top of page

Beyond Macros and Weight Loss: Promoting Flourishing Health with Comprehensive Coaching

What is your role as a coach?

There seems to be a lingering perception in the fitness industry that the role of a coach is limited to helping someone achieve their body composition or performance goals. Whilst there isn’t anything inherently wrong with this, there is certainly more scope to improve the health of the individuals we work with. Comprehensive Coaching seeks to promote Flourishing Health, which includes one’s physical, social, psychological and philosophical health [1], to facilitate growth across different domains of life.

In addition to potential body composition changes and performance enhancement, a Comprehensive Coach will consider:

  1. Reducing dysfunctional behaviours and cognitions such as disordered eating, negative body image, psychological inflexibility and experiential avoidance, while

  2. Promoting functional behaviours and cognitions, such as a positive body image; behavioural commitment to clearly-defined values; metacognitive awareness of decision-making processes; psychological flexibility; and self-compassion.

When we understand the conditions people need to thrive, we can identify and target important variables amenable to improvement, thus catalysing positive change.

Flourishing Health

To flourish means to grow and prosper across different domains of life. Flourishing Health expands far beyond the physical domain to include one’s social, psychological and philosophical wellbeing. It is a comprehensive consideration of all of the factors that may influence one’s experience of health and wellbeing. This perspective of healthy functioning includes meaningful connections with others, mental wellbeing, self-efficacy, autonomy, resilience and a sense of meaning and coherence, amongst other things. Subsequently, health-seeking behaviours include not only eating vegetables and exercising, but also spending time with loved ones, managing stress levels, building confidence and developing a clear sense of direction.

It has been suggested that the absence of mental illness is not necessarily reflective of genuine mental health and that languishing, which is common, is also associated with considerable psychosocial impairment [2]. Inspired by this notion, Flourishing Health views health as a positive state, an expanding strength that is constantly achieved, and not simply a background operation of a well-functioning system. Moreover, flourishing in life could be a source of resilience, acting as a stress buffer against stressful events and life transitions.

We may consider Flourishing Health promotion from two perspectives: reducing aspects of maladaptive functioning, and promoting aspects of adaptive functioning. Six dimensions of psychological well-being are proposed: self-acceptance, positive relations with others, personal growth, purpose in life, environmental mastery, and autonomy [3]. Individuals who function well are comfortable with most parts of themselves, have warm and trusting relationships, see themselves developing into better people, have a direction in life, are able to shape their environments to satisfy their needs, and have a degree of self-determination. Taking care of one’s physical health is merely one aspect of achieving adaptive functioning; psychological, social and environmental factors play a role too.

Addressing Maladaptive Functioning

Addressing Disordered Eating

Given the conspicuous links between body weight, body dissatisfaction, eating-disordered behavior and mental health, and the fact that disordered-eating behaviours appear to be increasing [4], it is pertinent for coaches to be cognisant of the behavioural and attitudinal red flags that clients may display. Subclinical eating pathologies may affect a large subset of individuals and research has indicated that, in many cases, these individuals do not differ significantly from those receiving a diagnosis of anorexia nervosa or bulimia nervosa in terms of how distressing the symptoms can be and how they affect quality of life [5]. Eating disorder risk factors and behaviours, such as body image concerns and disordered eating, are associated with significant health impairments and are robust predictors of eating disorder onset [6]. Early intervention is thought to reduce the likelihood that an individual with subclinical eating pathology will develop a clinical eating disorder and can help to improve quality of life [7]. Crucially, a large number of individuals struggle to spot disordered eating behaviours in themselves [8] and those high at risk are less likely to reach out for help [9]. As coaches, it is our responsibility to be aware of this.

Symptoms of disordered eating may include obsessive thinking about food and appearance, restriction, repetitive shape checking, fasting or skipping meals, compulsive exercise, chronic dieting, obsessive calorie counting, anxiety around eating out, viewing foods as good or bad, fear of fat gain, feeling anxious without a plan, and a lack of flexibility. We can help clients to move towards more flexible and adaptable styles of eating by considering the context and circumstances under which dietary restraint is employed, methods of self-evaluation and self-regulation, and individual differences in eating disorder risk [10].

Reducing Negative Body Image

Body dissatisfaction is defined as a subjective negative evaluation of body size, shape, muscularity/muscle tone, and weight [11], and is associated with poorer mental and physical health-related quality of life [12], independent of its association with body weight or eating disorder symptoms [13].

Body image attitudes are comprised of:

  • Appearance evaluations - one's beliefs and appraisals (e.g., satisfaction or dissatisfaction) regarding their body, and

  • Appearance investment - the cognitive, behavioral, and emotional importance of an individual’s body in relation to their sense of self-worth [14].

Individuals with a negative body image tend to have negative thoughts (e.g., “I’m extremely unattractive”), feelings (e.g., weight dissatisfaction), and perceptions (e.g., magnification of perceived ‘flaws’) about their own body, and engage in behaviours such as excessive mirror-checking, pinching of the skin, or avoidance of public situations.

Due to its prevalence and impact on one’s quality of life, body dissatisfaction is considered a public health concern [15]. Given the link between negative body image and the development of eating disorders [16], and the fact that many clients have body composition goals, it is crucial to understand a client’s body image attitudes and the motivations behind their goals.

The cognitive model best describes body image disturbance (BID) in a nonclinical sample, implicating maladaptive cognitions in the development of BID and supporting the application of cognitive strategies to target dysfunctional beliefs [17]. Some of these beliefs may include ‘I would enjoy life more if I looked the way I wished’, ‘My appearance influences my ability to do things’, or ‘People will think less of me if I don’t look my best’ [18]. When a client engages in intentional weight loss for appearance modification, understanding and addressing their appearance beliefs may be an important part of improving a negative body image.

Alongside targeting beliefs such as body-related perfectionism, importance of appearance and uncertainty about one's looks, additional steps to reduce a negative body image may include: reducing over-reliance of self-esteem on one's appearance [19]; shape checking [20] and appearance comparisons [21]; labeling experiences when one experiences feelings of fatness [22]; and reducing focus on weight and shape by putting energy into other areas in one’s life [23].

Addressing Experiential Avoidance

The Acceptance and Commitment Therapy (ACT) approach posits that psychological human suffering is due to a lack of behavioral flexibility and effectiveness, which emerges from experiential avoidance, cognitive entanglement, difficulty with perspective taking, loss of contact with the present, and failure to take needed behavioral steps in accord with core values - this is termed psychological inflexibility [24]. Experiential avoidance (EA), behavior that attempts to alter the frequency or form of unwanted private events, including thoughts, memories, and bodily sensations [25], has been associated with a wide variety of negative outcomes [26], including poorer physical health [27] and lower quality of life [28], and seems to describe a pattern of adjustment seen in those unable to maintain weight loss [29].

The Multidimensional Experiential Avoidance Questionnaire identified six factors of EA, including behavioral avoidance, distress aversion, procrastination, distraction/suppression, repression/denial, and distress endurance [30]. Individuals high in EA are more likely to engage in avoidance behaviors when a distressing situation arises or is anticipated, such as skipping the gym due to anxieties about being watched, or distracting oneself from sadness by comfort eating.

‘Pain in this life is not avoidable, but the pain we create avoiding pain is avoidable’ - R.D.Laing

A Comprehensive Coach can help a client identify when experientially avoidant behaviours create obstacles to the goals they wish to achieve. The pros and cons of both avoidance and overcoming avoidance may be examined to explore the client’s motivation to reduce these behaviours. Change talk may be elicited from the client: statements of desire, ability, reasons to and need to overcome avoidance [31]. This may open the floor to work on increasing willingness and building distress tolerance skills, helping a client to take committed action towards their goals in spite of uncomfortable internal experiences.

