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Running head: SELF-CHANGE PROJECT PROPOSAL

Part 1A: Self-Change Project Proposal – Body Image

Michelle Popielarz

[email protected]

CAAP 6635 Health Psychology

Jennifer Thannhauser

University of Lethbridge

Master of Counselling Program

Date Submitted: June 2nd, 2013

Assignment Deadline: June 2nd, 2013

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SELF-CHANGE PROJECT PROPOSAL

Self-Change Project Proposal – Body Image

According to Young (2010), I am body preoccupied. A quiz titled Do you have a healthy

body image? offered in Best Health’s May 2010 issue, interpreted my responses in a way that

grouped me in a category that I am well aware I stand within. The following is a summary of the

category, you are body preoccupied:

You may underestimate how much you blame your body flaws for failures in your life.

You frequently compare yourself to movie stars and svelte friends, and come up short. You

often experience “I feel fat” days, feel self-conscious around others you find attractive, and

spend a lot of time in front of a mirror. You believe you would be more attractive if you

were thinner or more muscular, and beat yourself up for not exercising enough or for

having a decadent meal. (para. 18)

Russell-Mayhew (2010, as cited in Young, 2010) stressed that, “the female definition of beauty

has narrowed over time, and now it’s an impossible standard,” (para. 2). She defined an

individual’s ability to accept their body as the ability to recognize and understand “that how

one’s body looks is only one part of who we are” (para. 3). This is the very matter that I have

struggled with in the past, in the present, and likely in the future, if changes to my health

behaviours are not made. A disfavored body image can lead to a number of undesirable

consequences, such as social isolation, eating disorders, and depression (Young, 2010);

consequently, it is important to recognize any unhealthy behaviour choices associated with our

body images, which in turn, can alter our emotions, mood, experiences, etc.

Why is body image so important? The answer is seemingly obvious when reviewing

statistics concerning the subject of self-image. In one study conducted by Brown University

(2011), 74.4% of college females, classified as having a normal weight, “stated that they thought

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about their weight or appearance ‘all the time’ or ‘frequently’” (para. 2). In addition, 46% of

college males with a normal body weight also responded with the same concerns. One of the

most valuable pieces of information that I have found regarding body image was retrieved from

TeensHealth (2012), a website that provides adolescents with accurate and honest advise about

health, emotions, and life. It is not surprising to me that such constructive information would be

found here, as it is common for adolescents to carry highly dynamic perceptions of body image

due to physical changes resulting from puberty (Croll, 2005). According to TeensHealth (2012),

body image is strongly correlated with self-esteem, which defines our perception of self-worth.

Subsequently, the amount of worth we allocate to ourselves “can affect [our] mental health and

how [we] behave” (para. 2). Therefore, it is essential that I learn to make peace with my body

image, as the risks of maintaining such an attitude can lead to a slew of concerns, including:

emotional distress, depression, anxiety, social withdrawal, eating disorders, and even substance

abuse (Rice University, 2011).

The following paper will propose an intervention plan that will aim to improve my own

health behaviours in relation to the way I perceive my body image. Cognitive and behavioural

strategies will be presented, along with methods for monitoring the impact that results from any

changes that are made. In addition, I will use the Transtheoretical Model to help vindicate the

proposed intervention’s design, as well as a literature review on body image and the intervention

strategies that will be discussed.

Rationale for Personal Behaviour Change

Concern for my body image has been an exhausting journey from the time when I retired

as a gymnast over ten years ago. Prior to ending my 12-year stretch as an athlete in competitive

gymnastics, I did not experience any discomfort with my weight or body appearance as I do

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today. I believe that my positive body image while doing gymnastics was due to the extraneous

exercise (six days a week for five hours each session) that I endured for the length of time I was

a competitive athlete. I recall eating what I wanted with zero reservation about how what I ate

could possibly affect the way I looked. During these years I would effortlessly consume high

carbohydrate foods, such as pasta and bread, whereas I have eliminated these foods from my diet

for many years now. There are numerous and frequent accounts of disordered eating habits and

body image concerns in athletes of elite sports. Twenty-two former college gymnasts, in a study

conducted by O‘Connor, Lewis, Kirchner, and Cook (1996), reported greater preoccupation with

body image and thinness after having retired from gymnastics. A more recent study conducted

by Kerr, Berman, and De Souza (2006) attained results indicating that, of the retired gymnasts,

20% of the participants struggled with an eating disorder and 73% reported having disordered

eating behaviours. These results were compared with participants who were current gymnasts,

3% of which reported eating disorders and 18% who reported disordered eating behaviours.

