Overcoming Body Image Problems: Veale, Wilson, Clarke

Body Image Problems

Structure

What it means to be me, is predominantly what I look like and what I look like is wrong or substandard in some way.

Types and definitions

1. BDD: Extreme preoccupation with body that is not noticeable to others
2. Skin disorders and disfigurements
3. Trichotillomania.: repeated hair pulling
4. Anorexia: keeping body weight low by restricting what is eaten or conceivably high levels of gym work. The a sense where the patient feels fat but others don’t notice this
5. Bulimia: binge eating following by purging.

So the primary problem of all body image problems is

1. High identification of my body with my self image
2. Seeing my body as defective

The secondary which splits the group is do others think my body is defective and do I

What keeps a body image problem going?

Thoughts

1. Time spent thinking about body problem that is disliked
1. Triggers to thinking about body problem
2. Distinction between thoughts as cognitions\images

Perceptions

1. Focus on the negative aspects of  body

Treatment

1. Identify self-identity and challenge how much your body defines you
2. Self focussed attention
1. Monitor
2. Alter
3. Do a theory A and B on
1. Theory A

                                                               i.      I have a body image problem, and I do everything I can to minimize the impact of this problem

2. Theory B

                                                               i.      I am excessively worried about my body image and the solutions I have adopted to this have become the problem

4. Looking at the effect of short term and long term coping strategies
5. Build a vicious flower with the centre around Preoccupation and shame with my appearance
6. Task concentration training, this improves the ability to not be self attentioned, so whenever you notice your attention on yourself turn your attention to the task. If you have no task in hand then focus your attention on the environment.
1. Sit back to back with client tell story, get them to concentrate on story, rate attentional levels and then repeat story back rate how much attention is on task, aim to increase to 51
2. Now sit facing each other and repeat exercise. Continue until level of self attention is 51
3. Now distract yourself and repeat the exercise and see how well the task is performed what does this tell you about your life.
4. Tell a story, face to face about someone with a body image  problem, similar to clients and repeat the four exercises until attention can be maintained at 51%
5. Now put yourself in a non  threatening situations and look to maintain the levels of attention to the environment or the task at hand, then put yourself in a threatening one

If task attention training and attentional training do not improve self attention then:

1. Understand
1. the contexts of self attention
2. the pay offs for self attention, what  you get or what you reduce, i.e. reinforcement

Managing rumination\self criticism

1. What are the triggers for rumination
2. What are the intended and unintended effects of rumination
3. What alternative behaviour could you take that accords with your values

Also look at meta beliefs about rumination and self criticism and challenge them.

Behaviours

1. Rumination about body image, why am I this way
2. Safety behaviours
1. Checking
2. Avoidance
3. Substance abuse

Body Shame

The emotions created by that are a combination of anxiety\depression and disgust. Disgust is an emotion that represents something that is offensive that can cause illness that must be expelled. That can be moral disgust, substance disgust. With disgust there is a reflex of the muscles clenching around the mouth.

Shame is broken down into internal shame and external shame.  External shame means that you think other people see you as disgusting. Internal shame means that you see you as disgusting. Internal and external shame doesn’t always go together.

Treating body shame

1. Question identity: Is your value what you look like, if not what else is important
2. Question a static identity: Is what it means to be you too complex, too dynamic to be given a global static value
3. Invitation technique: If other people laugh at you, or criticise you, you can think of this as an invitation to a party where you consider yourself unattractive or unloveable which you can accept or decline
4. Acceptance
1. Does one bruised apple in a beautiful bowl of fruit, mean that the whole bowl is unappealing
5. Formulation
1. Understanding why the level of importance you have of your body and your feelings you have about your body are the case, what early experiences help us to understand this
6. Rescript early experiences
1. Allow younger self to be comforted, or have older self intervene
7. Blame
1. If you want to blame someone for BDD, who should we blame for how they act. There is a likelihood that we will end up back at Adam and Eve.