The Two Faces of ACT


Childhood Obesity News has talked about the poetic and philosophical attributes of Acceptance and Commitment Therapy. Through mindfulness, the patient can learn to tolerate cravings and even find entertainment in the devious head trips that a craving will put a person through when trying to have its way. When this urge-surfing skill has been mastered, says Bay Area CBT Center,

[…] your urges will no longer act as barriers or be your enemies, instead your urges will inform you about what matters to you and what kind of person you want to be.

Utah State University researchers reported on a pilot randomized trial of an acceptance and commitment therapy matrix mobile application. These quotations are relevant to our concerns:

A growing body of research indicates the efficacy of acceptance and commitment therapy for improving healthy diet and exercise behaviors… ACT has been found in eight published randomized controlled trials to improve diet, exercise, and/or weight relative to waitlists, education control groups, treatment as usual, a walking program with pedometer, and standard behavioral treatment for weight loss.

In other words, it works better than several other approaches. How, especially, does it apply to diet and exercise behaviors? ACT suggests that the habit of experiential avoidance, also known as making “away moves,” is ultimately futile. The purpose of any away move is to avoid inner experiences such as thoughts, feelings, cravings, and sensations.

ACT, on the other hand, encourages the confrontation. The preferred course is to make “toward moves” and use inner experience as fuel to perform an ever-increasing number of valued actions.

Nuts and bolts

During the two-week test period, each participant received two check-in phone calls from the same researcher who had conducted their app orientation. A typical call would last from five to 10 minutes and focus first on supporting compliance (or, to put it more gently, adherence) by addressing any technical questions. Then, the therapist and client figure out the more elusive angles, like where resistance is coming from, and how to convert it to enthusiasm.

Clinicians are excited about smartphone apps to teach ACT skills because the phone is a convenient, familiar, and relatively undemanding format that lends itself to low-intensity, high-frequency communications. Further, since it’s always there, it encourages the generalization of ACT skills to everyday situations beyond the original presenting problem.

Apparently, most of the participants felt they could have done without the orientation, and possibly even without the human therapist. The researchers are cautiously optimistic about the chances for making it all technology, all the time. One caveat: The patients or clients who already possess great psychological flexibility will create better outcomes for themselves.

ACT respects human free will. It does not dictate that a person must repress every instance of every urge, forever. ACT merely reminds us that to snuggle up close and personal with one’s urges is to expand the repertoire of possibilities and increase the number of behavioral choices, which is always a good thing.

Your responses and feedback are welcome!

Source: “Ride the Waves with Urge Surfing,”
Source: “The acceptance and commitment therapy matrix mobile app: A pilot randomized trial on health behaviors,”, 2017
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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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