The role of imagery and the self in the eating disorders

Abstract

The first part of this thesis is a systematic review evaluating the role of spontaneous imagery and the use of imagery techniques in people with eating disorders and sub-clinical populations. 14 studies were selected for review and their methodological quality was assessed. The findings suggest spontaneous images of items such as the self, food and social interactions are present more often in people with eating disorders than those without and could be a potential maintaining factor in the disorders. The findings suggest imagery techniques including guided imagery, positive self-imagery and imagery rescripting can effect change in several key aspects of the eating disorders. However, this body of research is in its infancy and the quality of the studies included means the results must be interpreted with caution.

Eating disorders are characterised by a negative sense of self and current eating disorder treatments typically use verbal based techniques such as cognitive restructuring to target these views of the self. Imagery has shown promise in targeting aspects of the self, however no studies have compared whether one approach is more effective than the other. The empirical part of this thesis compared a positive self-imagery intervention with a cognitive restructuring intervention on aspects of the self (self-concept clarity, self discrepancies, self-esteem), affect and eating pathology in a sub-clinical eating disorder population. Both interventions reduced negative state self-esteem, eating pathology and bingeing behaviour and had no effect on self-concept clarity or self-discrepancies. Only the imagery intervention improved positive state self-esteem and positive affect and reduced negative affect and restricting behaviour. The imagery intervention was more effective compared to the control group than the verbal intervention, however, there were no significant differences between the effectiveness of the interventions when compared with each other. Clinical implications, limitations and future research directions are discussed.

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