Using Objectiﬁcation Theory to Examine the Effects of Media
on Gay Male Body Image
Published online: 13 October 2015
ÓSpringer Science+Business Media New York 2015
Abstract Research has increasingly noted that gay male
adults are more at risk for developing body image dissat-
isfaction than other male populations. Body image issues
warrant attention, particularly since they have been con-
nected to the development of disordered eating patterns.
Studies have often traced gay male body dissatisfaction to
various sociocultural elements and phenomena, particularly
the media. In fact, various media genres have been impli-
cated as being instrumental in propagating idealized male
physiques, which in turn may negatively inﬂuence obser-
vers. Using objectiﬁcation theory, this paper aims to review
the process by which media imagery are internalized by
some gay men and how such internalizations harmfully
impact their body image. The clinical implications and
treatment of body dissatisfaction will be reviewed in terms
of social work practice with gay male populations.
Keywords Gay Body image Media Objectiﬁcation
Within the last two decades the scientiﬁc study of male
body image has received progressive attention (McCabe
and Ricciardelli 2004; Morrison et al. 2004b; Rosenmann
and Kaplan 2014). Research has consistently indicated that
male body image is centered on both leanness and mus-
cularity (Hargreaves and Tiggemann 2009; Martins et al.
2008; Tiggemann et al. 2007; Tod et al. 2013; Yelland and
Tiggemann 2003). The progressive emphasis that society
places on both traits has contributed to a record increase in
the number of men who experience body dissatisfaction.
Gay males are said to constitute a large proportion of this
population and research has shown that they are dispro-
portionately at risk to developing it (Morrison et al. 2004b).
When compared to heterosexual men, gay men are reported
to desire more muscle tone (Calzo et al. 2013), are thought
to experience greater dissatisfaction with their level of
muscularity (Kaminski et al. 2005; Levesque and Vichesky
2006; Martins et al. 2008; Yelland and Tiggemann 2003),
have greater dissatisfaction with their overall body fat
content or thinness (Martins et al. 2008; Russell and Keel
2002), and generally experience more dissatisfaction with
most body parts, including head and body hair, height, and
penis size (Martins et al. 2008).
Past research has correlated body dissatisfaction and
disordered eating in gay men to various causative roots
including, biology: Rikani et al. (2013), gender non-con-
formity and bullying: D’Augelli et al. (2005), Levesque
and Vichesky (2006), attractiveness schemes within the
gay community: Varangis et al. (2012), Yelland and
Tiggemann (2003), and the media: Bartlett et al. (2008).
When focusing on sociocultural elements such as the
media, it may be noted that not all gay men respond to the
cues of body imagery in the same way. Two gay men will
look at the identical image of an idealized male physique
but one of them may come away from the observational
experience unaffected, while the other may have internal-
ized the image and consequently use it as a comparative
tool to modify his eating behavior and to judge his own
body and the bodies of other men. The reasons for the
difference in the way the two men are affected is multi-
faceted. It may lie in the hardwiring of their own genetics
New York University, New York, USA
Mt. Sinai Hospital, New York, USA
Clin Soc Work J (2016) 44:105–113
and neurochemistry and it may also be correlated to their
own experiential environment. Utilizing objectiﬁcation
theory, this paper will discuss the process by which some
gay men, in viewing the images of idealized male physi-
ques portrayed by the media, will internalize these per-
spectives as components of the body that they must come
to resemble. A clinical case will be used to both exemplify
and discuss the implications of this internalization process.
With further elaboration on the clinical example, this
article will also review the cognitive behavioral techniques
that may be used to address body image dissatisfaction.
Several studies noted that gay men’s maladaptive percep-
tion of body image were propagated by their afﬁliation to
media images that idealized a certain body type (Kaminski
et al. 2005; Levesque and Vichesky 2006; Strong et al.
