Adjunctive mirror exposure for eating disorders: A randomized controlled pilot study

Mirror exposure therapy has proven efficacious in improving body image among individuals with shape/weight concerns and eating disorders. No randomized controlled trials have examined the effect of mirror exposure in a healthy-weight clinical sample of eating disordered individuals. The purpose of the current study was to test the efficacy of a five-session acceptance based mirror exposure therapy (A-MET) versus a non directive body image therapy (ND) control as an adjunctive treatment to outpatient eating disorder treatment. Thirty-three males and females aged 14–65 with a body mass index of 18.5–29.9 were randomized to five sessions of A-MET or ND with a 1-month follow-up. Results indicated large to moderate effect size differences for efficacy of A-MET across measures of body checking, body image dissatisfaction, and eating disorder symptoms (d = ?0.38 to ?1.61) at end of treatment and follow-up. Baseline measures of social comparison and history of appearance-related teasing were predictive of treatment response. There were also differential effects of treatment on participants' perceived homework quality, but no differences in therapeutic alliance. Results suggest that A-MET is a promising adjunctive treatment for residual body image disturbance among normal and overweight individuals undergoing treatment for an eating disorder. Future research and clinical implications are discussed.     

Cognitive Behavior Therapy With Body Image Exposure for Bulimia Nervosa: A Case Example

Cognitive behavior therapy (CBT) is an effective treatment for bulimia nervosa (BN). However, among patients with BN, symptom improvement is more pronounced for behavioral eating symptoms (i.e., bingeing and purging) than for body image disturbance, and the persistence of body image disturbance is associated with relapse. The need for more effective body image interventions led to the development of mirror exposure, which focuses on encouraging patients to view themselves in a holistic, nonjudgmental, mindful fashion. Behavioral manifestations of body image disturbance—body checking and avoidance—are also targeted in order to reduce and eliminate such behaviors and their associated preoccupation and distress. A preliminary trial of Body Image Exposure has shown promise, but it has not yet been tested in the context of CBT for BN. The case of “Sara” illustrates the application of this targeted treatment for body image disturbance. Central clinical issues around the perceptual, cognitive, and behavioral components of body image are delineated as they arose in treatment, as are issues of motivation and compliance. Treatment was associated with improvement in eating symptoms, body image, and mood.     

Toward an integration of child and family therapy

Current forms of treatment for the symptomatic child are reviewed and analyzed. There are four general approaches to treatment: individual child psychotherapy, conjoint parent-child psychotherapy and counseling, parent therapy and counseling, and conjoint family therapy. Each approach has certain strengths, but in-and-of itself is an incomplete treatment mode. An integration of child and family therapy is recommended, and recent attempts at this integration are described. These include approaches which work within the framework of conjoint family therapy and those which provide concurrent child and family therapy.     

Rational-emotive therapy and the reduction of interpersonal anxiety in junior high school students

This study evaluated the effectiveness of rational-emotive therapy and rational-emotive imagery. Fifty-nine junior high school students who volunteered to participate in treatment for interpersonal anxiety were randomly assigned to rational-emotive therapy without imagery (RET), rational-emotive therapy with imagery (REI), relationship-oriented counseling (ROC), and waiting-list control (WLC) groups. Groups met for seven 50-minute treatment sessions during a three-week period. Assessments were conducted at pretreatment, posttreatment, and three-week follow-up. Both self-report and sociometric measures were used to evaluate treatment outcome. At postassessment, both the RET and REI groups were rated on sociometric measures as significantly less interpersonally anxious than the WLC group. Mean scores favored the RET and REI groups, but no significant differences between these groups and the ROC group were obtained. The self-report measure did not significantly differentiate between groups, but the REI group demonstrated significant pre- to follow-up changes. Both the RET and REI groups yielded greater reductions in irrational thinking than did the ROC and WLC groups. In addition, the pattern of the results supported the use of rational-emotive imagery as a component of rational-emotive therapy. The practical implications of these findings are discussed.     

