1 INTRODUCTION

… being ourselves pure and not entombed in this which we carry about with us and call the body, in which we are imprisoned like an oyster in its shell (Plato, 250c).

Over the past two decades, research has begun to shift its attention towards positive body image, in order to elicit a more holistic and comprehensive account of the concept of body image (for reviews, see Tylka, 2011, 2012). Positive body image can be broadly defined by one's love and acceptance of their body and is attained by appreciating the body's uniqueness and functionality (Tylka, 2011, 2012; Tylka & Wood-Barcalow, 2015b). Importantly, accumulating evidence suggests positive body image to be associated with outcome variables (e.g. self-esteem, intuitive eating; Avalos & Tylka, 2006; Gillen, 2015; Tylka & Wood-Barcalow, 2015a) either directly or indirectly (e.g. by reducing self-objectification; Menzel & Levine, 2011), over and above aspects of negative body image (Swami, Weis, Barron, & Furnham, 2018b; Wood-Barcalow et al., 2010). Research has therefore challenged us to consider its role in promoting both physical and psychological health and well-being. Accordingly, cultivating positive body image has been found to be positively associated with indicators of psychological well-being (e.g. positive affect) and, beyond more ‘traditional’ therapeutic goals, to nurture a healthier relationship with one's body (Avalos et al., 2005; Cook-Cottone, 2015; Morgan et al., 2014; Wood-Barcalow et al., 2010). Further, it is suggested that positive body image could supplement interventions which aim to promote positive affect and quality of life (Morgan et al., 2014; Swami et al., 2018b). Through awareness and active practice, positive body image can therefore be experienced alongside improved physical and mental health (Cook-Cottone, 2015).

Traditionally, both body image research and therapeutic practice have predominantly focused on improving negative body image (Smolak & Cash, 2011). Broadly speaking, psychological therapy has tended to modify one's dysfunctional thoughts, feelings and behaviours that contribute to negative body image or enhance certain aspects of the self (e.g. self-confidence; Alleva et al., 2015). Whilst this may consider the influential role of negative body image on indices of well-being (Swami et al., 2015), such methods are limited to normative discontentment: the Westernised norm, or commonality, of body dissatisfaction (Rodin et al., 1985). Without considering positive body image, this inadvertently perpetuates an ‘imbalanced’ approach and may simply promote neutral body image at best (Lopez et al., 2003; Smolak & Cash, 2011). In response, Tylka and Wood-Barcalow (2015b) assert that promoting positive body image can, by itself or as an integrated part of therapy, enhance the efficacy and longevity of therapeutic gains (e.g. self-esteem and compassion). This approach has been encouraged for both ‘global’ and ED-related contexts and populations (Cook-Cottone, 2015; Gillen, 2015; Linardon et al., 2021; Swami, Barron, Weis, & Furnham, 2016a). Psychological therapy is therefore changing in ways that positively address the current increase of body image-related difficulties and associated negative outcomes (e.g. emotional distress; Linardon, Gleeson, et al., 2019; Linardon, Kothe, et al., 2019; Williams et al., 2004; Zilcha-Mano & Ramseyer, 2020).

This shift in focus, however, requires advancing our understanding of the construct of positive body image, including its position in psychological therapy. This leads us to question: What is positive body image? What are its characteristics and expressions? How do these emerge? Moreover, when situated in the context of therapeutic practice, how is positive body image promoted and maintained? By reviewing seminal works on its theoretical foundations and construct definitions, this paper aims to demonstrate that positive body image is: (a) a multidimensional construct, distinct from negative body image; (b) a confluence of theoretical disciplines and influences; (c) protective and therapeutic; and (d) socially and politically relevant. This paper further situates and contextualises positive body image within the practice of therapy, through extracting its correlates, predictors and consequences from quantitative and qualitative research. In doing so, it will illustrate the role which psychological therapy could play in promoting positive body image; and its therapeutic capacities for promoting well-being.

