Mirrors have been used to calm, to groom, for self-care, to teach and to foster self-acceptance (Freysteinson, 2009). Evans (1998) felt that “The therapeutic mirror in group psychotherapy may be beneficial in the treatment of resistant depression” (p. 94). They have also been used to improve balance and postural alignment (Galeazzi et al., 2006; Watson & Peck, 2008). Mirror therapy and the use of parasaggital mirrors are effective therapeutic tools in retraining the mind and body to respond to visual impulses in paralysis and reduce phantom pain in amputees (Altschuler & Hu, 2008; Giraux & Sirigu, 2003; Hunter, Katz & Davis, 2003; Fukumura et al., 2007; MacLachlan, McDonald & Waloch, 2004). It is believed that the reflection of the intact or good limb normalizes the perception of the affected limb, replacing or driving proprioception movement (Rosén & Lundborg, 2005). Proprioception is the stimuli, sensation or feedback that is activated with the movement of the body (Merriam-Webster, 2009).
However, the use of mirrors in the study of treatment for eating disorders is controversial. Conflicting study results suggest more research is necessary in order to validate and replicate various studies. Key et al (2001) cautioned that the use of a mirror may be contraindicated for those suffering from eating disorders and have experienced sexual abuse because “The mirror exercise can create an intolerable anxiety for some people, and how it is implemented is particularly important” (p. 189). The integration of a healthy control group that has a randomized assignment between experimental and controlled conditions, investigation into the effect of variables that may impact research results and comparison to other approaches to body image disturbances was recommended by researchers (Delinsky & Wilson, 2006; Vocks et al., 2008). Body image disturbance is a core diagnostic feature of anorexia nervosa and bulimia nervosa (American Psychiatric Association, 1994).
In one study, Delinsky and Wilson (2006) randomly assigned 45 female participants reporting extreme weight and shape concerns into two study groups; mirror exposure and nondirective body image treatment. Mirror exposure therapy (in a three session format) included a systematic, non-judgmental, holistic and mindful observation of ones image, and its associated anxiety and body avoidance. Nondirective body image treatment included a daily journal and observations and attitudes to body image. The results of this study indicated that mirror exposure therapy “decreased body checking and avoidance, body dissatisfaction, weight and shape concerns, dieting, depression, and increased self-esteem among women without clinical eating disorders” (p. 115). Further research involving participants in obese or overweight populations was recommended.
In a study of eating disorders and body image therapy, Vocks, Wächter, Wucherer, and Kosfelder (2008) found “that the extent of negative emotions and cognitions evoked by looking into a mirror can be reduced by cognitive-behavioral interventions aiming at an improvement of body image” (p. 153). This study included 17 female participants diagnosed with an eating disorder and a healthy control group of 24 female participants. Cognitive therapy was used to identify and then modify dysfunctional body-related thoughts with positive interventions, and behavioral therapy utilized body-exposure techniques coupled with regular self-management exercises. Vocks et al. (2008) concluded that these interventions influenced the positive result in cognitive and emotional reactions to looking in the mirror.
The therapeutic use of mirrors in contour drawing was illustrated in The Life & Art of Elizabeth “Grandma” Layton (Lambert, 1995) who used this technique to recover from mental illness. Layton started drawing at 68 years of age after going through 30 years of unsuccessful modern psychiatry and changed her life through art. She depicted numerous topics that included aging depression, dieting, relationships, grand-mothering, death, hunger, nuclear holocaust and capital punishment over an art career that spanned 15 ½ years. The captions that accompanied her drawings captured the artist’s thoughts about her work and life.
Altschuler, A. L., & Hu, J. (2008). Mirror therapy in a fractured wrist and no active wrist extension. Scandinavian Journal of Plastic & Reconstructive & Hand Surgery, 42, 110-111. doi:10.1080/02844310701510355
American Psychiatric Association. (1994). Diagnostic and statistical manual for mental disorders (4th ed.). Washington, DC: Author.
Delinsky, S. S. & Wilson, G. T. (2006). Mirror exposure for the treatment of body image disturbance. International Journal of Eating Disorders, 39(2), 108-116. doi:10.1002/eat.20207
Evans, S. (1998). Beyond the mirror: A group analytic exploration of late life and depression. Aging & Mental Health, 2(2), 94-99. Retrieved from http://www.tandf.co.uk/journals/titles/13607863.asp
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Galeazzi, G. M., Monzani, D., Gherpelli, C., Corvezzi, R., & Guaraldi, G. P. (2006). Posturographic stabilization of healthy subjects exposed to full-length mirror image is inversely related to body-image preoccupations. Neuroscience Letters, 410, 71-75. Retrieved from http://www.elsevier.com/wps/find/journaldescription.cws_home/506081/description
Giraux, P., & Sirigu, A. (2003). Illusory movements of paralyzed limb restore motor cortex activity. NeuroImage, 20, S107-S111. doi:10.1016/j.neuroimage.2003.09.024
Hunter, J. P., Katz, J., & Davis, K. D. (2003). The effects of tactile and visual sensory inputs on phantom limb awareness. Brain: A Journal of Neurology,126(3), 578-589. doi:10.1093/brain/awg054
Key, A., George, C. L., Beattie, D., Stammers, K., Lacey, H., & Waller, G. (2001). Body image treatment within an inpatient program for Anorexia Nervosa: The role of mirror exposure in the desensitization process. International Journal of Eating Disorders, 185-190. Retrieved from http://www.wiley.com/WileyCDA/WileyTitle/productCd-EAT.html
Lambert, D. (1995). The Life & Art of Elizabeth “Grandma” Layton. Waco, TX: WRS Publishing.
MacLachlan, M., McDonald, D., & Waloch, J. (2004). Mirror treatment of lower limb phantom pain: A case study. Disability and Rehabilitation, 26(14/15), 901-904. doi:10.1080/09638280410001708913
Proprioception. (2009). In Merriam-Webster’s Collegiate Dictionary (11th Ed.). Springfield, MA: Mirriam-Webster Inc.
Rosén, B., & Lundborg, G. (2005). Training with a mirror in rehabilitation of the hand. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 39, 104-108. Retrieved from http://informahealthcare.com/loi/alp
Vocks, S., Wächter, A., Wucherer, M., & Kosfelder, J. (2008). Look at yourself: Can body image therapy affect the cognitive and emotional response to seeing oneself in the mirror in eating disorders? European Eating Disorders Review, 16, 147-154.doi:10.1002/erv.825
Watson, M., & Peck, M. (2008). A pilot study of the immediate effects of mirror feedback on sitting postural control in normal healthy adults [Abstract]. Physiotherapy Research International, 13(4), 204. doi: 10.1002/pri