Interventions Designed to Improve Body Image

Goals of this Module To provide information about The targets (who/what) of interventions Frameworks used to guide interventions Activities to encourage confidence in relation to appearance Resources to supplement interventions

Who/what are the Targets of Interventions? Public Policy Interventions aimed at facilitating change in the physical and social environment that may be contributing to appearance dissatisfaction Eg., influencing laws regarding the images used in the advertising of beauty products Individuals and groups Interventions aiming to change attitudes and behaviour at an individual level. These are often conducted among groups at risk for appearance dissatisfaction Eg.,school-based programmes delivered to small groups or whole classes

Reducing Risk: Framing the Content & Delivery of Interventions The ‘Risk Factor Model’ – Most accepted theoretical framework for improving body image – Targets sociocultural and individual risk factors for the development of appearance dissatisfaction – Based on the theory that if you reduce the presence of influential risk factors, appearance dissatisfaction is less likely to occur – For example, targeting known risk factors such as The internalisation of appearance ideals Making unfavourable appearance-comparisons with peers

Common Approaches to Intervention 1. Media Literacy 2. Targeting Peers 3.Cognitive Dissonance

1. Media Literacy Click on the image above to watch the Dove film ‘Onslaught’

Why focus on the media? Exposure to media images of the male and female ‘ideals’ has a negative impact on body image in the short and long term (Levine & Murnen, 2009) Media images are everywhere – it is easier to change our response to them than banning or changing the images Young people with higher levels of media literacy have lower levels of body dissatisfaction (McLean, Paxton & Wertheim, 2013)

Media Literacy Media Literacy is ‘the ability to access, analyze, evaluate and create media in a variety of forms’ (Center for Media Literacy, 2011) We aim to provide young people the skills to deconstruct and critique the media images and messages they see to reduce the negative impact of media exposure.

Media Literacy: Media Smart The most effective media literacy program that has been tested in the school environment is Media Smart (Australian version) Australian program that consists of eight, 50- minute classroom lessons. Activities focus on media literacy, activism, and advocacy, including an exploration of the media's stereotypical portrayal of women and men in advertising, learning about airbrushing, and writing protest letters to industry. Recent trials have found this program to be effective in reducing 13-year old girls' and boys' concerns with, and over-evaluation of, body weight and shape, dieting, body dissatisfaction, and depression (Wilksch & Wade, 2009). ne/projects/5

Improving Media literacy: Caution! If you are thinking of implementing a media literacy intervention…..Before you start: It is tempting to show trainers/students lots of media images of ideal bodies when demonstrating the portrayal of men and women in the media However- we know that exposure to these images increases appearance dissatisfaction. Begin the session by introducing the concept of consuming images and messages with critical eye - prior to displaying images.

Media Literacy: Ideas for Activities Start a discussion about stereotypes portrayed in the media: – Ask trainers/students to brainstorm the typical appearance of men/ woman in the media (eg newscasters; presenters). Why might these people be selected? Is this what they personally consider attractive? – What about people with disfigurements? How are they portrayed? What characters do they play?

Media Literacy: Activities Media tricks- Watch the Dove ‘Evolution’ clip to find out what goes into a photoshoot. Discuss whether this is what was expected? Or do they use more manipulation than the students expected thought?

Media Literacy: Activities “Photoshop Fakes”- use before/after pictures of men and women and ask students to identify what elements of an image have been altered. – Start with faces/hair and progress to full body shots. [Try to avoid showing trainers/students too many models that represent the thin/muscular ideal]. – Discussion why the images have been photoshopped – Finish with a debate: do we feel comfortable with this? What might be impacts be? Should it be allowed?

Before & After Images

Media Literacy: Resources Swedish retouching site ch/ ch/ Center for Media Literacy (USA) Young women, and body image in the digital agehttp:// ms/past-programs/positive-body- image/ ms/past-programs/positive-body- image/

2. Addressing the Impact of Peers

Why Target Peers? Peers are the most important social context for adolescents Research by Helfert & Warschburger (2011) & Paxton, Schutz, Wertheim, & Muir (1999) have demonstrated that the following are risk factors for appearance dissatisfaction – Making appearance comparisons with peers – Having appearance conversations with peers & – Appearance-related teasing by peers

