Elsevier

Behavior Therapy

Volume 52, Issue 4, July 2021, Pages 830-846
Behavior Therapy

Consequences of Repeated Critical Versus Neutral Body Checking in Women With High Shape or Weight Concern

https://doi.org/10.1016/j.beth.2020.10.005Get rights and content

Highlights

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    142 women randomized to critical or neutral body checking or non-body high checking.

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    Critical body checking directly lowered body satisfaction v. control.

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    Body satisfaction & self-esteem higher right after neutral body checking v. control.

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    Negative affect decreased to follow-up in neutral and critical checking v. control.

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    Self-esteem and affect increased to follow-up in neutral checking v. control.

Abstract

Body checking is a repeated behavior conducted in an attempt to gain information about one’s shape, weight, size, or body composition. Body checking is associated with negative behavioral, emotional, and cognitive outcomes and may maintain body dissatisfaction and eating disorders. The precise function and consequences of body checking remain less well understood. Specifically, immediate and delayed impacts of repeated critical body checking (CBC) have not been determined. The current study randomly assigned 142 young women with high shape/weight concern to daily 10-min CBC, neutral body checking (NBC), or a non-body critical checking (NBCC) comparison condition, examining their immediate and delayed (one-week follow-up) effects on body satisfaction, self-esteem, and negative affect. Multilevel modeling and follow-up planned comparisons found that compared to NBCC, CBC participants’ body satisfaction and self-esteem immediately decreased, but negative affect improved from baseline to follow-up. Compared to CBC, NBC participants’ self-esteem and negative affect improved immediately, and their self-esteem improved over time compared to NBCC. Over time, all participants’ state body satisfaction improved, regardless of condition. Our findings suggest a 10-min CBC session may function differently than typical (harmful) in vivo body checking. However, reasons for this difference are unclear. Additional research is needed to distinguish (harmful) in vivo body checking from CBC procedures such as this and other mirror exposure interventions. Research is needed to examine the effects of varying CBC duration and instructions during body exposure to further clarify mechanisms of change during body exposures.

Section snippets

Function of Body Checking in Body Dissatisfaction and ED Etiology

Body checking may increase vigilance and selective attention to disliked body parts (Shafran et al., 2004, Walker and Murray, 2012). In both clinical treatment-seeking (Jansen et al., 2005) and nonclinical (Roefs et al., 2008) samples, women higher in body dissatisfaction demonstrate greater visual attention to self-described unattractive body parts compared to women with lower body dissatisfaction. Selectively attending to disliked body parts may increase body dissatisfaction by magnifying

Clinical Implications

Because of its role in the etiology and maintenance of EDs, CBC and body avoidance are targeted in ED and body dysmorphic disorder treatments. Interventions targeting CBC and avoidance include scheduled weekly weighing, education, assessment, and addressing motivations for, and consequences of, checking and avoidance via behavioral experimentation and Socratic questioning (Fairburn, 2008). Other research suggests potential utility for habit reversal, given body checking appears to reflect

Mirror Exposure

Mirror exposure involves systematic exposure to the body, and has consistently demonstrated efficacy in improving body dissatisfaction and decreasing body checking and avoidance in clinical and nonclinical samples (Griffen et al., 2018). Mirror exposure has been combined with cognitive techniques to reframe how individuals think about their body, such as mindfulness (Delinsky & Wilson, 2006) and cognitive dissonance (Stice & Presnell, 2007). Mirror exposure has also been assigned without

Current Study

Experimental body checking examinations have typically manipulated body checking in a single session of mirror exposure (e.g., Shafran et al., 2007, Smeets et al., 2011, Svaldi et al., 2012, Tanck et al., 2019, Vocks et al., 2008a). However, single-session body checking manipulations do not provide information on body checking’s impacts over time. They also lack ecological validity, given that body checking behaviors are typically repeated frequently over time (Shafran et al., 2004, Walker and

participants

Female participants were recruited via the university’s research participant pool and flyers posted on campus advertising a study “examining body dissatisfaction and related behaviors” in women in return for course credit or raffle entry for gift cards. Inclusion criteria were >18 years of age and ≥1 SD above age- and sex-matched norms (Mond et al., 2006) on the Eating Disorder Examination–Questionnaire EDE-Q (EDE-Q; Fairburn & Beglin, 1994) Shape or Weight Concern subscales. See Figure 1 for

participant characteristics

There were no significant differences between conditions at baseline in BCQ scores (see Table 1) or across any of the three baseline days for any of the three main outcome variables (BISS, RSES, and NA), with type 1 error rate set to p < .05. Accordingly, the data for the three baseline days were averaged to yield a composite score for the remaining analyses. Data were examined for multivariate outliers, multicollinearity, skewness, kurtosis, and random response patterns. No cases were detected

Discussion

This study was the first to directly compare immediate and delayed impacts of CBC and NBC to a non-body control condition that involved critical checking behavior. The additional NBCC condition suggests that the impacts of CBC may have been a result of body checking in particular, rather than a result of critical checking behaviors more generally. Overall, the CBC condition produced the expected negative consequences compared to NBCC immediately following the manipulation, with a significant

Conflict of Interest Statement

The authors declare no conflicts of interest.

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    • Cited by (0)

    This research was supported by internal research grants from the University at Albany, State University of New York; Dr. Gorrell is supported by the National Institutes of Mental Health [T32 grant MH0118261-33].

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