Building Positive Body Image through an Interactive Body Positivity Program: A Positive Psychology Perspective Journal of Social Science & Allied Health Professions

Purpose: With this pilot study, we evaluate the outcomes of an interactive body positivity program designed to mitigate symptoms of negative body image and to support the development of positive body image among college women who self-identified as experiencing struggles with body dissatisfaction. To develop the body positivity program, we adopted a positive psychology approach to nurturing positive body image. The specific purpose of this research was to explore college women’s perceptions about how participation in the program supported changes in their ways of thinking relative to body image. Methods: In-depth interviews were conducted with nine participants before and after program participation. Data were transcribed and were analyzed using the constructionist grounded theory approach. Findings: Participants uniformly appreciated the opportunity to be a part of our program. Although participation did not wholly ameliorate participants’ body image concerns, participants frequently articulated post-program experiences reflective of the positive psychology conceptualization of flourishing and of the core features of positive body image, including (a) a newfound appreciation and care for the self/body, (b) flexible thinking, (c) engaged coping, and social support. Participants also offered recommendations for future offerings of the program. Conclusions: Participation in our program served a protective function against feelings of body negativity by strengthening participants’ body images and by providing participants’ access to a “toolkit” of skills to combat body negativity when it did arise. In the future, it will be important to build upon this exploratory analysis by assessing whether the benefits discovered in the present work are sustained long-term. Advances in Knowledge: Our interactive body positivity program represents a beginning effort to develop, pilot, and evaluate a body positivity program grounded in positive psychology and related empirical work on the concept of positive body image.

health represents the absence of negative mental health as well as characteristics associated with positive mental health, such as flexible thinking, enriched interpersonal relationships, and resilience (1,3,4). As such, within therapeutic interventions, it is essential to both minimize negative characteristics of a mental health construct (e.g., body image) as well as to foster positive characteristics of that construct (1). According to the positive psychology perspective, minimizing negative characteristics without nurturing positive characteristics will yield an intermediate mental health state, but not one characterized by exceptional well-being, or "flourishing" (1,5,6). Individuals who flourish have generally positive affect, which allows them to appreciate themselves, to engage in flexible thinking and proactive coping, and to feel accepted in and positive about their social relationships (1).
In recent years, researchers have dedicated attention to conceptualizing and exploring the construct of positive body image, adopting a positive psychology perspective to do so (1,7,8).
This research suggests that positive body image is independent of negative body image, is multifaceted, and is protective. This work further suggests that positive body image is not incumbent upon satisfaction with all components of one's appearance, is not limited to aspects of physical appearance at the exclusion of other aspects of the body (e.g., functionality), and is not indicative of being vain or narcissistic (7). Core features of positive body image identified through this work include body appreciation, body acceptance and love, a broad conceptualization of beauty, inner positivity, and filtering information in a body positive manner (1,8).
Researchers also have identified characteristics that promote and emerge from having a positive body image (1,8,(9)(10)(11). This work suggests that positive body image is supported by being unconditionally accepted by others, by developing media literacy skills, by embracing one's spirituality, and by practicing self-compassion.
Consequences or outcomes of having a positive body image may include offering help to others suffering from negative body image; engaging in self-care behaviors (i.e., behaviors to nurture the mind, body, and soul); and opting to befriend others who also have a positive body image.
With this exploratory pilot study, we describe and evaluate the outcomes of a body positivity program grounded in positive psychology and designed to mitigate symptoms of negative body image and to support the development of positive body image, including "appreciating, honoring, and celebrating" the body (1) through interactive discussions and activities. With our initial offering of the program, we chose to target the needs of early adult college women 1 (aged [18][19][20][21][22] who selfidentified as experiencing struggles with body dissatisfaction. Among young women, dissatisfaction with the body has been found to increase during the transition from adolescence to early adulthood, a trend that is linked to attendant increases in body mass index (BMI) (13). It has been argued that demands for thinness and attractiveness may be particularly intense within the context of the college campus, prompting concern for and attentiveness to body image among college women, in particular (14). As many as 90% of college women report some degree of dissatisfaction with the body (15), which places them at increased risk for compromised self-esteem, depression, and disordered eating (16). Our key research question for this inquiry, then, was whether participants perceived a change in their body images and selves by virtue of their participation in our body positivity program?

Program Development
Wood-Barcalow et al. (8) and Tylka (1)  Consistent with the positive psychology approach, our body positivity program seeks to nurture positive body image by positioning participants to "flourish" (1,5,6). Participants met every other week across eight weeks. Table 1 includes a summary of the content of each program session, including objectives that guided the session, topics covered in the session, sample activities participants completed, and core features of the positive psychology perspective on body image integrated into session content. We purposefully opted not to include content addressing weight-loss strategies in our program curriculum, as we sought to mitigate negative body image and to support positive body image among women regardless of their weight/body mass index (BMI) (18). In facilitating the program sessions, we attempted to foster experiential learning and interactions among participants whenever possible through in-session discussions and hands-on activities.
With the present work, we consider the analysis of qualitative data collected to address outcomes of participation in our body positivity program; analyses of quantitative data are forthcoming. Insomuch as qualitative approaches emphasize participants' voices, they are valuable in understanding the meanings that individuals assign to a lived experience (19). Thus, of interest in the present analysis were college women's perceptions about how participation in our body positivity program -that is developed with a positive psychology perspective -supported (or did not support) changes in their ways of thinking and seeing relative to their body image and their sense of self.

