The effectiveness of stand-alone cognitive-behavioural therapy for body image: a meta-analysis

This meta-analysis examined the effectiveness of stand-alone body image (BI) cognitive-behavioural therapy (CBT). Nineteen studies met inclusion criteria. The behavioural dimension of BI improves most after BI CBT while the investment dimension improves the least. Individuals with clinical BI disturbances improve more than do college student samples. Treatments addressing the attitudinal, behavioural, and perceptual components of BI are more effective than treatments addressing attitude and behaviour only. Therapist-assisted therapy is more effective than is self-directed therapy. BI variables improve somewhat more than do general psychological variables, while the latter show equivalent improvement. Finally, treatment gains are maintained at follow-up. More research is needed to better understand and treat the investment dimension of BI.     

Cognitive-behaviour therapy for depersonalisation disorder: an open study

Depersonalisation (DP) and derealisation (DR) are subjective experiences of unreality in, respectively, one's sense of self and the outside world. These experiences occur on a continuum from transient episodes that are frequently reported in healthy individuals to a chronic psychiatric disorder that causes considerable distress (depersonalisation disorder: DPD). Despite the relatively high rates of reporting these symptoms, little research has been conducted into psychological treatments for this disorder. We report on an open study where 21 patients with DPD were treated individually with cognitive behavioural therapy (CBT). The therapy involved helping the patients re-interpret their symptoms in a non-threatening way as well as reducing avoidances, safety behaviours and symptom monitoring. Significant improvements in patient-defined measures of DP/DR severity as well as standardised measures of dissociation, depression, anxiety and general functioning were found at post-treatment and six-months follow-up. Moreover, there were significant reductions in clinician ratings on the Present State Examination (Wing, Cooper & Sartorius, 1974), and 29% of participants no longer met criteria for DPD at the end of therapy. These initial results suggest that a CBT approach to DPD may be effective, but further trials with larger sample sizes and more rigorous research methodology are needed to determine the specificity of this approach.     

Group versus individual cognitive-behavioural treatment for obsessive-compulsive disorder: a controlled trial

The efficacy of group cognitive behaviour therapy (CBT) for obsessive-compulsive disorder (OCD) has received relatively little research attention compared with the large number of studies that have investigated individual CBT. The current study is the first controlled study to compare an identical CBT protocol, containing both cognitive and behavioural elements, delivered either individually or in a group. Participants were randomly assigned to either 10 weeks of individual CBT, 10 weeks of group CBT or a 10 week wait-list. Participants with significant rates of secondary comorbidity were included in the study to enhance the generalisability of results. Intention-to-treat and completer analyses were carried out and indicated no differences between the group and individual treatments on outcome measures. Large effect sizes were found for both conditions. Analysis of clinically significant change indicated that the individual treatment was associated with a more rapid response but that both treatments had equivalent rates of recovered participants by brief follow-up. The importance of further investigations of the efficacy of group CBT for OCD is discussed.     

Measuring "negative body image": validation of the Body Image Disturbance Questionnaire in a nonclinical population

Despite numerous measures of facets of the body image construct, no single assessment broadly measures a continuum of body image disturbance. Accordingly, this study developed the Body Image Disturbance Questionnaire (BIDQ), derived from the Body Dysmorphic Disorder Questionnaire. Participants were 220 college women and 75 college men who completed an online survey containing this new assessment and established measures of body image and psychosocial functioning. Results confirmed that the Body Image Disturbance Questionnaire was internally consistent and free of impression-management response bias. For both sexes, the measure converged appropriately with other body image indices (evaluation, affect, investment, and impact), was positively correlated with depression, social anxiety, and eating disturbance. Scores on this assessment also predicted psychosocial functioning above and beyond body dissatisfaction as a predictor. Greater body image disturbance was observed among women than men, among heavier than lighter women, and among White than African American women. Limitations and future research implications are discussed.     

Body image and disfigurement: issues and interventions

Whether present at birth, congenital or acquired later in life, a visible disfigurement can have a profound psychological impact upon the individual concerned. Difficulties include adverse effects on body image, quality of life, and self-esteem. In addition, social encounters can present many challenges, however many individuals adapt to the demands placed upon them and appear relatively unaffected by their visible difference. This article reviews current literature exploring the psychosocial implications of living with a visible difference and considers the complex influence of physical, cultural, and psychosocial factors on adjustment. Attempts that have been made to theorise individual’s experiences, relevant interventions and care provision are then examined and the challenges facing researchers in this area are outlined.     

