The Body Image Psychological Inflexibility Scale: development and psychometric properties

The Relationship Between Body Image and Meaning of Life Among Women with Breast Cancer in Kerman, Iran

We aimed to examine the relationship between body image and the meaning of life among women with breast cancer. The analytic sample included 142 women with breast cancer, and data were collected using a standardized questionnaire through face-to-face interviews. We used Kolmogorov-Smirnov test, Pearson test, Spearman and Mann-Whitney U test to determine the relationship between the research variables. We found an association between the mean score of body image and the mean score of the meaning of life. As the average score of body image increases, the score of the meaning of life increases (p < 0.05). Findings indicated that the body image score increases by increasing the score of the meaning of life and its dimensions, especially existential vacuum and acceptance of death. Future research and targeted treatments should consider the role of body image in shaping the meaning of life among women with breast cancer.

Self-objectification and cosmetic surgery consideration among Chinese young women: The mediating roles of alienation and body image inflexibility

The behavior of undergoing cosmetic surgery is a coping strategy for body-image threats and challenges. Self-objectification is associated with alienation and body image inflexibility, and all of these are associated with stronger cosmetic surgery considerations. This study evaluated the relationship between self-objectification and cosmetic surgery consideration, and whether this relationship was mediated by alienation and body image inflexibility. The participants were 650 Chinese female college students. Serial mediation analysis indicated that the relationship between self-objectification and cosmetic surgery consideration was significantly mediated by alienation followed by body image inflexibility. The total mediating effect value was 0.424, accounting for 57.5% of the total effects. These results suggest that reducing alienation and improving the flexibility of body image can reduce the influence of self-objectification on young women's willingness to undergo cosmetic surgery. These findings provide a basis for intervening or preventing the self-objectified young women's willingness for cosmetic surgery.

The quality of life and body image disturbances of Turner syndrome patients in Malaysia: a cross-sectional study

BACKGROUND

Turner Syndrome (TS) is a rare sex chromosome abnormality occurring in 1 in 2500 female live births. To date, there is limited data on TS patients in Malaysia. This study aimed to investigate the quality of life (QoL) and body image disturbances among adult population with TS in comparison to age-matched controls in a tertiary hospital in Kuala Lumpur: Hospital Chancellor Tuanku Mukhriz, Universiti Kebangsaan Malaysia (HCTM, UKM).

METHODS

This was a cross-sectional study carried out in HCTM, UKM, Kuala Lumpur. TS participants who attended clinic in HCTM, UKM and controls who were hospital staff members were recruited via purposive sampling. TS participants' sociodemographic and clinical profiles were retrieved from medical records. Two validated, translated questionnaires; World Health Organization Quality of Life (WHOQOL-BREF) questionnaire and Body Image Disturbances Questionnaires (BIDQ) were completed by participants.

RESULTS

A total of 34 TS patients were approached and 24 (70.5%) of them participated in this study. Their median (IQR) age was 24.0 (7.0) years and their responses were compared to 60 age-matched healthy females as controls [median age (IQR) = 24.0 (8.0) years]. The most common medical problem in TS participants was premature ovarian insufficiency (n = 23; 95.8%). There were no significant differences between TS and control groups' median scores (overall QOL; 4.00 vs. 4.00, general health; 3.50 vs. 4.00, physical health; 14.86 vs. 15.43, psychological health; 14.67 vs. 14.00 and environment; 15.00 vs. 15.50) of the different WHOQOL-BREF domains. However, TS participants were found to score 13.33 against 16.00, lower than the control group (p < 0.05) in the social relationship domain. Comparatively, body image concerns among TS respondents were significantly higher in impairment in the mainly social areas of functioning (p < 0.05).  CONCLUSION: The study demonstrated that the overall QoL of TS participants was good and almost similar to that of the controls. However, TS group had significantly lower scores for social domain and had greater concerns in social interactions, thus affecting their social life.

Body Acceptance Scale for Women with Breast Cancer: Development and Validation of a Measurement

PURPOSE

Breast cancer and its treatment result in drastic physical changes that can negatively affect a woman's body image. Body acceptance in women with breast cancer is crucial in enhancing their body image and overall quality of life. Despite its significance, there are currently no specific tools to measure body acceptance among cancer patients. This study aimed to develop a Body Acceptance Scale for Women with Breast Cancer (BAS-BC).

