Rebuilding self-image with CBT

Feeling self-conscious about your appearance?
CBT can help! Here’s how.
by Noah Clyman, LCSW-R

Spring has arrived and summer is soon to follow! It’s time to retire your bulky winter coat and put away your sweaters. It’s time to feel the sun on your bare skin and wear shorts, t-shirts, and bathing suits! While you may look forward to this opportunity, you may also find yourself feeling self-conscious and insecure. 

In this blog post, I will discuss how a cognitive therapist helps patients with body image problems.
Almost everyone likes to look their best. Because it feels good to be complimented on your physical appearance, most people try to look good. However, people who are highly concerned about their physical appearance tend have distorted thoughts about their appearance and engage in behaviors that maintain their unrealistic standards and perfectionistic beliefs.

Challenging perfectionistic beliefs: Rather than assuming your perfectionistic beliefs are true, it is important to test the validity of your beliefs by examining the evidence. This is a standard cognitive technique. 

Below I illustrate how I used this “Examining the evidence” approach in session with a client (details have been changed to protect confidentiality). In this example, the client is working with me on his insecurity about going bald
.
Me: How much time do you spend thinking about that fact that you are balding?
Client: It’s on my mind all the time. I haven’t dated in about three years, mostly because I’m afraid of having someone discover my bald head. I wear a toupee, but I still worry that it might fall off sometime. If I could afford a hair transplant, I would do it in a second.
Me: Do you recall how you came to be so unhappy about being bald?
Client: I’ve always hated it. I’m only thirty-five! I should have more hair than I do. I think baldness is unattractive. I think other people find it unattractive as well.
Me: Do you have any evidence that other people find balding unattractive?
Client: Before I started wearing the toupee, a few people made comments about my thinning hair.
Me: Have you ever teased someone about some physical characteristic?
Client: I used to make fun of my brother because he’s shorter than me. But now that I’ve lost my hair, I don’t make fun of anyone about anything.
Me: Did the fact that you teased your brother mean that shorter people are unattractive?
Client: I know that some women prefer men who are taller, but I think there are lots of people who couldn’t care less.
Me: So, it is possible to be teased about almost any physical feature. What does that say about your earlier statement that you knew your baldness was unattractive because you were teased?
Client: I guess that just because I was teased doesn’t mean that its ugly.
Me: Can you think of any evidence that balding is attractive?
Client: Well, there are a number of bald celebrities I know many people find attractive. People like Sean Connery, for example. Also, some people shave their heads. I guess that means that they find baldness attractive.
Me: What if someone did find you unattractive because you were bald? Would that mean everyone would find you unattractive?
Client: I suppose not. Different people like different things.

​Cognitive Behavioral Therapy is proven to help. Cognitive strategies are used to teach the individual to identify unrealistic and distorted beliefs about the perceived defect and learn to replace distorted beliefs with a more realistic view. Behavioral strategies such as exposure and ritual prevention encourage the person to confront anxiety-provoking situations (e.g., socializing with other people) without engaging in various behaviors to hide the perceived physical defect. Through this process, the individual learns that their thoughts are untrue, or that they can cope with problems that arise.