2000). Within gay media sources, studies have depicted the
normative ideals of the male body to being tall, muscular,
and lean (Bartlett et al. 2008; Lanzieri and Cook 2013;
Saucier and Caron 2008; Schwartz and Andsager 2011).
Saucier and Caron (2008) conducted a content analysis of
the articles and advertisements contained in four popular
gay male magazines: The Advocate,Genre,Instinct, and
Out. In their assessment of issues from 2001 to 2004,
Saucier and Caron (2008) found that the magazines were
objectifying certain male body types and were placing
importance on having the right physique, namely one that
was lean and muscular. Schwartz and Andsager (2011)
analyzed images from The Advocate and Out magazines
from 1967 to 2008, and found that images had become
increasingly thinner and more muscular over time. The
authors equally noted that images directed toward hetero-
sexual male populations were just as muscular but were
comparably not as thin as those directed to gay males.
Similarly, in their review of twenty-three magazines tar-
geting heterosexual, gay and general audiences, Lanzieri
and Cook (2013) found that magazines targeting gay
audiences depicted images that were thinner than those
targeting heterosexual male and general audiences. The
authors further noted that gay and heterosexual male tar-
geted magazines depicted models with greater muscularity
than general audience magazines.
Objectiﬁcation theory is one perspective that lends some
understanding to the process by which gay men view
advertising images, internalize the messages in a manner in
which they experience dissatisfaction with their own bod-
ies, and subsequently develop behaviors that promote a
drive to be muscular (e.g., exercise) and leaner (e.g.,
dieting). Self objectiﬁcation involves a process of body
monitoring, whereby an individual exhibits a self-
consciousness that motivates increasing surveillance about
his own appearance. Such ‘‘body vigilance’’ is not done in
isolation but rather it’s conducted comparatively by using
the idealized images as a frame of reference to evaluate the
self and the other.
Objectiﬁcation theory asserts that individuals who live
in cultures that sexually objectify the body, wholly or in
parts, will eventually adopt an observer’s perspective and
become judgmental of their own physique’s ability to
emulate the idealized type (Fredrickson and Roberts 1997;
Martins et al. 2007). They learn to see their bodies as
objects and consequently place values on themselves based
on cultural idealized schemes (Davis et al. 2001). An
individual’s self identity is represented by his body or a
part of his body (Kozak et al. 2009). Although much of
objectiﬁcation’s theoretical principles have been formu-
lated from research conducted on women (Slater and
Tiggemann 2002; Tiggemann and Lynch 2001), studies
have also corroborated that objectiﬁcation is observed in
men. In fact, objectifying portrayals of men have increased
in the past two decades (Martins et al. 2007), and research
has suggested that the strongest contributor to that objec-
tiﬁcation process is the media (Morrison et al. 2003).
For example, the case of John, a 31 year old gay male,
highlights how media can inﬂuence the development and
evolution of one’s body image. Presenting for treatment
with persistent body image dissatisfaction that has consis-
tently interfered with seeking and maintaining healthy
relationships, reduced job performance, and disturbances in
eating, shape, and weight control that threatened his health,
John described a shift in his body awareness that occurred
in adolescence. He recalls seeing shirtless men with no
chest hair and well deﬁned abs on the covers of health and
ﬁtness magazine’s and thinking ‘‘that is what real men are
supposed to look like’’. As he consumed more and more of
these cultural messages from movies and TV, his focus
turned to achieving this desired masculinity and social
status through his physical appearance. He began shaving
his body hair, wearing tight shirts to highlight his body
deﬁnition, and spending a lot of time and energy in the
Similar to John, gay male patients with body image
disturbance cite media as a source of promoting a particular
look. The gay magazines they read or ‘‘check out’’ con-
sistently portray images of men that are lean and muscular.
