Mirror exposure to increase body satisfaction: Should we guide the focus of attention towards positively or negatively evaluated body parts?

•Guiding one's focus of attention towards positively or negatively valenced body parts during body exposure both increase body satisfaction and mood.•Improvements were maintained or even stronger at the one month follow up.•‘Positive’ exposure induces positive feelings during all exposure sessions while ‘negative’ exposure induces a worsening of feelings short-term but feelings started to improve after some sessions.•The most unattractive body part was rated increasingly attractive in both conditions though this increase was significantly larger in the negative compared to the positive exposure condition.•The negative exposure tended to decrease long-term body image avoidance.

Background and ObjectivesThough there is some evidence that body exposure increases body satisfaction, it is still unclear why exposure works and how attention should be guided during exposure. This pilot study manipulates the focus of attention during body exposure.MethodsFemale participants high in body dissatisfaction were randomly assigned to an exposure intervention that exclusively focused on self-defined attractive (n = 11) or self-defined unattractive (n = 11) body parts. Both interventions consisted of five exposure sessions and homework. Outcome and process of change were studied.ResultsBoth types of exposure were equally effective and led to significant improvements in body satisfaction, body checking, body concerns, body avoidance and mood at post-test. Improvements for body satisfaction and mood were maintained at follow-up while body shape concerns and body checking still improved between post-test and follow-up. Body avoidance improvements were maintained for the positive exposure while the negative exposure tended to further decrease long-term body avoidance at follow-up.. The ‘positive’ exposure induced positive feelings during all exposure sessions while the ‘negative’ exposure initially induced a worsening of feelings but feelings started to improve after some sessions. The most unattractive body part was rated increasingly attractive in both conditions though this increase was significantly larger in the negative compared to the positive exposure condition.LimitationsThe sample size was small and non-clinical.ConclusionsBoth types of exposure might be effective and clinically useful. Negative exposure is emotionally hard but might be significantly more effective in increasing the perceived attractiveness of loathed body parts and in decreasing avoidance behavior.