BUT WE ARE NOT BOUND TO BE UNHAPPY WITH OUR BODIES Thomas Cash TERMINOLOGY The concept of body image is complex and multifaceted extreme shape concern Farrell et al 2005 It refers to an individuals view of their body size shape weight and appearance total body or specifi ID: 465418
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Slide1
WE ARE BOUND TO OUR BODIES
BUT
WE ARE NOT BOUND TO BE
UNHAPPY WITH OUR BODIES
Thomas CashSlide2Slide3Slide4
TERMINOLOGY
The concept of body image is complex and multi-faceted
‘extreme shape concern’ (Farrell
et al
2005)Slide5
It refers to an individual’s view of their body size, shape, weight and appearance (total body or specific parts)Slide6
BODY IMAGE AND EATING DISORDERS
Importance recognised by incorporation into DSM-IV
Negative body image:
is a pre-cursor for eating disorders in at risk populations (Killen
et al.
1994)
is the main factor in the psychopathology of eating disorders (Gleaves & Eberenz 1993)Slide7
Historically little emphasis has been placed on body image in therapy
Successful treatment may not bring body image satisfaction
The level of body image distress at the end of treatment for Bulimia Nervosa predicts relapse (Freeman
et al
. 1985; Fairburn
et al
. 1993)
The risk of relapse may be enhanced because of inadequate provision of treatment for extreme shape concern within eating disorder treatment (Farrell
et al
. 2005)Slide8
COMPONENTS
Perceptual distortion
Body dissatisfaction
Behaviours
Cognitions Slide9
PERCEPTUAL DISTORTION
An imagined bodily defect or exaggeration of features in which a discrepancy occurs between actual and perceived sizeSlide10
It was recognised as a feature of:
Anorexia Nervosa by Hilda Bruch (1962)
Bulimia Nervosa by Stice (2004)
Size is frequently over-estimated
Fairburn
et al.
(1999) a combination of behaviours e.g. body checking and selective attention to body parts
The internalization of a thin ideal (Stice 2004)
Body dissatisfaction and the internalization of a thin ideal (Mussap et al. 2008)Slide11
Perceptual distortion may result from psychosocial stimuli:
Low mood
Hunger
Eating high calorie foods
Farrell, Shafran & Fairburn (2003) indicate that distortion varies depending on the measurement technique.
It is unclear what is within the normal range of attitudes towards the body (Probst et al. 2008)Slide12
BODY DISSATISFACTION
Features include discomfort and complaint about appearance; whole body or discrete areas frequently described as fatSlide13
Thighs, buttocks, stomach and breasts
Muscular physiqueSlide14
Increasing dissatisfaction can predict the onset and elevation in bulimic pathology (Stice 2004)
Attention to disliked parts can lead to pre-occupation (Freeman
et al
. 1999) and maintain the problemSlide15
Dissatisfaction has been ascribed to cultural/societal views and personality
Western media encourages thinnessSlide16
BEHAVIOURS
These include
avoidance
of situations (fear of attention, self consciousness)
of seeing oneself in the mirror
problem areas may hidden by clothing or postureSlide17
BEHAVIOURS
Body checking
Grooming
Looking in the mirror at perceived defects
Pinching and measuring specific areas
Comparison with media figuresSlide18
Frequent weighingSlide19
Body dissatisfaction can be maintained by checking behaviours
When emotions aroused by checking are extreme, checking may be avoided to prevent discomfort
Engagement in avoidance or checking depends on several factors including mood, weight and eating changes (Safran
et al.
2004)Slide20
COGNITIONS
Cognitive biases include selective memory and extreme drive for thinness
Obsessionality and fear of fatness
Pre-occupation with appearance is distressing and time consuming
Intrusive thoughts even if recognised as abnormal or untrue can cause difficulty in functioningSlide21
Thought- shape fusion is a cognitive distortion associated with eating disorders (Safran & Robinson 2004)
Three components:
Likelihood:
thinking about food makes it likely that the individual has gained weight even though this is illogical
Moral
: thinking about eating forbidden foods is morally equal to eating them
Feeling
: thoughts about food increases the feeling of fatness
Thought-shape fusion may help to maintain the disorderSlide22
Distorted psychological perceptions can occur as cognitions of apparent delusional intensity in direct response to appearance
Slide23
Body image is closely linked to self-esteemSlide24
THE APPLICATION OF CBT TO BODY IMAGE DISORDERS
CBT is widely acknowledged as a leading treatment for Bulimia Nervosa and Binge Eating Disorder (NICE 2004)
Group CBT has been proposed as the most favourable way to address body image in eating disorder treatment (Cash & Strachan 2004; Reas & Grilo 2004)Slide25
Improvements in body image, self-esteem, depression & social anxiety were reported by Strachan & Cash (2002), however, improvements in eating pathology were ‘weaker’Slide26
CBT BODY IMAGE GROUP
Use of the Body Image Workbook (Cash 1997) can improve body image
CBT group package was designed using components from Cash’s workbookSlide27