Promoting Positive Functioning

Promoting Positive Body Image

A positive body image is qualitatively distinct from a negative body image, meaning that absence of a negative body image doesn’t necessarily predict a positive one [32]. Rather, a positive body image is something we actively strive towards. Positive body image is defined as: favorable opinions of the body regardless of actual physical appearance; acceptance of the body despite incongruences with media appearance ideals; respect toward the body by tending to its needs and engaging in healthy behaviors; and protection of the body by rejecting unrealistic appearance ideals [33]. A positive body image is uniquely associated with well-being: individuals with a positive body image report fewer depressive symptoms, higher self-esteem, fewer unhealthy dieting behaviours, and greater intentions to protect one’s skin from UV exposure and damage [34]. These findings occurred independently of BMI meaning that, regardless of actual body size, those who have higher positive body image experience better physical and mental health outcomes.

Fostering a positive body image can serve as a protective factor that disrupts body image-related variables implicated in the etiology of eating pathology [35], namely thin-ideal internalization, self-objectification, poor interoceptive awareness, body or appearance comparisons, body dissatisfaction, and drive for thinness [36]. A positive body image can serve as a protective filter against the many body image threats that may be experienced on a daily basis, such as direct and indirect appearance‐related pressures from peers, family, partners, society, and the media [37], being sexually objectified [38], or being told to ignore internal self‐regulatory hunger and satiety cues [39]. Those with a higher positive body image are also more likely to engage in self-care behaviors such as exercise, yoga, meditation, or unwinding by reading novels [40].

Strategies to promote a positive body image include: increasing body appreciation [41], body acceptance [42] and body image flexibility [43]; promoting a broad conceptualisation of beauty [44]; engaging in mindful self care [45]; and practicing self-compassion [46] and gratitude [47]. For a more comprehensive approach to improving a client’s body image, see the Body Image Webinar series.

Promoting Psychological Flexibility

Psychological flexibility is the ability to defuse from difficult thoughts and accept difficult feelings while persisting in values-based action [48]. It is defined in terms of six processes or factors: acceptance of experience, cognitive defusion, contact with the present moment, contextual self, life values and actions linked to chosen values. It has been suggested that psychological flexibility may be a fundamental aspect of health, since it enables one to recognise and adapt to various situational demands; shift mindsets or behavioral repertoires when these strategies compromise personal or social functioning; maintain balance among important life domains; and be aware, open, and committed to behaviors that are congruent with deeply held values [49]. ACT could be useful as an add-on treatment, or in a combined format, for improving long-term weight loss outcomes [50]. Coping with unwanted cognitive and emotional experiences seems to play a vital role in predicting long-term weight loss success.

Body image-flexibility, a specific type of psychological flexibility relevant to the context of eating and body image, is the capacity to experience and accept unwanted thoughts and feelings regarding the body so that one is able to engage in value-consistent action despite being concerned about body size, weight, or shape [51], and constitutes an adaptive strategy in managing distressing cognitions [52]. Diminished levels of body image flexibility and attempts to avoid aversive ideas related to the body have been associated with enhanced eating disorder psychopathology as well as reduced body appreciation among non-clinical samples [53]. A recent meta-analysis found strong evidence that body image flexibility is connected to various adaptive psychological processes, including lower levels of eating, body image, and mental health disturbances, and higher levels of positive body-related and general psychology constructs [54].

Psychological inflexibility has also been associated with eating-related difficulties. Dietary restraint seems to be a complex construct that involves distinct facets and that cannot be categorized as entirely beneficial or detrimental [55], yet rigid adherence to restrictive eating rules is associated with increased concerns about eating and pathological dietary behaviours [56].

The Inflexible Eating Questionnaire (IEQ) is a self-report measure designed to capture psychological inflexibility focused on eating, involving:

  1. The inflexible adherence to eating rules, without meeting internal (e.g., hunger or satiety cues) or external (e.g., certain social contexts) contingencies

  2. A sense of control when meeting such rules; and

  3. Distress when perceiving failures in meeting such rules [57].

The IEQ presented significant associations with dietary restraint, eating psychopathology, body image inflexibility, general psychopathology symptoms, and decreased intuitive eating. On the other hand, an increase in flexible cognitive restraint is related to better weight loss maintenance and wellbeing [58]. These findings suggest that flexible eating attitudes and behaviours are fundamental to positive physical and psychological functioning.


Values are statements about how you want to behave or act on an ongoing basis; how you want to treat yourself, others, the world around you [59]. They can be regarded as an autonomous motivation framework for living a complete, whole life. Values are distinct from goals, in that they cannot be ‘checked off’ a list. Rather, values establish the direction you want your life to head and goals serve as markers to help you navigate and let you know whether you’re still on course. Engaged living (defined as the evaluation and performance of valued life activities) has been empirically associated with decreased psychological distress, higher levels of life fulfillment, and improvements in psychological quality of life [60].

Some of the most common reasons for dieting are to lose weight, look better, and build confidence [61]. Unfortunately, being motivated in one’s dietary choices by mood or by weight control leads to pretty poor outcomes in the long term [62]. An Acceptance and Commitment Therapy (ACT)-based values-clarification exercise may be an effective way to determine more intrinsic reasons to change and ensure that one’s goals are in service of the things that are truly important to them. This may help to improve one’s motivation to change [63] and shift some of the focus to health, a motivator associated with longer term success [64].

Values-clarification can also help to guide goal setting, by translating one’s values to concrete and small behaviours that incorporate a valued path [65]. Being sensitive to contextual cues, this process allows one to change and stop a behaviour when it is inconsistent with their chosen values. This may help clients let go of problematic behaviours that aren’t serving them, such as inflexible eating rules, dieting or body checking, and take committed action towards what is truly important to them. Committed action is persistent, even when the engagement in valued behaviours might trigger or increase uncomfortable experiences. Having a clear idea of one’s values can provide a basis for willingness to do the uncomfortable work of letting go of avoidant behaviours.

Increasing Meta-Cognitive Awareness

Nutritional education may form an important part of coaching, but a knowledge-deficit is very rarely the largest obstacle to changing one’s eating behaviours [66]. Oftentimes, clients will feel like they ‘know what to do, but just can’t stick to it’. Perhaps it’s not a lack of nutritional awareness, but a lack of self-awareness that’s the missing piece. Increasing in the moment awareness of how a client is feeling, thinking and behaving may help clients identify the why behind their eating and body-related behaviours, opening up avenues for change.

Sometimes the barriers to change are internal. Shame [67], self-criticism [68], internalised stigma [69], difficult emotions [70], psychological inflexibility [71], and body dissatisfaction [72] present obstacles to pursuing health-seeking behaviours and may increase engagement in health-risk behaviours. Food-related cues may also be internal, such as different emotional states that trigger hunger or prompt someone to eat [73]. For example, negative affect has been linked with increased appetite and unhealthy snack choices [74]. Further, negative emotions such as anger, fear, and sadness have been associated with increased impulsive eating and the consumption of unhealthy foods, perhaps due to impaired cognitive control over eating leading to increased snack consumption [75]. Finally, some research indicates that negative affect may influence food intake when it is used as a coping strategy to distract oneself from stress [76], particularly in those with high cortisol reactivity levels [77].

