Response: ACT Approach to Anorexia 243 Wilson, K. G., & Hayes, S. C. (2000). Why it is crucial to understand thinking and feeling: An: analysis and application to drug abuse. The BehaviorAnalyst, 23, 25-43. Wilson, K. G., Hayes, S. C., & Byrd, M. (2000). Exploring compatibili- ties between Acceptance and Commitment Therapy and 12-step treatment for substance abuse. Journal of Rational-Emotive and Cognitive-BehaviorTherapy, 18, 209-234. Wilson, K. G., Hayes, S. C., Gregg,J., & Zettle, R. D. (2001). Psychopa- thology and psychotherapy. In S. C. Hayes, D. Barnes-Hohnes, & B. Roche (Eds.), Relational frame theory: A post-Skinnerian account of human language and cognition (pp. 211-237). New York: Plenum Press. Address correspondence to Kelly G. Wilson, Department of Psychology, 205 Peabody Building, University of Mississippi, Oxford, MS 38655; e-mail: kwilson@olemiss.edu. Received: March 1, 2001 Accepted: June 8, 2001 Response Paper Experiential Avoidance, Cognitive Fusion, and an ACT Approach to Anorexia Nervosa Steven C. Hayes andJulieann Pankey University of Nevada, Reno Case conceptualization and treatment planning for indi- viduals with eating disorders seem tofollow logicaUy from within the framework of Acceptance and Commitment Therapy (ACT), which focuses on maladaptive control strategies directed toward emotional avoidance, cognitive fusion, and failure to act in accord with chosen values. The use of ACT in this case is discussed with recommen- dations for further ACT intervention strategies, why an A C T conceptualization makes sense with this population, and anticipated issues to consider. Presenting Problem and Diagnosis E MILY is an adolescent female who is presenting with behaviors indicating anorexia nervosa, restricting type. She evidences behavioral control strategies such as restricted dietary intake, misrepresentation of food in- take, and excessive weighing of herself. Physiologically, Emily evidences excessive weight loss leading to a Body Cognitive and Behavioral Practice 9, 243-247, 2002 1077-7229/02/243-24751.00/0 Copyright © 2002 by Association for Advancement of Behavior Therapy. All rights of reproduction in any form reserved. Mass Index below accepted figures for being under- weight (< 18), fatigue, and loss of monthly menses. Assess- ment data from the Eating Disorder Inventory-2 (EDI-2) indicate that Emily's scores on drive for thinness, ineffec- tiveness, and body dissatisfaction scales were in the an- orexic, restricting type, range. Assessment The ACT conceptualization of most psychological problems can be summarized in the following points: • Experiential avoidance: Most psychological difficulties have to do with the unnecessary avoidance and ma- nipulation of private events. • Cognitive fusion: This avoidance emerges from the domination of verbal regulation over other behavior regulatory processes. • Contextual control: Both experiential avoidance and cognitive fusion are contextually controlled and thus the goal of ACT is to alter these destructive contexts. • The solution is the problem: To take a new direction, we must let go of an old one. If a problem is chronic, the client's "solutions" are probably part of the problem. • Value action is the goal'. The value of any action is its workability measured against the client's true values (those he or she would have if it were a free choice). The bottom line issue is living well, not having small sets of "good" feelings. Emily presents with classic behaviors related to restrictive- type eating disorders. The specific features of assessment in this case are determined by that general problem do- main. Based on the ACT approach to psychological prob- lems just delineated, the initial ACT assessment always includes an attempt to delineate present and historical maladaptive control strategies directed toward experien- tial avoidance, ways that verbal formulations may be domi- nating direct experience, and the contextual supports for both. Particular care is given to seeing whether the pre- senting problem is a "solution" gone awry, linked to expe- riential avoidance and cognitive fusion. It is clear that this patient has become entangled in negative cognitions around body image and image of self, and is trying to regulate the upset produced by these thoughts through anorexia itself. We do not know much about other forms of experiential avoidance or their his- tory. It is common in these kinds of problems for eating regulation to be linked to other forms of emotional avoidance, such as regulating upset felt over conflicted family relationships. A detailed list of every method the patient has used to "try to solve their problems" will usu- ally link back to this history, and will provide useful