A social cichlid fish failed to pass the mark test

Since the pioneering work in chimpanzees, mirror self-recognition (MSR), the ability to recognise oneself in a mirror, has been reported in great apes, Asian elephants, dolphins, and some social birds using the mark test, in which animals that possess MSR touch an imperceptible mark on their own bodies only when a mirror is present. However, giant pandas, which are solitary, failed to pass the mark test, suggesting that MSR evolved solely in highly social animals. In contrast to the increasing evidence of MSR in mammals and birds, little is known about MSR in fish. A Tanganyikan cichlid, Neolamprologus pulcher, is a good candidate for study because these fish live in highly social groups and recognise conspecifics about as rapidly as primates. We examined their responses to a mirror image and tested whether N. pulcher could pass the mark test. When the mirror was first exposed, they stayed in front of the mirror and exhibited aggressive behaviour towards the mirror image. These social behaviours suggested that the focal fish perceived the mirror image as an unfamiliar conspecific. The social responses decreased over the following days, as has generally been the case in animals with MSR. After mark injection, we found no increase in scraping behaviour or prolonged observation of the marked side. These results show a lack of contingency checking and mark-directed behaviours, meaning that N. pulcher failed to pass the mark test and did not recognise their self-image in the mirror.     

The Attractiveness of Telephone Counseling: An Empirical Investigation of Client Perceptions

Telephone counseling clients reported that convenience, accessibility, control, and inhibition were the most attractive attributes of receiving counseling (not crisis intervention) via telephone. The results mirror many opinions in the literature. Of the 186 counseling clients who responded to the survey, 96% would be willing to seek telephone counseling again compared with 63.1% who reported being willing to seek face‐to‐face counseling. More than half (58%) of the respondents who had experienced both telephone and face‐to‐face counseling preferred telephone counseling.     

Deconstructing the Mirror's Refection: Narrative Therapy Groups for Women Dissatisfied With Their Body

Women facing middle age and beyond are pressured by a cultural ideal of slim‐ness. The authors review literature pertaining to the factors affecting the societal perceptions of body image and address relevant counseling interventions, specifically, group therapy based on narrative theory, that are aimed at this population.     

Mirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder

Patients with Body Dysmorphic Disorder (BDD) may spend many hours in front of a mirror but little is known about the psychopathology or the factors that maintain the behaviour. A self-report mirror gazing questionnaire was used to elicit beliefs and behaviours in front of a mirror. Two groups were compared, which consisted of 55 controls and 52 BDD patients. Results: Prior to gazing, BDD patients are driven by the hope that they will look different; the desire to know exactly how they look; a belief that they will feel worse if they resist gazing and the desire to camouflage themselves. They were more likely to focus their attention on an internal impression or feeling (rather than their external reflection in the mirror) and on specific parts of their appearance. They were also more likely to practise showing the best face to pull in public or to use “mental cosmetic surgery” to change their body image than controls. BDD patients invariably felt worse after mirror gazing and were more likely to use ambiguous surfaces such as the backs of CDs or cutlery for a reflection. Conclusion: Mirror gazing in BDD consists of a series of complex safety behaviours. It does not follow a simple model of anxiety reduction that occurs in the compulsive checking of obsessive–compulsive disorder. The implications for treatment are discussed.     

Assessing and Constructing a Meaningful System: Systemic Perspective in a College Counseling Center

The author describes an application of family systems therapy to treatment in a college counseling center. This approach organizes treatment around the “meaningful system” rather than the family system and includes nonfamily significant others in treatment. Using the Brief Therapy model of the Mental Research Institute, the author addresses special considerations in providing systemic treatment in a college counseling center, assessment and construction of a meaningful system, and specific working procedures. Two case illustrations are provided.     