Stress can impact health directly through autonomic and neuroendocrine processes [78] and, alarmingly, it is not just the presence of physical stressors that induces the physiological stress response. The perseverative cognition hypothesis proposes that cognitive representation, particularly rumination [79], is enough to increase susceptibility to stress-related ill-health [80]. Stress can also impact health indirectly, by influencing engagement in health-seeking behaviours. Research supports associations between stress and poorer sleep outcomes [81], greater alcohol consumption [82], unhealthy eating behaviors [83], and less physical activity [84]. Support for additional indirect pathway between perseverative cognition and health outcomes has via reduced engagement in physical activity has also been found [85].

Increasing one’s meta-cognitive awareness can bring to light these issues and foster insight, the conscious process of making novel connections [86], to help clients understand their own thoughts, feelings and behaviours. Once an individual is more aware of these habitual reactions, they may be able to relate to themselves in a new way, and develop tools to interrupt the cycle, thus increasing their behavioural repertoire.

Specific research on emotion regulation indicates that attempting to change/control momentary negative affect reduces blood glucose levels, which consequently reduces performance on subsequent self-regulation tasks [87]. Therefore acceptance-based strategies may be effective to help clients persist in values-based health-seeking behaviours in the presence of negative internal stimuli.

Mindfulness, deliberately paying attention to the present moment experiences with an attitude of non-judgemental awareness [88], is an object of much scrutiny in the evidence-based fitness community, perhaps due to its phenomenological origins in Eastern traditions and questions about the defining characteristics of mindfulness. Although much of the field has proceeded in the absence of an operational definition [89], and most reviewed meditation studies have several key methodological shortcomings which preclude robust conclusions [90], mindfulness in contemporary psychology has been adopted as an approach for increasing awareness and responding skillfully to mental processes that contribute to emotional distress and maladaptive behaviour. Being more mindful has been theorised to help people to let go of harmful, automatic responses to their experience by creating the space for one to select healthier, more adaptive ways of responding [91].

Some of the main neurocognitive mechanisms implicated in mindfulness meditation include attention control, emotion regulation, and self-awareness [92]. In addition, mindfulness strategies such as mindful attention may have potential mental and physical health benefits, including stress reduction [93], enhanced emotional regulation [94], decreased reactivity and increased response flexibility [95], increased empathy [96], and interpersonal benefits [97]. It seems that mindfulness may serve as a form of mental training to reduce cognitive vulnerability to reactive modes of mind that might otherwise heighten stress and emotional distress.

A recent proposed operational definition of mindfulness consists of a two-component model comprising of :

  1. Self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment, and

  2. Adoption of a particular orientation toward one’s experiences in the present moment, an orientation that is characterized by curiosity, openness, and acceptance [98].

The Monitor and Acceptance (MAT) theory suggests that monitoring skills may only be associated with beneficial mental and physical health outcomes when accompanied by acceptance skills [99]. This suggests that bringing an attitude of acceptance toward monitored experiences may be a key emotion regulation mechanism for the effects of mindfulness interventions on affective, stress, social relationship, and health outcomes [100].

We cannot change anything unless we accept it. Condemnation does not liberate; it oppresses- Carl Jung

In regards to disordered eating behaviours, research indicates that non-judgmental awareness may be less important in explaining levels of ED psychopathology than the nature of one’s interaction with emotionally charged, negative experiences [101]. It may be that mindfulness is a necessary initial step for promoting awareness, but it is what you do with that awareness, and how you relate to it, that plays a larger role in determining health outcomes.

Promoting Acceptance

When we avoid our reality, including difficult thoughts and feelings, by chasing short-term relief of discomfort, we usually perpetuate the problem we are facing. This avoidance has been associated with a wide variety of negative outcomes [102], including poorer physical health [103] and lower quality of life [104], and seems to describe a pattern of adjustment seen in those unable to maintain weight loss [105]. Acceptance means opening up to our experience and acknowledging where we are and what we’re struggling with. It involves the active and aware embrace of difficult feelings, thoughts, memories and bodily sensations without unnecessary attempts to change their frequency or form. Etymologically, acceptance comes from the word ‘to take’, meaning to receive or take what is offered. Before we can change, we must ‘take in’ the fact that there is a problem to work on. If we can acknowledge it, we can work on it.

The curious paradox is that when I accept myself as I am, then I can change - Carl Rogers

Acceptance‐based behavioral interventions infuse behavioral treatment with strategically chosen self‐regulation skills that are adapted primarily from ACT [106] and have shown promise in improving weight loss outcomes in those with obesity [107], and reducing cravings [108], particularly in those who are responsive to the presence of food [109].

Practicing acceptance may involve mindfulness techniques such as Urge Surfing, which teaches one to observe and experience their urges or emotions. Learning to focus on the present moment when cravings occur is a technique that can be applied in a wide range of different settings, meaning it’s likely to serve clients well for the long term [110].

Acceptance is also an important component of promoting a positive body image [111]. Body acceptance involves a comfort for the body exactly as it is [112]. It can be developed through the cultivation of a cognitive schema for the body that accepts all shapes, sizes, and unique qualities, in addition to an emotional valence of loving-kindness toward the body. In this way of viewing the body, it is understood that no one can be perfect and that pursuit of illusory media ideals can be physically and mentally harmful. In support of this model, a one day ACT workshop targeting body dissatisfaction and disordered eating attitudes in 73 women with body dissatisfaction was effective in improving eating attitudes, body anxiety, and preoccupation with eating, weight, and shape [113].

Finally, preliminary evidence suggests that women who feel the urgent need to regulate their emotions, and exhibit non-acceptance of distress, may experience a higher drive for muscularity [114], a risk factor for disordered eating pathology [115]. Acceptance is thought to transform how momentary experiences are observed and processed, facilitating engagement (welcoming in) and subsequent disengagement (letting go) with emotional stimuli [116], and thus enriching experience while also reducing emotional reactivity. Women who learn to be more accepting of unpleasant thoughts and emotions regarding their muscularity may not feel urged to employ strategies, such as compulsive exercise, to regulate them. Pilot research suggest that ACT techniques may be effective in addressing distress related to body image concerns [117].

Acceptance isn’t easy and often requires a great degree of courage. People often regard their health difficulties as personal faults or failings, arising from their own inadequacies. Health-related stigma is associated with shame [118], a self-conscious, negative emotion that arises when one is seen or judged by others to be flawed in some crucial way, or when some part of oneself is perceived to be inadequate, inappropriate or immoral [119]. Psychosocial processes associated with experience of low self-esteem and psychophysiological stress resulting from chronic shame, marginalisation and stigma are significant factors in determining health outcomes and wellbeing [120].

Comprehensive Coaches can help to evoke self-acceptance by providing a relationship where clients feel safe and know that they won’t be judged. When safety is expressed, defensiveness is down-regulated. Therapeutic acceptance involves honoring a client’s worth and potential, recognising and supporting their autonomy, seeking through accurate empathy to understand their perspective, and affirming the client’s strengths and efforts. Cultivating presence and engaging in present-centred relationships can facilitate an effective alliance by having both client and coach enter a physiological state that supports feelings of safety, positive therapeutic relationships, and optimal conditions for growth and change [121].

‘If I can provide a certain type of relationship, the other will discover within himself the capacity to use that relationship for growth, and change and personal development will occur’ - Carl Rogers

Facilitating Defusion

Suppose a client is struggling with a negative thought like ‘I will never make progress’, ‘I can’t do this’, or ‘I’m a failure’. They probably will at some point, given that negative thoughts are experienced by 80-99% of the non-clinical population and have been linked to the development of psychopathology [122]. An entanglement between thoughts, feelings, and behaviors, whereby an individual becomes overly identified with distressing thoughts, can lead to behavioural inflexibility. In a state of cognitive fusion, individuals may react to thoughts as though they are literal truths, resulting in difficulty disconnecting from them [123]. This may guide behaviours aimed at alleviating distress, which could be harmful in the long run.

