With the rise of social media and the hunt for ‘the perfect body’ hurtling towards a greater eating disorder and body image crisis, eating disorder OT Daune Green explains how her model of OT can help those struggling to accept their own body.

The over-arching aim of the group is to help dispel and challenge unhelpful thoughts around body image and formulate positive coping strategies. 

The programme can be implemented on an individual or group basis. Group tends to be more successful as it brings like-minded youngsters together who experience similar issues. This can be empowering as they realise they are not alone. Like minded youngsters understand and can offer positive support and develop strong friendships. 

The group can be same gender or mixed, but I try to ensure similar age groups. The group tends to be for adolescents suffering from an eating disorder – mostly anorexia – however, it can be used for youngsters with bulimia and EDNOS, low self-esteem, poor body image or body dysmorphia. Referrals are accepted from tier two or three professionals in CAHMS.

Body image issues can occur in both men and women however, boys tend to keep their problems more private. Young boys tend to strive for either the super skinny, low weight shape or the more toned body shape of an athlete. Unfortunately, this can be distressing for the young lad as no matter how much exercise, weights, protein shakes, diets or clean eating, they will struggle to achieve it due to genetics. 

As an OT, it is all about how poor body image issues impact on their physical and psychological wellbeing. How it impacts on their function, and what it stops youngsters doing? 

Poor body image issues can occur at any time, however transition into puberty age often causes difficulties. Many youngsters want to remain pre-pubertal; they fear growing up and their body changing, wanting to remain a child. I have also experienced youngsters who have gender identity issues who restrict their food intake to prevent hormones kicking in and body changes which is becoming more common. 

The programme runs for eight weeks and sessions last two and half hours including a break.

Body Image Programme 

Week 1
The first week includes an introduction, warm up game, and a chat about previous youngsters’ journeys. We discuss the programme, formulate group rules, identify individual aims and complete three questionnaires; body image behaviours, body image anxiety scale and distressing situations test, before finishing the session with compliments. 

Week 2
Through exploring what body image is, we give definitions and then explore how poor body image impacts thoughts, feelings and behaviours. We then explore different body types and how they have changed over centuries and how different body shapes are more favoured across the world. We also discuss genetics, so youngsters can identify what characteristics they have from different family members. 

Week 3
The youngsters then search magazines, name celebrities, get images and put together their ‘ideal body image’, before we ask ‘what is perfect?’ We then dispel myths around the media. The youngsters complete a spot the difference activity before and after photoshop. I show a number of YouTube videos to illustrate this and the technology out there. 

We then prepare for DBT activity where all staff and youngsters do something as a group that makes them feel anxious such as exposing a certain part of their body, wearing no makeup or wearing contact lenses instead of glasses or vice versa. This demonstrates that we don’t automatically change just because we don’t wear make-up or expose our legs. 

Unfortunately, there’s no escape from today’s technology and media access. We are exposed to it 24/7. The images shown are not accurate and not a true representation of an individual. This can lead to feelings of poor body image and poor confidence and in turn could lead to engaging in unhelpful or risky behaviour to try and achieve a ‘perfect image’. 

‘Perfect’ does not exist – everybody’s idea of perfect is very different. I try to remind the youngsters the way you look doesn’t define you, it’s who you are. The reality, is all images, whether they posted on your phone, in magazines or on TV, can be edited in some way. France introduced a law ruling all photos must state if they have been photoshopped. If not, they will be fined 37,500 euros or 30% of the cost of creating the advertisement. 

Week 4
We discuss how we are feeling and our anxieties regarding our DBT activity rating our anxiety level from 0-10, ten being the highest. We then write down our immediate thoughts and play a distraction game, then return to the thought they wrote down. I ask if they thought of it during the game and if not they burst a balloon. If not, they keep the balloon until they feel ready, helping them consider letting go of the thought as we discuss unhelpful cognitive distortions. 

I then do a ‘fact or opinion?’ session, showing a picture of someone covered in tattoos or with wild hair and get them to describe the person, then deciding if its fact or opinion. I then show them another picture of that person appearing as a lawyer or doctor etc. 

I relate this back to unhelpful thoughts. I go through different cognitive errors, talking about mislabeling, black and white thinking and making unfair comparisons. 

We then identify triggers, document thoughts and behaviours and formulate a positive coping strategy, before discussing the pending group trip in week eight where we go shopping, social eating and trying on clothes. 

Week 5
I ask the youngsters to define what a mirror is and explore what mirrors are used for. I then ask how many mirrors they have at home, and to write down a typical day’s mirror use, adding up time spent body checking in one day, one week and one month to realise how much time is wasted body checking and how this is a maintaining behaviour. 

Mirrors are not magic. I place an object in front of the mirror and ask if it grew taller, wider, or “got fatter”. I get them to measure my waist or leg away from the mirror and then in front of it and reassure there is no change. 

I then talk about what weight means, what the body is made up of and how weight fluctuates throughout the day. I weigh first thing in the morning, after breakfast, drinks, going to the toilet and lunch etc. This helps the individual put things into perspective. I also talk about the risks of not eating a healthy balanced diet and physical complications that occur in the moment and later in life which they sometimes don’t accept. 

Week 6
This is a relaxed session about motivational words have helped promote recovery, completing an A-Z of emotional strength. We then put together a self-soothe box, full of positive coping strategies, motivational quotes and anything that will help relax and reduce unhelpful behaviours. 

Week 7 
Using a self-esteem game, we assess how far they have come; rating where they started, where they are now and where they would like to be and what they can do to progress. We then discuss recovery and what this looks like, formulating a relapse prevention plan. 

Week 8
A group trip consolidates all the skills learnt, before they write about their journey through the programme, complete an evaluation and get their parents to complete one to see if they notice any changes. 

Throughout the programme mindfulness activities can be implemented.

(This article appeared in the Mar/Apr 2018 issue of The OT Magazine)

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