Participants
The body positivity program was piloted to nine women in spring 2018 2   Demographic profiles for participants are reported in Table 2. Within Table 2, and throughout the discussion, participants are referred to by code 2 We originally recruited 13 participants, but 4 participants discontinued their enrollment in the course of the program due to schedule conflicts. This was understandable given that the participants were drawn from the college student population, and all sessions were scheduled on Saturday mornings. Later, with the agreement of study participants, we shifted program sessions to late weekday afternoons, and the issue was resolved.
identifiers (e.g., P1, P2, etc.). Participants ranged in age from 18 to 20 years (mean = 18.6 years). Six participants self-reported their race/ethnicity as "White," two participants self-reported their race/ethnicity as "Hispanic," and one participant self-reported her race/ethnicity as "Black." Participants' body mass indices (BMIs) were calculated based upon self-reported weight and height and ranged from 21.8 to 46.1 (mean = 27.5).
Three participants were classified as "normal weight" based upon their BMIs, five participants were classified as "overweight" based upon their BMIs, and one participant was classified as "obese" based upon her BMI.

Data Collection
All nine participants gave written, informed consent to participate in two assessment sessions immediately before and after the program. As part of the initial assessment session, we conducted a semi-

Data Analysis
Interviews were transcribed verbatim. Prior to beginning the data analysis, we divided the interviews into meaningful chunks of text, a process referred to as "unitizing" the data (20). Although our aim was not to develop a new theory, we adapted elements associated with the "constructionist grounded theory" approach (21) to analyze our data.
We valued this approach for its emphasis upon gaining interpretive understanding of participants' realities and its focus upon identifying emergent meanings within the data (21). First, we adapted an "open coding" process to search each text unit, line by line, for key concepts meanings within the data (21,22). Although, during this process, our primary aim was to understand participants' views of their realities, we also remained attuned to how the "sensitizing concepts" of positive psychology and positive body image could deepen our understanding of the data (i.e., insomuch as participants' realities aligned with prior understandings in the literature) (21). Next, we compared concepts identified through open coding to one another and grouped similar concepts together under more general "categories," engaging in "constant comparison" (21)(22)(23). We then developed the concepts and categories into a coding guide (i.e., a list of inductively generated codes), which the first author applied to the data by identifying all instances of each concept/category in the data, thereby facilitating a more in-depth analysis. During this process, the first author continued to search the data for new meanings, incorporating additional concepts and categories into the coding guide as needed. Finally, we adapted more conceptual, directed searches of the data for fit with emerging themes -sometimes referred to as We adapted several strategies to establish trustworthiness and dependability of data collection and analysis (24). To encourage open dialogue with participants, we guided participants to be candid in their interview responses and reassured them that there were no "right or wrong answers" to the questions asked. All interviews were conducted by the body positivity program staff who were acquainted with the participants, which could have increased participants' comfort in sharing their experiences within the program. 3 Additionally, throughout the data analysis process, we engaged in regular dialogue, contemplating meanings and relationships discovered within the data until mutual understanding among authors was achieved. And, to confirm the reliability of the first author's application of the coding guide to the data, the third author independently coded three randomly selected transcripts (i.e., 1/3 of the data). Interrater reliability between the first and third authors was 85% and was calculated by dividing the number of agreements about coding decisions by the total number of 3 It is possible, however, that the interviewers' affiliation with the body positivity program may have compromised some participants' willingness to disclose negative experiences within the program. This is a limitation of the study. coding decisions made. The authors negotiated disagreements about the application of the coding guide.

Results
In the following discussion, we present themes that emerged from our analyses of preprogram and post-program interview data. In analyzing our data, we took the position -often advanced by qualitative researchers -that, if even a single participant reported an experience, it could produce a meaningful insight and be worthy of careful consideration to the research. Further, rather than to yield to the positivistic impulse to quantify our data by reporting frequency counts for the occurrence of various themes or subthemes, we have used terms such as "most," "many," "selected," and "few" to provide a sense of how many participants within the data set shared a given perspective. Such an approach is generally considered most appropriate with a small, purposive sample (25).

Pre-Program Interview Data: A Critical Interpretive Lens
Brief narrative sketches of the critical body image experiences each participant shared in her pre-program interview are presented in Table 2.
These sketches -and the themes discussed in this section -offer a critical interpretive lens for understanding the potential for our body positivity program to give rise to more positively-charged body image experiences. In critiquing their bodies and appearances, participants also often regarded themselves as "body parts" rather than as whole individuals with unique bodies and souls. In prior work, this tendency has been linked to body-focused negativity and has been found to be more common among women (30) In spite of a history of discouragement and disappointment, several participants continued to intermittently restrict their food intake in various ways (e.g., omitting various foods from their diets, consuming diet products, consuming foods perceived to be "healthy"), often with the intent of losing weight. Participants framed exercise more positively than dieting, praising it for its capacity to support self-image and to assist with stress management.