Defusion is an acceptance-based technique which teaches one to see thoughts for what they are - simply thoughts, not literal truths of the world. There are a wide range of defusion techniques [124], but they all serve the same purpose; to help us respond to the thought more flexibly. Defusion has been shown to help non-clinical samples cope with negative self-statements [125], and increase comfort, willingness and positive affect significantly more than cognitive restructuring [126]. Helping clients to detach from negative thoughts may increase behavioural flexibility in pursuit of meaningful goals.

Body image cognitive fusion (BI-CF) describes the extent to which body image-related thoughts are endorsed and drive behaviours and is an important contributor to disordered eating [127]. An individual may experience recurring negative body image-related thoughts that they strongly believe to be true and endorse behaviourally. Negative body image-related thoughts alone may not result in disordered eating, yet research shows that the extent to which body image-related thoughts are endorsed and drive behaviors is an important contributor to ED vulnerability [128]. Individuals may be unaccepting of their body image, but only some may identify with body image-related distressing thoughts to the extent that they would engage in disordered eating behaviors as a result. Individuals experiencing higher BI-CF also experience more disordered eating behaviors and thoughts [129]. It may be prudent to target body image cognitive-fusion in individuals at risk of disordered eating in an attempt to produce psychologically flexible thinking patterns associated with body image [130].

Increasing Self-Compassion

Self-compassion is an alternative way to conceptualize having a healthy stance towards oneself that does not involve evaluations of self-worth [131]; in this way it differs markedly from self-esteem. While self-esteem is contingent on success in valued domains such as appearance or social approval [132], self-compassion involves treating oneself kindly in times of failure. It’s about developing a caring and accepting relationship with yourself, particularly when you face hardships [133]. There are three main components of self-compassion: self-kindness; mindful awareness of negative thoughts and emotions; and a sense of common humanity (recognising that everyone fails, makes mistakes, and gets it wrong sometimes) [134].

‘Every man bares the whole stamp of the human condition’ - Michel de Montaigne

Self-compassion is associated with more stability in state feelings of self-worth than trait self-esteem [135], potentially because self-compassion is less contingent on things like physical attractiveness or successful performances. Additionally, self-compassion is associated with lower levels of social comparison, public self-consciousness, self-rumination, anger, and need for cognitive closure, than self-esteem. This suggests that self-compassionate people are less focused on evaluating themselves, feeling superior to others, worrying about whether or not others are evaluating them, defending their viewpoints, or angrily reacting against those who disagree with them.

A wealth of research has reported consistent associations between self-compassion and lower levels of body image concerns, ED pathology, and negative affect [136]. Self compassion is inversely related to body preoccupation and concerns about weight, and positively related to body appreciation, even after adjusting for self-esteem, suggesting that self-compassion may serve as an alternative to self-esteem in reducing body dissatisfaction [137]. Self-compassion was the most robust predictor of BI-CF, whereby individuals who display higher self-compassion experience lower BI-CF [138]. The ability to be kinder towards oneself may be a more adaptive strategy for dealing with such upsetting and persistent thoughts regarding body image and may help reduce the impact of disturbing thoughts on behaviors by supporting more flexible thinking.

On the other hand, self-criticism is negatively associated with goal-attainment [139]. Critical self talk can lead to rumination or procrastination, whereas people who are kind to themselves and accepting of their own failures may actually be more motivated to improve [140]. Additionally, individuals who treat themselves with kindness and without unfair criticism, and who refrain from over-identifying with negative internal experiences, are less likely to impulsively react to adverse situations [141]. Furthermore, self-compassionate individuals are less likely to suppress unwanted thoughts and emotions than those who lack self- compassion and more likely to acknowledge that their emotions are valid and important [142]. Given that the majority of people are kinder to others than they are to themselves [143], developing a compassionate inner voice, potentially through writing interventions [144], may be a fundamental part of promoting Flourishing Health.

Future Directions

The goal of this article was to outline how a Comprehensive Coach might target the numerous factors affecting an individual’s physical, social, psychological and semiotic health, to promote Flourishing Health and facilitate growth across different domains of life. It is likely that the Comprehensive Coaching model will continue to evolve alongside developments in the fields of research pertaining to dietary restraint, body image and psychological indices of wellbeing, yet the overarching aim remains the same: to promote deep health that helps individuals get the most out of their lives.

To learn more about Comprehensive Coaching, check out the upcoming webinar series HERE, or the 1-to-1 mentorship with myself HERE or Dr Gabrielle Fundaro HERE.


[1] Sturmberg JP. The personal nature of health. J Eval Clin Pract. 2009;15(4):766-769. doi:10.1111/j.1365-2753.2009.01225.x

[2] Corey L. M. Keyes. (2002). The Mental Health Continuum: From Languishing to Flourishing in Life. Journal of Health and Social Behavior,43(2), 207-222. Retrieved March 4, 2021, from

[3] Keyes, Corey L. M. and C. D. Ryff. 1999. "Psychological Well-Being in Midlife." Pp. 161-80 in Middle Aging: Development in the Third Quarter of Life, edited by S. L. Willis and J. D. Reid. Orlando, FL: Academic Press

[4] Hay PJ, Mond J, Buttner P, Darby A: Eating disorder behaviors are increasing: findings from two sequential community surveys from South Australia. PLoS One 2008, 3(2):e1541.

[5] Fairburn CG, Bohn K. Eating disorder NOS (EDNOS): an example of the troublesome "not otherwise specified" (NOS) category in DSM-IV. Behav Res Ther. 2005 Jun;43(6):691-701. doi: 10.1016/j.brat.2004.06.011. PMID: 15890163; PMCID: PMC2785872.

[6] Mitchison, D., Hay, P. J., Slewa-Younan, S., & Mond, J. (2012). Time trends in population prevalence of eating disorder behaviors and their relationship to quality of life. PloS One, 7, 1–7. doi:10.1371/journal.pone.0048450

[7] Ratnasuriya, R. H., Eisler, I., Szmukler, G. I., & Russell, G. F. (1991). Anorexia nervosa: Outcome and prognostic factors after 20 years. The British Journal of Psychiatry, 158, 495–502.

[8] Gratwick-Sarll K, Bentley C, Harrison C, Mond J. Poor self-recognition of disordered eating among girls with bulimic-type eating disorders: cause for concern? Early Interv Psychiatry. 2016 Aug;10(4):316-23. doi: 10.1111/eip.12168. Epub 2014 Aug 11. PMID: 25112818.

[9] Mond JM, Hay PJ, Paxton SJ, et al. (2010a). Eating disorders mental health literacy in low risk, high risk, and symptomatic women: Implications for health promotion programs. Eat Disord, 18, 267–85.

[10] Schaumberg K, Anderson DA, Anderson LM, Reilly EE, Gorrell S. Dietary restraint: what's the harm? A review of the relationship between dietary restraint, weight trajectory and the development of eating pathology. Clin Obes. 2016 Apr;6(2):89-100. doi: 10.1111/cob.12134. Epub 2016 Feb 3. PMID: 26841705.

[11] Grogan, S. (2016). Body image: Understanding body dissatisfaction in men, women and children: Routledge/Taylor & Francis Group (2016). doi: 10.4324/9781315681528

[12] Mond, J., Mitchison, D., Latner, J. et al. Quality of life impairment associated with body dissatisfaction in a general population sample of women. BMC Public Health 13, 920 (2013).

