“Fine-tuning one’s inner monologue” on body image can minimize the distress caused by negative body perceptions in young women between the ages of 20-30 who often develop eating disorders, according to Prof. Guy Doron of Reichman University in Herzliya and colleagues at the University of Padua in Italy.
The adjustment of this “inner monologue” is done using an application that Doron developed in Israel with the company GGtude, which was established in Tel Aviv in 2019, conducts research and offers digital mental health tools.
In today’s world, the standard of beauty is almost impossible to attain, said Doron of Reichman’s Ivcher School of Psychology.
“Because social networks like Instagram – and Internet influencers who have become models because of various commercial collaborations – set unachievable standards for what is considered beautiful, we encounter more and more young men and women who tell themselves that they ‘hate their bodies’ or that ‘nothing looks good on me,’” he said. “On top of this are the natural physiological changes that occur at this age, such as weight gain and changes in body shape, which contribute to body image distress.”
Doron and his colleagues decided to isolate the element of the inner dialogue – all those thoughts that arise in the minds of young people regarding body image – and try to reduce body image distress through the adaptation and calibration of this monologue.
Psychological interventions such as cognitive behavioral therapy (CBT) are known to be effective in these cases, but at the same time, the shortage of trained professionals, high cost, geographical limitations, stigma and lack of anonymity involved in CBT often prevent young people from seeking such treatments. Mobile health apps, on the other hand, because they are constantly available, accessible from anywhere and for low cost, and allow for anonymity, are therefore enticing for young people to use.
Using technology to fight body dysmorphia
IN THE STUDY, clinical interviews were used to select 95 young women between the ages of 20 and 30 at high risk of developing body image disorders such as eating disorders or Body Dysmorphic Disorder (BDD) – which involves an obsessive preoccupation with certain body parts such as skin, the size or shape of the nose, hair and so on. They were then randomly divided into two groups.
One group started using the app “OCD.app – Anxiety Mood & Sleep” immediately at baseline, while the other group waited 16 days and only then began using the app. At baseline, the two groups did not differ in demographic variables (such as age and years of education), Body Mass Index (BMI), or symptoms of BDD, eating disorder, social anxiety, perfectionism, self-esteem and general distress.
The app, said Doron, helps young people refine their inner monologue by presenting statements that support or contradict their negative perceptions of their bodies – for example, that external appearance alone determines academic, professional, marital and family success; or that self-worth depends solely on appearance, and comparisons to unrealistic beauty ideals.
The users were asked to pull sentences that challenge negative body attitudes (such as “an imperfect body is a real body” or “even Internet celebrities have wrinkles”) toward themselves (by swiping downwards). They were also asked to reject (by swiping up) sentences that reinforce negative body perceptions (for example, “imperfection is a failure” or “people are always looking for my flaws”).
Pulling negative statements toward themselves leads the app to provide users with feedback that draws their attention to the unhealthy thought, while embracing statements that encourage healthy thoughts about the body draws positive feedback from the app.
By doing this exercise for three to four minutes a day for about two weeks, the users learn to adopt a healthier mindset toward their bodies and to reject thoughts that are harmful to their body image. In this way, the authors explained, they rewire their inner monologue to be constructive rather than destructive.
Reduction in negative body image
THE STUDY’S findings show that women in the group who began using the app immediately reported fewer thoughts and behaviors associated with extreme body dissatisfaction and BDD (i.e., repetitive and avoidance behaviors and social comparisons) than the group that started using the app later. The first group also reported less overall dissatisfaction with their body shape and body parts that are a focus of concern in people with eating disorders, such as the stomach, thighs and buttocks.
Moreover, once the women in the delayed-use group started using the app, they also reported a significant decrease in symptoms of extreme body dissatisfaction, BDD and body dissatisfaction associated with eating.
Overall, 34.7% of the women who participated in the study reported reliable clinical change with less body dissatisfaction or BDD symptoms after using the app for 16 consecutive days. And these results were maintained for at least two weeks without using the app. The effects of using the app were more limited on other symptoms of eating disorders, such as the desire to lose weight, bulimia and associated traits.
“Considering the effectiveness of the application in reducing negative body image, the time saved and the potential widespread applicability of this type of intervention, the findings of this study are promising,” Doron concluded. “Its results indicate that even brief, daily cognitive training by using this app may lead to a significant reduction in symptoms related to body image distress.”