Castle Craig HospitalSlide28
GROUPS
6 sessions
once a week
Topics
Personal assessment of the problems, relaxation/distress tolerance
Origins of body disparagement: historical and current
Triggers to body disparagement, NATs, corrective thinking
Practical exercises including rituals and mirror work
Review and repeat questionnaires
Plan for on-going actionSlide29
Group treatment aimed at normalising body shape concern in people suffering from an eating disorderSlide30
CASH’S STEPS
Body Image Workbook p9
Step 1
Discover your own body image and set your goals for change
Step 2
Understand the causes of your discontent
Step 3
Get comfortable with your body through body-and-mind relaxation and body image desensitization
Step 4
Discover your appearance assumptions and challenge their control over your body imageSlide31
Step 5
Change your faulty Private Body Talk with corrective thinking
Step 6
Defeat your self-defeating behaviour by facing what you avoid and by eliminating your appearance preoccupied rituals
Step 7
Treat your body right with affirming and enhancing activities
Step 8
Continue to improve and prevent relapse by preparing today for tomorrowSlide32
SESSION ONE
Questionnaires
Relaxation/distress tolerance
HomeworkSlide33
SESSION TWO
Body image profile constructed from questionnaires
Historical and cultural perspectives
Body image diary, ABCs
Helpsheet for changeSlide34
SESSION THREE
Appearance assumptions
Triggers to negative body image
Negative automatic body image thoughts
Mirror desensitization introducedSlide35
SESSION FOUR
Self-defeating behaviours, checking and avoidance
Thinking errors
Mirror desensitizationSlide36
SESSION FIVE
Perceptions
Mirror desensitizationSlide37
SESSION SIX
My proudest moments
Letter to my body
Relapse prevention
Questionnaires & evaluationsSlide38
All areas indicated an improvement.
At follow up improvements remained but were less marked.
With extra mirror work and behavioural tasks improvements have been greaterSlide39
‘I determined how I perceived my body and that had a huge impact on the way I thought about myself. I could choose to see bad things or I could choose to see good things’
‘I would love this friend regardless of what they looked like. If my body were an estranged friend why shouldn’t I love that….I gave it such a hard time’Slide40
REFERENCES
Bruch, H. (1962). Perceptual and conceptual disturbances in anorexia nervosa.
Psychosomatic Medicine
, 24, 187-194.
Cash, T.F. (1997).
The body image workbook: an 8-step program for learning to like
your looks.
Oakland, CA. Harbinger Fairburn, C.G., Peveler, R.C., Jones, R., Hope, R.A. & Doll, H.A. (1993). Predictors of 12-month outcome in bulimia nervosa and the influence of attitudes to shape and weight.
Journal of Consulting and Clinical Psychology
, 61, 696-698.
Cash, T.F., & Strachan, M.D. (2004). Cognitive behavioral approaches to changing body image. In T.F Cash, & T. Pruzinsky
(Eds.),
Body Image a handbook of theory, research and clinical practice
(pp. 478-486)
.
New York. Guilford.
Fairburn, C.G., Shafran, R., & Cooper, Z. (1999). A cognitive behavioural theory for anorexia nervosa.
Behaviour Research and Therapy
, 37, 1-13.Slide41
Farrell, C., Shafran, R., & Fairburn, C.G. (2003). Body size estimation: testing a new mirror based assessment method.
International Journal of Eating Disorders
, 34, 162-171.
Farrell, C, Shafran, R., Lee, M., & Fairburn, C.G. (2005a). Testing a brief cognitive-behavioural intervention to improve extreme shape concern: A case series.
Behavioural and
Cognitive Psychotherapy
33, (2) 189-200.
Freeman, C., Beach, B., Davis, R., & Solyom, L. (1985). The prediction of relapse in bulimia nervosa.
Journal of Psychiatric Research
, 19, 349-353.
Gleaves, D.H., & Eberenz, K. (1993). The psychopathology of anorexia nervosa: a factor analytic investigation.
Journal of Psychopathology and Behavioural Assessment
, 15, 141-152.
Killen, J.D., Taylor, C.B., Hayward, C., Wilson, D.M., Haydel, K.F., Hammer, L.D., Simmonds, B., Robinson, T.N., Litt, I., Varady, A., & Kramer, H. (1994). Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: A three-year prospective analysis.
International Journal of Eating Disorders
, 13, 227-238.Slide42
National Institute for Clinical Excellence (2004).
Eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders.
Nice Clinical Guideline No 9. London: National Institute for Clinical Excellence. Available from: http://
www.nice.org.uk
Reas D.L., & Grilo, C.M. (2004). Cognitive behavioural assessment of body image disturbances.
Journal of Psychiatric Practice
10 (5), 314-322.
Shafran, R., Fairburn, C.G., Robinson, P., & Lask, B. (2004). Body checking and its avoidance in eating disorders.
International Journal of Eating Disorders
, 35, 93-101.
Shafran, R., & Robinson, P. (2004). Thought-shape fusion in eating disorders.
British Journal of Clinical Psychology
, 43, 399-408.
Stice, E. (2004). Body image and bulimia nervosa. In T.F Cash, & T. Pruzinsky
(Eds.),
Body Image a handbook of theory, research and clinical practice
(pp. 304-311)
.
New York. Guilford.