DUMC Box 3842

Duke Clinics, 40 Duke Medicine Circle

3rd Floor, Purple Zone, Suite 3700
Durham, NC 27710
Tel: 919-681-7231

© 2014 by ACT at Duke 

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Phone: 919-681-7231

Using Contextual Behavioral Science to Alleviate Human Suffering

All behavior is wholly sensible in the context in which it emerges.

The ACT in Context Research Lab is a lab affiliated with the ACT at Duke program. It is based in the Duke Division of Behavioral Medicine and led by Dr. Rhonda Merwin. The laboratory uses contextual behavioral science to understand and treat human suffering. Although there are many ways in which humans suffer, current research focuses on suffering that arises from having an adversarial relationship with the body and signals arising from the body (this includes hunger/satiety, but also somatic constitutes of emotion and physical pain). We study populations for whom rejection of body signals has resulted in profound deprivation or impairment, including individuals with anorexia nervosa and individuals with type 1 diabetes who withhold life-saving insulin to lose weight.


Follow the links for more information about our current or recent projects. 


Act in Context Research Lab

Available Now

ACT for Anorexia Nervosa: A Clinician's Guide

Topics/Areas of Investigation

  • Experiential or Interoceptive Willingness

  • Mindfulness, Acceptance and Psychological Flexibility

  • Real-Time Antecedents of Avoidance and Mobile Treatment Delivery

  • Maladaptive Eating and Weight Control in Type 1 Diabetes

  • Innovations in the Treatment of Anorexia Nervosa

  • Appetite Regulation

  • Novel Delivery of Acceptance and Commitment Therapy

  • Acceptance and Commitment Therapy in Resident and Graduate Student Training 

Collaborations/Other Research Activities

  • Visceral Sensitivity in Anorexia Nervosa (Zucker)

  • Process of Change in the Treatment of Anorexia Nervosa (Timko)

  • Fear and Disgust Conditioning in Anorexia Nervosa (Zucker and LaBar)

  • ACT for FMS (Bigatti)

  • Mechanism of Change in Pain Coping Interventions (Keefe)

Our Research

For a list of peer-reviewed manuscripts connected with the studies below, please visit our Resources page.

See also our current research page:

Duke T1D Research

Hunger and Hormones Study

Funded by the Duke Department of Psychiatry and Behavioral Science Pilot Research Award

This study investigates appetite regulation among individuals with T1D with eating disorder behaviors. Individuals with and without these behaviors complete an oral glucose tolerance test, during which ghrelin levels, sensations of hunger etc are assessed. 

This study tests a novel intervention for individuals with type 1 diabetes who omit insulin to lose or control weight. Treatment combines mobile technology and individual ACT-based therapy to help individuals recognize triggers for insulin omission in-the-moment and use acceptance, mindfulness and value-oriented skills to cope more effectively.

Real-Time Precursors and Correlates of Maladaptive Eating and Weight Control, R01DK089329

Individuals with type 1 diabetes mellitus (T1D) who develop an eating disorder are at high risk for diabetes-related medical complications and premature death. Eating disorders affect a significant subset of T1D patients who often withhold insulin as a means of controlling weight. Yet what accounts for the prevalence of this dangerous comorbidity and how to effectively treat these patients is unknown. Interventions developed for non-diabetic patients have failed to improve key metabolic parameters in T1D patients, suggesting extant models of eating pathology are inadequate for this unique population. This study tested somatic-affective antecedents to eating disorder symptomatology among individuals with T1D. Participants wore continuous glucose monitors (CGM) while simultaneously being cued to make diary entries of psychological state and behavior (randomly and for all eating episodes). Glucose data and diary data were then time-synced to answer novel questions about eating disorder etiological factors, including whether nonacceptance (or rejection) of diabetes leads to aberrant responding to normal fluctuations in blood glucose.

ACT for Fibromyalgia

This study examined the efficacy of individual Acceptance and Commitment Therapy (ACT) for women with FM, compared to an education-control.  This project was a collaboration with Dr. Bigatti at Indiana University.

ACT for Adolescent Anorexia Nervosa​

Acceptance-based Separated Family Treatment for Adolescent Anorexia Nervosa, (R21 MH085975)

We developed and tested a 20-week acceptance-based separated family treatment (ASFT) for adolescents with anorexia nervosa, or eating disorder NOS in which the primary symptoms were restrictive eating and excessive weight loss. Treatment components were based on ACT and included a parent skills based on Off the C.U.F.F. (Zucker, 2006). This study was in  collaboration with Dr. C. Alix Timko, now at the Children's Hospital of Philadelphia (CHOP).

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Student Projects

From Rewarding to Remembering: The association between food reward responsiveness and food-related autobiographical memory

Led by Lori Keeling

A Systematic Review of Acceptance and Commitment Therapy for the Treatment of Eating Disorders

Led by Heather Batchelder and Jan Mooney

Poster presented  at the MAC ACBS Regional Conference, October 13-14, 2017 in Arlington, VA

Difficulties with Emotion Regulation in Individuals with Type 1 Diabetes and Eating Disorder Symptom

Led by Jan Mooney

Poster presented at the MAC ACBS Regional Conference, October 13-14, 2017 in Arlington, VA

ACT Psychoeducational Course for the Community (delivered in faith communities)

Led by Jaimie Lunsford

ACT to Prevent Eating Disorders: Evaluation of the AcceptMe A Digital Gamified Prevention Program Based on Acceptance and Committment Therapy

Doctoral Dissertation, Patrisia Nikolaou

A Dissertation Submitted to the University of Cyprus in Partial Fulfilment of the Requirements for the Degree of Doctor of Philosophy.

The present doctoral thesis aimed to investigate the effectiveness and acceptability of a digital Acceptance and Commitment Therapy (ACT; Hayes et al, 1999) based prevention program in comparison to a wait-list control group for young women identified to be at risk for ED. The goals of the study were to describe the development of the AcceptME protocol and digitalized program, assess participants’ feedback and the acceptability of the program, and examine the effectiveness of the ACT-based prevention program compared to a wait-list control group.

Sensitivity to Affect and Body Image Inflexibility as Risk Factors for Eating Disorders

Doctoral Dissertation, Maria Koushiou

Rule-Governed Behavior in Anorexia Nervosa

Doctoral Dissertation, Ashley Moskovich

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