2 WHAT IS POSITIVE BODY IMAGE? IT IS: 2.1 A multidimensional construct

As initially defined by Schilder (1950, p. 11), body image is ‘the picture of our own body which we form in our mind, that is to say, the way in which the body appears to ourselves’. Body image, however, further refers to ‘how individuals feel toward, think about, perceive and treat their body’ (Tylka, 2012, p. 657). Moreover, it is described as elastic and therefore malleable, as it adapts to internal and external information (Grogan, 1999). Whilst body image encapsulates the ‘outsiders' view’ of appearance, thus how we look on the outside, it extends itself to the ‘inside view’ by considering the internal and subjective experiences of appearance (Cash, 1990). By pertaining to one's social reality, body image is therefore not exclusive to one's physical being, as it extends itself to one's experience of embodiment (Cash, 1990, 2004). As Cash and Pruzinsky (1990, p. xi) describe, ‘body image is body images’. Body image therefore refers to much more than just body satisfaction and is not a comprehensive gauge for the extent to which an individual favourably, or unfavourably, views their appearance (Tylka & Wood-Barcalow, 2015b).

When situated in the context of psychopathology, body image is often described as unidimensional with polarised (negative and positive) states. Hence, positive body image is erroneously considered as an endpoint along a body image continuum; instead, it is an independent construct to negative body image (Tylka, 2012). This conceptualisation is demonstrated by individuals with positive body image reporting superior well-being in comparison with those with negative body image (Williams et al., 2004), as well as being uniquely associated with optimism and proactive coping, over and above negative body image (Avalos et al., 2005). This is noteworthy, as positive body image therefore displays direct unique relationships with outcome variables (e.g. self-care; Andrew et al., 2014) or through indirect, yet distinct, pathways (e.g. disengaging from negative societal influences; Holmqvist & Frisén, 2012; Wood-Barcalow et al., 2010). Moreover, positive body image is suggested to alternatively incorporate protective processing styles, which facilitate in avoiding the impact of negative influences (Avalos et al., 2005; Swami et al., 2008). Though seemingly discordant, positive body image can be both consistent and stable, and malleable and transitional (Tylka & Wood-Barcalow, 2015b). Thus, positive body image is adaptable and may be promoted by formulating a template, which elicits a new or more positive orientation and effectively refers to its varying facets (Tylka, 2012).

2.2 A multifaceted and constellated concept

Research has elicited a more detailed conceptualisation of features of positive body image, including factors that serve to promote, maintain and emerge from it (Tiggemann, 2015). In effect, positive body image does not simply serve as a comprehensive measurement and is, instead, multifaceted (Tylka & Wood-Barcalow, 2015b). Broadly defined, facets of positive body image include the following: body appreciation, the appreciation of what one's body is able to do and ‘what it represents’ (Avalos et al., 2005; Tylka & Wood-Barcalow, 2015, p. 122); body flexibility, the willingness to embrace, rather than avoid, one's aversive perceptions, feelings and thoughts about their body (Webb et al., 2014); and body acceptance, the expression of acceptance of and comfort with the body, even if not entirely satisfied (Tylka & Wood-Barcalow, 2015b). Positive body image further demonstrates its multifaceted, and therefore complex, nature by its diversification, specifically how it is constructed uniquely to each individual and is a ‘constellation of social identities’ (Tylka & Wood-Barcalow, 2015b, p. 127). Positive body image is an intersection of identities, which informs its expression and therefore demonstrates variances in culture (Ng et al., 2015), age (Tiggemann & McCourt, 2013), gender (Frisén & Holmqvist, 2010; Grogan, 1999) and sexuality (Dahlenburg et al., 2010)—suggesting that there is no unitary experience which applies to all social identities. It is therefore crucial to recognise, as well as celebrate, individual differences and diversity as part of promoting positive body image; thus, therapeutic practices benefit from utilising an intersectional approach (Cole & Sabik, 2009).

