Acceptance and change in the treatment of eating disorders and obesity

Abstract

Recently it has been argued that the explicit focus on behavior change in behavior therapy must be complemented by recognition of the value of acceptance, and the importance of the relationship between these two treatment goals. The same dialectic is central to the treatment of eating disorders and obesity. Having made nutritionally sound and psychologically adaptive lifestyle changes, patients need to accept whatever shape and weight these changes produce. Treatment strategies for overcoming obstacles to acceptance are discussed. These include education, the use of the therapeutic relationship, and cognitive restructuring. Acceptance is an active process of self-affirmation rather than passive resignation to an unhappy fate. It involves emotional processing as well as cognitive and behavioral change. The focus on acceptance and the empirical evidence on the effectiveness of cognitive behavioral therapy (CBT) in promoting self-acceptance in patients with eating disorders contrasts with the treatment of obesity where the value of self-acceptance has received less research attention. Aside from being important in its own right, enhancing self-acceptance might lead to more lasting changes in health-relevant eating and exercise behavior.