps you can track things on, or some people prefer pencil and paper. This client chose to use his notes app to record data about at least one meal a day.
Ideally you want clients to track data for all meals to begin with, but you have to be flexible, as not everyone will be able to. You don’t want to set behavioral goals so high that clients can’t follow through on them. For at least one meal a day, then, they’ll track their hunger level from 1-7 before eating, where seven is stuffed, one is incredibly hungry, and four is neutral.
Asking how hungry someone was before eating on a scale from 1-7 seems simple enough. Yet some people might not even know what hunger or fullness are. How do you know if you’re hungry? What does your body feel or sound like? What is a one for you vs a two or a seven? There may need to be discussions around those understandings.
Clients are also asked to track on a scale from 1-7 how full they were when they stopped eating. So there are two scores to track, hunger before eating and fullness after eating.
Behavioral Tracking
Tracking something is an intervention in itself because you’re bringing more awareness to things you want to grow. The research that Dr. Hill undertook as part of her graduate studies found that people who track their food get more obsessive about and preoccupied by food.
With binge eating disorder, this is something we don’t want to increase. The clients are already thinking about food a lot. We want to increase their awareness of their physical signals instead, and use those to guide their eating. One committed action skill is self-monitoring something that clients may want to increase; appetite awareness is a good one.
Binge Episodes
It may be helpful for a client to self-monitor binge episodes, writing a B on the day they binged, and identifying some of the precipitating factors that led to it. Was it emotional eating? Was it because food was just available, perhaps something from a cupboard was out in the open, or a roommate had made cookies? Did they think they broke a rule, and were following their thoughts very tightly? This information about types and triggers of binges can be very helpful for the clinician in deciding which processes to target with the client.
Small Changes
Another aspect of committed action is making the behavior changes you’re working on with clients really small. There’s something called the 90% rule by Dayna Lee-Baggley which posits that, 90% of the time, you feel confident a client will be able to carry things out. But while the therapist might think something is small, if it’s not actually small enough, then the client feels disappointed that they couldn’t do it. It can be counterproductive.
Something like exercising for 20 minutes a day may be too large a task for some. If so, break it down. A client could move their body for three minutes after an hour of studying, or have a brain break now and then, getting up for a minute of jogging in place or to do sun salutations.
This was worked on with this client because, given his dyslexia, it took him longer to study. So he would have these brain breaks throughout his study periods during which he would get up and just move his body, go and walk around the block outside, or call somebody for a few minutes to check in. These things fed into his committed action skills.
Get Support
There was also work on committed action around how to get the client some more support. Looking at contextual factors is really important. This was not just an individual’s “fault” that he was struggling with the MCAT. He needed more support, especially with his dyslexia.
This included making sure that he had extra time on the exams, that he had a tutor who specialized in learning differences who could help him, and learning how to be psychologically flexible. All of the psychological flexibility processes, especially acceptance, defusion, and values, motivated him to seek out some of this help and support.
Self-Compassion
Finally, self-compassion with committed action came into the picture as well. A lot of the ways the client related to himself around food and eating were punishing. So what would it be like if he responded to a binge with kindness and love as opposed to self-punishment?
For him, part of that looked like, when he binged, waiting until he was hungry before eating again and, when he was hungry, eating something nourishing rather than restricting his food. This intervened in that cycle of avoidance for him.
Committed action also had to do with cultural and familial factors, reclaiming time to have meals with his family, where he could focus on enjoying the food and being present with his family, as opposed to being caught up in shame and comparison. This type of self-compassion is an umbrella that encompasses all of ACT.