DATA SOURCES

The scale's initial items were generated based on a conceptual framework of body acceptance and were reviewed by three clinical and five experiential experts. A preliminary instrument was developed through a content validity assessment by six clinical experts and a pilot test with 20 women with breast cancer. Validity and reliability were evaluated via an online survey of 411 women who had undergone breast cancer surgery.

CONCLUSION

The scale consists of 17 items across six factors (encountering, understanding, adaptation, return to daily life, successful transition, and leap into the future). The scale's validity-including construct validity, cross-validity, known-groups validity, and criterion validity-was satisfactory, exhibiting a Cronbach α of .91. The BAS-BC demonstrated good validity and reliability.

IMPLICATIONS FOR NURSING PRACTICE

The BAS-BC will contribute to improving the quality of life of female breast cancer survivors by providing fundamental information for future research. The BAS-BC may enable nurses to provide tailored interventions to promote body acceptance.

Understanding the influence of irrational beliefs and body image inflexibility on exercise dependence and psychological well-being: A latent profile analysis approach

Irrational beliefs are a risk factor for mental ill-health and exercise dependence. In addition to this, researchers have also proposed that body image inflexibility can determine mental health and behavioural outcomes. However, research is yet to explore whether and to what extent irrational beliefs and body image inflexibility align to influence mental health and exercise dependence. We examined the latent profile structure of irrational beliefs and body image inflexibility, and how these latent profiles relate to mental health and exercise dependence in exercise active adults. Results indicate a two class profile, whereby class 1 is characterized by high irrational beliefs and body image inflexibility, and class 2 is characterized by low irrational beliefs and body image inflexibility. Those in class 1 reported significantly greater depression, anxiety, stress, and exercise dependence than those in class 2 (p ≤ .02). The findings are discussed in relation to the implications for practitioners in the mental health of exercise participants.

Examining the Role of Body Image Instability in Young Adult Women: Conceptualization, Development, and Psychometric Evaluation of the Vacillating Body Image Scale (VBIS)

The current study conceptualized body image instability as a maladaptive tendency to vacillate between different self-perceptions of one's overall body image and developed a corresponding measure to assess body image instability. Results from a series of studies of young adult women demonstrated the validity, reliability, and utility of the Vacillating Body Image Scale (VBIS) as a meaningful measure of body image instability. In Study 1, we found that body image instability, as assessed by the VBIS, represents a unidimensional and reliable construct. In Study 2, we found evidence for both the convergent and discriminant validity of the VBIS in relation to other individual differences measures (i.e., self-concept schema, broad personality factors). In Study 3, the concurrent criterion validity of the VBIS was supported for young adult women in relation to a range of adjustment measures. Finally, in Study 4, we found consistent evidence for the incremental validity of the VBIS in predicting subsequent variations in eating disturbances, even after controlling for global self-esteem and self-concept instability. Overall, our findings offer promising support for our contention that body image instability, as measured by the VBIS, represents an important construct for understanding eating-related disturbances and other health outcomes in young adult women.

The development and validation of multidimensional workplace compassion scale: Linking its conceptualization and measurement

Organizational compassion is a powerful force that possesses the capability to move individuals and groups towards a common good. Research on organizational compassion or compassion in the workplace has discussed its potential to reduce individual suffering and enhance positive emotions, wellbeing, and dignity. The existing literature lacks a valid and reliable measure of workplace compassion that follows the recent conceptualization of organizational compassion. This research presents the development and validation of workplace compassion scale. The scale development process consisted of four studies with a total sample of 947 respondents. In study 1, we developed the items for the new measure, by considering the four-factor conceptualization of organizational compassion. Study 2 and 3 focuses on item purification and testing the model fit indices of the proposed scale. In study 4, we followed a time separated design to test the nomological network and discriminant validity of the workplace compassion scale. The final workplace compassion scale consists of 12 items that measure other-oriented/expressed compassion in the workplace. The scale is beneficial for providing impetus to future quantitative research in organizational compassion.