[13] Wang, S. B., Haynos, A. F., Wall, M. M., Chen, C., Eisenberg, M. E., & Neumark-Sztainer, D. (2019). Fifteen-year prevalence, trajectories, and predictors of body dissatisfaction from adolescence to middle adulthood. Clinical Psychological Science, 7(6), 1403–1415.

[14] Cash, T. F. (1994). Body-Image Attitudes: Evaluation, Investment, and Affect. Perceptual and Motor Skills, 78(3_suppl), 1168–1170.

[15] Bornioli A, Lewis-Smith H, Slater A, et al Body dissatisfaction predicts the onset of depression among adolescent females and males: a prospective studyJ Epidemiol Community Health Published Online First: 07 December 2020. doi: 10.1136/jech-2019-213033

[16] Rohde P, Stice E, Marti CN. Development and predictive effects of eating disorder risk factors during adolescence: implications for prevention efforts. Int J Eating Disord (2015) 48(2):187–98. doi: 10.1002/eat.22270

[17] Blakey, Shannon & Reuman, Lillian & Buchholz, Jennifer & Abramowitz, Jonathan. (2017). Experiential Avoidance and Dysfunctional Beliefs in the Prediction of Body Image Disturbance in a Nonclinical Sample of Women. Body Image. 22. 72-77. 10.1016/j.bodyim.2017.06.003.

[18] Spangler, Diane & Stice, Eric. (2001). Validation of the Beliefs About Appearance Scale. Cognitive Therapy and Research. 25. 813-827. 10.1023/A:1012931709434.

[19] Aboody D, Siev J, Doron G. Building resilience to body image triggers using brief cognitive training on a mobile application: A randomized controlled trial. Behav Res Ther. 2020 Nov;134:103723. doi: 10.1016/j.brat.2020.103723. Epub 2020 Sep 4. PMID: 32920164.

[20] Stefano EC, Hudson DL, Whisenhunt BL, Buchanan EM, Latner JD. Examination of body checking, body image dissatisfaction, and negative affect using Ecological momentary assessment. Eat Behav. 2016 Aug;22:51-54. doi: 10.1016/j.eatbeh.2016.03.026. Epub 2016 Apr 8. PMID: 27086048.

[21] Van den Berg, P., Thompson, J. K., Obremski-Brandon, K., & Coovert, M. (2002). The Tripartite Influence Model of body image and eating disturbance: A covariance structure modeling investigation testing the mediational role of appearance comparison. Journal of Psychosomatic Research, 53, 1007–1020. http://dx.doi. org/10.1016/S0022-3999(02)00499-3

[22] Tiggemann, M. (1996). ‘Thinking’ versus ‘feeling’ fat: Correlates of two indices of body image dissatisfaction. Australian Journal of Psychology, 48, 21–25.

[23] Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press.

[24] Hayes S, Strosahl K, Wilson K. Acceptance and commitment therapy: the process and practice of mindful change. New York: Guilford Press; 2011.

[25] Hayes, Steven & Pistorello, Jacqueline & Levin, Michael. (2012). Acceptance and Commitment Therapy as a Unified Model of Behavior Change. The Counseling Psychologist. 40. 976-1002. 10.1177/0011000012460836.

[26] Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K. Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol. 1996; 64: 1152–1168.

[27] Andrew, D. H., & Dulin, P. L. (2007). The relationship between self-reported health and mental health problems among older adults in New Zealand: Experiential avoidance as a moderator. Aging & Mental Health, 11(5), 596–603.

[28] Kirk, A., Meyer, J. M., Whisman, M. A., Deacon, B. J., & Arch, J. J. (2019). Safety behaviors, experiential avoidance, and anxiety: A path analysis approach. Journal of Anxiety Disorders,64,9–15.

[29] Byrne S, Cooper Z, Fairburn C. Weight maintenance and relapse in obesity: A qualitative study. Int J Obes. 2003; 27: 955–962.

[30] Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., & Watson, D. (2011). Development of a measure of experiential avoidance: The Multidimensional Experiential Avoidance Questionnaire. Psychological Assessment, 23(3), 692–713.

[31] Miller, William R, and Stephen Rollnick. Motivational Interviewing: Helping People Change. New York, NY: Guilford Press, 2013. Print.

[32] Tylka, Tracy & Wood-Barcalow, Nichole. (2015). What is and what is not positive body image? Conceptual foundations and construct definition. Body Image. 14. 10.1016/j.bodyim.2015.04.001.

[33] Tylka, T. L., & Wood-Barcalow, N. L. (2015). The Body Appreciation Scale-2: Item refinement and psychometric evaluation. Body Image, 12, 53–67. http://dx.doi. org/10.1016/j.bodyim.2014.09.006

[34] Gillen MM. Associations between positive body image and indicators of men's and women's mental and physical health. Body Image. 2015 Mar;13:67-74. doi: 10.1016/j.bodyim.2015.01.002. Epub 2015 Feb 12. PMID: 25682474.

[35] Tylka, T. L. (2011). Positive psychology perspectives on body image. In T. F. Cash & L. Smolak (Eds.), Body image: A handbook of science, practice, and prevention (p. 56–64). The Guilford Press.

[36] Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review.Psychological Bulletin, 128, 825–848.

[37] Jones, D.C. & Smolak, L.. (2011). Body Image during Adolescence: A Developmental Perspective. 10.1016/B978-0-12-373951-3.00005-3.

[38] Calogero, R. M., Tantleff-Dunn, S., & Thompson, J. K. (Eds.). (2011). Self-objectification in women: Causes, consequences, and counteractions. American Psychological Association.

[39] Cook-Cottone, C. P., Tribole, E., & Tylka, T. L. (2013). Healthy eating in schools: Evidence-based interventions to help kids thrive. Washington, DC: American Psychological Association.

[40] Tylka, T. L. (2011). Positive psychology perspectives on body image. In T. F. Cash & L. Smolak (Eds.), Body image: A handbook of science, practice, and prevention (p. 56–64). The Guilford Press.

[41] Alleva, Jessica & Martijn, Carolien & Breukelen, Gerard & Jansen, Anita & Karos, Kai. (2015). Expand Your Horizon: A programme that improves body image and reduces self-objectification by training women to focus on body functionality. Body image. 10.1016/j.bodyim.2015.07.001.

[42] Augustus-Horvath CL, Tylka TL. The acceptance model of intuitive eating: a comparison of women in emerging adulthood, early adulthood, and middle adulthood. J Couns Psychol. 2011 Jan;58(1):110-125. doi: 10.1037/a0022129. PMID: 21244144.

[43] Rogers, C. B., Webb, J. B., & Jafari, N. (2018). A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science(2011–2018). Body Image, 27, 43–60. bodyim.2018.08.003

[44] Tylka, T. L., & Iannantuono, A. C. (2016). Perceiving beauty in all women: Psychometric evaluation of the Broad Conceptualization of Beauty Scale. Body Image, 17, 67–81.

[45] Cook-Cottone, C.P., Guyker, W.M. The Development and Validation of the Mindful Self-Care Scale (MSCS): an Assessment of Practices that Support Positive Embodiment. Mindfulness 9, 161–175 (2018).

[46] Türk, Fidan & Waller, Glenn. (2020). Is self-compassion relevant to the pathology and treatment of eating and body image concerns? A systematic review and meta-analysis. Clinical Psychology Review. 79. 101856. 10.1016/j.cpr.2020.101856.

[47] Homan, Kristin & Tylka, Tracy. (2018). Development and exploration of the gratitude model of body appreciation. Body Image. 25. 14-22. 10.1016/j.bodyim.2018.01.008.