Social Comparisons Have a negative impact because young people compare their body to that of their peers, and become dissatisfied if they feel that the peers are more attractive Often, comparisons are not valid, as the other person is taller/shorter/has different genetic make-up. We need to try to encourage young people to avoid comparing their appearance to their peers

Appearance-based Teasing Has obvious direct negative impact on body image of recipient There is also a negative impact of vicarious teasing (i.e., watching others get teased about their weight) as it established group norms and standards of appearance. We need to make efforts to stop teasing at system and individual levels

Appearance Conversations Initiate and maintain group norms and expectations about appearance, convey the importance of looks, and model behaviours to change weight and shape. We need to make young people aware of the influence of these conversations so that they can monitor them

An Example of a Peer Intervention: Appearance Conversations Introduce the concept of ‘appearance talk’ (eg comments made about a person’s body shape, size, facial appearance, clothing, skin colour, disfigurement) Ask trainers/students to brainstorm the potentially negative impacts of these conversations on their own physical, social, and emotional health and the wellbeing of others In groups, develop scenarios of common ‘appearance talk’ situations, then exchange your scenario with another group. Choose one scenario and ask trainers/students to write an ‘alternative ending’ After sharing all of the scenarios and endings, brainstorm a list of ‘things we can do’ to reduce appearance talk.

Alternative endings: What could you do to stop Appearance Talk? Divert the conversation to another topic Ignore the appearance talk without ignoring the person Highlight qualities other than appearance Try not to direct attention towards body size or any other aspects of physical appearance Don’t dismiss the concerns as fake, provide reassurance without buying into the appearance-talk cycle Focus on health talk, not appearance-talk – Eg “healthy eating” rather than “dieting” Remember that it’s okay for people to feel confident about their body, and it doesn’t mean they are bragging or stuck- up (Taken from Happy Being Me- Richardson & Paxton, 2010 )

Ideas for Additional Activities Encourage trainees/students to identify and discuss examples of appearance- based discrimination and the bias towards attractive people in current society. Encourage trainees/students to explore the laws concerning discrimination in your country. Do they include discrimination on the basis of appearance? Do they think the laws be changed? Ask whether anyone experienced examples of appearance based teasing or discrimination in practice? Share the examples and choose one or two to develop an ‘alternative ending’ to the situation Brainstorm a list of ‘things we can do’ to prevent appearance based discrimination What about the ‘victims’ of appearance-related teasing? Can anything be done to reduce the negative impacts? Can they do anything themselves? What can ‘bystanders’ do?

Evidence based Peer Interventions Happy Being Me has been the most successful peer program among adolescent girls (Richardson & Paxton, 2010). This programme been replicated with other age groups and with groups of males and females in both Australia and the UK with promising results (Diedrichs et al., 2012). This program can be accessed with permission by contacting Prof. Susan Paxton

Peer Programmes: Additional Resources Y’s Girl Download Resources from What-We-Do/Ys-Girl What-We-Do/Ys-Girl

3. Cognitive Dissonance

How do Cognitive Dissonance Approaches Work? ‘Internalization’ occurs when people adopt the societal appearance ideals as something to which they believe they should aspire to. Internalization of the thin and muscular ideals for women & men is one of the strongest risk factors for the development of body dissatisfaction (Thompson & Stice, 2001). Cognitive dissonance interventions attempt to reduce internalisation of the thin ideal

Explaining Cognitive Dissonance ‘Cognitive Dissonance’ (Festinger, 1957) refers to a the discomfort felt when there is an inconsistency (‘dissonance’) between an individual's beliefs and their behaviours. This discomfort motivates the person to change either their attitude or their behaviour in order to reduce this inconsistency (Stice et al., 2008).

Explaining Cognitive Dissonance For example: Many girls diet because they have internalized the idea that being thin is an ideal they must aspire to, and because they believe this will make them more popular A cognitive dissonance approach encourages girls to challenge the connection between thinness and popularity If the intervention is successful, the dieting will become inconsistent with their new attitude (there is no relationship between thinness and popularity), so they will stop dieting.

Cognitive Dissonance: Evidence base There is a substantial amount of evidence supporting the success of this approach in older adolescents and young women. Research has focused on two main programs, The Body Project and Reflections Body Image Program (references in later slide) This approach has been effective with women and groups of female high school and university students (Stice et al., 2008; Halliwell & Diedrichs, in press).