Psychological inflexibility in university students: the european portuguese version of the acceptance and action questionnaire-university students

Psychological inflexibility is defined as a transdiagnostic mechanism characterized by rigid efforts to control psychological reactions to painful, undesirable, unpleasant internal experiences. The Acceptance and Action Questionnaire-University Students (AAQ-US) was designed to assess students' academic context-related psychological inflexibility. This study adapted the AAQ-US to Portuguese and examined its factor structure, validity, and reliability in a college student sample (sample 1: N = 262). Exploratory factor analysis and parallel analysis suggested a two-factor structure. A confirmatory factor analysis was conducted in a second sample to cross-validate the AAQ-US factor structure (sample 2: N = 260). One higher-order factor (psychological inflexibility) with two lower-order factors (cognitive fusion and experiential avoidance) revealed a very good fit to the data. The AAQ-US total and dimensions showed good reliability, convergent and incremental validity. Overall, the Portuguese version of the AAQ-US is a reliable and valid instrument for assessing context-specific psychological inflexibility in university students.

Body image flexibility and its correlates: A meta-analysis

Body image flexibility refers to the ability to openly experience thoughts or feelings about the body without acting on them or trying to change them. Accumulating evidence has demonstrated that body image flexibility is connected to numerous adaptive processes, and that it is sensitive to change during psychological interventions. However, a quantitative synthesis of empirical research on body image flexibility is lacking. We conducted the first meta-analysis on body image flexibility and its correlates. Sixty-two studies were included. Random effects meta-analyses were conducted on 19 psychological correlates, divided into three clusters: eating and body image disturbances, positive body-related and general psychological constructs, and general psychopathology. Meta-analyses showed inverse correlations between body image flexibility and each construct within the eating and body image disturbances cluster (rs= -.45 to -.67), and the general psychopathology cluster (rs= -.37 to -.58). Body image flexibility was positively associated with each positive psychology construct (rs = .23 - .58). Men reported higher levels of body image flexibility than women (d = 0.32). Psychological interventions were more effective than control groups at enhancing body image flexibility in randomized controlled trials (d = 0.42). Findings confirm that body image flexibility is consistently connected to indices of mental health, and that it can be enhanced during psychological interventions.

Relative associations of body image avoidance constructs with eating disorder pathology in a large college student sample

Models of eating disorder development point to the significant role body image avoidance plays in the development and perpetuation of eating disorder pathology (EDP), highlighting the importance of continued conceptual development. For example, approaches to assessing and conceptualizing body image avoidance vary in the extent to which they emphasize topography (i.e., common forms of avoidance), or their function (i.e., the conditions under which they occur). This study considered four body image avoidance constructs and their relative incremental contribution to predicting concurrent EDP in a college student population (N = 1228). Participants self-reported both the form and function of body image avoidance, including specific behaviors, appearance fixing and avoidant coping, and body image flexibility. A measure of the form of body image avoidance emerged as the best predictor of EDP, both in terms of consistently predicting aspects of disordered eating and in terms of accounting for the largest proportions of unique variance. Body image flexibility also contributed significantly to the prediction of cognitive and emotional aspects of concurrent EDP above and beyond self-report of common forms of avoidance only. Both form and function may be important when assessing and intervening on body image avoidance to prevent EDP.

Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: study protocol of the THERAFAMBEST study

Background

Anorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted.

Methods

One hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out.

Discussion

We hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome.

Trial registration

ClinicalTrials.gov, NCT03350594. Registered on 22 November 2017. IDRCB number 2016-A00818-43.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3347-y) contains supplementary material, which is available to authorized users.

A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science (2011-2018)

The emergence of body image flexibility into the positive body image nomenclature has innovatively expanded the conceptualization of how individuals may adaptively respond to body image threats. Given the notable growth of interest in researching this construct over nearly the past decade, the present analysis provides a systematic and critical review of evidence examining the roles of body image flexibility as correlate, mediator, moderator, and in intervention research. Results indicated that body image flexibility tended to demonstrate a pattern of relationships with correlates in directions predicted by its conceptualization and showed promise in functioning as both effect modifier and as an explanatory variable in the associations evaluated. Multiple studies demonstrated susceptibility to change following intervention. Although the current state of the literature is bound by notable limitations, the results of this review point to pertinent future steps in advancing the theory and application of body image flexibility scholarship.