Positive body image is also a constellate of trait qualities, which, like happiness, can be enhanced and maintained through intentional activities (Lyubomirsky et al., 2005). In this view, these traits are heritable in nature (Bartels & Boomsma, 2009) and, therefore, for some individuals, certain aspects of positive body image may be more effortful to attain and preserve (Tylka & Wood-Barcalow, 2015b). This may be indicative of one's environment and experiences, with body image varying temporally and according to situational contexts (Cash, 1990; Tiggemann, 2001): ‘malleable from the impact of experiential states’ (Melnyk et al., 2004; Wood-Barcalow et al., 2010, p. 106). Hence, positive body image further pertains to state qualities, which are contextually adaptable and subject to fluctuation (Cash, 2002, 2004). In turn, positive body image is further a constellation of positive outcomes (e.g. inner positivity). Promoting positive body image should therefore be sensitive to one's immediate environment, broader affective experiences and their susceptibility or responsiveness to situational contexts (Cash, 1994; Labarge et al., 1998). This, however, requires contextual and theoretical understanding, which accords to relevant disciplines and influences.

2.3 A confluence of psychological disciplines and influences

Positive body image research has referred to one's (hedonic and eudaimonic) well-being (Swami et al., 2018b; Tylka, 2012) and continues to focus on associated positive experiences and emotions (e.g. self-care and body confidence), which contribute towards desired positive changes (e.g. subjective happiness; Seligman & Csikszentmihalyi, 2000; Seligman et al., 2005; Tylka, 2012). Accordingly, positive body image is historically positioned by positive psychology: a strength-based discipline that pertains to one's strengths and a greater sense of pleasure and contentment (Fredrickson, 2001). It should be noted, however, that this ‘position’ is not to shift the focus of pathology, ‘but to complement it with a comprehensive understanding of what is desirable’ (Tylka, 2012, p. 657). Thus, it is imperative that a positive state should be encouraged without simply reducing one's negative state, by identifying and amplifying one's strengths (Fredrickson & Losada, 2005; Tylka, 2012). For instance, promoting positive body image may consist of ‘practising’ activities which demonstrate embodiment (feeling the sense of connection between mind and body (Bush et al., 2014; Perey & Cook-Cottone, 2020) and self-care, by ‘listening to the body's needs and choosing behaviours based on the needs of the body’ (Cook-Cottone, 2015, p. 164). From a more (traditional) therapeutic point of view, this may consist of discovering one's mental reflections and engaging in mindfulness as part of developing body awareness (Morgan et al., 2014).

Positive body image is also found to stem from perceiving (internal and external) unconditional acceptance (McVey et al., 2010). Hence, humanistic psychology has proven its foundational influence on positive body image, by conceptualising the promotion of physical and psychological well-being as being achieved through unconditional acceptance (Rogers, 1961). For instance, when applied to body image, this entails individuals perceiving both internal and external unconditional acceptance of their bodies, thus being loved ‘as is’ and ‘not treated in a negative way by society at large’ (Avalos & Tylka, 2006; Tylka & Wood-Barcalow, 2015b, p. 120). Humanistic psychology also posits moving beyond the physical form of the body, by considering one's existential significance and meaning (Jacobson et al., 2013), thus directing our attention outside of ourselves and towards our external world(s) (Worth & Smith, 2021). From a salutogenic perspective, Cook-Cottone (2006) conceptualised this as attunement: an interconnected process between one's inner (e.g. feelings of self-compassion) and outer aspects of self (e.g. culture). Within a therapeutic context, cultivating an inner and outer attunement consists of self-care practices (e.g. reading material that empowers or celebrates bodies in all shapes and sizes; Cook-Cottone, 2015) which refer to, or even promote, facets of positive body image (e.g. having a broad concept of beauty).

As emphasised by counselling psychology, positive body image considers the importance of recognising one's strengths and weaknesses, as well as appreciating body-related diversity and well-being (Gelso & Fretz, 2001; Tylka & Wood-Barcalow, 2015b). Positive body image is further positioned by counselling psychology as representing an empathetic understanding and acceptance of the body regardless of one's incongruences, and respecting and protecting the body by tending to its needs (Rogers, 1961; Tylka & Wood-Barcalow, 2015b). Moreover, positive body image and counselling psychology are mutually conceptualised by the positive features required for developing ‘optimal human functioning’ (e.g. self- and social acceptance, autonomy; Gelso & Fassinger, 1992, p. 293; Keyes, 2007).

