Cognitive Behavior Therapy for Negative Body Image in Obese Women

Negative body image is a major concern of overweight persons, yet current obesity treatment programs have not addressed this problem. In the present study, 51 obese women were randomly assigned to cognitive behavioral body image therapy (CBT) or no-treatment. Patients were treated in small groups for 8 two-hour sessions. Therapy included information to challenge negative stereotypes of obesity, modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. No assistance was provided to change eating or exercise behaviors. CBT subjects showed significantly improved body image. Psychological symptoms, self-esteem, overeating, and eating guilt also improved. Weight was unchanged for most subjects and unrelated to treatment outcome overall.

[1]  K. Brownell,et al.  Handbook of Eating Disorders: Physiology, Psychology, and Treatment of Obesity, Anorexia, and Bulimia , 1986 .

[2]  M. Najjar,et al.  Anthropometric reference data and prevalence of overweight, United States, 1976-80. , 1987, Vital and health statistics. Series 11, Data from the National Health Survey.

[3]  E. Seddon,et al.  Long-term effects of a psychologically based group programme for women preoccupied with body weight and eating behaviour. , 1990, International journal of obesity.

[4]  T. F. Cash,et al.  Cognitive-behavioral body image therapy: Comparative efficacy of group and modest-contact treatments , 1995 .

[5]  J. Rosen.  The nature of body dysmorphic disorder and treatment with cognitive behavior therapy , 1995 .

[6]  P. D. Silva.  Book reviewThe etiology of bulimia nervosa—The individual and family context: J.H. Crowther, D.L. Tennenbaum, S.E. Hobfell and M.A.P. Stephens (Eds): Hemisphere, Washington (1992). xvi + 252 pp. £35.00 , 1994 .

[7]  T. Wadden,et al.  Psychological aspects of severe obesity. , 1992, The American journal of clinical nutrition.

[8]  P J Cooper,et al.  The Validity of the Eating Disorder Examination and its Subscales , 1989, British Journal of Psychiatry.

[9]  C. Fairburn,et al.  The eating disorder examination: A semi‐structured interview for the assessment of the specific psychopathology of eating disorders , 1987 .

[10]  M. Taylor,et al.  The development and validation of the body shape questionnaire , 1987 .

[11]  Mason.  Methods for Voluntary Weight Loss and Control , 1993, Annals of Internal Medicine.

[12]  M. Rosenberg.  Conceiving the self , 1979 .

[13]  T. F. Cash,et al.  Cognitive-behavioral treatment of women's body-image dissatisfaction. , 1987, Journal of consulting and clinical psychology.

[14]  A. Crisp,et al.  The reliability of estimates of body width and their relationship to current measured body size among anorexic and normal subjects , 1984, Psychological Medicine.

[15]  J. K. Collins,et al.  Variability in body shape perception in anorexic, bulimic, obese, and control subjects , 1987 .

[16]  J. Rosen,et al.  Cognitive behavior therapy with and without size perception training for women with body image disturbance. , 1990 .

[17]  Clinically significant change: Jacobson and Truax (1991) revisited. , 1992 .

[18]  Thomas F. Cash,et al.  Body Images: Development, Deviance, and Change , 1991 .

[19]  E. Mason.  Methods for Voluntary Weight Loss and Control A National Institutes of Health Technology Assessment Conference, 30 March-1 April 1992, Bethesda, Maryland, USA , 1992 .

[20]  D. Speer.  Clinically significant change: Jacobson and Truax (1991) revisited. , 1992, Journal of Consulting and Clinical Psychology.

[21]  T. Wadden,et al.  Binge eating disorder: its further validation in a multisite study. , 1993, The International journal of eating disorders.

[22]  T. Wadden,et al.  Three-year follow-up of the treatment of obesity by very low calorie diet, behavior therapy, and their combination. , 1988, Journal of Consulting and Clinical Psychology.

[23]  J. Rosen,et al.  Cognitive behavior therapy for negative body image , 1989 .

[24]  B. Dolan,et al.  Body Shape Questionnaire: derivation of shortened "alternate forms". , 1993, The International journal of eating disorders.

[25]  David M. Garner,et al.  Confronting the failure of behavioral and dietary treatments for obesity , 1991 .

[26]  T. Wadden,et al.  The heterogeneity of obesity: Fitting treatments to individuals. , 1991 .

[27]  T. F. Cash.  Body image and weight changes in a multisite comprehensive very-low-calorie diet program , 1994 .

[28]  J. Rosen,et al.  Development of the body dysmorphic disorder examination. , 1996, Behaviour research and therapy.

[29]  G. Bray,et al.  Pathophysiology of obesity. , 1992, The American journal of clinical nutrition.

[30]  Thomas F. Cash,et al.  Current and vestigial effects of overweight among women: Fear of fat, attitudinal body image, and eating behaviors , 1990 .

[31]  David H. Demo.  The Measurement of Self-Esteem: Refining Our Methods , 1985 .

[32]  B. Kerr,et al.  Comparison of interventions for women experiencing body image problems. , 1987 .

[33]  J. Rosen,et al.  Body-image disturbances in eating disorders. , 1990 .

[34]  E. Rothblum,et al.  Gender differences in social consequences of perceived overweight in the United States and Australia , 1988 .

[35]  K. Phillips.  Body dysmorphic disorder: the distress of imagined ugliness. , 1991, The American journal of psychiatry.

[36]  C. Ross,et al.  Concern with appearance, health beliefs, and eating habits. , 1987, Journal of health and social behavior.

[37]  H. Leitenberg,et al.  Validity studies of the eating disorder examination , 1990 .

[38]  C. Peter Herman,et al.  Undieting: A program to help people stop dieting , 1992 .

[39]  T. F. Cash.  The psychology of physical appearance: Aesthetics, attributes, and images. , 1990 .

[40]  H. Leitenberg,et al.  Body size distortion in bulimia nervosa , 1985 .

[41]  D. Ciliska.  Beyond dieting : psychoeducational interventions for chronically obese women : a non-dieting approach , 1990 .

[42]  A. Summerfield,et al.  A Pilot Study of the Therapeutic Usefulness of Videofeedback for Weight Loss and Improvement of Body Image in the Treatment of Obesity , 1988, Behavioural and Cognitive Psychotherapy.

[43]  M. Katzman,et al.  Feminist perspectives on eating disorders , 1994 .