A meta-analysis of the relationships between body checking, body image avoidance, body image dissatisfaction, mood, and disordered eating

OBJECTIVE

Body checking (BC) and body image avoidance (BIA) have been proposed as etiological and maintaining mechanisms for eating disorder (ED) pathology. To date, no comprehensive review summarizes the relationships of BC and BIA with ED pathology, body image dissatisfaction, or mood/affect.

METHOD

Meta-analyses examined the relationships of BC and BIA with ED pathology, body image dissatisfaction, and mood/affect. Gender, publication status, and presence or absence of ED diagnoses were examined as potential moderators.

RESULTS

Results showed strong relationships between BC and ED pathology (ρ = 0.588) and BC and body image dissatisfaction (ρ = 0.631) and a moderate relationship between BC and mood/affect (ρ = 0.385). Similarly, results showed strong relationships between BIA and ED pathology (ρ = 0.553) and BIA and body image dissatisfaction (ρ = 0.543) and a moderate relationship between BIA and mood/affect (ρ = 0.392). Overall, limited evidence supported publication bias; however, publication bias may exist in the relationship between BIA and body image dissatisfaction in the literature. Subgroup moderator analyses suggested that gender moderates the strength of the relationships between BC and ED pathology, body image dissatisfaction, and mood/affect and between BIA and body image dissatisfaction.

DISCUSSION

Results are consistent with cognitive-behavioral models of ED pathology that suggest BC and BIA are behavioral expressions of overvaluation of weight and shape. Notably, more published research has investigated BC than BIA. Future studies, incorporating methods such as meta-analytic structural equation modeling, should examine these variables to further test cognitive-behavioral models of ED development and maintenance.

Acceptance and Commitment Therapy for People Experiencing Appearance-Related Distress Associated With a Visible Difference: A Rationale and Review of Relevant Research

People may have a visibly different appearance due to various causes, such as congenital conditions, injury, disease, or medical treatment. Some individuals with a visible difference experience social anxiety and isolation, body image dissatisfaction, shame and self-stigma, psychological trauma, and challenges managing their condition. In this article, we synthesize the relevant literature and present the theoretical rationale for the application of Acceptance and Commitment Therapy (ACT), a third-wave behavioral therapy combining mindfulness skills and value-driven action, to those experiencing distress relating to an unusual or altered appearance. We also outline how ACT may be tailored to the specific considerations of this population and recommend next steps in researching its acceptability and clinical effectiveness.

Body Image-Acceptance and Action Questionnaire-5: An Abbreviation Using Genetic Algorithms

Body image concerns are typically linked with negative outcomes such as disordered eating and diminished well-being, but some people can exhibit psychological flexibility and remain committed to their valued goals despite being dissatisfied about their bodies. Such flexibility is most frequently measured by the Body Image-Acceptance and Action Questionnaire (BI-AAQ). This study used a recently validated, fully automated method based on genetic algorithms (GAs) on data from an American community sample (N₁=538, 71.5% female, Age: M = 40.87, SD = 13.5) to abbreviate the 12-item BI-AAQ to a 5-item short form, BI-AAQ-5. Validation tests were conducted on data from an independent community sample (N₂₌ 762, 44.6% female, Age: M = 40.65, SD = 13.06). The short form performed comparably to the long form in terms of its factor structure and correlations with theoretically relevant constructs, including body image dissatisfaction, stigma, internalization of societal norms of appearance, self-compassion, and poor mental health. Further, preliminary analyses using structural equation modeling showed that body image flexibility, as measured by either the long or short form, was associated with almost all the criterion variables, even while controlling for a highly related construct of body image dissatisfaction. These results demonstrate the potential discriminant validity of both the long and short form of the BI-AAQ, and show that the BI-AAQ-5 is a suitable alternative to its long form. We discuss how psychological flexibility with respect to body image dissatisfaction can be conducive to positive functioning.

Development of the body image self-rating questionnaire for breast cancer (BISQ-BC) for Chinese mainland patients

Background

Body image is a complex post-treatment concern among female patients with breast cancer, and various tools have been developed and applied to measure this multifaceted issue. However, these available tools were developed in other countries and only a few have been modified into Chinese versions. Furthermore, body-image evaluation instruments that are specific to Chinese mainland female patients with breast cancer have not been devised yet. Therefore, we developed the Body Image Self-rating Questionnaire for Breast Cancer for Chinese mainland female patients with breast cancer.