‘Practices’ of positive body image, specifically embodiment, further demonstrate theoretical influences which have contributed towards positive body image theory, research and applications—most imperatively, feminist theory (Tylka & Wood-Barcalow, 2015b). For instance, feminist existentialist Simone de Beauvoir described accounts of eroded body and self-experiences among adolescent and adult women: ‘her body is getting away from her, it is no longer the straightforward expression of her individuality’ (de Beauvoir, 1974, p. 346). In response, Piran (2016, 2017) conceptualised Experience(s) of Embodiment, which provided a novel, integrative perspective on ways that women ‘inhabit their bodies’, in effect, identifying experiences that accord with positive body image (e.g. self-care, agency, functionality). Moreover, feminist and body image scholars, such as Lindo Bacon, Rachael Calogero, Marika Tiggemann and Linda Smolak, have disseminated commentary on the resistance of internalising media ideals of appearance, as well as eliciting intersectional perspectives of body image. Positive body image therefore shares theoretical links with feminism, as they mutually argue for a culture which accepts bodies that do not accord with societal ideals and continually uncover and challenge deleterious cultural influences on bodies and individual appearances (Tylka & Wood-Barcalow, 2015b). As Dionne et al. (1995) argue, body satisfaction is successive to changes in cultural attitudes, rather than one's appearance.

2.4 Protective, with therapeutic applications

Western society has presented increased pre-occupation with attractiveness and proliferation of body ideal representations and societal standards (Thompson et al., 1999). This has been met with social comparisons, which serve to prompt and maintain negative self-evaluation (e.g. body objectification)—a contributing factor of negative body image (Leahey et al., 2007). Accordingly, research has associated negative body image with adverse outcomes (e.g. depressive mood) and impaired quality of life (Nayir et al., 2016; Tiggemann & Kuring, 2004). To understand the emergence of negative body image and its reported effects, the tripartite influence model of body image posits three primary sources of influence (peers, parents and media), which exert their effect on one's body image via mechanisms of appearance comparison and internalisation of appearance ideals (Keery et al., 2004; Thompson et al., 1999).

Positive body image is found to promote or maintain protective factors, which are found to ‘buffer’ these exerting forces (e.g. media), as well as the effects of negative body image on affective and perceptual states (Rodgers et al., 2017). Preliminary research has therefore suggested positive body image as being potentially protective of physical health and psychological well-being (Tylka & Wood-Barcalow, 2015b). For instance, facets of positive body image (e.g. body appreciation) were being associated with engaging in health-promoting behaviours (e.g. sleep hygiene, meditation; Gillen, 2015), as well as being inversely linked with maladaptive beliefs and behaviours (e.g. perfectionism, disturbed eating patterns) and depressive symptoms (Gillen, 2015; Iannantuono & Tylka, 2012; Tylka & Kroon Van Diest, 2013). Inherent with these findings, however, is the incomplete portrayal of positive body image—entirely absent of negative body image. As Wood-Barcalow et al. (2010, p. 106) accordingly states, ‘the absence of pathology does not always signal flourishing’. It is therefore imperative that positive body image should serve itself as a continual preventative, as well as therapeutic, measure (Andrew et al., 2016).

Positive body image is further suggested to yield a greater degree of human ‘flourishing’: the ‘awareness of, and commitment to, an attuned inner and outer life’ (Cook-Cottone, 2015, p. 159), specifically establishing a mindful connection with one's body, both internally and externally (Albertson et al., 2014; Augustus-Horvath & Tylka, 2011). Here, positive body image promotes flourishing through ‘traditional’ therapeutic strategies (e.g. mindful, adaptive self-care; Wood-Barcalow et al., 2010) and health-promoting behaviours (e.g. intuitive eating, yoga; Cook-Cottone, 2015). Hence, it is suggested that positive body image could be supplemented in interventions that serve to promote aspects of well-being (Swami et al., 2018b). For example, Webb et al. (2015) found that positive rational acceptance serves as an adaptive response to body image-related challenges, which, in turn, increases positive body image. This can be applied therapeutically by encouraging individuals to accept distressing events, as well as engage in rational self-talk. For instance, mindfulness and acceptance skills (e.g. acceptance and commitment therapy, ACT) are found to promote indices of positive body image (e.g. inner positivity), by encouraging ‘present moment awareness’ and engaging flexibly in ‘value-driven actions’ (Fogelkvist et al., 2016; Frisén & Holmqvist, 2010).

