CONTENT
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) body image and (2) checking and avoidance behaviours.
2) Review of Goals/Homework from Previous Sessions (approx. 10 mins)
Review goal to expand marginalised areas of life
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Questions to ask client:
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What did you decide to do?
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What happened? Did you notice an impact on your mood?
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How will you continue to work on this goal in the future?
3) Body Image (approx. 10 mins)
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Body image refers to the thoughts/feelings we have about our own bodies – it can be either positive or negative or neutral.
Questions to ask client:
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What is the difference between positive and negative body image?
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What is the difference between negative body image and muscle dysmorphia?
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Everyone has some degree of body image dissatisfaction or negative body image at times, but this does not result in significant impairment for everyone, nor is it chronic for everyone.
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People with MD tend to judge themselves/others based on physical characteristics (e.g., weight/shape) more than people without MD.
Questions to ask client:
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What are potential downsides of this approach?
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Downsides: (1) neglects intangible qualities like kindness, humour, patience, and values, which are better predictors of long-term compatibility + (2) may lead to high physical standards which are impossible or overly demanding to meet.
4) Checking Behaviours (approx. 10 mins)
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Developing a healthier relationship with your body involves both:
(1) increasing your self-evaluation with parts of the pie that are not aligned with your disorder + (2) decreasing disordered behaviours (e.g., body checking and avoidance) that maintain your disorder.
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Checking and avoidance are opposite responses that both maintain overvaluation of shape. 10 minutes
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Lots of checking behaviours exist in MD:
(1) normative but excessive checking (e.g., weight + mirrors + clothes) + (2) secretive/embarrassing checking (e.g., measuring/pinching fat + muscles).
Questions to ask client:
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Are there any checking behaviours you perform daily?
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Why is it important to reduce compulsive checking behaviours?
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Rationale for reducing compulsive checking:
(1) increased scrutiny of your body leads to an increased chance of picking up on flaws + (2) regardless of whether the judgement is positive or negative, it will further reinforce MD behaviours.
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The treatment approach to address excessive checking is to do the opposite – reduce or cease a checking behaviour.
5) Avoidance Behaviours (approx. 10 mins)
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Avoidance can occur in many different ways (e.g., avoiding mirrors + avoiding checking weight + avoiding taking shirt off in public or in intimate settings).
Questions to ask client:
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Are there any avoidance behaviours you engage in that come to mind?
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Why is it important to challenge avoidance behaviours?
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Rationale for addressing avoidance behaviours:
(1) we never get the opportunity to challenge feared beliefs about what will happen during exposure + (2) avoidance is life-interfering and makes it difficult to expand marginalised areas of life (particularly social interactions).
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The treatment approach to address avoidance is to do the opposite – increase exposure to feared situations and behaviours.
6) Addressing Checking and Avoidance Behaviours (approx. 20 mins)
Addressing checking behaviours
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Step 1: Monitor checking behaviours in real-time for at least one day. List all the behaviours you would consider unhelpful checking behaviours.
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Step 2: Take steps to change the environment to cease/reduce one or more checking behaviours (e.g., move mirror to a less accessible location or block out with a sheet + give weight scales to a friend + get rid of measuring tape).
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Step 3: Engage in distraction activities when you feel the urge to check (e.g., call a friend + go for a walk + watch a TV episode of your favourite show).
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Step 4: Keep track of the number of checks (per day) for relevant behaviours over the next week to review during the next session.
Addressing avoidance behaviours
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Step 1: Identify problematic avoidance behaviours related to: (1) seeing body (e.g., avoiding mirrors) + (2) touching body (e.g., not touching self when washing) + (3) others seeing body (e.g., keeping shirt on at the beach or wearing baggy clothes when at the gym).
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Step 2: Create a graded exposure hierarchy to target 1-2 specific avoidance behaviours – rank exposure tasks from least difficult to most difficult.
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Step 3: Create goals to begin working through the graded exposure hierarchy – monitor anxiety pre- and post-exposure each time. It is important to work on exposure at least multiples times per week (ideally daily).
7) Setting Homework/Goals
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Pick 1-2 checking behaviours and avoidance behaviours to challenge over the next week.
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Continue implementing plans to expand marginalised areas of life.