An investigation of new methods to improve body image among people with eating disorders

Trained student therapists will deliver Imagery Rescripting (IR) in person in the first few days of admission to Treatment as usual over a one hour session. In the IR condition, participants will first be introduced to IR and provided with rationale to use this intervention. Then participants will be asked to identify a negative experience/image associated with the (negative) ways they feel about themselves. Participants will be doing other exercises such as identifying a kinder, older self to prepare themselves for the intervention. After this preparation stage, there will be three phases of the IR intervention itself: (1) Reliving as the younger self; (2) Rescripting as the older self, and (3) Rescripting as the younger self. During the first phase – reliving as the younger self, participants will revisit the most significant negative event that they identified during the preparation stage. They will then be asked prompt questions such as “where are you? What are you doing? Who is there?” in order to relive the experience in as many details as possible from their own perspective. During the second phase – rescripting as the older self, participants are asked to recall the same experience again but this time they will observe the event through the lens of their older selves. They will also be given the opportunity to intervene in the situation and help their younger selves. They will be asked questions such as “How do you feel offering this support? Where do you feel this in your body?” to help participants articulate their emotions. During the third and final phase – rescripting as the younger self, participants are asked to recall the same experience but imagine they are the younger self again. This time, however, their older, kinder self is also present in the image. They will be reliving the “updated” version of their experience as their older kinder self intervenes in the situation. They will be asked prompting questions such as “what is happening? How are you feeling?” Debriefing will be provided at the end of the IR session. In this debrief, patients will reflect on their experience with prompted questions asked by the student therapist, for instance, "what did you learn about the original event" and "what impact does this new perspective have on how you feel about the event". The student therapist will also check in with the patient in terms of their distress level and help patients utilise their own helpful coping strategies that were identified at the beginning of the IR session if needed. Participants will practice IR exercise daily for a week after the initial meeting. Specifically, they will receive a link to write about the the content of the third phase of the IR that they did with the student therapist (i.e., rescripting as the younger self with adult self intervening) for 5 minutes everyday. A quality rating scheme was developed from a previous study that included such home practice (Pennesi & Wade, 2018) and will be used to assess intervention fidelity at home practice in this study. Patients and therapists will meet again at the end of the first week to review progress and modify the IR exercise as needed. Patients will practice IR for another week after the meeting. The IR procedure is exactly the same for both inpatients and outpatients. The only procedure element that is different between inpatients and outpatients is the assessment timepoints. Specifically, inpatients will complete 3 assessments (at the beginning of their treatment program, after the IR session, and at completion of their treatment program); outpatients will complete 5 assessments (at the beginning of their treatment program, 2 and 4 weeks after treatment commences, at completion of their treatment program, and 3 months after completion of their treatment program).