Methods

We performed two rounds of the Delphi technique and a cross-sectional pilot survey. Items were selected using a Likert scale (1–5) to determine ratings of importance (i.e., the significance of the item from experts’ perspective; coefficients of variation ≤0.25), internal consistency reliability (Cronbach’s α ≥ 0.70), convergent validity (hypothesized item-subscale correlations ≥0.40), and discriminant validity (stronger correlations of the item with the hypothesized subscale than for other subscales). All decisions on items were made based on statistical analysis results, experts’ recommendations, and in-depth discussion among researchers.

Results

Twenty-five eligible experts completed the two Delphi rounds (mean age: 42.20 ± 8.90 years). Over half the experts were professors (56%, n = 14) or worked as clinical staff (68%, n = 17). Twenty (mean age = 49.55 ± 10.01 years) and 50 patients (mean age = 48.44 ± 9.98 years) completed the first- and second-round survey, respectively. Over half the patients had a tertiary education level, were married, and were employed. Regarding the revised questionnaire (comprising 33 items across seven subscales), the expert panelists’ ratings of each item met the criteria (Kendall’s W = 0.238, p < .001). Five subscales had a Cronbach’s α value over 0.60 (range: 0.62–0.69) and two subscales were over 0.80 (range: 0.84–0.88). All items satisfied the criteria for convergent and discriminant validity.

Conclusions

The findings of this study provide evidence of a suitable tool for body image evaluation among Chinese mainland female patients with breast cancer. Studies with larger sample sizes should be conducted to validate this questionnaire in this patient population.

Electronic supplementary material

The online version of this article (10.1186/s12885-017-3865-5) contains supplementary material, which is available to authorized users.

Targeting Body Compassion in the Treatment of Body Dissatisfaction: A Case Study

Mindfulness and acceptance-based cognitive-behavioral therapies (MAB CBTs) are increasingly used in the treatment of body image disturbances. This case report describes an adjunct treatment component targeting body compassion in the course of an MAB CBT for an individual with body dissatisfaction. Body compassion is a new body-focused mindfulness and acceptance-based (MAB) construct that specifically describes the facets of the relationship individuals have with their bodies. The course of treatment included the originally planned MAB CBT protocol plus the additive component for five weekly 50-min individual sessions. During these sessions, body compassion was the primary treatment target. This phase of treatment utilized cognitive defusion, mindfulness, and self-compassion exercises. Over the course of this phase of treatment, the patient’s body compassion and body image flexibility significantly improved. The patient’s presenting symptoms also abated. Improvements were maintained at 1-, 3-, and 18-month follow-up time points. This case study illustrates several clinical strategies and provides initial support for body compassion as a viable treatment target for individuals struggling with body dissatisfaction.

The body compassion scale: Development and initial validation

As the newer mindfulness and acceptance-based cognitive behavioral therapies continue to grow, it is important that corresponding valid and reliable assessment tools are developed and evaluated. This article describes the initial development and validation of the body compassion scale. The body compassion scale is a theoretically derived measure designed to bridge the constructs of body image and self-compassion to provide a targeted measure of underlying mindfulness and acceptance-based constructs. Herein, two studies using exploratory and confirmatory factor analysis and examining subsequent relationships among other health-related constructs in college-age samples are presented.

Body image inflexibility mediates the relationship between body image evaluation and maladaptive body image coping strategies

Body image inflexibility, the unwillingness to experience negative appearance-related thoughts and emotions, is associated with negative body image and eating disorder symptoms. The present study investigated whether body image inflexibility mediated the relationship between body image evaluation and maladaptive body image coping strategies (appearance-fixing and experiential avoidance) in a college and community sample comprising 156 females aged 18-51 years (M=22.76, SD=6.96). Controlling for recruitment source (college vs. community), body image inflexibility fully mediated the relationship between body image evaluation and maladaptive body image coping strategies. Results indicated that an unwillingness to experience negative appearance-related thoughts and emotions is likely responsible for negative body image evaluation's relationship to appearance-fixing behaviours and experiential avoidance. Findings support extant evidence that interventions that explicitly target body image inflexibility, such as Acceptance and Commitment Therapy, may have utility in treating body dissatisfaction in nonclinical populations.