Although I am not content with my external image, I am comfortable to admit that I am

undeniably preoccupied with my self-image. As a result, I experience episodes of emotional

distress, decreased self-esteem, and disordered eating habits. It is my hope that the following

self-change proposal will help me learn how to increase both my mental and physical well-being

by changing the current negative perception I have about my body image. This concern is of the

utmost importance to me for the simple reason that it has imprisoned my everyday perceptions,

cognitions, and behaviours. I fail to accept the positive comments I receive from others,

convincing myself that they are just trying to be nice. I continuously scrutinize my eating habits

and exercise regime. My distorted perception of my size and shape has resulted in me being

extremely self-conscious and uncomfortable in my own body. I am completely aware that this

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behaviour is detrimental to my physical and mental health and is in need of immediate change.

Transtheoretical Model

According to Holland (2005), it is understandably a difficult task to make changes to the

way we perceive ourselves. She emphasized that the Transtheoretical Model (TTM) provides an

effective process for implementing necessary change in our lives. Hales (2012) noted that the

TTM is a foundational model for a number of health behaviour programs, including body image

issues. Prior to this self-change proposal, I would have grouped myself into the contemplation

category, where individuals often acknowledge that the issues they are faced with are dominating

their everyday lives. Hales stated that individuals in this stage often “alternate between wanting

to take action and resisting it” (p. 20). As this proposal is the framework for the preparation

stage, I would currently place myself in the action stage, aiming to produce change that is visible

to others. Within this stage, it is my hope that I will begin “to acquire a sense of comfort and ease

with the change in [my] life” (p. 20).

Literature Review

To be able to comprehend the influential factors and impact that body image has on an

individual, we must first understand what exactly constitutes as a positive body image and a

negative body image. Rice University (2011) suggested that having a positive body image

involves maintaining a realistic perception of the way you look and feeling comfortable with

your external appearance. They listed the following factors that validate an individual’s positive

self-image:

Acceptance and appreciation for your natural body shape and body differences;

Understanding that your looks do not determine your self-worth, character, and value;

Feelings of comfort and confidence in your own body;

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A perverse amount of time spent on food and calorie intake, and weight concerns;

Nonjudgmental views of others’ weight, shape, eating habits, and exercise regimes.

With regard to possessing a negative body image, Rice University listed the following

behaviours that an individual is likely to possess:

Distorted perception of your shape;

Belief that others are more attractive and your size end shape is a personal failure that

does not correspond with the ideals of family, society, and media;

Feeling ashamed, self-conscious, and anxious about your body;

Constant comparison with yourself to others.

Influential Factors and the Media

The perceived image we have of our bodies, or body image, “is the mental representation

we create of what we think we look like” (Psychology Today, n.d.). According to Brown

University (2011), it is a widespread preoccupation. Jessie’s Legacy, a program at the Family

Services of the North Shore (n.d.) and a provincial leader for the Provincial Eating Disorders

Awareness (PEDAW) campaign, emphasized that possessing a healthy body image means

recognizing your “individual qualities and strengths that make you feel good about yourself

beyond weight appearance” (para. 3), while disregarding the pressure to aspire for the perfect

body. Harriger and Thompson (2012) revealed that there are an array of factors that account for

the development of body image issues, some of which include: biological, familial,

psychological, and sociocultural. Despite these factors, they stressed that the media’s influence

on body image significantly increases body dissatisfaction, internalization of the thin ideal, and

behaviours associated with eating disorders, as suggested in several recent studies.

“Encouragement to focus on appearance is at an all-time high in this culture” (Brown University,

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2011, para. 3). Hendriks and Burgoon (2003) concluded that the messages sent through the

media concerning body image emphasize the thin-ideal; thinness is an advantageous quality

signifying success and social desirability. Their findings suggested that women who are exposed

to greater amounts of media, such as those within the North American culture, are likely to

accept the thin-ideal as the norm.

Impact of Body Image

Predictably so, individuals’ perceptions of their body image generate outcomes that are

either beneficial or detrimental to their well-being. According to the National Eating Disorders

Collaboration (NEDC, 2013), sustaining a positive body image generally results in a “higher

level of physical and psychological health, and better personal development” (para. 6).

Consequently, an individual will experience heightened levels of self-esteem and self-

acceptance, as well as a more balanced lifestyle with healthier attitudes and behaviours.