[48] Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and Commitment Therapy: Model, processes, and outcomes. Behav Res Ther. 2006; 44: 1–25.

[49] Kashdan TB, Rottenberg J. Psychological flexibility as a fundamental aspect of health. Clin Psychol Rev. 2010 Nov;30(7):865-78. doi: 10.1016/j.cpr.2010.03.001. Epub 2010 Mar 12. PMID: 21151705; PMCID: PMC2998793.

[50] Lillis, J., & Kendra, K. E. (2014). Acceptance and Commitment Therapy for weight control: Model, evidence, and future directions. Journal of Contextual Behavioral Science, 3(1), 1–7. doi:10.1016/j.jcbs.2013.11.005

[51] Sandoz, E. K., Wilson, K. G., Merwin, R. M., & Kellum, K. K. (2013). Assessment of body image flexibility: The Body Image-Acceptance and Action Questionnaire. Journal of Contextual Behavioral Science, 2, 39–48. jcbs.2013.03.002

[52] Webb, J. B. (2015). Body image flexibility contributes to explaining the link between body dissatisfaction and body appreciation in White college-bound females.Journal of Contextual Behavioral Science, 4, 176–183. 10.1016/j.jcbs.2015.06.001

[53] Rogers, C. B., Webb, J. B., & Jafari, N. (2018). A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science(2011–2018). Body Image, 27, 43–60. bodyim.2018.08.003

[54] Linardon J, Anderson C, Messer M, Rodgers RF, Fuller-Tyszkiewicz M. Body image flexibility and its correlates: A meta-analysis. Body Image. 2021 Mar 5;37:188-203. doi: 10.1016/j.bodyim.2021.02.005. Epub ahead of print. PMID: 33684721.

[55] Schaumberg K, Anderson DA, Anderson LM, Reilly EE, Gorrell S. Dietary restraint: what's the harm? A review of the relationship between dietary restraint, weight trajectory and the development of eating pathology. Clin Obes. 2016 Apr;6(2):89-100. doi: 10.1111/cob.12134. Epub 2016 Feb 3. PMID: 26841705.

[56] Brown AJ, Parman KM, Rudat DA, Craighead LW. Disordered eating, perfectionism, and food rules. Eat Behav. 2012 Dec;13(4):347-53. doi: 10.1016/j.eatbeh.2012.05.011. Epub 2012 Jun 9. PMID: 23121786.

[57] Duarte C, Ferreira C, Pinto-Gouveia J, Trindade IA, Martinho A. What makes dietary restraint problematic? Development and validation of the Inflexible Eating Questionnaire. Appetite. 2017 Jul 1;114:146-154. doi: 10.1016/j.appet.2017.03.034. Epub 2017 Mar 27. PMID: 28347777.

[58] Westenhöfer, Joachim & Engel, Daniel & Holst, Claus & Lorenz, Jürgen & Peacock, Matthew & Stubbs, James & Whybrow, Stephen & Raats, Monique. (2013). Cognitive and weight-related correlates of flexible and rigid restrained eating behaviour. Eating behaviors. 14. 69-72. 10.1016/j.eatbeh.2012.10.015.

[59] Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist, 40(7), 976–1002.

[60] Wilson, K. G., & Murrell, A. R. (2004). Values work in acceptance and commitment therapy: Setting a course for behavioral treatment. In S. C. Hayes, V. M. Follette, & M. Linehan (Eds.), Mindfulness & acceptance: Expanding the cognitive-behavioral tradition (pp. 120–151). New York: Guilford Press.

[61] Silva DFO, Sena-Evangelista KCM, Lyra CO, Pedrosa LFC, Arrais RF, Lima SCVC. Motivations for weight loss in adolescents with overweight and obesity: a systematic review. BMC Pediatr. 2018 Nov 21;18(1):364. doi: 10.1186/s12887-018-1333-2. PMID: 30463551; PMCID: PMC6247735.

[62] Lanoye A, Grenga A, Leahey TM, LaRose JG. Motivation for weight loss and association with outcomes in a lifestyle intervention: comparing emerging adults to middle aged adults. Obes Sci Pract. 2018 Dec 4;5(1):15-20. doi: 10.1002/osp4.313. PMID: 30847223; PMCID: PMC6381300.

[63] Legault L. (2017) Self-Determination Theory. In: Zeigler-Hill V., Shackelford T. (eds) Encyclopedia of Personality and Individual Differences. Springer, Cham.

[64] Lanoye, Autumn & Grenga, A. & Leahey, Tricia & LaRose, Jessica. (2018). Motivation for Weight Loss and Association with Outcomes in a Lifestyle Intervention: Comparing Emerging Adults to Middle Aged Adults. Obesity Science & Practice. 5. 10.1002/osp4.313.

[65] Trindade, Inês & Ferreira, Cláudia & Pinto-Gouveia, José & Nooren, Loes. (2015). Clarity of Personal Values and Committed Action: Development of a Shorter Engaged Living Scale. Journal of Psychopathology and Behavioral Assessment. 38. 10.1007/s10862-015-9509-7.

[66] O'Brien G, Davies M. Nutrition knowledge and body mass index. Health Educ Res. 2007 Aug;22(4):571-5. doi: 10.1093/her/cyl119. Epub 2006 Oct 13. PMID: 17041019.

[67] Melo D, Oliveira S, Ferreira C. The link between external and internal shame and binge eating: the mediating role of body image-related shame and cognitive fusion. Eat Weight Disord. 2020 Dec;25(6):1703-1710. doi: 10.1007/s40519-019-00811-8. Epub 2019 Nov 12. PMID: 31721102.

[68] Duarte C, Matos M, Stubbs RJ, Gale C, Morris L, Gouveia JP, Gilbert P. The Impact of Shame, Self-Criticism and Social Rank on Eating Behaviours in Overweight and Obese Women Participating in a Weight Management Programme. PLoS One. 2017 Jan 20;12(1):e0167571. doi: 10.1371/journal.pone.0167571. PMID: 28107449; PMCID: PMC5249118.

[69] Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. American journal of public health, 100(6), 1019–1028.

[70] Frayn, M., Livshits, S., & Knäuper, B. (2018). Emotional eating and weight regulation: a qualitative study of compensatory behaviors and concerns. Journal of eating disorders, 6, 23.

[71] Duarte C, Ferreira C, Pinto-Gouveia J, Trindade IA, Martinho A. What makes dietary restraint problematic? Development and validation of the Inflexible Eating Questionnaire. Appetite. 2017 Jul 1;114:146-154. doi: 10.1016/j.appet.2017.03.034. Epub 2017 Mar 27. PMID: 28347777.

[72] Stice, Eric & Shaw, Heather. (2002). Role of Body Dissatisfaction in the Onset and Maintenance of Eating Pathology: A Synthesis of Research Findings. Journal of psychosomatic research. 53. 985-93. 10.1016/S0022-3999(02)00488-9.

[73] Lutter, M., and Nestler, E. J. (2009). Homeostatic and hedonic signals interact in the regulation of food intake.J. Nutr.139, 629–632. doi: 10.3945/jn.108.097618

[74] Cleobury, L., and Tapper, K. (2014). Reasons for eating ‘unhealthy’ snacks in overweight and obese males and females. J. Hum. Nutr. Diet. 27, 333–341. doi: 10.1111/jhn.12169

[75] Macht, M. (2008). How emotions affect eating: a five-way model. Appetite 50, 1–11. doi: 10.1016/j.appet.2007.07.002

[76] Wardle J, Steptoe A, Oliver G, Lipsey Z. Stress, dietary restraint and food intake. J Psychosom Res. 2000;48:195–202.

