Reflections

1. Reflections April Schuster Kristen Davidson Alyssa Heggen Lauren LaFayette

2. Reflections • Focuses on Body Image and Self-Esteem • Adolescent girls in a Middle School Setting (grades 6-8) • After-school program, 1 hour a week for 7 weeks • Completed through education, interaction, and discussion through a CBT approach • Taught by school counselor

3. Why adolescent girls? • Aging, Body Image, and Body Shape by The University of North Dakota • 62.8% of females exercise to lose weight • 3.3% of females vomit or take laxatives to lose weight • 3.8% of females take diet pills to lose weight • 28.8% of females are overweight or obese. However, 38% of females describe themselves as overweight. • (Ferraro, 2008, pg. 379)

4. Why adolescent girls? • Many studies have shown that gender differences in self-esteem emerge during early adolescence, with many more girls being plagued by low self-esteem than boys. • For example, in a large Internet study in which men’s and women’s self-esteem was tracked across the lifespan, girl’s self-esteem dropped about twice as much as boy’s self-esteem in adolescence. • Developmental studies of young adults have indicated that self-esteem is important for promoting both mental and physical health, as well as for preventing behavioral and emotional problems such as aggression and delinquent behavior. • Body image is also central to adolescent’s self-definition, particularly for girls as they are socialized to believe that appearance is an important basis for self-evaluation and evaluation by others. Indeed, perceptions of one’s appearance and self-esteem are inextricably linked, such that satisfaction with one’s body or appearance emerges as the strongest predictor of self-esteem for both male and female adolescents. • (Impett et al., 2008)

5. Why adolescent girls? • “Girl Talk” by Donna Eder “Given the importance of good looks for gaining status among peers and avoiding negative evaluations, it is not surprising that girls devote so much attention to their appearance.”

6. Why adolescent girls? • The media – magazines, TV, films, advertising, music videos – not only emphasize that female self-worth should be based on appearance, but present a powerful cultural ideal of female beauty that is becoming increasingly unattainable. (Clay et al., 2005)

7. Rationale: Beyond Appearance: A New Look at Adolescent Girls • “In our culture, physical attractiveness contributes significantly to interpersonal success.” (Johnson, N. G., 1999) • “Physically attractive girls or women are perceived as more feminine than less attractive girls or women.” (Johnson, N. G., 1999) • “Women who challenge traditional views of femininity because of their political views or sexual orientation are often stereotyped as being physically unattractive. • “The combination of the cultural prescript for girls to care about others opinions and to define themselves through their physical appearance, and the particular beauty ideal of extreme thinness, creates a powerful motivational force for girls to pursue thinness”. (Johnson, N. G., 1999)

8. Previous Research on Body Image & Self-Esteem Groups • An evaluation of a body image intervention based on risk factors for body dissatisfaction: A controlled study with adolescent girls (Richardson & Paxton, 2010) • An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls (Stice et al., 2009)

9. Advertising and Marketing • Announcement for students during daily announcements • Information letter sent home to parents • Flyers around school advertising the group • Mention of group in health and physical education classes • Email sent out to teachers and staff about group, encouraging them to refer students

10. Selection Criterion for Reflections • Inclusion: • Adolescent girls attending the school • Parental Permission • Agreed to Confidentiality • Exclusion: • Boys (obviously) • Open to all middle school girls in hopes of providing diversity in age, culture, and personality style • Cautious of the group composition (introvert vs. extravert, members from different “cliques”)

11. Goals of Reflections • To increase total body health • Healthy eating and exercise • Setting goals and implementing the goals • Media and body image awareness • Coping skills/stress management

12. Theoretical Framework of Reflections: CBT • Help people change maladaptive behavior and thoughts • Most problematic behaviors, cognitions, and emotions have been learned and can be changed by new learning. • CBT principles are easy to understand and can be adapted to children of most ages and from many cultural backgrounds • CBT groups tend to be short term and employ brief interventions, which fits in school settings where time is limited

13. Theoretical Framework of Reflections: CBT • The teachable concepts can be translated into acquiring life skills • Children and adolescents can learn emotional and behavioral self-control through understanding the connection between thoughts, feelings, and behaviors • CBT groups help participants to cope with what they can change and to accept what they cannot change • The cognitive principles empower young people to deal with both present concerns and future problems

14. Competence to Work with Group • School Counselor must complete research on body image, self-esteem, other issues that pre-teen and teenage girls come into contact with, and other body image programs. • School Counselors should be aware of pre-teen and teenage girls interactions and how to manage group conflict. • School Counselor must also be competent implementing and scoring self-esteem questionnaire and Body Image States Scale. • School Counselor should have adequate knowledge of group processes, therapeutic processes, theoretical orientation and how to incorporate that into groups. • Must also be able to know how to implement group goals.

15. Preparation of Group Members • Meeting with Guidance Counselor • Discussion of the concept of group therapy • Norms of the group • Expectations • Confidentiality and its limits • Why the member wants to be a part of the group? • Questions?

16. Confidentiality and its Limits • Will be discussed during individual meeting with guidance counselor in preparation for therapy, and at first group session • Importance of confidentiality • Unique characteristics of girls (gossip, etc.) • Cliques • School environment • Limits of… • Harm to self or others • Abuse of children or elderly • Questions?

