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

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.