If you struggle with both Anorexia Nervosa (AN) and Obsessive-Compulsive Disorder (OCD), you already know how loud and convincing your thoughts can feel. Thoughts about food, routines, body image, or “something bad will happen if I don’t do this” can take over quickly. The goal isn’t to get rid of these thoughts, because that often backfires. Instead, evidence-based approaches like Acceptance and Commitment Therapy (ACT) teach something different—and far more effective.
ACT is especially helpful for co-morbid AN and OCD because traditional approaches like cognitive restructuring (challenging or debating thoughts) can sometimes unintentionally strengthen obsessive thinking. When you engage deeply with a thought—arguing with it, analyzing it, or trying to prove it wrong—you are still giving it attention and importance. This can keep the cycle going: an intrusive thought leads to anxiety, which leads to mental engagement, followed by temporary relief, and then the thought returns stronger. ACT interrupts this cycle by shifting the goal from changing thoughts to changing your relationship with thoughts.
One of the core skills in ACT is cognitive defusion—learning to step back from your thoughts instead of getting tangled in them. Rather than saying, “I shouldn’t eat outside my routine or something bad will happen,” you can practice saying, “I am having the thought that I shouldn’t eat outside my routine or something bad will happen.” This small shift creates space and helps you recognize that a thought is not a command, not a fact, and not who you are. You might remind yourself, “I am having a thought, not stating a truth,” “I cannot control all my thoughts,” “I am not my thoughts,” and “This is part of being human.”
Mindfulness plays a central role in this process and is strongly supported in research for both OCD and eating disorders. Mindfulness is not about clearing your mind; it is about observing what is already there without reacting. You might notice sensations like anxiety in your chest, thoughts about needing to follow a routine, or fear about eating certain foods. Instead of trying to fix or avoid these experiences, you practice allowing them. Over time, this builds the ability to feel discomfort without needing to act on it.
When you choose not to engage with obsessive thoughts, something important happens. The anxiety may rise at first, but it will peak and then fall on its own. This process is well-supported in exposure-based therapies and is often referred to as habituation or inhibitory learning. If you instead argue with the thought, seek certainty, or follow the rule, you unintentionally reinforce the idea that the thought is important and must be obeyed.
Distress tolerance becomes essential in these moments. For example, when a routine is broken ~ such as eating outside of a set time or eating foods that feel unsafe ~ anxiety will likely increase. Your mind may urge you to fix the situation or return to what feels safe. ACT encourages you to stay with the discomfort anyway. You might tell yourself, “This is uncomfortable, but I can handle it,” “My body is reacting, and that’s okay,” and “This feeling will pass.” By doing this, you learn through experience that you are okay even without following the thought.
Over time, this creates new learning. You might notice, “I ate in the morning. I felt some discomfort in my stomach while digesting, which makes sense because my body is working. Now that feeling has passed, and I am ok. My body has not changed ~ this was just a fear.” This kind of experience helps your brain learn something new without needing to argue with the original thought.
It is also important to normalize the human experience. Everyone has intrusive thoughts. Research shows that most people experience strange or unwanted thoughts at times. The difference in OCD and eating disorders is not the presence of these thoughts, but how much meaning and control we give them. You are not broken ~ your brain is trying to protect you, even if it is doing so in an overactive way. ACT helps you respond with openness, flexibility, and self-compassion.
Ultimately, the goal is not just to reduce symptoms, but to build a life guided by your values rather than your fears. This may look like eating with others even when it feels difficult, letting go of rigid routines, nourishing your body consistently, and choosing connection over control. Each time you notice a thought, choose not to engage with it, and act in line with your values instead, you weaken the cycle and strengthen your freedom.
You do not need to win the argument with your thoughts, and you do not need to eliminate them. You can learn to notice them, step back from them, let them pass, and choose your actions anyway. At Healing Stones Therapy, we specialize in evidence-based approaches like ACT to support individuals navigating eating disorders, OCD, and anxiety. Learn more at healingstones.life for therapy in Wyoming, Montana, Colorado, Utah, Nevada, Oklahoma, wiht online support for eating disorders and OCD. We are physically located in Wyoming and provide telehealth sessions out of state. We accept Blue Cross Blue Shield, Aenta, Unitedhealth Care and much more. You are not alone in this, and change is absolutely possible.
