How to Navigate Bad Body Image Days: A Therapist’s Guide to Evidence-Based Strategies

We all have those days. The ones where we catch a glimpse in the mirror and suddenly feel like we’re inhabiting the wrong body. Or when old thought patterns creep back in and whisper those familiar lies about our worth being tied to the space we occupy. Bad body image days happen to all of us, even well into recovery, and I think we can agree that they’re a special kind of hell.

The Body as Battleground

First things first…I think it’s important to give credit where credit is due here. We live in a culture that’s designed to make us feel inadequate in our bodies. Every advertisement, every “wellness” influencer, every before-and-after transformation story reinforces the message that our bodies are projects to be fixed rather than homes to be inhabited and vessels in which and through which we do our lives. 

Is it any wonder we sometimes wake up feeling like our skin is enemy territory?

When I’m working with clients, I often tell them that having bad body image in our society isn’t a personal failure – it’s a reasonable response to unreasonable expectations. The problem isn’t us; it’s a culture that profits from our dissatisfaction.

Perspectives Shift

I also like to frame body image as the result not of our body, but of our brain. Specifically, of our perspective, or the many factors that contribute to how we see something at any given moment. Take, for example, my kitchen table. 

My kitchen table is, let’s just say, well-loved. It’s beat up, replete with scratches and water marks, paint splatters and nail polish spills, and somehow always also some maple syrup. And on a good day, I recall the many activities that have made it so: months(!) spent doing online school and work during Covid, literal years of rainy day craft projects and after school homework sessions, and the meals that we share daily when we freaking can. 

But on a not so good day, on a day when my stress has been high or my sleep was not good or, for whatever reason, my window of tolerance is more narrow, I make it mean something much more negative and self-critical, and it takes everything in my power to not throw it on the burn pile in the backyard.

The table did nothing wrong. The table is the same. It’s me, and my lens, that’s different.

Sometimes, that’s enough. It’s enough to remember that, if I can avoid making this moment mean more than it does in the moments to come, then sooner or later, I will feel differently towards whatever it is that has got me in knots – my table one day, my body another. 

But sometimes, as is to be expected, we need more tools. So below are some other evidence-based therapeutic techniques to get us through the worst of body image distress.

Acceptance and Commitment Therapy: Letting the Hard Stuff Stay, but Mean Less

Acceptance and Commitment Therapy (ACT) offers, I think, a radical option. Instead of trying to positive-think our way out of body hatred and self-criticism, ACT invites us to make room for these difficult thoughts and feelings (acceptance) while still moving toward what matters to us (commitment).

On bad body image days, the ACT approach looks something like this:

1. Notice without attachment: “I’m having the thought that my body is disgusting today.” Just naming it as a thought, not a truth.
2. Create some distance: “I notice that my mind is having a thought that my body is disgusting today.” Or you can get creative: “My mind is playing that greatest hits album of body shame again.” Bonus points for actually singing the thought to, say, the tune of “Happy Birthday.” It’s just a thought: a selection of words strung together. You are not your thoughts.
3. Connect with context: “I’m noticing I’m having more body image struggles since that comment at dinner/after scrolling through Instagram/before this event.” Understanding triggers doesn’t eliminate feelings but can add empathy or compassion and can help us respond more skillfully.
4. Clarify values: “Even with these thoughts present, what kind of person do I want to be today? What matters to me beyond how I look?”

The point isn’t to make the uncomfortable thoughts disappear – let’s be honest, that approach is about as effective as telling someone to “calm down” when they’re upset, which has literally never worked. Instead, it’s about changing our relationship with those thoughts so they don’t dictate our actions.

Exposure and Response Prevention: Doin’ the Damn Thing

Borrowed from OCD treatment, Exposure and Response Prevention (ERP) principles can be game-changers for body image struggles. The core idea is deliciously simple yet profoundly difficult: face the fear without engaging in the compulsive behaviors that temporarily reduce anxiety.

On bad body image days, this might look like:

• Wearing the outfit that feels comfortable rather than the one that “hides” your perceived flaws
• Looking in the mirror without engaging in the usual body-checking ritual
• Going to the social event even though your brain is telling you that you shouldn’t be seen
• Not seeking reassurance about how you look

Each time you face a body-related fear without avoiding it or giving in to it in some way (through restriction, over-exercise, body checking, or other compensatory behaviors), you’re teaching your nervous system that you can tolerate the discomfort. The key is to resist the urge to “fix” the feeling, which only reinforces the idea that there’s something wrong with your body…that it needs fixing.

