Integrating Chair Work and Acceptance and Commitment Therapy in Eating Disorders: A Practice-Based Perspective on Dysfunctional Schema Modes and Psychological Flexibility.

Abstract: Eating disorders are frequently accompanied by rigid dysfunctional schema modes, harsh internal criticism, emotional avoidance, and limited psychological flexibility, which may complicate the therapeutic process. This practice-based paper presents a structured overview of clinical experience with integrating the Chair Work Technique from Schema-therapy and selected processes from Acceptance and Commitment Therapy in a private psychotherapy setting in Ukraine. The approach was applied between October 2024 and July 2025 in clinical work with 167 adults presenting with anorexia nervosa, bulimia nervosa, or binge-eating disorder. It combined collaborative schema-mode conceptualisation, experiential dialogue, cognitive defusion, mindful observation, self-as-context, values clarification, value-oriented behavioural experiments, and relapse-prevention planning. Routine clinical monitoring suggested recurring changes in the prominence of the Punitive or Demanding Critic, Detached Protector, Vulnerable Child, and Healthy Adult modes. Lower eating-disorder and depressive symptom scores and higher psychological flexibility scores were also recorded at the post-programme assessment. These patterns are presented as retrospective descriptive clinical observations rather than evidence of treatment efficacy or causal change, given the absence of randomisation, a comparison condition, blinded assessment, formal institutional research ethics approval, and long-term follow-up. The integrative framework may provide a clinically relevant formulation-guided option when internal criticism, emotional avoidance, vulnerability, and psychological inflexibility are prominent. However, it should be regarded as an adjunct to established evidence-based and multidisciplinary care. Further ethically approved controlled and longitudinal research is required to examine its clinical value across specific eating-disorder presentations.