Positive Body Experience protocol

Domain IV · Body-oriented psychotherapy · Rekkers, Van Gullik · 2021 · Netherlands

What it is

PBE is a manualised psychomotor therapy (PMT, the Dutch body- and movement-oriented profession) intervention for negative body image in eating disorders (EDs). It was developed over roughly ten years in Dutch outpatient ED care. Its core technique is positive body exposure: guided, structured…

Format

• Format. Individual or group delivery in outpatient ED treatment, by a psychomotor (body- and movement-oriented) therapist. In the pilot it was delivered alongside the patients' broader ED treatment. Which format the pilot used, and how long each session lasted, were not reported.
• Dose. 12–17 sessions in total, depending on how much psychoeducation and stabilisation a patient needs. Sessions were generally held once every two weeks. In the pilot the mean was about 14 sessions, about a quarter had 11 or fewer, and the maximum was 27.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• a vague plan. Make it specific and written. It's working when the patient can name warning signs and the steps they will take.
• gains that hold only with therapist prompts. Lengthen stabilisation rather than ending. It's working when the patient can lead the exposure independently.
• the patient agreeing politely but privately believing that only weight change will help. Ask directly. It's working when the patient can explain the rationale and agrees to try.
• the patient describing only disliked parts. Note it as part of the pattern rather than correcting it. Distress rising during listing is a cue to slow down. It's working when the patient can name…
• upward comparison sneaking back in, or weight-stigmatising remarks about the other person. Redirect both. Some patients feel guilty about downward comparison, so frame it as attention training, not…

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.