Depersonalisation disorder: a cognitive-behavioural conceptualisation

Depersonalisation (DP) and derealisation (DR) are subjective experiences of unreality in, respectively, one’s sense of self and the outside world. These experiences occur on a continuum from transient episodes that are frequently reported in healthy individuals under certain situational conditions to a chronic psychiatric disorder that causes considerable distress (depersonalisation disorder, DPD). Despite the relatively high rates of reporting these symptoms, little research has been conducted into psychological treatments for this disorder. We suggest that there is compelling evidence to link DPD with the anxiety disorders, particularly panic. This paper proposes that it is the catastrophic appraisal of the normally transient symptoms of DP/DR that results in the development of a chronic disorder. We suggest that if DP/DR symptoms are misinterpreted as indicative of severe mental illness or brain dysfunction, a vicious cycle of increasing anxiety and consequently increased DP/DR symptoms will result. Moreover, cognitive and behavioural responses to symptoms such as specific avoidances, ‘safety behaviours’ and cognitive biases serve to maintain the disorder by increasing awareness of the symptoms, heightening the perceived threat and preventing disconfirmation of the catastrophic misinterpretations. A coherent model facilitates the development of potentially effective cognitive and behavioural interventions.     

Clinical perfectionism: a cognitive-behavioural analysis

This paper reviews the characteristics of clinical perfectionism and proposes a new definition of the phenomenon. It is suggested that the defining feature of clinically significant perfectionism is the overdependence of self-evaluation on the determined pursuit (and achievement) of self-imposed personally demanding standards of performance in at least one salient domain, despite the occurrence of adverse consequences. It is suggested that such clinical perfectionism is maintained by the biased evaluation of the pursuit and achievement of personally demanding standards. Specifically, it is suggested that people with perfectionism react to failure to meet their standards with self-criticism. If they do meet their standards, the standards are re-evaluated as being insufficiently demanding. Anorexia nervosa and bulimia nervosa are considered to have a particular relationship to perfectionism, with both disorders often being direct expressions of perfectionism. Under these circumstances self-evaluation is dependent on the pursuit and attainment of personally demanding standards in the domain of control over eating, shape and weight. The implications of this analysis for research and practice are considered.     

Efficacy of a cognitive-behavioural therapy administered by videoconference for generalized anxiety disorder

IntroductionDelivering psychotherapy by videoconference could considerably extend the accessibility of empirically validated treatments.ObjectiveThe aim of this study was to evaluate the efficacy of a cognitive-behavioural therapy (CBT) for generalized anxiety disorder (GAD), administered via videoconference.MethodFive participants with a primary diagnosis of GAD took part in an experimental multiple baseline case study protocol. The efficacy of the treatment was evaluated using a semi-structured interview, self-report questionnaires, and daily self-monitoring diaries.ResultsThe results demonstrate that overall, participants’ conditions were improved following treatment and they no longer met the diagnostic criteria for GAD in the short-term. Participants’ conditions improved clinically and statistically at each follow-up point, achieving a greater global level of functioning at post-test, as well as at 3-month and 12-month follow-up.ConclusionClinical implications of this new treatment modality and directions for future research are discussed.     

Body image among eating disorder patients with disabilities: A review of published case studies

While individual cases of eating disorder (ED) patients with disabilities have been reported, there has been little synthesis of their experiences of body image and thin idealization. This study reviews 19 published clinical reports of ED patients with sensory, mobility-related, or intellectual disabilities and evaluates the extent to which their experiences align with or challenge current conceptions of body image in ED. ED patients with visual impairment reported a profound disturbance of body image, perceived intersubjectively and through tactile sensations. Reducing dependence in mobility was an important motivation to control body size for ED patients with mobility-related disabilities. ED as a way of coping with and compensating for the psychosocial consequences of disability was a recurrent theme for patients across a range of disabilities. These experiential accounts of ED patients with disabilities broaden current understandings of body image to include touch and kinaesthetic awareness, intersubjective dynamics, and perceptions of normalcy.     

Perfectionistic self-presentation, body image, and eating disorder symptoms

A specific model for eating disorder symptoms involving perfectionistic self-presentation and two different moderators (i.e., body image evaluation and body image investment) was tested. Participants completed measures of perfectionistic self-presentation, body image dysfunction, and eating disorder symptoms. Findings indicated that all three dimensions of perfectionistic self-presentation were associated with eating disorder symptoms. Results also showed that perfectionistic self-presentation predicted eating disorder symptoms in women who were dissatisfied with their bodies, but that it did not predict eating problems in women who liked their bodies and felt there was little or no discrepancy between their actual and ideal appearances. Body image investment did not moderate the relationship between perfectionistic self-presentation and eating disorder symptoms, suggesting that ego-involvement alone is insufficient to promote eating disturbance in the context of perfectionism. The importance of self-presentation components of perfectionism and specific body image difficulties in predicting eating disorder symptoms are discussed.     

