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1 Does Practical Body Image with mirror exposure improve body image and increase acceptance of a healthy weight in adolescents with an eating disorder? Sarah Astbury Assistant Psychologist sarah.astbury@newbridge-health.org.uk

2 Overview Body Image Research Practical Body Image (PBI) Preliminary Data - Outcome measures - Feedback - Limitations Pilot Study Implications

3 Body Image Research Strong predictor of onset, maintenance and relapse of eating disorders (ED) 1-3 Substantial support for the effectiveness of cognitive behavioural body image therapies and mirror exposure techniques 4-9 Majority of research has involved adult groups 4-7 or non-clinical adult samples 8,9 Limited research testing the effectiveness of individual treatments for children and adolescents with ED

4 Practical Body Image (PBI) Bespoke 1:1, manualised body image treatment 14 sessions (10 weeks) Weight restoration and maintenance Cognitive behavioural techniques - perception, avoidance, negative beliefs Mirror exposure (ME) - anxiety, avoidance

5 Preliminary Data n=10, female, age (M=14.7), anorexia nervosa (AN)

6 Score Eating Disorder Examination Questionnaire (EDE-Q) 10 6 Weight and Shape Concern 5 Non-significant decrease in weight concern (t(9)=1.68, p=0.128) Non-significant decrease in shape concern 1 (t(9)=1.61, p=0.141) 0 Weight concern Before PBI After PBI Norm Shape concern

7 Anxiety Physical Appearance State and Trait Anxiety Scale: Trait Version (PASTAS) Physical Appearance Anxiety Non-significant decrease in trait anxiety (z=-0.97, p=0.333) Before PBI After PBI

8 Avoidance Body Image Avoidance Questionnaire (BIAQ) 12 5 Body Image Avoidance 4 Non-significant decrease in clothes avoidance 3 (z=-1.43, p=0.153) Significant decrease in social avoidance (z=-2.21, p=0.027) 0 Clothing Avoidance Social Avoidance Before PBI After PBI

9 Acceptance Healthy Weight Body Acceptance Scale (HWBAS) 10 Acceptance of a Healthy Weight Body Non-significant increase in acceptance of a healthy weight body (t(9)=1.98, p=0.079) 2 0 Before PBI After PBI

10 Self-esteem Rosenberg Self-esteem Scale (RSE) Self-esteem Significant improvement in self-esteem (t(9)=-2.61, p=0.028) Before PBI After PBI Norm

11 What I thought was helpful the most was probably getting evidence about my beliefs Feedback It helped me to understand that how I perceive my body is different to what other people will think Positive feedback with reports that it has been helpful in supporting body image concerns Sessions exploring errors in perception and negative beliefs reported as most useful Mirror exposure least liked part of the programme, but rated as helpful in tackling anxiety I found mirror exposure really helpful and I can see a difference in how I feel about my body, weight and shape It helped me a lot as I can now wear clothes that I couldn t wear before easily

12 Limitations Limited data Only females Additional psychological therapies (CBT-E or psycho-dynamic therapy) No standard treatment comparison group No validated acceptance measure

13 Pilot Study Aim: evaluate the effectiveness of PBI and add to the evidence base for the treatment of body image in children and adolescents with ED Questions: 1. Does PBI with ME improve body image and increase acceptance of a healthy weight in adolescents with an ED? 2. Is there an additional effect of ME on body image and acceptance? 3. What is the impact of treatment on self-esteem, anxiety and depression?

14 Pilot Study Hypothesis: 1. PBI with ME will improve body image and lead to increased acceptance of a healthy weight in adolescents with ED 2. ME will lead to further improvement of body image and acceptance of a healthy weight in this sample 3. Treatment will improve self-esteem and reduce anxiety and depression

15 Pilot Study Design: Body Image Acceptance and Action Questionnaire (BI-AAQ) 14, Hospital Anxiety and Depression Scale (HADS) 15

16 Implications Provide an effective manualised individual body image treatment for young people Prevent long-term illness and reduce the risk of severe and enduring ED Reduce the risk of relapse and readmission

17 Acknowledgements Research: Amanda Beavan 1, Professor Hubert Lacey 1,2, Professor John Morgan 3, Rachel Matthews 1 PBI Development: Amanda Beavan 1, Jessica Schall 1, Sophie Bates 1,4, Nicola Malone 1, Dr Matt Hutt 1, Rachel Matthews 1 1 Newbridge House, Birmingham, United Kingdom 2 St George's University of London, London, United Kingdom 3 The University of Leeds, United Kingdom 4 University of Surrey, Surrey, United Kingdom