Additionally, in reference to ‘applied’ disciplines of psychological therapy, positive body image can be further situated within psychodynamic analysis and psychoanalysis. Freud considered ‘the body ego as the foundation for subsequent ego development’ (Boag, 2014; Weiss, 2004, p. 282), informing the later conceptualisation of body-orientated psychotherapy: a therapeutic modality that focuses on the body as a means to elicit a dialogue of one's experiences and perceptions (Probst et al., 1995; Weiss, 2004). However, Krueger (1989) argues that referring to these disciplines often focuses on the self without ‘regard for the body self as [the] container and foundation of the psychological self’ (Weiss, 2004, p. 282). Accordingly, cognitive behavioural therapy (CBT) has received much attention in the literature when examining interventions for body image dissatisfaction (Lewis-Smith et al., 2016), as it refers to manualised techniques that improve identified traits of the self, respective to positive body image (e.g. self-esteem; Kolubinski et al., 2018). In turn, body image-specific CBT aims to modify dysfunctional thoughts, feelings and behaviours through media literacy, self-esteem enhancement and psychoeducation (Alleva, Sheeran, et al., 2015). Newell (1991) and Cash (2002) provided theoretical foundations for these alternative body image-related therapies, by alternatively positing a cognitive behavioural process model of body image. Their model posits socio-developmental and cognitive emotional body image-related threats or challenges, which are suggested to inform one's body image-related experiences (e.g. weight-related teasing, societal pressures, viewing stigmatising media content) and perceptions (Cash et al., 2005; Webb et al., 2014). Overall, positive body image is suggested to demonstrate its therapeutic capacities in a reciprocal nature, by simultaneously expressing its protective influence both directly (as a therapeutic technique or mediator) and indirectly (as an outcome of therapy).

2.5 A positive preventative and interventional outcome

With positive body image serving as a direct and indirect outcome, it is unsurprising that evidence supports positive body image as a necessary target for intervention—in other words, positive body image can be fostered through intervention (Tylka & Wood-Barcalow, 2015b). Alleva, Sheeran, et al. (2015) conducted a meta-analysis of stand-alone interventions to improve body image and identified effective techniques, including the following: discussing one's cognitions and their role in their body image, teaching self-monitoring behaviours, providing preventative and/or management strategies, engaging in physical activity, and guided imagery. Research has, however, identified strategies that are more target-driven, in particular reducing body dissatisfaction by ‘buffering’ against known risk factors (e.g. internalising sociocultural ideals; Stice & Shaw, 2002); and, most notably, media literacy strategies (e.g. discussing the beauty ideal, awareness of media motives for profit; McLean et al., 2016) that aim to encourage clients to consider their priorities regarding goals, values, personal qualities and skills, and can be enhanced through attuned self-care (Piran, 2017; Wilksch, 2019). Strategies may also target outcomes associated with body dissatisfaction, such as distorted embodiment and emotional dysregulation (Elliott et al., 2004; Piran, 2016, 2017). Imperatively, through an empathetic therapeutic relationship and therapy tasks (e.g. reflecting and making meaning of one's experiences by symbolising them into words; Ivanova & Watson, 2014), emotion-focused therapy has been shown to effectively target maladaptive emotional schemes (e.g. shame) by improving one's acceptance and modulation of their emotions (Elliott et al., 2004; see Ivanova, 2019). ACT is also found to improve psychological flexibility, however, by utilising self-regulatory techniques (e.g. present moment awareness, experiential acceptance, self-as-context), which enable greater freedom to engage with one's personal values, for instance, encouraging one to embrace uncomfortable sensations and emotions (e.g. body shame) by physicalising them and then letting them go (Sandoz & DuFrene, 2013). However, as aforementioned, scholars argue a more contemporary approach of promoting positive body image, rather than simply reducing negative body image—an approach that, at best, yields small positive effects and maintenance gains (Stice et al., 2007; Webb et al., 2015).