This body type alludes to their sexuality and sexual pro-
wess. These standards of gay physicality are consequently
absorbed by gay male audiences and subsequently those
advertised features are internalized as blueprints of how
they must view their own physiques wholly or in part. John
remembers being ‘‘repulsed’’ by the bodybuilder look, but
‘‘enticed’’ by the idea of the ﬁtness model. To him, this
image maintained an ‘‘undeniable sexual attractiveness,’’
106 Clin Soc Work J (2016) 44:105–113
but without losing its connection to masculinity. He tightly
controlled his eating and became highly invested in his
appearance. As he became more invested, he consumed
more media and progressively recognized that he acted as a
conduit for the messages inherent in these images, judging
others for not achieving or endorsing similar standards and
ultimately holding his own self-worth contingent on these
culturally deﬁned appearance standards.
As noted in the clinical example, the image is of primary
importance in what it elicits in the observer. Models’ gazes
are particularly relevant in implying situations and contexts
that will affect consumer interactions and internalizations
(Hakala 2006). For instance, when a model’s gaze is
voyeuristic and is focused directly at the consumer, it will
be equated as if the viewer himself were looking into a
mirror. The model is saying ‘‘I want you,’’ and its inter-
active gaze may incite the consumer to identify with the
model, and to believe that he will resemble him if he uses
the advertised product (Hakala 2006). In pictures where the
model is not looking at the viewer, the lack of eye contact
has a narcissistic element. It is an objectifying look and
implies some subordinate qualities, essentially giving the
message of unavailability and inattainability (Hakala
2006). Kolbe and Albanese (1996) found that when a male
model’s gaze appeared to be downward and not looking
into the eyes of the observer, the model lost its subjectivity.
That particular stance motivates viewers to treat models
more as objects than as bodies in process (Rohlinger 2002).
Models take on the appearance of gods whose gazes are
groomed to instigate and allure.
In many cases, such as John’s, the culmination of this
body idealization is the escalating extremes of physical
appearance control. John reported ﬁrst taking anabolic–
androgenic steroids (AAS) when he was 18. For him it was
a perfect form of drug use because it promised an increase
in lean muscle mass, while also improving sex drive and
vigor. John’s ideal body had to be as potent in sexual
performance as it was attractive to others. At the height of
this drug use, John was spending several thousand dollars
per month on the AASs and other ﬁtness supplements and
other ancillary agents needed to control the effects of these
drugs. He would spend 4–5 h per day in the gym and took
to personal training as a career so he could maintain the
lifestyle associated with the pursuit and maintenance of this
masculine ﬁtness ideal. As was noted by McCreary et al.
(2007), men will often turn to using AASs in order to have
their bodies more fully take on the physiques that the
socioculture is expounding. John recounts that he learned
the majority of these behaviors through consumption of
magazines and internet sites designed to sell this masculine
The models used in media advertisements propagate
their visibility through desire and consumption. The image
of the body thus becomes greater than the reality of the
actual commodity being sold or the model who possesses
the idealized physicality (see Stratton 1996). In fact, the
human who created the muscular symmetry being observed
is lost. Total value is in what the ﬁgure exudes and the
sexual pleasures that would be exchanged in possessing the
commodity or body. Gay men with body image issues
consume and internalize muscular and toned bodies as a
way of reacting and compensating for being demasculin-
ized by a heterosexist society. This consumer-oriented
process touches on expressed and repressed sexual
desires—to ‘‘internalize, consume and possess the phallus’’
(Stratton 1996, p. 182). The more beautiful, muscular, and
toned the body, the bigger its phallus power will appear,
making the image more attractive and desirable. The
mesomorphic body satisﬁes the visual gaze and it also is
the representative fetished phallus that makes the gay man
more visible to others. The phallus in this regard is stret-
ched beyond the penis; it is meant to be the archetype,
never to be fully attained; the originator, from which all
others have been modeled and constructed. Internalizing
the ﬁgures in such an evaluative manner not only lends to
the objectiﬁcation of self (viewing one’s own body as an
externalized object to be judged) but it also triggers a
comparative mode by which to view one’s own body in
relation to the other.
