By Jennifer Rollin, MSW, LCSW-C, Therapist & Founder of
The Eating Disorder Center
If you’re reading this as a therapist, there’s a good chance you’ve worked with clients who feel completely stuck in unhelpful thoughts and patterns around food or body image. You may have seen clients who understand, on an intellectual level, that their eating disorder thoughts are distorted, yet still feel unable to disengage from them or behave differently in the moment.
In my work treating eating disorders, two clinical patterns show up again and again.
First, clients are often highly fused with eating disorder thoughts. These thoughts are not experienced as “mental events,” but as facts or rules that must be obeyed. Many clients do not initially recognize these as thoughts at all. Instead, the eating disorder voice feels authoritative.
Second, eating disorder behaviors often function as subconscious coping strategies. Restriction, bingeing, purging, or compulsive exercise are frequently attempts to manage overwhelming emotions, trauma responses, anxiety, shame, experiences of oppression, or attachment and relational wounds. This is important to name clearly for clients: eating disorders are not choices or a result of being ‘vain.’ They are serious mental illnesses that often develop as attempts to survive unbearable internal experiences.
Acceptance and Commitment Therapy (ACT) is one of the modalities used by myself and members of my team at The Eating Disorder Center. ACT can be particularly effective for eating disorder treatment because it shifts the therapeutic focus away from eliminating thoughts and emotions and toward changing a client’s relationship with their internal experience.
One ACT process that is especially useful in eating disorder recovery is cognitive defusion.
Thought Defusion in Eating Disorder Treatment
Defusion refers to a set of skills designed to help clients create distance from their thoughts, rather than automatically believing or obeying them. In the context of eating disorders, defusion allows clients to notice eating disorder thoughts without acting on them, so they can move toward behaviors that align with recovery and with their deeper values.
Importantly, ACT does not ask clients to determine whether a thought is “true” or “false.” Instead, we help clients assess whether a thought is helpful or unhelpful in moving them toward the life they want.
Below are several defusion strategies that can be particularly effective when working with eating disorder thoughts.
1. “I Am Having the Thought That…”
One of the simplest and most accessible defusion techniques is linguistic distancing.
When a client notices an eating disorder thought, invite them to add the phrase: “I am having the thought that…”
For example: “I am having the thought that I cannot eat carbohydrates.”
An additional layer is: “I am noticing that I’m having the thought that…”
This subtle shift can be powerful. It helps clients begin to experience thoughts as events occurring in the mind, rather than truths that require immediate action. Over time, this practice can loosen the grip of rigid eating disorder rules and create space for choice.
2. Labeling Repetitive Eating Disorder Stories
Many eating disorder thoughts show up in predictable, repetitive narratives. Helping clients identify and label these patterns can reduce their intensity and authority.
For example, a client might label a recurring thought pattern as: “This is the ‘If I recover, I won’t be able to cope’ story.”
Or: “This is the ‘I can’t trust my body’ story.”
By externalizing and naming these stories, clients can learn to recognize them more quickly and respond with greater flexibility, rather than being pulled into automatic behavioral responses.
3. Using Metaphor and Analogy
ACT metaphors can be especially effective with eating disorder clients, as they bypass debate and engage experiential understanding.
One analogy I frequently use is to compare eating disorder thoughts to unhelpful TikTok videos. Clients can click on them, engage, and watch them all the way through. Or they can notice the thought and swipe past it. With enough swiping, the algorithm begins to change.
Other clients resonate more with the idea of eating disorder thoughts as spam emails or scam texts. They may still arrive, but clients do not need to open them, analyze them, or respond.
Metaphors like these help normalize the presence of eating disorder thoughts in recovery while reducing the urgency to act on them.
4. Singing the Thought
This technique does not resonate with everyone, but for some clients it can be surprisingly effective.
Inviting a client to sing an eating disorder thought to the tune of a familiar song can strip the thought of its seriousness and perceived authority. The goal is not to mock the client’s experience, but to highlight that thoughts are sounds and words produced by the mind, not commands that must be followed.
Bringing It All Together Clinically
When using ACT with eating disorder clients, the broader therapeutic goal is to help clients learn how to:
For therapists who do not specialize in eating disorders, it’s crucial to refer out or seek consultation. Eating disorders are treatable, yet complex illnesses and are the second deadliest mental illness. With treatment and support, full recovery is possible.
About The Eating Disorder Center
The Eating Disorder Center is a premier outpatient eating disorder therapy practice founded by Jennifer Rollin, MSW, LCSW-C. We specialize in treating teens andadults with anorexia, bulimia, binge eating disorder, OSFED, and body image concerns.
We offer eating disorder therapy in Rockville, Maryland, serving individuals in Potomac, North Potomac, Bethesda, Olney, Silver Spring, Germantown, and Washington, D.C. We also provide virtual eating disorder therapy in Maryland, Virginia, Washington, D.C., Florida, Pennsylvania, and California.
www.gwscsw.org PO Box 711 | Garrisonville, VA 22463 | 202-478-7638 | admin@gwscsw.org
