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Objective: Increasing evidence suggests that mindfulness- and acceptance-based psychotherapies (MABTs) for bulimia nervosa (BN) and binge-eating disorder (BED) may be efficacious however little is known about their active treatment components or for whom they may be most effective. Methods: We systematically identified clinical trials testing MABTs for BN or BED through PsychINFO and Google Scholar. Publications were categorized according to analyses of mechanisms of action and moderators of treatment outcome. Results: Thirty-nine publications met inclusion criteria. Twenty-seven included analyses of therapeutic mechanisms and five examined moderators of treatment outcome. Changes were largely consistent with hypothesized mechanisms of MABTs, but substandard mediation analyses, inconsistent measurement tools, and infrequent use of mid-treatment assessment points limited our ability to make strong inferences. Discussion: Analyses of mechanisms of action and moderators of outcome in MABTs for BN and BED appear promising but use of more sophisticated statistical analyses and adequate replication are necessary.

The current study examined psychological inflexibility and self-compassion as theoretically relevant mediators and moderators of outcomes following acceptance and commitment therapy (ACT) for clinical perfectionism. Fifty-three participants with clinical perfectionism were randomized to either a 10-session ACT condition or a 14-week waitlist control condition (only 39 completed the posttreatment assessment). Outcomes tested include concern over mistakes, doubting of actions, personal standards, quality of life, symptom distress and functional impairment, and valued action. Multilevel modeling analyses showed reduced psychological inflexibility mediated the relationship between condition and higher quality of life and increased self-compassion mediated the relationship between condition and decreased concern over mistakes. No other mediation effects were observed. In addition, baseline psychological inflexibility differentially moderated outcomes depending on outcome tested; for example, lower baseline inflexibility predicted more improvement in quality of life whereas higher baseline inflexibility predicted more improvement in symptom distress and functional impairment. Participants with average baseline self-compassion tended to benefit the most from ACT. These findings clarify how psychological inflexibility and self-compassion influence outcomes following ACT for clinical perfectionism. Theoretical and clinical implications of ACT for clinical perfectionism are discussed.

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This article describes the initial phase of acceptance and commitment therapy (ACT). The article begins with a review of ACT's theoretical orientation. Basic empirical support for ACT and its model are covered. A case description follows that highlights the initial phases of ACT. The article concludes with practical recommendations for starting therapy using ACT. Clinical Impact StatementQuestion: The goal of this article is to present the manner in which acceptance and commitment therapy (ACT) is initiated. Findings: There are specific theoretical elements of ACT that suggest certain approaches be taken at the beginning of therapy. Meaning: Before starting ACT with a new client, therapists should be familiar with the theoretical orientation of the therapy and the techniques needed to imitate it. Next Steps: Research on how to train these skills appears needed.