17. Group Sessions: Week 1 • Week one: Getting to know each other • Goal: Introductions, confidentiality, norms, expectations, goals • Activities: Icebreaker: thumb ball

18. Group Sessions: Week 2 • Week two: Eating healthy foods • Goals: Recognize the difference in healthy and unhealthy eating habits • Activities: • What size is a portion? • ie: One medium sized apple =a baseball • Mythbusters! • Is it true that you should not eat after 8:00 p.m.? • Ways to NOT diet: skipping meals, starving yourself

19. Group Sessions: Week 3 • Week three: Physical activity • Goals: Ideas for getting our bodies moving, using up energy • Activities: • Which specific activities are good for your health? • Light, moderate, vigorous • Which types of activities? • Resistance, weight-bearing exercise

20. Group Sessions: Week 4 • Week four: Look around you • Goals: Realizing that unreal media images can affect the way we think of ourselves • Activities: • Reality check- What do you see around your home and school? • Media smarts- 40,000 advertisements a year, models and movie stars

21. Group Sessions: Week 5 • Week five: Getting ready • Goal: Create an action plan • Activities: • Identify small changes • Drinking more water, eat breakfast, try low-fat milk • Start a food and exercise diary • What is stopping you?! No time? No Energy?

22. Group Sessions: Week 6 • Week six: Taking action • Goal: Begin to enact action plan, learn tips for real-life • Activities: • Establish breakfast ideas, sack lunch ideas, family meals • Fast food tips- grilled chicken, smaller sandwich

23. Group Sessions: Week 7 • Week seven: Maintenance, coping with stress, fallbacks • Goals: Learn ideas for dealing with stress and “mess-up moments” • Activities: • Stress busters- Sleep, limiting caffeine, take a break • Scenarios/planning ahead: I skipped breakfast, what can I do now?

24. Evaluation Method • Body Image States Scale • Measures 6 domains of current body image • Responses are based off a 9-point, bi-polar likert scale • This instrument has been empirically validated for both sexes • Group members will take this after each session to determine progress and which sessions are most effective • (Cash et al., 2002)

25. Multicultural Considerations • No racial or ethnic group in the western hemisphere is exempt from the pressures of peers and the media • No significant differences in body image dissatisfaction between Hispanic, Asian, American, and Caucasian girls • African Americans are less likely to have negative body image than other girls, which creates an issue in maladaptive eating behavior (Hensley, 2007)

26. Multicultural Considerations Continued… • Must also be conscious of cultural differences in… • Communication styles • Gender expectations • Rules for friendship • Ways of expressing conflict • Here, it is important to model and encourage understanding and empathy of differences • (Letendre, 2007)

27. Therapeutic Factors: UniversalityConcept Taken From: The Theory and Practice of Group Psychotherapy, Fifth Edition, Irvin D. Yalom & MolynLeszcz • Girls will share stories, thoughts, feelings, and opinions. • They will recognize similarities between themselves and other group members. • They will begin to understand that they are not unique with their presentation of issues and that there are people just like them. • They are not alone in their worries. • A bond/connection will form between the group members, facilitating other therapeutic factors.

28. Therapeutic Factors: AltruismConcept Taken From: The Theory and Practice of Group Psychotherapy, Fifth Edition, Irvin D. Yalom & MolynLeszcz • Girls will directly and indirectly help other group members. • Girls will internalize the sense that they helped someone. • This will lead to a sense of personal importance and contribute positively to their self-worth, self-image, and self-esteem. • Key issues/goals of this particular group

29. Reference Page Cash, T. F., Fleming, E. C., Alindogan, J., Steadman, L., & Whitehead, A. (2002). Beyond body image as a trait: The development and validation of the Body Image States Scale. Eating Disorders: The Journal of Treatment & Prevention, 10, 103-113. doi:10.1080/10640260290081678 Clay, D., Vignoles, V. L., & Dittmar, H. (2005). Body image and self-esteem among adolescent girls: Testing the influence of sociocultural factors. Journal of Research on Adolescence, 15(4), 451-477. doi:10.1111/j.1532-7795.2005.00107.x Corey, G. (2012). Theory & Practice of Group Counseling (8th ed.). Belmont, CA: Brooks/Cole. Eder, Donna. (1951). School Talk: Gender and Adolescent Culture. (pp. 103-123). New Brunswick, NJ, US: Rutgers University Press.

30. Ferraro, F.R. Aging, Body Image, and Body Shape. The Journal of General Psychology, 2008, 379-392. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer? vid=6&hid =119&sid=64568674-c310-4ea7-83fb-e8b7208f1c86%40sessionmgr112 Impett, E. A., Sorsoli, L., Schooler, D., Henson, J. M., & Tolman, D. L. (2008). Girls' relationship authenticity and self-esteem across adolescence. Developmental Psychology, 44, 722-733. doi:10.1037/0012-1649.44.3.722 Letendre, J. (2007). 'Sugar and spice but not always nice': Gender socialization and its impact on development and maintenance of aggression in adolescent girls. Child & Adolescent Social Work Journal, 24, 353-368. doi:10.1007/s10560-007-0088-7 Neiss, M. B., Stevenson, J., Legrand, L. N., Iacono, W. G., & Sedikides, C. (2009). Self-esteem, negative emotionality, and depression as a common temperamental core: A study of mid-adolescent twin girls. Journal of Personality, 77, 327-346. doi:10.1111/j.1467-6494.2008.00549.x

31. Richardson, S. M., & Paxton, S. J. (2010). An evaluation of a body image intervention based on risk factors for body dissatisfaction: A controlled study with adolescent girls. International Journal of Eating Disorders, 43, 112-122. Stice, E., Rohde, P., Gau, J., & Shaw, H. (2009). An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. Journal of Consulting and Clinical Psychology, 77, 825-834. doi:10.1037/a0016132