Cognitive Restructuring of Body Image
Session 15, as with all sessions, should begin with a review of the patient’s homework from the previous week. In particular, reviewing the patient’s body image triggers will set the stage for cognitive change exercises in the current session. After noting in the last session that body image is a subjective and highly variable quality, the patient should be better able to disengage from her negative thoughts about her body, which will then allow her to begin questioning the validity of these thoughts. By noting her body image triggers over the past week, the patient will have a clearer idea of when and where these destructive thoughts arise. Session 15 can, therefore, be devoted, in part, to cognitive restructuring, which is the process of evaluating and adapting these negative thoughts. The seven-column technique for cognitive restructuring, as described earlier, involves identifying unrealistic and distorted shape-related thoughts, considering evidence for and against these thoughts, revising these thoughts to better reflect the gathered evidence, and ultimately adopting a more compassionate and realistic view of her body (see Form 4.11). Cognitive restructuring should be practiced in session and assigned as ongoing homework between treatment sessions.