Interventions for promoting positive body image accordingly refer to specific approaches that enhance emotional and psychological well-being (e.g. self-compassion, mindfulness; Duarte et al., 2017; Rodgers et al., 2017), in order to target concerning outcomes (e.g. negative affect, disordered eating; see Stice & Shaw, 2002). For instance, mindfulness-based techniques encourage the cultivation of a fuller awareness and engagement with the present, in terms of both mind and body; and developing/maintaining an attitude of self-kindness, acceptance and compassion towards one's body and self (Atkinson & Wade, 2019). This can be fostered by engaging in body-related activities, such as yoga (Neumark-Sztainer et al., 2018), breathing exercises (e.g. 3-min breathing space; Atkinson & Wade, 2015), meditation (Albertson et al., 2014), intuitive eating (Bush et al., 2014) and exposure to nature (Swami et al., 2018a, 2016a; Swami, von Nordheim, & Barron, 2016b). Directly referring to (facets of) positive body image is also evidently fruitful for improving one's body image, such as focusing on body functionality (everything that the body is able to do; Alleva & Tylka, 2021). This has been found to improve functionality satisfaction and body appreciation and may utilise body-related activities, as well as reflexive-based techniques, such as writing exercises (e.g. participants are asked to describe one's bodily functions and reflect on why they are personally meaningful; Alleva, Sheeran, et al., 2015; Alleva et al., 2018a, 2018b). Given that intervention techniques predominantly pertain to one's physical appearance, it is therefore imperative to also refer to one's internal experiences (e.g. bodily senses and sensations, internal processes) and aspects of self-care (e.g. sleeping, eating, communication with others; Alleva, Sheeran, et al., 2015; Webb et al., 2015).

With positive body image still in its recency, our extant understanding of the effectiveness of interventions is predominantly limited to reduction in body dissatisfaction (Halliwell, 2015). Accordingly, Guest et al. (2019) conducted a systematic review which examined the effectiveness of interventions that alternatively aim to promote body image among adults. Overall, interventions were found to be self-directed or group-based, and most commonly used self-compassion- and functionality-based approaches. Aspects of psychoeducation or cognitive dissonance were, however, also incorporated. Online, writing-based functionality interventions (e.g. Expand Your Horizon; Alleva, Sheeran, et al., 2015; Alleva et al., 2018a, 2018b) were identified as having the best evidence of effectiveness. Specifically, they were found to significantly increase aspects of positive body image (e.g. body appreciation, satisfaction with body functionality; Alleva et al., 2018a, 2018b). Exercise and gratitude-based workbook interventions also presented positive outcomes (e.g. improved body esteem; Srismith et al., 2020; Wolfe & Patterson, 2017). Guest et al. (2019), however, identified that interventions were predominantly evaluated among female samples, and all but one study was carried out in Western cultures. In effect, the field has limited knowledge of the effectiveness of interventions in non-Western cultures, and across varying identities—namely ethnicities and special populations (e.g. sexual minorities, older individuals; Guest et al., 2019; Tiggemann, 2015). By addressing this line of research, strategies and interventions for promoting positive body image may be more broadly useful across social groups and contexts (Halliwell, 2015).