DBT Skills: When Your Emotions Have Run Amok

Okay but how, right? How do we resist the urge and tolerate the discomfort that comes up? That’s where Dialectical Behavior Therapy (DBT) comes it. DBT offers concrete tools (and acronyms!) for those days when your emotions about your body are so intense they feel like they might swallow you whole:

Distress Tolerance:

• STOP skill:
  • Stop: literally, don’t move a muscle 🛑
  • Take a step back: take a slow, deep breath to create some space
  • Observe: notice what is happening in your body, what is happening around you, and what you may be making it mean
  • Proceed Mindfully: consider, “What do I want from this situation,” and move forward calmly
    
    
• TIPP skill:
  • Temperature change: cold water on your face, for example
  • Intense exercise: only a quick burst – get your heart rate up fast and then rest
  • Paced breathing: try inhaling for four seconds, exhaling for six seconds
  • Progressive muscle relaxation: tense a muscle group, relax the muscle group, head to toe
    
    
• Radical acceptance:  
  
  “My body image is in the toilet today, AND I can still show up for my life,” OR, “Okay, I’m having a difficult time with how I feel about my body today. I’m feeling [describe the feeling, e.g., ashamed, disgusted, self-critical]. It’s okay to feel this way. I am not going to fight it or try to push it away. I am just going to acknowledge that this feeling exists right now and try to be kind to myself as it passes through.”
  

Emotional Regulation:

• Opposite action: When shame tells you to hide, gently push yourself to remain engaged
• Check the facts: “Is my entire worth really determined by how my stomach looks in this outfit?”

Mindfulness:

Okay, you know how a lot of people talk about mindfulness like watching clouds in the sky or leaves in a stream. That’s lovely, but y’all, that is NOT how my brain works, and that can feel a little inaccessible when I’m in a moment of high emotion.

I find it more helpful to think about it as standing on a busy street corner – think Boston over Brattleboro – and watching the cars by. They get louder as they get closer (the Doppler effect – middle school science FTW!), and some can feel down right menacing as they do. But if we let them pass without asking them to pull over and take us wherever it is they’re going, they pass. They get quieter. And we can breathe again as, for at least a time, one unthreatening minivan-of-a-thought after another passes by.

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But here’s the thing about DBT skills: they’re not about making you feel better immediately. They’re about helping you not make things worse while you navigate the storm. Because sometimes, that’s the victory – not making a hard day catastrophically worse by restricting food, canceling plans, or diving headfirst into shame spirals.

A Practice for Bad Body Image Days

So what does all this look like in real life? Here are a few scripts, from a few different modalities. Choose your own adventure!

1. Name it (ACT): “I’m having a bad body image day. These thoughts are showing up, and they’re really loud right now.”
2. Feel it fully (DBT): Allow the emotions to be present without judgment. Use mindfulness to observe where you feel it in your body without trying to change it.
3. Breathe (DBT): “This is temporary, and I and I can help my body and brain get through this moment.”
4. Broaden the lens (ACT): “My body is just one aspect of who I am. What else is true about me today? What else matters? Who would my friends say that I am? Who would I say I was prior to this discomfort?”
5. Choose a valued direction (ACT): “Even with these thoughts present, how can I move toward what matters to me today?”
6. Practice self-compassion: “This is really hard. Many people struggle with this. How would I respond to a friend feeling this way?”
7. Face fears without feeding them (ERP, no pun intended): Identify one small way you can resist the eating disorder voice today.
8. Stay connected (RCT): Reach out to someone safe. Share vulnerably or simply be in their presence without the need to perform “okayness.”

A Reminder About Recovery

Recovery isn’t about never having bad body image days. It’s about having different responses when they inevitably arrive. It’s about expanding your life so that body image becomes just one small part of your experience rather than the center of your universe.

And it’s about knowing even in the midst of a body image ups and downs that something more true and steadfast and inherently worthy about you endures.

In a culture obsessed optimization and ease, perhaps the most radical act is accepting that some days will be hard, some feelings will be uncomfortable, and that’s not a sign of failure – it’s just part of being human.

On bad body image days, let’s try to remember that our bodies aren’t projects to be perfected but vehicles through which we experience everything that matters: connection, purpose, joy, and yes, even conflict and messiness and hurt.

Need More Support With Body Image Struggles?

And of course, if it feels hard to do this alone (which it so, so often does), please don’t (do it alone, that is). Body image concerns often benefit from professional support, especially when they’re impacting your daily life and well-being.

As a therapist specializing in eating disorders, disordered eating, and body image concerns, I work with clients to develop personalized strategies for navigating these challenges using evidence-based approaches like ACT, DBT, and ERP.

Get in touch to schedule a free 15-minute consultation call to see if we might be a good fit to work together on your relationship with your body.

You got this! 🫶

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What practices help you navigate bad body image days? I’d love to hear your experiences in the comments.