CONTENT
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1) Welcome, Review of Treatment Map, and Agenda-Setting
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Review goals/homework from previous sessions.
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Topics today: (1) overvaluation of shape + (2) pie chart exercise.
2) Review of Goals/Homework from Previous Sessions (approx. 20 mins)
1. Review cognitive reappraisal and emotion regulation techniques
Questions to ask client:
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What situations did you encounter in the past week that triggered distress or a negative mood state?
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What strategies did you use to reappraise the situation or regulate your emotions?
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What are your main takeaways from this exercise?
2. Review exercise exposure and response prevention task
Questions to ask client:
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How did you go with exposing yourself to the urge to exercise and then attempting to resist that urge to exercise?
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How did your anxiety change over time?
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What thoughts and feelings popped up when completing the task?
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What did you learn?
3) Overvaluation of Shape (approx. 15 mins)
Questions to ask client:
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What is the first thing you notice about people when out in public? What informs your judgement of whether you like them as a person?
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If you reflect at night on whether you had a good or a bad day, what are the main things which impact your judgement?
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People with MD tend to value weight/shape (e.g., muscularity + leanness + attractiveness) more than the average person without MD.
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When we appraise other people or ourselves, it is important to also consider a number of intangible characteristics in addition to physical characteristics (e.g., morals/virtues + how we treat other people + friendliness + kindness + dependability).
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People with MD tend to evaluate both themselves and other people based primarily on weight/shape which leads them to neglect other important factors.
Questions to ask client:
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What factors influence our long-term compatibility with someone (e.g., friend or partner?)
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How much impact does weight/shape have?
4) Activity 1: Pie Chart Exercise (approx. 25 mins)
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Draw out all domains of your life in a pie chart structure with the associated percentages of how important each domain is to you – the judgement of importance should be a combination of intuition/gut feel but also consider the time/financial commitment towards each of these domains.
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Example life domains include:
(1) improving or thinking about eating/weight/shape (i.e., exercising + dieting + body checking) + (2) work + (3) study + (4) social and/or romantic relationships + (5) family + (6) self-improvement + (7) hobbies.
Review Pie Chart
Questions to ask client:
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What are the largest parts of your pie? Is this different to what you expected?
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What areas of your life are missing or have been neglected?
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What are the main downsides of valuing exercise/diet so much more than other parts of your life?
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Main downsides:
(1) ‘eggs in one basket’ strategy (what happens if you are unable to exercise for a given period of time due to health issues or an accident?) + (2) hard thing to achieve (we all have different genetics which influence our body shape and genetic ceiling) + (3) if you focus exclusively on shape, it is inevitable that you will begin to neglect other areas of your life (e.g., maintaining social relationships + keeping up with work/study commitments) – which reduces opportunities for fulfilment/satisfaction in other life domains and increases your reliance on exercise/diet.
Addressing Pie Chart Imbalances
Questions to ask client:
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What are some marginalised/neglected areas of your life that you would like to build up?
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What can you do to build up those marginalised areas of your life? What are relevant activities you could engage in over the next week?
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How would you feel showing this pie chart to your romantic partner (if applicable)?
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What would your pie chart look like in an ideal world?
5) Setting Homework/Goals
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Schedule activities to build up 1-2 marginalised areas of your life.