Inevitably, not every gay man has the genetic predis-
position, time, energy, or motivation to endeavor certain
exercises and dietary regimens necessary to acquire the
body objects deﬁned or constructed as desirable. Conse-
quently, gay men with a predilection to body image issues,
whose bodies do not resemble the ideal objects they’ve
come to internalize, may likely develop dissatisfactions
with some aspect of their actual physiques. In the case of
John, he became preoccupied with the deﬁnition in his abs.
He desired the ‘‘V-line’’ that extends below the abdominal
wall to his pelvis, but could never satisfactorily achieve it.
Despite regularly maintaining body fat levels of 7–10 %,
John described himself as ‘‘chubby’’ and would often resist
taking his shirt off during sex and especially when in public
places where his appearance might be judged by others
(e.g., the beach).
The media’s propagation of idealized ﬁgures and its
inﬂuence on self objectiﬁcation inﬁltrates gay attractiveness
schemes. Advertisements directed toward gay male audi-
ences use body units, such as chests, biceps, shoulders, and
legs to simultaneously exude youthfulness, innocence (de-
pilated chests/androgyny), sensuality, and seductiveness
(Saucier and Caron 2008). The gay community proliferates
hypermasculine physiques in order to create visual cues that
will attract more male attention (Bridel and Rail 2007;
Duggan and McCreary 2004; Yelland and Tiggemann 2003).
The body is turned into a commodiﬁed representative of gay
Clin Soc Work J (2016) 44:105–113 107
sexuality and consequently the physique that is able to reﬂect
the idealized cultural standards is given a higher value than
the body that does not. Given such constructed dynamics, it
isn’t surprising that some gay men feel more pressure to be
attractive than their heterosexual counterparts (Marino
Carper et al. 2010). Research has suggested that gay men are
more likely than other individuals to obtain their sense of
self-worth based on their physical appearance (Yelland and
Tiggemann 2003). When held against such a backdrop, Sil-
berstein et al. (1989) ﬁndings continue to resonate today
when they noted that gay men cited attractiveness as the key
motivator for their exercise and weight control behaviors.
Studies have theorized that gay men are more concerned with
appearance and consider it an essential part of what consti-
tute sense of self (Gettelman and Thompson 1993; Siever
1994). Acknowledging the parameters of masculinity set by
the gay community and greater society, homosexuals turn
toward other males that exemplify the same physical aes-
thetics that demonstrate conformity to sociocultural con-
cepts of attractiveness (Kendall and Martino 2006; Lanzieri
and Hildebrandt 2011). Since similarities add to relational
attractiveness cues, gay men are attracted to speciﬁc physical
traits (e.g., muscularity, leanness, and athleticism) in a
potential partner because they too possess those same
In the case of John, he would only date or engage in
casual sex with men who had the speciﬁc detailing of
abdominal muscle that he pursued for his own appearance.
These men had to share a similar investment in outward
appearance and collude with the idea that self-worth was
contingent upon maintaining these appearance standards as
well as the sexual potency presumed to be natural to that
given physique. Ultimately, John would devalue himself in
these relationships and suffered from the inability of have
lasting or meaningful relationships with these men.
Daniel and Bridges (2010) write that [heterosexual] men
are subjected to the same sociocultural structure that
women are subjected to albeit without necessarily experi-
encing the evaluation from men that arise from being
objectiﬁed in various media genres. The premise of this
statement ironically shifts when relating it to gay men since
they, similar to heterosexual women, do experience the
evaluative gaze of other gay men. Bodies are considered
sexy in so much as they are successful in representing the
‘‘look’’ established as gay. Sexual bodies are commodities
evaluated for what they can attract and obtain from others.