[77] Newman E, O'Connor DB, Conner M. Daily hassles and eating behaviour: the role of cortisol reactivity status. Psychoneuroendocrinology. 2007 Feb;32(2):125-32. doi: 10.1016/j.psyneuen.2006.11.006. Epub 2007 Jan 2. PMID: 17198744.

[78] Cohen S, Janicki-Deverts D, Doyle WJ, Miller GE, Frank E, Rabin BS, Turner RB. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci U S A. 2012 Apr 17;109(16):5995-9. doi: 10.1073/pnas.1118355109. Epub 2012 Apr 2. PMID: 22474371; PMCID: PMC3341031.

[79] Smith JM, Alloy LB. A roadmap to rumination: a review of the definition, assessment, and conceptualization of this multifaceted construct. Clin Psychol Rev. 2009;29:116–128.

[80] Brosschot JF, Gerin W, Thayer JF. The perseverative cognition hypothesis: a review of worry, prolonged stress-related physiological activation, and health. J Psychosom Res. 2006 Feb;60(2):113-24. doi: 10.1016/j.jpsychores.2005.06.074. PMID: 16439263.

[81] Kim EJ, Dimsdale JE. The effect of psychosocial stress on sleep: a review of polysomnographic evidence. Behav Sleep Med. 2007;5(4):256-78. doi: 10.1080/15402000701557383. PMID: 17937582; PMCID: PMC4266573.

[82] Pratt WM, Davidson D. Role of the HPA axis and the A118G polymorphism of the mu-opioid receptor in stress-induced drinking behavior. Alcohol Alcohol. 2009 Jul-Aug;44(4):358-65. doi: 10.1093/alcalc/agp007. Epub 2009 Feb 24. PMID: 19240053; PMCID: PMC2732914.

[83] Wardle J, Steptoe A, Oliver G, Lipsey Z. Stress, dietary restraint and food intake. J Psychosom Res. 2000 Feb;48(2):195-202. doi: 10.1016/s0022-3999(00)00076-3. PMID: 10719137.

[84] Stults-Kolehmainen MA, Sinha R. The effects of stress on physical activity and exercise. Sports Med. 2014 Jan;44(1):81-121. doi: 10.1007/s40279-013-0090-5. PMID: 24030837; PMCID: PMC3894304.

[85] Clancy, F., O'Connor, D. B., & Prestwich, A. (2020). Do Worry and Brooding Predict Health Behaviors? A Daily Diary Investigation. International journal of behavioral medicine, 27(5), 591–601.

[86] Hill, C. E., & Castonguay, L. G. (Eds.). (2007). Insight in psychotherapy. Washington, DC: American Psychological Association.

[87] Muraven, M., Tice, D. M., and Baumeister, R. F. (1998). Self-control as a limited resource: regulatory depletion patterns. J. Pers. Soc. Psychol. 74, 774–789. Doi: 10.1037/0022-3514.74.3.774

[88] Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson,N. D., Carmody, J. & Velting, D. (2004). Mindfulness: A proposed operational definition. Clinical Psychology Science and Practice, 11, 230–241.

[89] Bishop, S. R. (2002). What do we really know about mindfulness-based stress reduction? Psychosomatic Medicine, 64, 71–84.

[90]Gu J, Strauss C, Bond R, Cavanagh K. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clin Psychol Rev. 2015 Apr;37:1-12. doi: 10.1016/j.cpr.2015.01.006. Epub 2015 Jan 31. Erratum in: Clin Psychol Rev. 2016 Nov;49:119. PMID: 25689576.

[91] Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology Science and Practice, 10, 144–156.

[92] Tang YY, Hölzel BK, Posner MI. The neuroscience of mindfulness meditation. Nat Rev Neurosci. 2015 Apr;16(4):213-25. doi: 10.1038/nrn3916. Epub 2015 Mar 18. PMID: 25783612.

[93] Shapiro, S., Astin, J., Bishop, S., & Cordova, M. (2005). Mindfulness-based stress reduction and health care professionals: Results from a randomized controlled trial. International Journal of Stress Management, 12, 164 –176.

[94] Hill, Christina & Updegraff, John. (2011). Mindfulness and Its Relationship to Emotional Regulation. Emotion (Washington, D.C.). 12. 81-90. 10.1037/a0026355.

[95] Adele, M. H., & Feldman, G. (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology, 11, 255–262. doi:10.1093/clipsy.bph080

[96] Walsh, R., & Shapiro, S. L. (2006). The meeting of meditative disciplines and western psychology: A mutually enriching dialogue. American Psychologist, 61, 227–239. doi:10.1037/0003-066X.61.3.227

[97] Siegel, D. J. (2007). The mindful brain: Reflection and attunement in the cultivation of well-being. New York: Norton.

[98] Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241.

[99] Lindsay, E. K., & Creswell, J. D. (2017). Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT). Clinical psychology review, 51, 48–59.

[100] Lindsay EK, Creswell JD. Mindfulness, acceptance, and emotion regulation: perspectives from Monitor and Acceptance Theory (MAT). Curr Opin Psychol. 2019 Aug;28:120-125. doi: 10.1016/j.copsyc.2018.12.004. Epub 2018 Dec 13. PMID: 30639835; PMCID: PMC6565510.

[101] Braun, Tosca & Park, Crystal & Gorin, Amy. (2016). Self-compassion, body image, and disordered eating: A review of the literature. Body Image. 17. 117-131. 10.1016/j.bodyim.2016.03.003.

[102] Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K. Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol. 1996; 64: 1152–1168.

[103] Andrew, D. H., & Dulin, P. L. (2007). The relationship between self-reported health and mental health problems among older adults in New Zealand: Experiential avoidance as a moderator. Aging & Mental Health, 11(5), 596–603.

[104] Kirk, A., Meyer, J. M., Whisman, M. A., Deacon, B. J., & Arch, J. J. (2019). Safety behaviors, experiential avoidance, and anxiety: A path analysis approach. Journal of Anxiety Disorders,64,9–15.

[105] Byrne S, Cooper Z, Fairburn C. Weight maintenance and relapse in obesity: A qualitative study. Int J Obes. 2003; 27: 955–962.

[106] Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy. New York: Guilford Press; 1999.

[107] Forman EM, Butryn ML, Manasse SM, Crosby RD, Goldstein SP, Wyckoff EP, Thomas JG. Acceptance-based versus standard behavioral treatment for obesity: Results from the mind your health randomized controlled trial. Obesity (Silver Spring). 2016 Oct;24(10):2050-6. doi: 10.1002/oby.21601. PMID: 27670400; PMCID: PMC5051349.

[108] Karekla, M., Georgiou, N., Panayiotou, G., Sandoz, E. K., Kurz, A. S., & Constantinou, M. (2020). Cognitive Restructuring vs. Defusion: Impact on craving, healthy and unhealthy food intake. Eating Behaviors, 37, [101385].

[109] Forman EM, Hoffman KL, McGrath KB, Herbert JD, Brandsma LL, Lowe MR. A comparison of acceptance- and control-based strategies for coping with food cravings: an analog study. Behav Res Ther. 2007 Oct;45(10):2372-86. doi: 10.1016/j.brat.2007.04.004. Epub 2007 Apr 18. PMID: 17544361.

[110] Tapper K. Mindfulness and craving: effects and mechanisms. Clin Psychol Rev. 2018 Feb;59:101-117. doi: 10.1016/j.cpr.2017.11.003. Epub 2017 Nov 13. PMID: 29169665.

