Building Positive Body Image in Chronic Illness

Brief name: Cognitive behavioural therapy targeting body image in adults with a chronic illness (Empower: Body Acceptance Skills program) Materials: The Empower: Body Acceptance Skills program was designed to target negative body image, positive body image and well-being in adults with a chronic illness. Each participant is provided with a Participant Handbook to accompany participation in the group program. This resource comprises an overview of the program aims, approach, and expectations for participation, as well as support services that might be of interest. Furthermore, each session includes psychoeducation and skills training materials related to focal topics so that participants can review these in their own time, as well as activities completed in session and for homework. These materials have been developed by psychologists based on evidence-based cognitive behavioural therapy programs and resources for body image enhancement, which have been adapted for the chronic illness context to address specific body image concerns reported in this population by the research team. The program also includes additional positive body image techniques which have been tested in this population. The structure and adaptation of these programs and techniques, and the resulting Participant Handbook and materials employed in this study, were developed specifically by the research team in a research project which employed co-production processes with adults with a chronic illness to tailor the program content and materials, which lead to the development of the Empower: Body Acceptance Skills through a project supported by the ACT Government under the ACT Health Promotion Grants Program 2021-2023. Session delivery also includes use of visual aids in the form of powerpoint slides to assist in provision of psychoeducation and skills training. Procedures: Individuals interested in participating in Empower: Body Acceptance Skills contact the ANU Psychology Clinic to express their interest. As a program delivered within the ANU Psychology Clinic, implementation is undertaken in line with policies and procedures of the service. Individuals who express their interest in the program undertake a telephone pre-screening and a face-to-face assessment session to determine suitability for the group program. During this assessment process participants complete paperwork required for clients of this service, and are informed that management of their chronic illness remains with their GP and other healthcare providers. Eligible participants are then allocated to the next available group program delivery, with those who do not meet eligibility criteria provided with alternative referral options. Participants are invited to take part in the voluntary research evaluation of the group program in the first session, and can choose to complete the group but not the research evaluation as this is an open pilot trial program evaluation in a service setting. Session attendance is documented each session, with those unable to attend provided with opportunities to ask questions about materials missed. Content: The cognitive behavioural therapy program (named Empower: Body Acceptance Skills) is delivered in a collaborative and supportive manner, with each session comprising a review of previous content or homework tasks, psychoeducation on concepts and skills training related to each session topic, and activities designed to facilitate discussion and reflection on participant experiences, and training in psychological skills to assist in body image enhancement. Facilitators encourage participants to ask questions and contribute to discussion throughout, ensuring that all have an opportunity to participate to the degree they are comfortable. Across sessions, two fictional characters are used as an alternative mode to demonstrate skills and concepts, and a tracking sheet is utilised to monitor body image experiences and progressively document the implementation of skills to manage barriers to positive body image throughout the program. Each session has associated take-home practice activities, amounting to approximately 30 to 60 minutes per week. A brief description of the content in each session is provided below: Session 1: Program information, aims, ground rules, confidentiality Defining body image and its importance in chronic illness Introducing cognitive behaviour therapy Identifying values to prepare for body image work H/W Program goals Session 2: Cognitive behavioural model of body image Development of body image, and your body image journey Investing in body care behaviours guided by values H/W Body image self-monitoring and body care Session 3: Shifting our focus on the body Body functionality and appreciation H/W Body image self-monitoring and functional appreciation Session 4: Identifying unhelpful body-related thoughts Addressing and reframing unhelpful body-related thoughts H/W Identifying and addressing unhelpful body-related thoughts Session 5: Body image threats and chronic illness Self-compassion and body image H/W Practicing self-compassion Session 6: Identifying unhelpful body image behaviours Addressing avoidance by approaching the body H/W Action plans to approach the body well Session 7: Building a body supportive environment Challenging ideals and assertive communication H/W Supporting a body positive environment Session 8: Fostering body protection Bringing it all together to maintain progress H/W Relapse prevention, taking care of your body for life Who: The program is delivered by AHPRA-registered provisional psychologists who are undertaking placement in the ANU Psychology Clinic as part of postgraduate study in clinical psychology under the supervision of AHPRA-registered Psychologists and Clinical Psychologists. The program is implemented in accordance with a Facilitator Handbook. Mode of delivery: The program is delivered face-to-face either in-person or via telehealth in a small group comprising up to eight participants per group. Number of times: The program comprises a total of eight sessions of up to 90 minutes duration each. During sessions in which evaluation measures are completed, the sessions are scheduled for two hours. It is planned that Sessions 1-4 will be delivered at weekly intervals, and Sessions 5-8 at fortnightly intervals. Location: The program is delivered by the ANU Psychology Clinic on-site or via telehealth at the ANU. Personalisation of the group program occurs to the extent that activities and discussion within each session is informed by the salient issues presented by participants. As such, materials (i.e., psychoeducation and skills training) are delivered using a consistent approach but the content of examples, discussion, and practice with the group is informed by the individuals within the group.