The sequelae of being scrutinized as an object to be valued
in attractiveness and sexual contexts may cause some
people to internalize the evaluative gaze. In a study
assessing physical attractiveness preferences between gay
and heterosexual men, Swami and Tovee (2008) found that
homosexuals had a greater preference for men with lower
waist to chest ratios. Their ﬁndings conﬁrmed that upper
body muscularity is a key attribute in attractiveness pref-
erences amongst gay men, which is consistent with similar
research investigating the attractiveness preferences of
heterosexual women (Maisey et al. 1999). Varangis et al.
(2012) concluded that gay men who were not in a long-
term committed relationship were more likely to ﬁnd
muscularity and leanness as body attributes worth seeking
in prospective mates.
For gay men with a predisposition to body image issues,
physical ideals are not internalized and then subsequently
nulliﬁed. Rather these images are kept active, forming
vivid paradigms that some gay men utilize in comparing
their own bodies to idealized ones and to the bodies of the
men with whom they seek to have in short and long term
relationships. Social comparisons may operate in a manner
that adds to the negative effects of being exposed to
sociocultural images that propagate an idealized body
physique (Morrison et al. 2004a), and which consequently
come to inﬂuence the deﬁnitions of attractiveness. Social
comparisons may be either downward (comparing oneself
to someone worse off in the dimension being assessed) or
upward (comparing oneself to someone better off in the
dimension being assessed) (Heinberg and Thompson 1992;
Wheeler and Miyake 1992). The effective consequences of
the comparison is on whether the person who is being
evaluated is deemed to be on a greater or lesser than plane
of appearance (Morrison et al. 2004a).
In order to compete within the culturally constructed
paradigm of attractiveness, gay men are caught in a cycle
of consistent comparisons with individuals/ﬁgures that
have muscular and lean physiques. The level of body
image dissatisfaction they experience can therefore be very
much connected to the degree that individuals experience
sexual objectiﬁcation internally, from other gay men and
their male suitors (Siever 1994). Since many gay men have
already experienced some form of being castigated for not
following heterosexual gender and sexual norms, they may
comply with aesthetic dictates. Those men that do not
depict attractiveness in its accepted constructions are iso-
lated, stigmatized, and marginalized. For example, John
found himself at the time of treatment unable to be social,
having not dated in over 2 years, and feeling so depressed
that he planned to take his own life. In his mind, he had lost
the ability to achieve the ﬁtness standards and having
reached his early 30s, found himself feeling like an out-
sider to his community. This experience was complicated
by the physical and emotional consequences of having
pushed his body so hard in his 20s that he suffered a
number of health consequences including damaged liga-
ments in his shoulders, chronic digestive trouble, and male
108 Clin Soc Work J (2016) 44:105–113
By understanding more of the sociocultural and behavioral
relationships that foster body image dissatisfaction in gay
men, social workers, in their role as clinicians, can use
various therapeutic methods to create more positive con-
ceptions of self and can assist gay men with body image
issues in addressing and ameliorating the negative effects
of media imagery.
According to Waller et al. (2007), the empirical evi-
dence regarding the treatment of body image dissatisfac-
tion is not overwhelmingly clear. Research is not explicit
as to which treatment modality to employ, the type of
patient that would beneﬁt the most by a particular
approach, or at what stage in the treatment process the
intervention should be utilized. Additionally, past studies
have not taken pivotal steps in addressing intervention
techniques to be successfully used within minority popu-
lations (i.e., gay males), men, the elderly, and children
(Cash and Strachan 2002). Nonetheless cognitive-behav-
ioral therapies (CBT) have been used to treat body image
dissatisfaction within general populations and can be
effective modes to assist gay men with body image issues.