Individuals exhibiting respectful self-images will find it easier to manage daily life, be sociable,

and live happier lives. In contrast, as discussed above, a poor body image is associated with an

abundance of adverse effects, which include: emotional distress, decreased self-esteem,

anxiety and/or depression, disordered eating habits, and social withdrawal (Rice University,

2011). In addition, research has validated that a preoccupation with body image can place

individuals at a “greater risk for engaging in dangerous practices to control weight and size”

(Brown University, 2011, para. 4).

Strategies within Intervention Plan

Cognitive strategies. Cognitive restructuring is understood as an effective cognitive

technique for creating a more positive body image. Caltabiano and Ricciardelli (2013)

emphasized the benefit of this approach, stressing that it reduces the negative views that one has

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about their body appearance and effectively challenges unhelpful beliefs that inhibit goal

attainment. Findings from a study conducted by Veale et al. (1996, as cited in Shohov, 2004)

revealed that cognitive restructuring can indeed reduce one’s preoccupation with his or her own

appearance. However, Wright and Thase (1997) warned that this approach can sometimes prove

challenging for the reason that some individuals’ maladaptive beliefs “are validated in the

current sociocultural context” (p. 120).

With regards to listing positive attributes of one’s self, numerous sources emphasized the

effectiveness of uttering positive self-talk for the purpose of improving one’s body image. Radar

Programs (n.d.), a leading clinical treatment center for eating disorders in the United States,

stressed that we can “deprogram ourselves from the negative messages we have internalized over

the years” (para. 9), simply by accepting and appreciating our bodies. They suggested that one

approach an individual can take to achieve this is by listing parts of the body that he or she

enjoys.

Behavioural strategies. Numerous sources and studies suggested that exercise is highly

correlated with improving body image. Appleton’s (2013) study concluded that, in a two-week

period, “improvements in body image can be achieved through [moderate] exercise while body

weight and shape remain unchanged” (p. 116). Cash and Smolak (2011) supported this claim by

emphasizing the effectiveness of exercise interventions on body image improvement for both

men and women. They stressed that individuals with the lowest levels of body satisfaction often

improve the greatest. Campbell and Hausenblas (2009) conducted a meta-analysis on 57 studies

concerning the impact of exercise on body image. Their findings concluded that, out of the four

major exercise components (frequency, intensity, type, time), frequency "is positively associated

with body image change" (Cash & Smolak, 2011, p. 382).

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Monitoring Techniques

According to Zweig and Leahy (2012), the Body Image Checklist (BIC) is an excellent

tool for assessing individuals’ dissatisfaction with their body image. They stressed that this tool

allows patients to better recognize their distorted thoughts and behaviours. In addition, Zweig

and Leahy noted that the responses obtained from the BIC “are a useful starting point for

behavioral change” (p. 55). Cooper, Fairburn, and Hawker (2003) outlined the benefits of the

BIC, stating that it is a valuable tool for identifying areas of greatest concern in order to target

them first. Although there are a number of different body image checklists available to the

public, the particular checklist employed within the following intervention plan has been utilized

in a number of peer-reviewed articles and published manuals.

A second assessment tool that will be used to monitor the impact of any changes made over

a four-week period is the eight-item version of the Body Shape Questionnaire, or BSQ-8C. This

questionnaire is a shortened derivation of the original 34-item version of the BSQ. According to

Pook, Tuschen-Caffier, & Brähler (2008), considering the original BSQ-34 and all of its

derivations, the BSQ-8C is the most appropriate version to employ for both non-clinical and

clinical uses, especially when used for treatment evaluation. Their findings demonstrated that the

BSQ-8C is the most favourable version of the BSQ, due to its psychometric qualities and its

ability to include items that appropriately “represent the concept of body dissatisfaction in

sufficient form” (p. 71). Welch, Lagerstrom, and Ghaderi (2012) supported Pook et al.’s findings

stating that, the BSQ-8C is “a valuable instrument for measuring body shape dissatisfaction

among young adult women” (p. 547). They added that the BSQ-8C is a proficient tool not only

for its low number of items, but also for its non-specificity to a particular gender.

Intervention Plan

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The NEDC (2013) emphasized four major aspects that structure one’s body image:

perceptual - how one sees themselves; affective - the amount of satisfaction or dissatisfaction one

feels about his or her appearance, weight, and shape; cognitive - how one thinks about his or her

own body; and behavioural - behaviours that one engages in as a result of his or her body image.

