The messages that run through your mind determine how you feel and what you do. Every time you feel anxious, discouraged, or self-conscious about your looks, it’s the result of negative thinking.

Our thoughts aren’t always trustworthy.

The fact that negative thoughts about your appearance often come into your mind doesn’t mean that they are true. Indeed, they may be absolutely illogical, inaccurate, even bizarre—and they’re certainly not helpful.

You start by learning to recognize illogical and self-defeating thinking, then learning to change these negative thoughts and painful feelings.

If you’re now thinking that your thoughts aren’t the problem (“Other people might just have a little problem with their thinking, and they can benefit from this psychological stuff, but I really have a physical problem! There’s something wrong with the way I look!”), you might be surprised to know that I hear the same protest from almost every new patient.

In fact, after the first session of the first BDD group that I ran, several patients called me to say they couldn’t come back to future sessions. Why? “Because everybody else in the group looked fine; they just have a psychological problem. I’m the only one who looks weird!”

You, too, have probably been convinced that all you need is a change in the way you look. But keep in mind that this belief is the core of your problem, and this is why your thinking needs fine-tuning: You have started to believe things that aren’t based on reality.

Your Negative Feelings Are Caused by Your Thoughts

One of the basic assumptions of CBT is that how you interpret a situation affects how you feel.

In other words, you aren’t reacting with anxiety or sadness to certain events or situations; rather, you are reacting to your interpretations of these situations.

Let me give you an example. Let’s say you are at a party chatting with some friends. All of a sudden, you realize that someone keeps looking at you.

What kinds of thoughts run through your mind? Just try to pick one of these interpretations:

1. He’s interested in our conversation.
2. He thinks I look strange.
3. He’s looking in my direction but not really looking at me (that is, he’s daydreaming).
4. He’s interested in me.

If you picked 1 or 4, you probably feel pretty good as a result of your interpretation. You might look back at the observer and smile. Or you might get more animated and confident in the conversation with your friends.

If you picked 3, you likely feel neutral and just keep doing whatever you are doing.

If you picked 2, however, you’ll probably feel anxious, and you may even change your behavior (for example, turn your back to the observer) as a result of this thought.

All of these interpretations are equally likely, and the one you picked created your reality and changed how you felt and behaved. The same relationship applies to most situations in life. It’s not really what’s happening to you that causes you to feel sad, self-confident, anxious, or neutral. It’s how you interpret what’s happening.

Likewise, when you look in the mirror, you’re not just getting input from your retina and visual cortex; you’re also interpreting your reflection in some way. If you look at your nose and decide that it looks disfigured because it’s a little bumpy, you feel sad and discouraged.

If you decide that although your nose isn’t perfect, it’s OK, and that you really love your eyes, you’ll feel good or relatively neutral as a result of your mirror

Typical Beliefs of People with Body Image Concerns

• If my appearance is defective, I’m worthless as a person.
• If my appearance is defective, I’ll always be alone.
• If I looked better, my whole life would be better.
• If I don’t look perfect, people won’t like me.
• If others knew what I really look like (for example, without makeup), they’d reject me.
• I need to look perfect to be accepted.
• If my appearance is flawed, I am inadequate.
• I’m ugly because I feel ugly.

Several of these assumptions contain the idea that appearance is central to being happy or loved and accepted. In other beliefs, appearance and self-worth have become interwoven.

Many of the assumptions contain perfectionist ideas, and some contain the idea that control over appearance leads to control over feelings.

You probably developed these beliefs while growing up; thus, over the years, they have been influenced by your family, cultural values, the media, and possibly even traumatic life experiences.

Any of the beliefs listed will influence what you think in any situation you encounter. They’ll make it hard for you to accept yourself as you are. This will make you feel sad, anxious, or embarrassed and might even impact how you behave.

And what if they’re not true? If your beliefs are false or exaggerated, your expectations and automatic thoughts in specific situations will be inaccurate. But you’ll still feel bad when they arise. The next step, is to learn how to recognize and change negative automatic thoughts in specific situations.

Identifying Your Negative Thoughts

If you’re going to eliminate negative thoughts, naturally you have to be able to identify them first. This may be quite easy for you, or it could be very challenging. You might think, “I’m not sure what I’m thinking; I just feel awful about the way I look.” Don’t worry; identifying your negative thoughts, like almost everything in life, gets easier with practice.

The most important next step is for you to start focusing on your thoughts and to write them down.

Thought Record

Below is a sample “Thought Record”, or buy yourself a small notebook and make up your own thought record, as long as you follow the suggested format.

The goal is to spend a minimum of 20–30 minutes a day during the coming week on your thought records.

It’s best to complete the Thought Record right after you’ve had a negative thought. Because these thoughts can occur anywhere, you should take your notebook or Thought Record forms with you wherever you go.

Take them to work and on vacation, on long walks or to the gym.

Sometimes, however, you’ll be in social or other situations in which working on a Thought Record would be inappropriate. In those cases, it’s OK to delay writing down the thoughts, but don’t wait too long, because you might forget important details.

If you don’t have any thoughts in the next few days that make you feel uncomfortable, just imagine a future situation that might be difficult for you.

Or try to remember a recent situation that made you feel bad. Remember the situation as vividly as you can, then complete the Thought Record.

Elements of the Thought Record

My Sample Thought Record:

This example is from right now when I am thinking about going to this event with my kids and family.

Download Blank Template: MS. Word (doc | docx)  Google Drive

You might be thinking that you really don’t want to write your negative, appearance-related thoughts down every day. They’re awful, and writing them down will just make you feel worse.

You may not want to spend any more time thinking about this than you already do.

It’s true that monitoring your thoughts initially might be a challenge, because I’m asking you to focus on something that is actually quite painful for you, and you don’t yet have the skills to cope.

But let me assure you that writing these thoughts down is a good investment in your future.

Yes, for a short period of time it may be difficult to do this exercise, but in the long term I have found it extremely helpful. So even if you don’t feel like it, use all your willpower to keep monitoring your thoughts. It’s worth it.

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