Dietitian Blog | May 5 2026
Utilizing Acceptance and Commitment Therapy in nutrition counseling
There are countless effective therapeutic modalities throughout the world. Acceptance and Commitment Therapy (ACT), developed in the 1980’s, is one such approach that can be used in a variety of settings. ACT is well-established in the treatment of eating disorders (ED), as well as other conditions, such as anxiety, depression, substance use, chronic pain, obsessive-compulsive disorder, and post-traumatic stress disorder. While eating disorders are referenced below, a patient does not need to have an active ED to benefit from this approach.
Dietitians aren’t therapists, but there can be quite a bit of overlap between the two professions. Depending on the setting and specialty, counseling may be a core component of a dietitian’s work. While incorporating therapeutic modalities isn’t a requirement, it can enhance a patient’s understanding and experience with a dietitian. Any interaction with a patient offers an opportunity to reinforce therapeutic practices.
What is Acceptance and Commitment Therapy?
Acceptance and Commitment Therapy is a form of psychotherapy that encourages psychological flexibility and mindfulness. In a nutshell, ACT can be simplified into two parts:
- Acceptance of one’s maladaptive or difficult thoughts and feelings
- Commitment to actionable change that aligns with one’s values
More specifically, ACT is broken down into 6 core principles, also known as the Hexaflex model. Each principle is explained below.
How can the principles of ACT be incorporated into nutrition care?
Acceptance: As mentioned above, this involves a willingness to experience uncomfortable thoughts and feelings. Humans naturally avoid uncomfortable emotions, such as sadness, anger, or anxiety, which often leads people to attempt to control or suppress their feelings in order to make them more tolerable. ACT practitioners believe that emotions can’t be controlled – and they don’t need to be. While it may sound counterintuitive, allowing emotions to be present without judgment may give people the sense of control they’re searching for.
In the context of nutrition counseling, the same pattern applies. When individuals attempt to control or suppress their emotions, the mind may respond by relying on maladaptive or disordered eating behaviors. Accepting emotions as they are can increase awareness and allow individuals to address the underlying drivers of their eating patterns, evoking change.
Cognitive defusion: This refers to the separation of self from thoughts and feelings. Consider the phrase “feelings aren’t facts.” The idea of defusion is for people to be neutral observers of their own mind. The practice of defusion decreases emotional intensity and increases emotional flexibility.
In nutrition counseling, defusion can be a crucial part of someone’s nutrition rehabilitation. In more extreme cases, it is common for people to have difficulty identifying who’s calling the shots – the eating disorder or their true self. Defusion can help clients separate themselves from harmful thoughts, allowing them to recognize that they don’t have to believe or give in to them.
To put defusion into practice, a patient can put the phrase “I’m having the thought that…” before a harmful thought. For example, instead of saying “I’m not worthy of food,” they can say “I’m having the thought that I’m not worthy of food.”
Being present: Mindfulness is a primary part of ACT’s modality. Being in the here and now can help prevent a client from spiraling about the past or future tripping (excessively worrying about the future).
It is common for those with disordered eating and eating disorders to have anxiety, which can make it difficult to be in the present moment. Practicing mindfulness decreases the chance of the eating disorder causing a spiral or interfering with one’s relationship with food.
One mindfulness practice is using the 5-4-3-2-1 technique, helping a patient be more present. This practice involves naming 5 things one can see, 4 things one feels, 3 things one hears, 2 things one can smell, and 1 thing one tastes. It is important to keep in mind that some patients, like those who have experienced complex trauma, may not be appropriate or ready for this activity.
Values: Connection, autonomy, innovation, and stability are some examples of values. Each person has a unique set of values they deeply connect with. When someone understands their core values, they often feel more empowered to live a life that’s in alignment with those values, which ultimately enhances their quality of life.
When a patient knows their values, they have something to work toward. Identifying a patient’s values can increase their motivation to make meaningful change, eat in a way that aligns with their values, help them separate from their ED, and help them live a life worth living.
Self-as-context: This offers the reminder that humans are more than their thoughts, feelings, and experiences. Even as those qualities change over time, each person is still uniquely themselves.
This principle says “you are more than your eating disorder” or “you are more than your relationship with food,” increasing awareness and separation from maladaptive thoughts. This gives patients the space to have an identity that is separate from their eating patterns. By putting the other principles into practice, one can get closer to believing this for themselves.
Committed action: This encourages one to take action to make meaningful change, despite maladaptive thoughts and feelings that may come up. Again, quality of life improves when people intentionally lean into their values.
When a client actively engages in behaviors that align with their values, they are actively deprioritizing their ED and prioritizing themselves.
In summary
Of course, ACT strategies may not be effective for everyone, which is why it is important to always consult with a multidisciplinary team regarding the best approach for each patient. As each person’s core values are unique and individualized, so must be their treatment. By understanding the foundational principles of ACT, dietitians can use these insights to gently support their patients moving toward the life they want.
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References:
Anusuya SP, Gayatridevi S. Acceptance and Commitment Therapy and Psychological Well-Being: A Narrative Review. Cureus. 2025; 17(1)e77705. DOI 10.7759/cureus.77705
Smout M. Acceptance and commitment therapy – pathways for general practitioners. Aust Fam Physician. 2012; 41(9):672-676. https://www.racgp.org.au/afp/2012/september/acceptance-and-commitment-therapy
Juarascio A, Shaw J, Forman E, et al. Acceptance and commitment therapy as a novel treatment for eating disorders: an initial test of efficacy and mediation. Behav Modif. 2013; 37(4):459-89. DOI: 10.1177/0145445513478633
About Taylor Moyer
Taylor Moyer, RD, LD, CEDS is a dietitian who specializes in treating those with eating disorders at multiple levels of care. She strives to help people make peace with their relationship with food and their bodies. In her free time, she enjoys hiking with her dog and gardening.
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