Psychological counseling as an adjunct to stuttering treatment: Clients’ experiences and perceptions

PurposeStuttering can trigger anxiety and other psychological and emotional reactions, and limit participation in society. It is possible that psychological counseling could enhance stuttering treatment outcomes; however, little is known about how clients view such counseling. The purpose of this study was to gain an understanding of clients’ experiences with, and perceptions of, a psychological counseling service that was offered as an optional adjunct to speech therapy for stuttering.MethodNine individuals who stutter (13-38 years old) participated in semi-structured interviews. Six participants had taken part in psychological counseling; three participants did not do so. Interview data were analyzed using grounded theory as a guiding framework.ResultsFour thematic clusters emerged from participants’ accounts: insights into personal decision-making, why others may not participate in counseling, psychological counseling as a worthwhile part of therapy, and counseling as a necessary component in a stuttering treatment program.ConclusionIn addition to experiencing barriers and facilitators to help-seeking that are reported in related fields, participants accounts also revealed novel facilitators (i.e., a ‘why not’ mentality and the importance of having a pre-existing relationship with the clinician who offered the service) and barriers (i.e., viewing the service as a ‘limited resource,’ and, the overwhelming nature of intensive stuttering treatment programs). Findings suggest that clients value the option to access psychological counseling with trained mental health professionals to support the stuttering treatment provided by speech-language pathologists. Participants made recommendations for the integration of psychological counseling into stuttering treatment programs.     

Counseling utilization by ethnic minority college students

Although multicultural awareness in counseling has risen substantially in the last decade, little research has examined counseling utilization and outcomes for ethnic minorities on university campuses. A sample of 1,166 African American, Asian American, Caucasian, and Latino help-seeking university students from over 40 universities nationwide filled out the Outcome Questionnaire 45 (OQ45) at the first and last therapy sessions. Caucasian students attended significantly more sessions than all other groups. Greatest distress was found at intake in Asian American students, followed by Latino, African American, and Caucasian students. All groups appeared to benefit from therapy, as noted by a decrease in symptomatology, but none of the groups met the criteria for clinically significant change for the OQ45. Implications for therapists working with minority clients are discussed.     

Psychological applications on the internet: A discipline on the threshold of a new millennium

The rapid developments in computers and information technology over the past decade has had an impact on psychology, which has moved in this context from local computer applications to network applications that take advantage of the Internet. This article critically reviews various psychological applications in use on the Internet, with special emphasis given to their promises and advantages as well as to their shortcomings and problems. Specifically, 10 types of psychological Internet applications are reviewed: information resources on psychological concepts and issues; self-help guides; psychological testing and assessment; help in deciding to undergo therapy; information about specific psychological services; single-session psychological advice through e-mail or c-bulletin boards; ongoing personal counseling and therapy through e-mail; real-time counseling through chat, web telephony, and videoconferencing; synchronous and asynchronous support groups, discussion groups, and group counseling; and psychological and social research. Following a discussion of ethical and related concerns, a call is voiced for intensive research and international brainstorming.     

Cognitive counseling for health care compliance

This paper proposes a therapy/counseling model based on RET and other cognitive approaches to enable the therapist in a health care setting to enhance patient compliance with medical and life-style treatment recommendations. Problems and reasons for low rates of compliance with treatment regimens in health settings are discussed. A four phase treatment/therapy approach including Assessment, Insight, Working Through and Homework is presented.     

The unraveling of a treatment paradigm: a followup study of the Milan approach to family therapy

A 2-year followup study was conducted to determine the efficacy and degree of satisfaction with Milan-style family therapy with families refractory to other treatment interventions. Fourteen families and 5 couples who received Milan-style family therapy participated in the study. Family outcome was found to be improved in 56% of parents and 89% of identified child-patients at followup. Improved self-outcome at followup was reported by 56% of fathers, 67% of mothers, and 78% of identified child-patients. A substantial percentage of fathers (68%) and mothers (59%) reported that at least one family member sought further therapy posttreatment. Factors associated with either parent's positive perception of the treatment in general included the time interval between sessions, experiencing the treatment as brief rather than long, and positive feelings for the group behind the mirror. Mothers who reported liking the treatment reported better family outcome. For mothers, disliking the treatment was related to family members seeking further treatment. The more negative the mothers' and fathers' spontaneous comments about therapy were, the more likely that a family member would seek further alternative psychotherapy. The outcome results are explained in terms of the treatment families' negative reactions to some aspects of the therapist's stance and to the group behind the one-way mirror, as in Milan-style therapy. The importance of modifying Milan-type therapy to foster a positive attitude toward the treatment procedures and the therapist's interventions is discussed.     