Activity based on the Cognitive Dissonance Approach Discuss current appearance ideals for men and women as depicted in the media (films, TV, magazines etc). Why to people aspire to these ideals? Are their beliefs about how their lives will be different if they achieve the ideals accurate? What are the costs to consumers of these images in trying to achieve these ‘ideals’? Brainstorm the physical, social, emotional, and financial costs…

Cognitive Dissonance: Resources The Body Project Eric Stice Purchase book from Amazon Purchase access online from Succeed Body Image Program Contact Succeed p p

ENCOURAGING BODY CONFIDENCE IN EVERYDAY PRACTICE Identify situations in your work where body image can be an issue for your trainees/students – or perhaps for you? How could you initiate simple actions to counteract this? – For example: students are often nervous before doing presentations to the class because they worry what people will think when they look at them – Solution: Encourage students to practice using confident posture and body language; use ‘ice breaker’ activities that build trust with the group prior to completing presentations, etc.

ENCOURAGING BODY CONFIDENCE IN EVERYDAY PRACTICE Consider engaging in social activism (for example, efforts to influence policy and practice in your institution, city, country) about the negatives impacts of appearance concerns for your trainees Consider advocating compulsory training about the impacts of appearance concerns for all vocational trainers and guidance counselors

Avoid using guest speakers, images, articles or books that relate to people who have recovered from eating disorders – These do not improve body image or ‘scare people off’ developing an eating disorder. Instead, they may glamourize disordered eating and may make this appealing to vulnerable young people. Avoid assignments focussing on eating disorders. – These topics are often chosen by young people who are susceptible and may give them access to information to initiate or fuel their disorder Don’t ask students to record food intake or keep a food diary. – This is behaviour associated with strict control of diet. Evidence shows that dieting this way is ineffective. Don’t weigh students in class, or conduct fitness testing. – This promotes self-consciousness, competition (which may trigger dieting regimes to improve scores) and appearance comparisons THINGS TO AVOID…..

SUMMARY Targets of interventions designed to promote positive body image include public policy, individuals and groups Frameworks guiding interventions focus on known risk factors, Approaches include media literacy, reducing the impact of peers, and creating cognitive dissonance to reduce internalisation of the thin and muscular ideals Specific activities can encourage confidence in relation to appearance, and resources have beem provided.

References Center for Media Literacy. (2011). Media Literacy- A definition and more. Available URL: Diedrichs, P. C., Bird, E., & Halliwell, E. (2012). "Happy Being Me" in Britain: The evaluation of a school-based disordered eating and neagtive body image intervention with pre-adolescent girls and boys. Paper presented at the International Conference on Eating Disorders, Austin, Texas. Festinger, L. (1957). A theory of cognitive dissonance. Stanford: Stanford University Press. Halliwell, E., & Diedrichs, P. C. (In press). Effectiveness of a Dissonance Eating Disorder Prevention Program among 12 and 13 year old British Girls. Health Psychology Helfert, S., & Warschburger, P. (2013). The face of appearance-related social pressure: Gender, age and body mass variations in peer and parental pressure during adolescence. Child and Adolescent Psychiatry and Mental Health, 7, Levine, M., & Murnen, S. K. (2009). "Everybody knows that mass media are/are not [pick one] a cause of eating disorders": A critical review of evidence for a causal link between media, negative body image, and disordered eating in females. Journal of Social and Clinical Psychology, 28, McLean, S. A., Paxton, S. J., & Wertheim, E. H. (2013). Mediators of the relationship between media literacy and body dissatisfaction in early adolescent girls: Implications for prevention. Body Image, 10(3), Paxton, S., Schutz, H. K., Wertheim, E. H., & Muir, S. L. (1999). Friendship clique and peer influences on body image concerns, dietary restraint, extreme weight loss behaviors, and binge eating in adolescent girls. Journal of Abnormal Psychology, 108, Richardson, S. M., & Paxton, S. J. (2010). An evaluation of a body image intervention based on risk factors for body dissatisfaction: A controlled study with adolescent girls. International Journal of Eating Disorders, 43(2), Stice, E., Shaw, H., Becker, C. B., & Rohde, P. (2008). Dissonance-based interventions for the prevention of eating disorders: Using persuasion principles to promote health. Preventive Science, 9, Thompson, J. K., & Stice, E. (2001). Thin-ideal internalization: Mounting evidence for a new risk factor for body- image disturbance and eating pathology. Current Directions in Psychological Science, 10(5),