Body image (BI) disturbance is a relevant factor in the etiology and treatment of eating disorders (ED). Although progress has been made in recent decades in understanding BI and its relationship with ED, the efficacy of BI disturbance prevention and intervention programs is still limited. In order to reach deeper understanding of BI disturbance and clarify the interactions between some protective and risk factors related to this construct, we carried out a literature review on some specific BI-related factors that so far have been analyzed independently. We specifically examined positive and negative BI; embodiment and its role in the development of positive and negative BI; and self-compassion as a protective factor that promotes positive embodiment (vs. disembodiment) and protection against body shame. We conclude that integrating the available evidence on these factors into BI models may be used to enhance our understanding of BI and improve the efficacy of prevention and intervention programs to help fight negative BI (by reducing body shame and disembodiment) and promote positive BI (by increasing self-compassion and positive embodiment).

Compassion-based interventions (CBIs) have been shown to be effective for increasing empathy and compassion, and reducing stress, anxiety, and depression. CBIs are based on constructive meditations where imagery abilities are essential. One of the major difficulties that participants report during the training is the difficulty related to imagery abilities. Virtual reality (VR) can be a useful tool to overcome this limitation because it can facilitate the construction and sustainment of mental images. The machine to be another (TMTBA) uses multi-sensory stimulation to induce a body swap illusion. This system allows participants to see themselves from a third perspective and have the illusion of touching themselves from outside. The main objective of the present study was to analyze the efficacy of a self-compassion meditation procedure based on the TMTBA system versus the usual meditation procedure (CAU) in increasing positive affect states, mindful self-care, and adherence to the practice, and explore the influence of imagery abilities as moderators of the effects of the condition on adherence. A sample of 16 participants were randomly assigned to two conditions: TMTBA-VR and CAU. All participants had to listen to an audio meditation about self-compassion and answer questionnaires before and after the training. The TMTBA-VR condition also had a body swap experience at the end of the meditation while listening to self-compassionate messages. Afterward, they were invited to practice this meditation for 2 weeks and then measured again. After the compassion practice, both conditions significantly increased positive qualities toward self/others, decreased negative qualities toward self, and increased awareness and attention to mental events and bodily sensations, with no differences between the conditions. After 2 weeks, both conditions showed a similar frequency of meditation practice and increases in specific types of self-care behaviors, with the frequency of clinical self-care behaviors being significantly higher in TMTBA. Finally, lower imagery ability in the visual and cutaneous modality were moderators of the efficacy of the TMTBA (vs. CAU) condition in increasing adherence to the practice. Embodied VR could be an interesting tool to facilitate and increase the efficacy of CBIs by facilitating the construction of positive and powerful mental images.

Background: Therapeutic alliance (TA) between the patient and therapist has been related to positive therapeutic outcomes. Because Internet-based interventions are increasingly being implemented, a tool is needed to measure the TA with Internet-based self-guided programs. The Working Alliance Inventory for online interventions (WAI-TECH-SF) was adapted based on the WAI Short Form (Hatcher & Gillaspy, 2006). The objectives of this study were: (1) to analyse the psychometric properties of the WAI-TECH-SF; (2) to explore the differences in the WAI-TECH-SF scores according to different categories of the sample; and (3) to analyse whether the WAI-TECH-SF can predict therapeutic outcomes and satisfaction with the treatment. Methods: 193 patients diagnosed with depression were included and received blended Cognitive-Behavioural Therapy. Measures of preferences, satisfaction, and credibility about the treatment, TA with the online program, depressive symptoms, and satisfaction with the treatment were administered. Results: An exploratory factor analysis revealed a one-dimensional structure with adequate internal consistency. Linear regression analyses showed that the WAI-TECH-SF predicted changes in depressive symptoms and satisfaction with the treatment. Conclusions: WAI-TECH-SF is a reliable questionnaire to assess the TA between the patient and the online program, which is associated with positive therapeutic outcomes and satisfaction with the treatment.

Interoception, a multifaceted concept defined as the perception of internal bodily signals, is crucially involved in mental health in general and in emotion regulation in particular, being interoceptive sensibility (IS) one of the most studied interoceptive processes. The main objective of this study was to explore the relationships between IS and emotion regulation processes, analyzing the role of the eight IS dimensions assessed by the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2) in alexithymia, emotion dysregulation, and depression. Additionally, this study also aimed to validate the MAIA-2 in a Spanish sample. To do so, 391 healthy adults, native Peninsular Spanish speakers (61.0% women, M_age = 29.00, SD_age = 11.40), completed the MAIA-2 and other self-reported questionnaires to measure alexithymia, emotion dysregulation, and depressive symptoms. Results showed that lower scores on the IS dimensions that involve an accepting attitude toward the bodily signals (e.g., not-worrying) were related to alexithymia and emotion dysregulation, which, in turn, predicted depression. Moreover, the eight-factor structure of the MAIA-2 was confirmed with acceptable fit indices. This study highlights the multidimensional nature of the IS and the relevance of IS dimensions that involve a positive appraisal of the body in regulating emotions.