Body matters : interventions and change techniques designed to improve body image Citation for published version (APA): Alleva, J. M. (2015). Body matters : interventions and change techniques designed to improve body image. Datawyse / Universitaire Pers Maastricht. https://doi.org/10.26481/dis.20151125ja Document status and date: Published: 01/01/2015 DOI: 10.26481/dis.20151125ja Document Version: Publisher's PDF, also known as Version of record Please check the document version of this publication: • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. 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Soete, in accordance with the decision of the Board of Deans, to be defended in public on Wednesday, November 25th, 2015, at 14:00 by Jessica Marie Alleva UMP UNIVERSITAIRE PERS MAASTRICHT Supervisors Prof. dr. Anita Jansen Prof. dr. Paschal Sheeran (University of North Carolina at Chapel Hill, USA) Co-supervisor Dr. Carolien Martijn Assessment Committee Prof. dr. Beatrice de Gelder (Chair of the committee) Dr. Sandra Mulkens Prof. dr. Madelon Peters Prof. dr. Brunna Tuschen-Caffier (University of Freiburg, Germany) Prof. dr. Annemarie van Elburg (Utrecht University, the Netherlands) Table of Contents CHAPTER 1 Introduction 7 PART 1 How Is Negative Body Image Currently Treated – and Are Existing Interventions Effective? 19 CHAPTER 2 A Meta-Analytic Review of Stand-Alone Interventions to Improve Body Image 21 PART 2 How Can We Improve the Way That Individuals Relate to Their Own Body? 63 CHAPTER 3 Body Language Improving Body Satisfaction by Describing the Body in Functionality Terms 65 CHAPTER 4 Expand Your Horizon A Programme That Improves Body Image and Reduces Self-Objectification by Training Women to Focus on Body Functionality 91 PART 3 How Can We Improve the Way That Individuals Relate to Their Own Body With Regard to the Social Environment? 119 CHAPTER 5 Seeing Ghosts Negative Body Evaluation Predicts Overestimation of Negative Social Feedback 121 CHAPTER 6 Covariation Bias in Women With A Negative Body Evaluation How Is It Expressed and Can It Be Diminished? 131 CHAPTER 7 Discussion 147 Summary 163 Valorisation 169 References 173 Acknowledgements 191 Curriculum Vitae 199 5 CHAPTER 1 Introduction 7 INTRODUCTION “The experience of embodiment is central to the quality of human life.” Cash & Pruzinsky, 2002a, p. 516 The term body image was first defined by Paul Schilder in 1935, as “the subjective picture of our own body which we form in our mind; that is to say, the way in which the body appears to ourselves.” Body image can be further conceptualised as a multi- dimensional construct, comprising a cognitive component (i.e., the thoughts about one’s own body), an affective component (i.e., the feelings about one’s own body), a perceptual component (i.e., the perception of one’s own body), and a behavioural component (i.e., the behaviours carried out with regard to one’s own body; Cash & Pruzinsky, 1990). When speaking of negative body image, it is generally meant that each of these components is negatively affected. That is, individuals with a negative body image tend to have negative thoughts (e.g., “I’m extremely unattractive”), feelings (e.g., weight dissatisfaction), and perceptions (e.g., magnification of perceived ‘flaws’) about their own body, and engage in behaviours such as excessive mirror-checking, pinching of the skin, or avoidance of public situations (Menzel, Krawczyk, & Thomp- son, 2011). It is difficult to pinpoint precisely how many women and men have a negative body image, given that – in contrast to clinical disorders – there are no concrete or agreed upon criteria for what is or is not considered a “negative body image.” However, stud- ies tend to estimate that as many as 50-60% of women and 30-40% of men have a negative body image, with the majority of these estimates based on measures of the cognitive and affective components of body image (see Tiggemann, 2004, for a re- view). Williams, Cash, and Santos (2004) have made a further distinction between women with a “very negative body image” (24%) and women with a “moderately negative body image,” or “normative body image discontent” (23%). Using cluster analysis, Williams et al. (2004) argued that although both groups of women may be equally dissatisfied with their body, women with a very negative body image differ in the extent that their body causes them substantial distress and affects their quality of life, as well as in the degree that they are ‘invested’ in their physical appearance. To our knowledge, similar estimates are not yet available for men. Regardless of the exact estimates, these numbers are alarming considering the aver- sive consequences that have been associated with negative body image. For example, negative body image has been identified as a risk factor for a range of unhealthy behav- iours, such as crash dieting, self-induced vomiting, laxative misuse, and excessive exer- cise, as well as the use of steroids, muscle-bulking products, and excessive weightlifting in men (Cafri et al., 2005; Neumark-Sztainer, Paxton, Hannan, Haines, & Story, 2006). In addition, negative body image predicts low self-esteem, depression, and obe- sity, and it is considered the key risk factor for the development and maintenance of an eating disorder and body dysmorphic disorder (Cooley & Toray, 2001; Fairburn & Garner, 1986; Grabe, Hyde, & Lindberg, 2007; Johnson & Wardle, 2005; Neumark- 9 CHAPTER 1 Sztianer et al., 2006; Paxton, Neumark-Sztianer, & Hannan, & Eisenberg, 2006; Phil- lips, 2011; Tiggemann, 2005). For these reasons, it has been said that body image is a “core aspect” of physical and psychological health – especially in women, for whom negative body image is more common (Grabe, Ward, & Hyde, 2008). Both the prevalence and potential consequences of negative body image motivated the overarching aim of this thesis. That aim is, to answer the question: How can body image be improved? This question was divided into three sub-questions that guided the research conducted during the PhD project: (1) how is negative body image currently treated – and are existing interventions effective?; (2) how can we improve the way that individuals relate to their own body?; and (3) how can we improve the way that indi- viduals relate to their own body with regard to the social environment? In the follow- ing, each sub-question is introduced, along with a specification of how it was addressed in the PhD project. At the end of the chapter, an outline of the remainder of the thesis is presented. 1. How Is Negative Body Image Currently Treated – and Are Existing Interventions Effective? In order to investigate how body image can be improved, it is necessary to evaluate how body image is currently treated and whether existing interventions are effective at improving body image. Extant interventions designed to improve body image can broadly be divided into five categories: (a) cognitive-behavioural therapy (CBT), (b) media literacy, (c) fitness training, (d) self-esteem enhancement, and (e) psychoeduca- tion. CBT-based interventions stem from the cognitive-behavioural perspective on body image (Cash, 2011). In brief, the cognitive-behavioural perspective posits that a range of historical (e.g., culture, family upbringing, personality traits) and proximal (e.g., current situations, emotional states, peer group) factors can shape and affect an indi- vidual’s body image. In addition, an individual’s thoughts, feelings, and behaviours interact with these factors. CBT-based interventions assume that negative body image is maintained by dysfunctional or irrational thoughts, feelings, and behaviours with regard to one’s own body. Thus, the aim of CBT is to modify these thoughts, feelings, and behaviours, and to help individuals to adopt healthier ones. To do so, a variety of techniques are used such as teaching monitoring and restructuring of cognitions and conducting exposure exercises (see Jarry & Cash, 2011, for more details).