2.6 A field which is young, yet flourishing

Given the rather ‘young’, yet expansive, state of positive body image research, it is a construct that many of its novel aspects are yet to be (un)covered (Tylka & Wood-Barcalow, 2015b). This is promising, as a greater understanding of what actually promotes positive body image will enhance our ability to accentuate it among affected individuals. Certainly, body image research requires greater expansion, as it has historically focused on adult, white, well-educated and heterosexual women. Psychometric tools that measure positive body image, such as the Body Appreciation Scale (BAS; Avalos et al., 2005) and its revised version, the BAS-2 (Tylka & Wood-Barcalow, 2015a), have, however, enabled the considerable expansion of research into positive body image (Tiggemann, 2015). In particular, they have facilitated researchers to investigate the construct across an array of social identities and characteristics (e.g. men, disabled, LBGTQ+; Alleva et al., 2018a; Bailey et al., 2015; Tylka, 2011). In doing so, this has elicited a more ‘diverse’ understanding of how positive body image is impacted by identity—that is, what positive body image looks like across different identities (see Tiggemann, 2015). For instance, quantitative research has either: (i) examined factorial and construct validity of psychometric measures (e.g. BAS-2) cross-culturally (e.g. Hong Kong, Latin-American; Góngora et al., 2020; Swami & Ng, 2015); or (ii) investigated its conceptual relevance using cross-sectional methods (see Tiggemann, 2015). This has illustrated positive body image as containing features which are culturally sensitive—operating similarly across groups, however, expressed uniquely in certain populations and/or contexts (Tiggemann, 2015). Qualitative research has built upon this by illustrating positive body image as a salient concept, applicable across an array of identities (see Swami, 2018). Yet, as Swami (2018) and Tiggemann (2015) argue, this field remains in its infancy and with challenges ahead, particularly regarding the development of conceptual frameworks and interventions which serve to identify/capture and promote the construct among differing groups—most pertinently, among children and young people (Bailey et al., 2019; Yager et al., 2013). As such, research and therapeutic practice should acknowledge both the nuances and importance of positive body image, in order to demonstrate its promotion on an individual, national and global scale.

2.7 Socially and politically relevant

Whilst its influence is predominantly referred to on an individual level, Newell (1991, p. 1400) argues that alterations in body image ‘have consequences both for the individual and for the society’—an observable contentious issue within our current climate (Women & Equalities Committee, 2021), for example, the detrimental effect of the COVID-19 pandemic on disordered eating and body image (Di Renzo et al., 2020; Robertson et al., 2021), the rise of ‘lockdown’ body shaming (Lucibello et al., 2021) and governmental weight-loss strategies as part of regulating the obesity ‘pandemic’ (Department of Health & Social Care, 2020; Public Health England, 2020)—arguably ‘yet another example of Westernised society's normative approach to health’ (Lucibello et al., 2021, p. 149). Accordingly, efforts for enhancing public understanding and awareness of promoting positive body image are invaluable. With 53% of adults and 58% of children reported to feel ‘worse or much worse’ about their appearance following the (first) COVID-19 lockdown (Women & Equalities Committee, 2021), this calls for greater attention due to the risk of adverse psychopathological effects among both relational and social contexts (Holsen et al., 2001; Nayir et al., 2016; Neumark-Sztainer et al., 2006; Wang et al. 2019). Addressing these challenges, however, requires a collaborative effort beyond research and therapeutic practice, such as within the community (e.g. schools), medical and scientific organisations and the government (Women & Equalities Committee, 2021). This should include no longer considering body image to be a niche difficulty but, instead, a public health concern (Mental Health Foundation, 2019; Solmi et al., 2021). Therefore, therapeutic practice should extend beyond what is perceived to be within its line of expertise, by being responsive regardless of one's health, weight and age. In other words, positive body image and its relevance is continuing to expand, in terms of both its prevalence and its relevance among varying social and political contexts (e.g. education; APPG, 2012; O'Dea & Maloney, 2000).

3 CONCLUSION

Conceptualising positive body image is inevitably complex, with our understanding of positive body image to be a multifaceted and multidimensional construct, distinct from negative body image. Moreover, our understanding of positive body image demonstrates that it is: appreciating, accepting and loving one's body; holistic, as well as being interwoven with culture and pathology; both stable and malleable, with trait and state qualities; and informed by both internal and external processes and social identities. Most pertinently, it has also demonstrated itself as having therapeutic capacities, both as a preventive and as an interventional measure. This paper has emphasised the historical backdrop and rationale for why and how therapeutic practice is imperative to addressing the epidemic of body image-related concerns. With positive body image being a novel construct, it will continue to cultivate in importance and relevance, as its many facets are yet to be discovered (Tylka & Wood-Barcalow, 2015b). Through critical inquiry and awareness, we should be confide