[111] Tylka, Tracy & Wood-Barcalow, Nichole. (2015). What is and what is not positive body image? Conceptual foundations and construct definition. Body Image. 14. 10.1016/j.bodyim.2015.04.001.

[112] Tylka, T. L. (2012). Positive psychology perspective on body image. In T. F. Cash (Ed.), Encyclopedia of body image and human appearance (Vol. 2) (pp. 657–663). San Diego, CA: Academic Press.

[113] Pearson, A. N., Follette, V. M., & Hayes, S. C. (2012). A pilot study of acceptance and commitment therapy as a workshop intervention for body dissatisfaction and disordered eating attitudes. Cognitive and Behavioral Practice, 19(1), 181–197.

[114] Cunningham ML, Szabo M, Rodgers RF, Franko DL, Eddy KT, Thomas JJ, Murray SB, Griffiths S. An investigation of distress tolerance and difficulties in emotion regulation in the drive for muscularity among women. Body Image. 2020 Jun;33:207-213. doi: 10.1016/j.bodyim.2020.03.004. Epub 2020 May 11. PMID: 32408165.

[115] McCreary, D. R. (2007). The Drive for Muscularity Scale: Description, Psychometrics, and Research Findings. In J. K. Thompson & G. Cafri (Eds.), The muscular ideal: Psychological, social, and medical perspectives (p. 87–106). American Psychological Association.

[116] Teper R, Inzlicht M. Meditation, mindfulness and executive control: the importance of emotional acceptance and brain-based performance monitoring. Soc Cogn Affect Neurosci. 2013 Jan;8(1):85-92. doi: 10.1093/scan/nss045. Epub 2012 Apr 15. PMID: 22507824; PMCID: PMC3541488.

[117] Pearson, A. N., Follette, V. M., & Hayes, S. C. (2012). A pilot study of acceptance and commitment therapy as a workshop intervention for body dissatisfaction and disordered eating attitudes. Cognitive and Behavioral Practice, 19(1), 181–197.

[118] Rose S, Paul C, Boyes A, Kelly B, Roach D. Stigma-related experiences in non-communicable respiratory diseases: A systematic review. Chron Respir Dis. 2017 Aug;14(3):199-216. doi: 10.1177/1479972316680847. Epub 2017 Jan 23. PMID: 28111991; PMCID: PMC5720230.

[119] Dolezal L, Lyons BHealth-related shame: an affective determinant of health?Medical Humanities 2017;43:257-263.

[120] Richard Layte, The Association Between Income Inequality and Mental Health: Testing Status Anxiety, Social Capital, and Neo-Materialist Explanations, European Sociological Review, Volume 28, Issue 4, August 2012, Pages 498–511,

[121] Geller, S. M., & Porges, S. W. (2014). Therapeutic presence: Neurophysiological mechanisms mediating feeling safe in therapeutic relationships. Journal of Psychotherapy Integration, 24(3), 178–192.

[122] Belloch, A., Morillo, C., Lucero, M., Cabedo, E., & Carrió, C. (2004). Intrusive Thoughts in Non-Clinical Subjects: The Role of Frequency and Unpleasantness on Appraisal Ratings and Control Strategies. Clinical Psychology & Psychotherapy, 11, 100-110.

[123] Spencer S, Hayes SC (2005) Get out of your mind and into your life: the new acceptance and commitment therapy. New Harbinger Publications, Oakland

[124] Harris, R. (2009). ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.

[125] Healy, Hillary-Ann & Barnes-Holmes, Yvonne & Barnes-Holmes, Dermot & Keogh, Claire & Luciano, Carmen & Wilson, Kelly. (2008). An Experimental Test of a Cognitive Defusion Exercise: Coping With Negative and Positive Self-Statements. The Psychological Record. 58. 623-640. 10.1007/BF03395641.

[126] Larsson A, Hooper N, Osborne LA, Bennett P, McHugh L. Using Brief Cognitive Restructuring and Cognitive Defusion Techniques to Cope With Negative Thoughts. Behav Modif. 2016 May;40(3):452-82. doi: 10.1177/0145445515621488. Epub 2015 Dec 18. PMID: 26685210.

[127] Ferreira C, Palmeira L, Trindade IA (2014) Turning eating psychopathology risk factors into action. The pervasive effect of body image-related cognitive fusion. Appetite 80:137–142. https :// .2014.05.019

[128] Trindade IA, Ferreira C (2014) The impact of body image-related cognitive fusion on eating psychopathology. Eat Behav 15(1):72– 75. https :// h.2013.10.014

[129] Ferreira C, Trindade IA, Duarte C, Pinto-Gouveia J (2015) Getting entangled with body image: development and validation of a new measure. Psychol Psychother 88:304–316. https ://doi. org/10.1111/papt.12047

[130] Scardera S, Sacco S, Di Sante J, Booij L. Body image-related cognitive fusion and disordered eating: the role of self-compassion and sad mood. Eat Weight Disord. 2020 Feb 21. doi: 10.1007/s40519-020-00868-w. Epub ahead of print. PMID: 32086789.

[131] Neff, K. D. (2003). Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self and Identity, 2(2), 85–101.

[132] Crocker, J., & Wolfe, C. T. (2001). Contingencies of self-worth. Psychological Review, 108(3), 593–623.

[133] Neff, K. D. (2003). Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self and Identity, 2(2), 85–101.

[134] Neff, K. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250.

[135] Neff KD, Vonk R. Self-compassion versus global self-esteem: two different ways of relating to oneself. J Pers. 2009 Feb;77(1):23-50. doi: 10.1111/j.1467-6494.2008.00537.x. Epub 2008 Nov 28. PMID: 19076996.

[136] Braun, T. D., Park, C. L., & Gorin, A. (2016). Self-compassion, body image, and disordered eating: A review of the literature. Body Image, 17, 117–131.

[137] Wasylkiw L, MacKinnon AL, MacLellan AM. Exploring the link between self-compassion and body image in university women. Body Image. 2012 Mar;9(2):236-45. doi: 10.1016/j.bodyim.2012.01.007. Epub 2012 Mar 7. PMID: 22406200.

[138] Bento S, Ferreira C, Mendes AL, Marta-Simões J (2017) Emotion regulation and disordered eating: the distinct effects of body image-related cognitive fusion and body appreciation. Psychologica 60:11–25. https :// /1647-8606_60-2_1

[139] Powers, T. A., Koestner, R., & Zuroff, D. C. (2007). Self-criticism, goal motivation, and goal progress. Journal of Social and Clinical Psychology, 26(7), 826–840.

[140] Breines, J. G., & Chen, S. (2012). Self-Compassion Increases Self-Improvement Motivation. Personality and Social Psychology Bulletin, 38(9), 1133–1143.

[141] Kelly,A.C., & Carter, J. C. (2015). Self-compassion training for binge eating disorder: A pilot randomized controlled trial. Psychology and Psychotherapy Theory Research and Practice, 88, 285–303.

[142] Neff, K. D. (2003). Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self and Identity, 2(2), 85–101.

[143] Leary MR, Tate EB, Adams CE, Allen AB, Hancock J. Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly. J Pers Soc Psychol. 2007 May;92(5):887-904. doi: 10.1037/0022-3514.92.5.887. PMID: 17484611.

[144] Seekis, Veya & Bradley, Graham & Duffy, Amanda. (2017). The effectiveness of self-compassion and self-esteem writing tasks in reducing body image concerns. Body Image. 23. 206-213. 10.1016/j.bodyim.2017.09.003.

654 views0 comments

Recent Posts

See All


bottom of page