Each component was rated on a scale from 1 to 5. Items were scored as a 1 if the component never occurred in that session, as a 2 if the component occurred at least once but not in an in-depth manner, as a 3 if it occurred several

times during the session and was covered at least once in a moderately in-depth manner, as a 4 if it occurred frequently and was covered in-depth, and as a 5 if it occurred with high frequency and was covered in considerable depth. The therapist was also rated with regard to overall adherence CAL-101 research buy to ACT principles as well as the overall competence of the therapist. Sessions 3 and 10 were rated for Participant 1, and Sessions 4 and 7 were rated for Participant 2. At least one of the rated ACT components was covered frequently in a very in-depth manner (i.e., received a rating of “5”) in each of the rated sessions. The means for each component over the rated sessions were as follows: creative hopelessness/workability = 4.00 BGB324 cell line (SD = .82), willingness/acceptance = 4.25 (SD = .96), defusion = 3.5 (SD = 1.29), values/goals = 2.25 (SD = .50),

committed action = 2.25 (SD = .50), and present-moment focus = 4.25 (SD = .50). Therapist overall adherence to the manual was also rated highly (M = 4.75; SD = .50) as well as therapist overall competence (M = 4.25; SD = .50). The therapist was also rated on use of techniques antithetical to an ACT intervention, including challenging cognitions, experiential avoidant change strategies, using a cognitive therapy rationale, and encouraging the idea that thoughts and feelings cause actions. Each

of these items was rated as a 1 across participants, indicating that none of these interventions were observed in any rated sessions. The primary dependent variable was participants’ daily self-monitored binge eating. The baseline phase, treatment phase, and follow-up phases of treatment are presented in Figure 1. Additionally, problematic eating and related outcome variables at pretreatment, Racecadotril midpoint, posttreatment, and 3-month follow-up are presented in Table 2 and Table 3. The average number of self-reported binge eating for Participant 1 was 3.0 times per week during the pretreatment period (see Table 2), which is consistent with the criteria for BED. Within the first 2 weeks of the intervention, the average number of binge eating decreased to approximately 1.5 times per week. Throughout the course of the 10-week ACT intervention, Participant 1 engaged in a total of only 5 episodes of binge eating. Her average number of binge eating episodes during the ACT intervention was .5 per week. Participant 1 did not report any episodes of binge eating at 3-month follow-up. The reduction in binge eating paralleled improvement in body image flexibility. Participant 1’s pretreatment level of body image flexibility (BI-AAQ) was 41.