Advances in a cognitive behavioural model of body dysmorphic disorder

Body dysmorphic disorder (BDD) is the most distressing and handicapping of all the body image disorders. A cognitive behavioural model of BDD is discussed which incorporates evidence from recent studies and advances in the author’s 1996 conceptual model. The model aims to understand the maintenance of symptoms in BDD, to assist in the process of engagement of therapy and to guide the strategies to use. At the core of BDD is an excessive self-focussed attention on a distorted body image, the negative appraisal of such images leading to rumination, changes in mood and the use of safety behaviours. Evidence for possible risk factors in the development of BDD is also discussed.     

Body image and cosmetic medical treatments

Cosmetic medical treatments have become increasingly popular over the past decade. The explosion in popularity can be attributed to several factors—the evolution of safer, minimally invasive procedures, increased mass media attention, and the greater willingness of individuals to undergo cosmetic procedures as a means to enhance physical appearance. Medical and mental health professionals have long been interested in understanding both the motivations for seeking a change in physical appearance as well as the psychological outcomes of these treatments. Body image has been thought to play a key role in the decision to seek cosmetic procedures, however, only recently have studies investigated the pre- and postoperative body image concerns of patients. While body image dissatisfaction may motivate the pursuit of cosmetic medical treatments, psychiatric disorders characterized by body image disturbances, such as body dysmorphic disorder and eating disorders, may be relatively common among these patients. Subsequent research on persons who alter their physical appearance through cosmetic medical treatments are likely provide important information on the nature of body image.     

Follow-up results of a cognitive-behavioural treatment for chronic pain in a primary care setting

Abstract

An outpatient cognitive-behavioural treatment programme for pain control was administered to chronic pain patients in three primary care practices with a medical psychologist as a group therapist. The patients suffered from headaches, migraines, cervical pain, shoulder-arm pain, and low back pain. A matched sample of patients with the same disorders served as a waiting-list control group. The programme consisted of training in progressive muscle relaxation, several attention related techniques, and cognitive restructuring as well as reinforcing non-pain behaviour, and aimed at an improvement of self-control strategies. At the six month follow-up, the treated subjects showed improvements in their average scores of anxiety, depression and bodily symptoms compared with the untreated controls. Pain intensity was reduced by 34% in those subjects (9 out of 25) who were most adherent to the treatment regimen. Our results indicate a long-term improvement in well-being as a consequence of the treatment. This was confirmed by the ratings of the physicians and by the reduced number of patient-physician contacts three months post treatment as compared to the controls. Treatment adherence seems to be a most important agent in maintaining long-term reductions of pain intensity.     

Women's exposure to thin-and-beautiful media images: body image effects of media-ideal internalization and impact-reduction interventions

Exposure to media images of thin-and-beautiful women negatively affects the body image and mood states of young women. However, not all women are equally susceptible to these effects. The present experimental investigation with 123 young college women evaluated the moderating effects of the extent of internalization of media ideals. It also examined the preventative impact of two brief interventions (i.e., media literacy information with and without a dissonance-induction procedure). Results indicated that relative to a control group, the exposure to thin-and-beautiful media images adversely influenced the state body image of participants with high internalization levels. Media-literacy psychoeducation prior to the media exposure prevented this adverse effect. Adding a pre-exposure dissonance-induction procedure did not significantly enhance the preventative effects relative to psychoeducation alone. These results and their implications for the treatment and prevention of body image disturbances are discussed in the context of the empirical literature on the media's effects on body image.     

Body dysmorphic disorder and appearance enhancing medical treatments

This article reviews the literature on body dysmorphic disorder (BDD) in persons who seek appearance enhancing medical treatments such as cosmetic surgery and dermatological treatment. We begin with a discussion of the growing popularity of cosmetic surgical and minimally invasive treatments. The literature investigating the psychological characteristics is briefly highlighted. Studies investigating the rate of BDD among persons who seek appearance enhancing treatments are detailed and, collectively, suggest that approximately 5–15% of individuals who seek these treatments suffer from BDD. Retrospective reports suggest that persons with BDD rarely experience improvement in their symptoms following these treatments, leading some to suggest that BDD is a contraindication to cosmetic surgery and other treatments. The clinical management of patients with BDD who present for these treatments is briefly described and directions for future research are provided.     