The established efﬁcacy of CBT has made it one of the
most widely used of psychological theoretical frames
(Granvold 1997). The empirically supported research that
lends credibility to CBT interventions and modalities
extend its broad base support across diverse populations of
clients and professional providers. Thompson et al. (1999)
stated that CBT was one of the two main treatment
approaches (the second being Feminist based psychother-
apy) for body image dissatisfaction that received high
endorsement from clinically controlled studies. Cash
(1996,1997) and Rosen (1996a) developed cognitive
behavioral strategies to address body image dissatisfaction
and their work has gained signiﬁcant empirical support and
is therefore recommended in treatment settings. A cogni-
tive-behavioral approach has also been supported and
proven efﬁcacious in the treatment of Body Dysmorphic
Disorder (Phillips 2001; Rosen 1996b).
The rationale for utilizing CBT in addressing body
image and eating disorders runs directly with the mental
thought processes that gay males with body image issues
are understood to possess. Maladaptive thought patterns are
believed to keep the individual tied to cycles of feeling
dissatisﬁed with his appearance and eating in an unhealthy
manner. Psychological issues are consistently centered on
the body’s muscularity, shape and overall appearance. It is
believed that the obsession with such issues stem from poor
self-esteem and the internalization of sociocultural mes-
sages (Beren et al. 1996; Levesque and Vichesky 2006;
Russell and Keel 2002). The low self-esteem induces
devaluation in physical appearance, which may motivate
the individual to partake in behaviors (e.g., dieting,
excessive exercising) aimed at improving appearance.
There are various CBT techniques used to treat body
image dissatisfaction and disordered eating patterns. The
Socratic method assists patients in identifying and chal-
lenging the thoughts that lead to negative body image and
poor eating behaviors. Within the Socratic technique there
are elements of psycho-education that may be used to fur-
ther facilitate the learning process (Fairburn 2008; Whit-
ﬁeld and Davidson 2007), although the primary function is
to raise dissonance between the entrenched belief and evi-
dence from real life that contradicts this belief or its value.
As was noted in John, some gay men do engage in dieting
behaviors related to negative body image, therefore it would
be important to assess whether foods are being consumed in
a healthy manner. Food records provide the opportunity to
achieve ‘‘regular eating,’’ while endeavoring to also estab-
lish cognizance with certain dietary marks and the feelings
that they induced (Fairburn 2008, pp. 75–77), especially
when assessing body appearance. This effect often occurs
when weight undergoes little measureable change after
weeks of stabilized regular eating that includes adequate
variety and the absence of rigid dietary rules.
Exposure exercises using media imagery can facilitate
cognitive restructuring. The clinician should gauge the
patient’s thoughts and feelings and the behavioral respon-
ses they elicit (O’Brien and LeBow 2006; Parent 2013),
particularly about the self and the cultural messages related
to attractiveness and the body. Throughout the exercise of
viewing different images, patients should be asked to
elaborate on their internal experience. Cognitive distortions
should be acknowledged and assessed. Cognitive restruc-
turing will help build a new set of values about the self in
relation to one’s appearance, and will also assist in modi-
fying the associated behaviors (Cash and Strachan 2002;
Parent 2013). Additionally, if patients’ eating patterns are
being affected by body image issues, therapists may
explore patients’ feelings in the presence of both food and
media imagery. Patients will be instructed to eat food while
looking at speciﬁc media photos, and then be asked to
reﬂect on the thoughts and feelings being experienced.
Both therapists and patients will sift through the cognitive
schemes and emotive responses, and pay particular atten-
tion to those that motivate harmful behaviors (e.g., exces-
sive dieting and exercise) (Fairburn 2008). Therapists will
work to help the patient restructure some of the destructive
thinking that keep patients in a looping mode.
CBT therapists also use mirrors to address feelings and
thoughts patients experience in viewing themselves. Patients
may be speciﬁcally asked to uncover parts of the body that
are deemed problematic or shameful in order to better
Clin Soc Work J (2016) 44:105–113 109
process underlying emotions (Cash and Strachan 2002).