Self-Disclosure as an Approach to Teaching Ethical Decision-Making

This article presents arguments for and against weight loss counseling in feminist therapy. Conflicts between feminist therapy and weight loss counseling are explored and the implications of counseling and not counseling on women's empowerment are considered. Although each case requires an individual ethical decision, the author, a feminist therapist who has done weight loss counseling in the past, concludes that the answer to the title question should, in general, be "no."     

Differential outcomes of skill training,group counseling,and individual cognitive therapy for persons with acquired visual impairment

As part of the Living Skills Training Program, group counseling and individual cognitive therapy were implemented to decrease psychological distress for adults with acquired visual impairment. This quasi‐experimental design study compared the outcomes of a 6‐month skill training program combined with a group counseling program (n = 37), with (n = 9) or without (n = 10) individual cognitive therapy, and with a control group (n = 42). The outcome measures were the Profile of Mood States and the Nottingham Adjustment Scale Japanese Version. The results showed that participants with low psychological distress decreased anxiety and increased acceptance of disability, even when they did not participate in group counseling. However, among the participants with high distress, they did not show any improvement without group counseling or individual therapy. The participants with high distress who engaged in group counseling showed an improving trend in attitudes toward others. Moreover, the participants who chose to engage in individual therapy in addition to group counseling showed decreased tension‐anxiety, depression, and fatigue, and significantly improved acceptance of disability. These results suggest that group counseling, combined with individual cognitive therapy, can be an effective part of rehabilitation treatment for clients who have high psychological distress.     

I like those glasses on you,but not in the mirror: Fluency,preference, and virtual mirrors

Consumers like the same accessories (eye glasses and earrings) more, and are more likely to recommend a purchase, when the accessories are displayed on a familiar other's regular image rather than mirror image. However, image format does not affect consumers' judgments when the other person is unfamiliar. These findings reflect differences in consumers' natural exposure history: we see others more often face-to-face than in the mirror, giving their regular image a fluency advantage; this advantage does not apply to unfamiliar others, whose image is disfluent in either presentation format. Theoretical and applied implications are discussed.     

Relationship between frames of reference and mirror-image reversals

The mirror puzzle related to the perception of mirror images as left-right reversed can be more fully understood by considering an extended problem that includes also the perception of mirror images that are not left-right reversed. The purpose of the present study is to clarify the physical aspect of this extended problem logically and parsimoniously. Separate use of the intrinsic frame of reference that belongs to the object and one that belongs to its mirror image always leads to the perception of left-right reversal when the object has left-right asymmetry; on the other hand, the perception of left-right nonreversal is always due to the application of a common frame of reference to the object and its mirror image.     

Infant social behavior in front of a mirror and in front of a familiar and an unfamiliar peer

In this study, we explored the differences in infant social behaviors in front of the mirror and in front of a familiar and an unfamiliar peer. We assumed that infant social behaviors in front of the mirror constitute mainly an exploration of the mirror image characteristics. Our observations were videotaped and coded according to definitions of social behavior in infant-infant situations. The results obtained indicate that 6- to 13-month-old infants display significantly more frequent social behaviors in front of a mirror than in front of a familiar or an unfamiliar peer. These behaviors are characterized by tactile contact with the mirror surface, adapting the hand to this surface, and very frequent coordinated social behaviors. This pattern of social behaviors in front of the mirror is discussed and linked to the exploration of distinctive characteristics of the self-reflected image such as perfect synchronicity of movement and two-dimensionality.