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In a 2020 survey, 61% of adults reported feeling negative about how they look. Could therapy change that?  

It’s been a month now since most menus across the UK have listed the calorific content of every bit of food and drink, and we’re still reeling. Much has been written about the impact on people with eating disorders, and the little evidence that supports the impact of this policy is poor quality.

In 2020, a parliamentary survey of nearly 8,000 people uncovered that 61% of adults reported feeling negative (or very negative) about their body image most of the time. The pandemic didn’t help: 53% of adults reported feeling ‘worse’ or ‘much worse’ about how they looked during the first lockdown.

Mental health services received a record 4.3 million referrals last year, according to new research by the Royal College of Psychiatrists. Helplines are also struggling: for example, the eating disorders charity Beat received 7,840 calls between December 2021 and February 2022, up from 3,346 in the same period in 2019/20. 

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It’s a problem that Dr Julia Coakes knows all too well. A consultant clinical psychologist based in Leeds, Dr Coakes says she’s had a wave of new clients over the last two years, the likes of which she hasn’t seen before during her career.

“The pandemic has been a massive trigger for a lot of mental health realisations,” she tells Stylist. “I’ve never seen such high numbers coming for therapy.”  

What is ACT, and how does it differ from more traditional therapies?

Dr Coakes specialises inacceptance and commitment therapy (ACT), a well-evidenced type of therapy that was developed in the 1980s. It’s similar to CBT, but with added mindfulness techniques. In a 2020 review of meta-analyses, it proved efficacy across 133 studies. ACT has been used to treat various mental health problems including depression, anxiety, OCD and workplace stress, and is also offered to people to help them cope with diagnoses such as chronic pain and cancer.

A couple of the core principles of this type of therapy are cognitive defusion and commitment. In defusion, the therapist teaches the client methods to reduce the amount that we treat thoughts (or feelings or memories) as reality. Then the therapist helps the client set goals and commit to action in line with the client’s values.

Dr Coakes says she also adds in modern concepts such as intuitive eating and health at every size when working on body image with clients.  

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“Intuitive eating is a technique with a great evidence base around having a healthy body at any size by what we choose to put in, how we honour our hunger and honour our emotions,” she explains. “ACT is very skill-based, which I love because I have something to give the client.”  

Why choose therapy for body image?

As the parliamentary study shows, poor body image is really common, but for some reason, we don’t take it seriously.

“It’s not recognised enough that body image dissatisfaction is a problem in itself,” Dr Coakes says. “Furthermore, it can cause other problems, and not just eating disorders: anxiety, social isolation – all kinds of areas are affected by our perception of our body.” A 2019 report by the Mental Health Foundation found that over a third of adults said they have felt anxious (34%) or depressed (35%) because of their body image.  

The parliamentary study from 2020 also highlighted that poor body image is a lifelong problem. Some 66% of under-18s they surveyed reported feeling negative or very negative about their body image, and respondents who worked with children warned that they were observing negativity in children as young as eight or nine.

Of course, anybody who wants to improve their relationship with their body has the power to do it. But for people who need more than self-help, or the support of friends and family, therapy might be able to help where simpler approaches haven’t made enough change. 

“In my experience, you’re more likely to change in therapy,” she explains, “because you’ve got somebody you’re discussing it with. Therapy just moves change that little bit quicker, with that little bit more structure.” 

How ACT works

Clients often start therapy with Dr Coakes after a relationship breakdown or new diagnosis, or another unexpected challenge. For example, she says, one of her clients started after a relationship ended. “She said, ‘I don’t want to repeat this. I keep having relationships I’m not happy with. Where am I going wrong?’” Dr Coakes says. “We looked at what she’s learned and how her thoughts take her in a certain direction.”

Another client Dr Coakes worked with recently had stopped doing the sports they loved because of how they looked. “The client was so focused on their BMI that they wouldn’t allow themselves to engage,” she says. 

“They had quite a positive relationship with exercise when they were younger. But as their body changed size and shape as they got older, they started to believe they shouldn’t do things they used to do.” So, Dr Coakes and her client shifted their focus onto what the client could do, rather than how they looked, and on capacity for exercise rather than a different BMI.  

Even predictable changes can be really hard to process from a body image point of view, as Dr Coakes herself discovered with the onset of the menopause. “I was surprised by how challenging I found that,” she says. 

“As an eating disorder psychologist who has worked with body image for 20 years, I thought I was comfortable with myself. I love my body, even though I was teased and bullied about it when I was much younger. But when my body changed – and in ways I didn’t expect – I had to put some of my own skills to work.”  

Good books to read about body image if you are struggling

For anyone toying with the idea of therapy for body image change or acceptance, Dr Coakes says there are plenty of resources to check out before making a decision. Her favourite starting place is Dr Russ Harris’s The Happiness Trap (a book Stylist also recommends). 

Reinforcing the importance of the function over form is key to rebuilding clients’ relationships with their bodies. Her go-to body book on this topic at the moment is More Than A Body: Your Body Is An Instrument, Not An Ornament by Lexie Kite and Lindsay Kite, which explains what ‘body image resilience’ means – a concept the authors call the next step after body positivity.

So, the next time that you find yourself in a low body image spell, know that there’s help out – whether that’s therapy or book-form.

For more body image ideas, visit the Strong Women Training Club.

Images: Getty

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