Cognitive-behavioral therapy (CBT) is an effective and widely used therapeutic approach that can be applied to issues including self-esteem, body image, and weight management.
Self-Esteem
There is evidence that CBT can be effective for low self-esteem, which is often at the root of weight or eating issues, or can come as a result of them. Every person, through their life experiences (including early experiences), creates a bottom line — a particular appraisal of themselves. If that self-appraisal is negative, low self-esteem follows. The person then develops rules for living that allow them to avoid situations that trigger difficult aspects of that self-appraisal (e.g., “I am unacceptable as I am, so I need to hide my real self”).
CBT focuses on reevaluating a person’s bottom-line beliefs and rules for living through cognitive techniques and behavioral experiments, and working on enhancing self-acceptance and reducing self-criticism.
Behavioral experiments will vary depending on the issue. For instance, if the person’s low self-esteem is associated with the idea that “others find me unlikeable because I am too fat,” the person will need to test this assumption. They might directly confront the belief by talking about it with their therapist and trusted others, or challenge it by seeking evidence against it. A psychologist might also support the client to develop the associated skill of communication, which can help a client with low self-esteem to better express themselves, and to assert their rights and preferences.
Body Image
Body image refers to the attitudes and perceptions a person has in relation to their body. CBT has been found to be effective in addressing and adjusting a person’s body image, with body image improvements being maintained over significant periods of time. CBT work with body image uses a variety of cognitive and behavioral techniques, and often involves homework, using aspects like self-help books and self-directed exercises that are elaborated upon in therapy.
By way of example, the therapist might ask their client to challenge core beliefs that may be associated with their body image (e.g., “I need to be thin to be happy”). Homework tasks might involve encouraging a client to fill in the blanks for three things they really like about their appearance (such as their hands or their smile), or in the case of self-esteem, it might be to notice three positive things they have done this week that made them feel good about themselves. Worksheets that consider cognitive and behavioral elements also are useful.
Weight Management
CBT also is an effective strategy for weight management. It focuses on challenging unhealthy ideas and beliefs that support weight problems (both if the person is underweight or overweight). It also brings awareness to behaviors that lead to weight problems, such as bingeing.
Some modalities, such as enhanced CBT, also target external factors that might be associated with weight — not only low self-esteem and poor body image, but also interpersonal difficulties and high levels of perfectionism. CBT can address different issues by teaching the person new skills and working on testing their beliefs. It can also give clients the tools for learning new behaviors that are more adaptive and conducive to good weight management.
There are a variety of skills that might be associated with all these interrelated issues. One that frequently comes up is emotional expression and mood regulation. CBT supports clients to identify their emotions, and express them in a healthy manner with the help of their therapist. Another skill might be learning to respond appropriately to the body’s messages and needs (e.g., hunger and thirst), and to attend to and acknowledge other personal and interpersonal needs that eating or weight issues might have been masking or substituting. Additionally, CBT can help you become positively aware of your body, and to approach exercise and nutrition in a healthy way, gradually and in a realistic fashion, so that goals are achievable and easier to maintain.
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