Homework assignments such as journaling and log keeping
are also prescribed in order to further identify the patterns of
dysfunctional cognitions and behaviors as they relate to body
image. The therapist and patient review the diary entries and
attempts are made to restructure the cognitive interactions
between self and situational triggers (Cash and Strachan
2002). The cognitive process is tracked by (1) noting the
contexts that particularly triggered a dysfunctional thought,
(2) identifying the thought and all its cognitive tags, and (3)
challenging the thought itself (Wilson et al. 1986). Mirror
exposure is a potent technique used to train individuals how
to process their visual image in a neutral and accurate way
(Hildebrandt et al. 2012). Individuals stand in front of a
mirror and describe themselves to a sketch artist who draws
them with precision, without seeing them. This focus shifts
attention from unwanted aspects of appearance to a more
gestalt conceptualization of the body. Because this type of
evaluation involves equal attention to visual inputs often
ignored by the patient, the output results in a more normal-
ized and healthy view of one’s appearance.
John received treatment for his persistent body image
concerns following the core CBT strategies described
above. The ﬁrst goal involved developing a mutually
deﬁned case-conceptualization of how is body image dis-
order functioned. The purpose was to identify key aspects
of his thinking and behavior that maintained poor body
image. For John, this involved conceptualizing his own
self-worth via outward appearance and integrating his
learning history (i.e., being praised for aspects of his
appearance, seeing others praised for aspects of their
appearance, cultural endorsement of appearance standards,
etc.) into day-to-day experiences with his body. The con-
nections to his history included how the sociocultural
environment reinforced the view of his outward appearance
as deterministic of his self-worth. The sequelae of speciﬁc
events or memories of engaging in the sociocultural envi-
ronment (peers, media, family, and partners) are all inte-
grated into a ﬂow-chart summarizing how these
experiences contribute to the core disturbances expressed
presently. Behaviors involving diet, shape and weight
control were further connected to this functional descrip-
tion via their temporary value in reducing distress, but their
added cost of further investment in the ﬁtness ideal. In
other words, the more he worked out, rigidly controlled his
diet, and took drugs to change appearance, the more
strongly he held to the belief that the appearance he desired
had immense value. Over time, this type of investment
weakened his resilience and adaptability to the normal life
demands inherent in development (e.g., professional iden-
tity, aging and disease, interpersonal relationships, etc.).
Consequently, he became depressed and hopeless that he
would ever achieve an adequate level of self-worth.
In traditional CBT approaches, it is common to have
patients explicitly seek to expand the sources of self-eval-
uation from body-focused to a broader range of domains
including relationships, profession, religion/spirituality,
family, friendships, and hobbies or interests. By expanding
the sources of self-evaluation, the patient aims to create a
more resilient and stable internal view. For John, this pro-
cess involved identifying his negative emotional response
to these messages, memories, and experiences and labeling
them as his ‘‘toxic self’’. This labeling process facilitates the
separation that lies between pathological and healthy
experiences and reduces shame related to his current
adoption of many unrealistic body standards. Once there
was a clear distinction between healthy and unhealthy
selves, goals were set to engage in meaningful things
unrelated to body image that were consistent with his
healthy self. For John, many of these actions involved small
daily events that were consistent with his overall values. For
example, he made a point of smiling to strangers, making
extra calls to family and friends, and writing notes to his
cousins with life updates. This expanded set of schemas
related to a healthy self allows for variability and imper-
fection in appearance without the threat of low self-worth.
Consequently, systematic goals are set to achieve greater
time, energy, and investment in these other domains.
Gay men may also beneﬁt with partaking in cognitive
dissonance interventions similar to the Body Project (Stice
and Presnell 2007). Originally, the Body Project focused
on teaching adolescent girls how to navigate through and
resist along the way the sociocultural messages to be thin.
In assessing the Body Project’s efﬁcacy in a large ran-
domized trial of 481 adolescent girls, Stice et al. (2006)
found that participants demonstrated a signiﬁcant reduction
in body image dissatisfaction compared to the control
group. By modifying certain aspects of the intervention to
be used for gay men (i.e., lean and muscular images instead
of thin), the cognitive dissonance related to sociocultural
values would be addressed (see Feldman et al. 2011). Gay
men would be engaged to critique lean and muscular
images through written, verbal and experiential exercises.