Body image and cystic fibrosis: a critical review

A slight frame and poor appetite are common among patients with cystic fibrosis (CF) yet healthy body weight has been related to a better prognosis. A review of studies exploring body image (BI) among adults and adolescents with CF was conducted. Seven electronic databases were searched for potential papers. They located 128 references, of which 24 were read in full and 12 included in the review. Accepted papers suggested females with CF had a better BI compared to males, but this could compromise survival, given their preference for a low body weight. Males may be more motivated to adhere to nutritional advice because they favor a larger form. Practitioners should broach the topic of BI at clinic appointments to ensure this does not have a detrimental impact on self-management, although more research is required to guide professionals in this task.     

Body image distortions in healthy adults

Distortions of body image have often been investigated in clinical disorders. Much of this literature implicitly assumes healthy adults maintain an accurate body image. We recently developed a novel, implicit, and quantitative measure of body image — the Body Image Task (BIT). Here, we report a large-scale analysis of performance on this task by healthy adults. In both an in-person and an online version of the BIT, participants were presented with an image of a head as an anchoring stimulus on a computer screen, and told to imagine that the head was part of a mirror image of themselves in a standing position. They were then instructed to judge where, relative to the head, each of several parts of their body would be located. The relative positions of each landmark can be used to construct an implicit perceptual map of bodily structure. We could thus measure the internally-stored body image, although we cannot exclude contributions from other representations. Our results show several distortions of body image. First, we found a large and systematic over-estimation of width relative to height. These distortions were similar for both males and females, and did not closely track the idiosyncrasies of individual participant's own bodies. Comparisons of individual body parts showed that participants overestimated the width of their shoulders and the length of their upper arms, relative to their height, while underestimating the lengths of their lower arms and legs. Principal components analysis showed a clear spatial structure to the distortions, suggesting spatial organisation and segmentation of the body image into upper and lower limb components that are bilaterally integrated. These results provide new insight into the body image of healthy adults, and have implications for the study and rehabilitation of clinical populations.     

A pilot study of two-day cognitive-behavioral therapy for panic disorder

The present study investigated the short-term efficacy of brief, intensive cognitive-behavioral therapy (CBT) for panic disorder (PD). The treatment involved 9h of therapist contact over two consecutive days and was developed for the purpose of delivering CBT for PD to a largely rural patient population that must travel long distances to find a treatment provider. Ten patients who elected to participate in brief, intensive CBT instead of weekly CBT were recruited from routine clinical practice in a hospital-based anxiety disorders clinic. Patients were not excluded based on the presence of agoraphobia, diagnostic comorbidity, concurrent use of PRN benzodiazepine medications, or previous nonresponse to psychotherapy for PD. Assessments conducted at pre-treatment and 1-month follow-up revealed large, clinically significant reductions in PD symptoms, anxiety sensitivity, body vigilance, and anxiety and depressive symptoms. Most patients (60%) were panic-free after treatment and evidenced normative levels of symptomatology at follow-up. The present study suggests that brief, intensive treatment may be an effective means of delivering CBT for PD.     

Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial

Halvorsen, J.Ø. & Stenmark, H. (2010). Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial. Scandinavian Journal of Psychology 51, 495–502. Torture has severe mental health effects, especially in terms of posttraumatic stress disorder (PTSD) and depression. However, there is still a lack of empirical treatment studies. The present paper presents data on 16 torture survivors receiving 10 sessions of narrative exposure therapy (NET). Symptoms of PTSD and depression, assessed by Clinician‐Administered PTSD Scale (CAPS) and Hamilton Rating Scale for Depression (HRSD), decreased significantly from pre‐treatment to 6‐month follow‐up, with Cohen’s d effect sizes of 1.16 and 0.84, respectively. Although treatment gains were moderate, further research on evidence‐based treatments for PTSD and depression in refugee torture survivors is warranted.     

Self-objectification,body image disturbance,and eating disorder symptoms in young Australian children

Self-objectification has been examined extensively in adult populations. Despite theoretical evidence suggesting that children may also be vulnerable to experiencing self-objectification, whether children do self-objectify has not been determined. Accordingly, the present study examined the degree to which children self-objectify. The prevalence of body image and eating disturbances in this population, and the relationship between self-objectification and these disturbances, were also investigated. Results from over 250 boys and girls aged 6–11 years revealed that young girls report levels of self-objectification that are similar to those observed among older girls and women. Self-objectification was also found to be meaningfully related to body image and eating disturbances in children. A significant proportion of children reported body dissatisfaction and a minority engaged in disordered eating behaviours in the four weeks prior to the assessment. These results suggest that children may be at risk of experiencing the negative psychological outcomes associated with self-objectification.