They stressed that one’s attempt to alleviate negative feelings by employing unhealthy practices

often does not result in physically and/or emotionally desired outcomes and can lead to “more

intense negative feelings of disappointment, shame and guilt, as well as place a person at greater

risk of developing an eating disorder” (How can you improve, para. 1). The NEDC advised that

challenging the standards one has about beauty and learning to accept his or her own body size

and shape is essential to achieving positive feelings about his or her body image. “We have the

power to change the way we see, feel, and think about our bodies” (NEDC, How can you

improve, para. 3).

Cognitive Strategies

One strategy that I will use to alter my current body image is by challenging the

maladaptive thinking patterns that influence the perceived image I have of my body. For the

reason that negative thoughts can inhibit our abilities to achieve goals, restructuring cognitions

can alleviate maladaptive thinking patterns in order to assist us in taking steps to reach our

desired goals. In order to restructure my current negative thoughts about my body image I will

first need to acknowledge my distorted thoughts when they occur. Over a period of four weeks,

I will record each negative thought in a log titled, the Triple-Column Technique (Memorial

University, 2002), which can be found in Appendix C. The negative thought will be recorded

under the automatic thoughts column and given a rating between 0 (not at all) and 100

(completely), as to how much I believe the thought is true. Under the distortions column, I will

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identify what is distorted about the thought. Finally, under the column rational responses, I will

record a realistic thought that counters the automatic thought and again, rate how much I believe

the rationale response to be true. In an attempt to restructure my negative thoughts, I will replace

my automatic thoughts with the formulated rationale responses in my daily life.

A second cognitive strategy that I feel will prove effective is listing a positive feature of my

inner or outer self every second day, for a period of four weeks. The completed list will consist

of 14 positive features that I will be required to review and recite to myself every other day. A

positive features template can be found in Appendix D.

Behavioural Strategies

Rather than focus my energy on all four components of exercise, (frequency, intensity,

type, time), which in turn often creates anxiety if I do not sufficiently accomplish each

component ever week, I will focus on attaining one component, frequency. I will set the

frequency of exercise at four days per week, for a duration of four weeks. I will record each

exercise session clearly on an oversized calendar that is positioned on my home office desk.

Exercise will consist of moderate- to vigorous-intensity physical activity, where on a scale of 1-

10 relative to an individual’s personal capacity, physical activity will be a five or above

(Canadian Society for Exercise Physiology, 2011). It is important that I only focus on the

frequency of exercise sessions prescribed and not on the components of intensity, type, or time.

Monitoring Strategies

To monitor the impact of any changes made over a period of four weeks, both the Body

Image Checklist and a derivation of the Body Shape Questionnaire will be employed prior to

starting the intervention strategies and after the interventions have been implemented. According

to Cooper et al. (2003), such assessment tools aim to “help patients learn to accept their

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appearances and themselves” (p. 102).

Body Image Checklist. Commonly abbreviated as the BIC, the Body Image Checklist is a

27-item self-report questionnaire measuring one’s degree of body dissatisfaction, as well as the

extent of checking and avoidance behaviours that he or she may be engaging in. The items

within the checklist are made up of 11 questions regarding avoidance behaviours, six questions

concerning checking behaviours, and ten general questions about one’s satisfaction with his or

her own body. A four-point Likert scale (not at all, sometimes, frequently, not applicable) is

provided on the questionnaire, where higher values, such as frequently, represent areas of greater

concern and body dissatisfaction. A sample of the BIC can be found in Appendix A.

BSQ-8C. The BSQ-8C, otherwise known as a derivation of the original 34-item Body

Shape Questionnaire, is an eight-item self-report questionnaire measuring the degree of one’s

concern for his or her own body shape. The items within the questionnaire refer to one’s state

over a period of the past four weeks and compose of three situational questions, two questions on

one’s feelings and worries for being or becoming fat, two questions on the consequences of

feeling fat, and one question concerning one’s personal antecedents (Pook et al., 2008). The

assessment’s scale is a six-point Likert scale ranging from never to always, where higher values

represent greater body dissatisfaction. A sample of the BSQ-8C can be found in Appendix B.

References

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Appleton, K. (2013). 6 x 40 mins exercise improves body image, even though body weight and

shape do not change. Journal of Health Psychology, 18(1), 110-120.

Brown University. (2011). Body image. Retrieved from

http://brown.edu/Student_Services/Health_Services/Health_Education/nutrition_&_eating_

concerns/body_image.php

Caltabiano, M. L. & Ricciardelli, L. A. (2013). Applied topics in health psychology. West

Sussex, England: John Wiley & Sons.