The primary purpose would be to target the cognitive
dissonance, and reduce the person’s valuation of idealized
male physiques (Feldman et al. 2011). Stice and Presnell
(2007) indicated that the Body Project was adapted suc-
cessfully by different populations without impacting the
program’s efﬁcacy. Therefore, it could very well be an
intervention tool utilized within the gay community.
Practical Implications for Implementation of CBT
for Body Image
Despite stereotypes about the lack of depth obtained in
treatment, CBT offers the ﬂexibility to ﬁlter almost any
110 Clin Soc Work J (2016) 44:105–113
relevant experience of a patient through a process of
thinking, feeling, and action. The divergence from insight
oriented therapies occurs most clearly in the focus on
achieving new learning. Consequently, insights obtained
through transference-countertransference, objective assess-
ment, or experiential work must be adapted to a sequence of
thinking, feeling, and action in order to be meaningfully
used in treatment. For instance, John’s initial idealization
of the therapist as a conﬁdent and attractive man was
broken down into the initial thoughts (e.g., ‘He must be
very conﬁdent in his appearance’), feelings (e.g., fear of
not being able to achieve this standard), and action (e.g.,
avoiding discussion when experiencing difﬁculty in com-
pleting exercises on body image outside of session).
Counter-transference is also dealt with through the same
framework, breaking down the therapist reaction to
inconsistent attendance as a sequence of thoughts (e.g.,
‘‘He is afraid of doing the work he needs to do in treatment
to get better’’), feelings (i.e., ‘‘worried that I am not doing
enough’’), and action (e.g., ‘‘making extra calls outside of
session to remind him of the assignments or to check that
he does not need extra support). The functional output of
these experiences is then applied to basic learning theory as
either being maintained through classical or operant con-
ditioning. In classical conditioning, the co-occurence of
two independent things (e.g., empathy by therapist and
discussion of changes in body image) lead to perceived
associations that reﬂect anticipation and response. In other
words, the therapist begins to anticipate that empathizing
will increase discussion of body image change. A second
form of learning, which often co-occurs with associative
learning, is operant conditioning. In this form of learning
there is a clear cause-effect sequence of events. For
instance, calling John outside of session to check on him
leads to decreased attendance and homework completion,
than the functional interpretation includes the basic
understanding that something about calling John elicits
poor attendance/compliance with treatment. From this
understanding, the therapist can begin to alter the func-
tional relationship via changes to the system. For instance,
not responding to the initial urge to call John and letting
him struggle with the CBT assignments until he develops
his own mastery over the skills.
Objectiﬁcation theory can adequately mark a pathway by
which media imagery are internalized by gay men and
consequently negatively affect their body image. Objecti-
ﬁcation theory frames the internalization process in a
manner that references various facets that contribute to gay
men’s body image scheme. By understanding these speciﬁc
nuances, we are better able to address the sociocultural
factors that play a role in creating body dissatisfaction. The
implications of body dissatisfaction are broad but particu-
larly impact eating patterns and exercise behaviors. Social
workers can therefore utilize treatment techniques to both
minimize and prevent the effects that viewing idealized
physiques portrayed in the media have on gay men.
Additionally, their treatment work can positively inﬂuence
future research endeavors by providing information on
which facets of the media and socioculture are particularly
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Nicholas Lanzieri, Ph.D, LCSW currently works with university
students providing wellness related services and teaches part-time at
NYU’s Silver School of Social Work.
Tom Hildebrandt, PsyD is the Director of the Eating and Weight
Disorders Program at Mount Sinai Hospital and Assistant Professor of
Psychiatry a the Icahn School of Medicine at Mount Sinai.
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