18 Does Practical Body Image with mirror exposure improve body image and increase acceptance of a healthy weight in adolescents with an eating disorder? Sarah Astbury Assistant Psychologist sarah.astbury@newbridge-health.org.uk

19 Questions 1. Is PBI suitable for males? Yes, the programme is mostly gender neutral and where necessary includes specific materials for both males and females. We have also completed PBI with a male prior to the introduction of outcome measures. 2. Is PBI suitable for adults? Although PBI has not been directly tested with adults, there is no reason to believe that it would not be appropriate for this cohort as no part of the programme is age specific and adults also present with body avoidance, anxiety and misperception. 3. Why is PBI delivered 1:1 and not in a group format? Although we accept the evidence with adult groups, a lot of what we do is personal and intensive and experience has shown that it is hard enough for young people to complete parts of the programme on their own. Also as PBI has specific weight criteria, it is not possible to have a group of individuals who weight restore at the same rate to complete the programme together.

20 Questions 4. How do you maintain consistency among different therapists? The delivery of PBI is highly consistent between therapists as it is a manualised treatment with clear guidelines on the content and structure of sessions. Furthermore therapists meet weekly to review protocol adherence. 5. Is the HADS appropriate for use with young people? Yes, this measure has been validated for use with adolescents: White, D., Leach, C., Sims, R., Atkinson, M., Cottrell, D. (1999). Validation of the hospital anxiety and depression scale for use with adolescents. The British Journal of Psychiatry, 175, Is the BI-AAQ appropriate for use with young people? Yes, this measure has been validated for use with a wide age range: Ferreira, C., Pinto-Gouveia, J., & Duarte, C. (2011). The validation of the body image acceptance and action questionnaire: exploring the moderator effect of acceptance on disordered eating. International Journal of Psychology and Psychological Therapy, 11,

21 References [1] Stice, E. (2002). Risk and maintenance factors for eating pathology: a meta-analytic review. Psychology Bulletin, 128, [2] Fairburn, C. G., Peveler, R.C., Jones, R., Hope, R, A., & Doll, H. A. (1993). Predictors of 12-month outcome in bulimia nervosa and influence of attitudes to shape and weight. Journal of Consulting and Clinical Psychology, 61, [3] Keel, P.K., Dorer, D.J., Franko, D.L., Jackson, S.C., & Herzog, D.B. (2005). Postremission predictors of relapse in women with eating disorders. American Journal of Psychiatry, 162, [4] Morgan, J. F., Lazarova, S., Schelhase, M., & Saeidi, S. (2014). Ten session body image therapy: efficacy of a manualised body image therapy. European Eating Disorders Review, 1, [5] Key, A., George, C. L., Beattie, D., Stammers, K., Lacey, H., & Waller. G. (2002). Body image treatment within an inpatient program for anorexia nervosa: the role of mirror exposure in the desensitization process. The International Journal of Eating Disorders, 31, [6] Legenbauer, T., Schütt-Strömel, S., Hiller, W., & Vocks, S. (2011). Predictors of improved eating behaviour following body image therapy: a pilot study. European Eating Disorders Review, 19, [7] Nye, S., & Cash, T. F. (2006). Outcomes of manualized cognitive-behavioral body image therapy with eating disordered women treated in a private clinical practice. Eating Disorders, 14,

22 References [8] Delinsky, S. S. & Wilson, G. T. (2006). Mirror exposure for the treatment of body image disturbance. International Journal of Eating Disorders, 39, [9] Butters, J. W., Cash, T. (1987). Cognitive behavioural treatment of women s body-image dissatisfaction. Journal of Consultant Clinical Psychology, 6, [10] Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: interview or self report questionnaire? International Journal of Eating Disorders,16, [11] Reed, D. L., Thompson, K., Brannick, M. T., & Sacco, W. P. (1991). Development and validation of the physical appearance state and trait anxiety scale (PASTAS). Journal of Anxiety Disorders, 5, [12] Rosen, J. C., Srebnik,, D., Saltzberg, E., & Wendt, S. (1991). Development of a Body Image Avoidance Questionnaire. Psychological Assessment, 3, [13] Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press. [14] Sandoz, E. K., Wilson, K. G., Merwin, R. M., & Kellum, K. (2013). Assessment of body image flexibility: the body image acceptance and action questionnaire. Journal of Contextual Behavioral Science, 2, [15] Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67,

Developing a new treatment approach to binge eating and weight management. Clinical Psychology Forum, Number 244, April 2013.

Developing a new treatment approach to binge eating and weight management Clinical Psychology Forum, Number 244, April 2013 Dr Marie Prince 1 Contents Service information Binge Eating Disorder Binge Eating