Campbell, A. & Hausenblas, H. A. (2009). Effects of exercise interventions on body image: A

meta-analysis. Journal of Health Psychology, 14, 780-793.

Canadian Society for Exercise Physiology. (2011). Canadian physical activity guidelines.

Retrieved from http://www.csep.ca/CMFiles/Guidelines/PAGuidelinesGlossary_E.pdf

Cash, T. F. & Smolak, L. (2011). Body image: A handbook of science, practice, and prevention.

New York, NY: Guildford Press.

Cooper, Z. Fairburn, C. G., & Hawker. D. M. (2003). Cognitive-behavioral treatment of obesity:

A clinician's guide. New York, NY: Guilford Press.

Croll, J. (2005). Body image and adolescents. In J. Strang & M. Story (Eds.), Guidelines for

adolescent nutrition services (155-166). Minneapolis, MN: Center for Leadership,

Education, and Training in Maternal and Child Nutrition.

Family Services of the North Shore. (n.d.). Jessie’s legacy. Retrieved from

http://www.familyservices.bc.ca/professionals-a-educators/jessies-legacy

Hales, D. (2012). An invitation to health: Choosing to change. Belmont, CA: Wadsworth.

Harriger, J. A. & Thompson, J. K. (2012). Hollywood and the obsession with the perfect body.

Sex Roles, 66, 695-697.

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Hendriks, A. & Burgoon, M. (2003). The relationship between fashion magazine consumption

and body satisfaction in women: Who is most at risk of influence? Paper presented at the

meeting of the International Communication Association, San Diego, CA.

Holland, (2005). Stages of change. Retrieved from

http://www.lifeinmotioncoaches.com/articles_files/page0006.htm

Kerr, G., Berman, E., & De Souza, M. J. (2006). Disordered eating in women's gymnastics:

Perspectives of athletes, coaches, parents, and judges. Journal of Applied Sport

Psychology, 18(1), 28-43.

National Eating Disorders Collaboration. (2013). What is body image? Retrieved from

http://www.nedc.com.au/body-image

O‘Connor, P. J., Lewis, R. D., Kirchner, E. M., & Cook, D. B. (1996). Eating disorder symptoms

in former female college gymnasts: Relations with body composition. The American

Journal of Clinical Nutrition, 64, 840-843.

Pook, M., Tuschen-Caffier, B., & Brähler, E. (2008). Evaluation and comparison of different

versions of the body shape questionnaire. Psychiatry Research, 158(1), 67-73.

Psychology Today. (n.d.). Psych basics: Body image. Retrieved from

http://www.psychologytoday.com/basics/body-image

Radar Programs. (n.d.). Body image: Self-worth is often entangled with physical appearance.

Retrieved from http://www.raderprograms.com/signs-symptoms/body-image.html

Rice University. (2011). Body image. Retrieved from http://wellbeing.rice.edu/bodyimage/

Shohov, S. P. (Ed.). (2004). Advances in psychology research (Vol. 48). Hauppauge, NY: Nova

Science Publishers.

TeensHealth. (2012). Body image and self-esteem. Retrieved from

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http://kidshealth.org/teen/your_mind/body_image/body_image.html

Welch, E., Lagerstrom, M., & Ghaderi, A. (2012). Body shape questionnaire: Psychometric

properties of the short version (BSQ-8C) and norms from the general Swedish population.

Body Image, 9(4), 547-550.

Wright J. H. & Thase, M. E. (Eds.). (1997). Cognitive therapy. Arlington, VA: American

Psychiatric.

Young, L. (2010). Quiz: Do you have a healthy body image? Retrieved from

http://www.besthealthmag.ca/embrace-life/mental-health/quiz-do-you-have-a-healthy-

body-image

Zweig, R. D. & Leahy. R. L. (2012). Treatment Plans and Interventions for Bulimia and Binge-

Eating Disorder. New York, NY: Guilford Press.

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APPENDICES

1. Body Image Checklist..................................................................................... Appendix A

2. BSQ-8C........................................................................................................... Appendix B

3. The Triple-Column Technique........................................................................ Appendix C

4. Positive Features Template............................................................................. Appendix D

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Jennifer Thannhauser, 06/11/13,

You do not need a table of content for the appendices.


Appendix A

(Zweig & Leahy, 2012, p. 147).

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Appendix B

(Welch, Lagerstrom, & Ghaderi, 2012)

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Appendix C

The Triple-Column Technique

(Burns, 1980, as cited in Memorial University, 2002).

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Appendix D

Positive Features Template

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