Mechanisms
However, exercising, too could be a source of guilt and shame, when participants could not make time for it, or when participation in it did not achieve desired (weight loss) ends. Selected participants also sometimes sought to soothe their body image concerns by pushing such concerns to "the back of Participants spoke candidly about severe food restriction that had its roots as a dare from an adolescent friend (P5), about a mother who required her daughter to diet and wear a corset for eight months in preparation for her quinceañera (P4), and about a mother who put down her own body (P7) or her daughter's body (P5): Analyses of post-program interview data revealed that participants uniformly appreciated the opportunity to be a part of our body positivity program, finding the experience to be valuable and rewarding and characterizing the program as "helpful," "informative," "educational," "fun," "enjoyable," and "empowering.  4 Interestingly, participants' post-program experiences did not vary in any distinct ways along BMI. What was clear is that participants approached program content from a standpoint of lived experience with body dissatisfaction, independent of BMI.
In seeking to accept their bodies "as is," these participants described how they were working to be less critical of and more forgiving of aspects of the self that they did not "like," even invoking the truism of self-compassion that they should treat themselves as a "loving friend" might (32). P8 identified her participation in the "Practicing Self-Compassion" activity (see Table 1 Additionally, a couple of participants articulated how, after their engagement in the body positivity program, they had become more confident about accepting compliments without feeling the need to offer a deprecating remark about the self, seemingly finding the courage to transcend Western cultural expectations for women to deflect praise about the self (33). And, as they became more accepting of themselves, several participants also began to value those aspects of themselves that they perceived as "unique," "special" or more authentically "themselves." For instance, P4 shared how her participation in the program prompted her to abandon her decision to "go blonde" and to instead embrace the beauty of her brunette hair.  As echoed in P5's remarks above, the deepened recognition that cultural beauty ideals are dynamic -and, frequently "out of reach" for most "real" women -positioned some participants to discount or question these ideals. Thus, although participants We characterized participants' acknowledgement that they were "more than" their appearances as the   5 In prior work, proactive coping, or coping undertaken in anticipation of a stressful experience (35), has been linked to flourishing. Here, we characterized the coping strategies described by participants during their interviews as "engaged" rather than as "proactive," because not all of the coping strategies discussed by participants represented future-oriented coping. For instance, reframing of a past interpersonal interaction was not undertaken in advance of the stressful situation. Like proactive coping, engaged coping does require the demonstration of initiative, and in this way, could be considered "proactive" (31,36). technology (e.g., Photoshop) is frequently used to digitally manipulate imagery of the female body. Through reframing, then, P5 came to see what she might have interpreted as an affront from her mother as an honest mistake on her mother's part. P5 also sought to assuage tense body-related exchanges with her mother through the adoption of a second coping strategy taught within our body positivity programbeing more assertive (39). Thus, when P5's mother "crossed a line" in her discussions about P5's body, P5 confronted her, noting, "You need to stop discussing my body." In the context of this discussion, P5 was able to share her concerns with her mother, with the goal that the two of them could achieve mutual understanding of the situation.
Social Support. In their post-program interviews, several participants articulated how their involvement in the body positivity program had prompted varied experiences in which they were either the recipients or the providers of social support, or those behaviors undertaken to help an individual navigate a stressful experience or reach a personal goal (40). The social support received and shared by participants was affective/emotional in nature and included expressions of concern, care, reassurance, sympathy, empathy, and love (41).  Participants' recognition of these readily accessible sources of support and acceptance is significant, as in prior work, support and unqualified acceptance by others have been found to promote (and develop from) positive body image (1,8).

Recommendations for Future Offerings of the Body
Positivity Program.
Although, as noted, all participants shared that they were grateful for the opportunity to participate in the body positivity program and perceived that they had benefitted from their engagement in the program, several participants also made recommendations for further strengthening the program. The most commonly shared suggestion was to provide even "more space for discussion" (P3). Thus, dialogue among members -and the ensuing support shared -was perceived as a "strong aspect that could be elaborated upon" (P6   (1,(9)(10)(11)42) -themes that were interwoven into the program content.
Notably, participants also described how the program helped them to develop skills (e.g., various engaged coping skills) and/or to recognize and appreciate resources (e.g., sources of social support) that could assist them in managing feelings of bodily 6 This is consistent with the proposition that negative and positive body image are independent of one another and can coexist as well as the idea that positive body image does not imply strong satisfaction with all aspects of one's appearance (1,8,42). concern when they did arise. Here, participants shifts in the social environment such that a broader range of bodily sizes, shapes, and appearances come to be valued and accepted (18). Although, there has been some positive movement in this direction in recent years (43), our participants' pre-program accounts suggested that they still felt quite stifled by contemporary Western beauty ideals and norms.
Through their consumer power, however, women may have the potential to play a critical role in prompting future changes in cultural representations of women's bodies (18). The key, then, is helping women to be empowered and to find a way to mobilize this potential.