Efficacy of Cognitive Behavioral Therapy on Body Image, Psychological Distress, and Eating Disorder Beliefs in Patients with Anorexia Nervosa

Document Type : Original Article

Authors

1 Department of Health Psychology, Khorramshahr-Persian Gulf International Branch, Islamic Azad University, Khorramshahr, Iran

2 Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran

3 Department of Psychology, Dezful Branch, Islamic Azad University, Dezful, Iran

Abstract

Background: Anorexia nervosa is a refusal to maintain the lowest normal body weight, a severe fear of weight gain, and a significant impairment in body image.
 
Objectives: The purpose of this study was to evaluate the impact of cognitive behavior therapy on anorexic patients' psychological distress, body image, and eating disorder beliefs in anorexic patients.
 
Methods: This was a semi-experimental study based on a pre-test, post-test, and follow-up design with a control group. The statistical population of the study included patients with eating disorders who were referred to obesity treatment centers in Tehran, from whom 30 patients were selected using a purposeful sampling method and were randomly assigned to two groups of experiment and control. Before the intervention, the Eating Disorder Beliefs Questionnaire was used as a pre-test. After then, the experimental group received the intervention (no intervention was carried out on the control group). The Body Image Concern Inventory, Psychological Distress Questionnaire, and Eating Disorder Beliefs Questionnaire were used to gather the data. Multivariate covariance analysis was used to examine the data using the SPSS program (Version 22).
 
Results: According to the findings, cognitive behavior therapy helped anorexic patients with their psychological distress (P<0.001), body image issues (P<0.001), and eating disorder beliefs (P<0.001), respectively.
 
Conclusion: It is evident that cognitive behavior therapy helps anorexic patients by lowering psychological discomfort, issues with their bodies, and ideas about eating disorders.
 

Keywords

Copyright © 2024, Razavi International Journal of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

1.Agras WS, Lock J, Brandt H, Bryson SW, Dodge E, Halmi KA, Jo B, Johnson C, Kaye W, Wilfley D, Woodside B. Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial. JAMA psychiatry.2014;71(11):1279-86. https://doi.org/10.1001/jamapsychiatry.2014.1025
https://doi.org/10.1001/jamapsychiatry.2014.1025
PMid:25250660 PMCid:PMC6169309
 
2.Allan S, Goss K. Eating disorder beliefs and behaviours across eating disorder diagnoses. Eating behaviors.2014;15(1):42-4. https://doi.org/10.1016/j.eatbeh.2013.10.002
https://doi.org/10.1016/j.eatbeh.2013.10.002
PMid:24411748
 
3.Alwerthan TA, Swanson DP, Rogge RD. It's better to give than to receive: Psychological need satisfaction mediating links between wasta (favouritism) and individuals' psychological distress. International JournalofPsychology.2018;53:11-20. https://doi.org/10.1002/ijop.12419
https://doi.org/10.1002/ijop.12419
PMid:28547913
 
4.American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). AmericanPsychiatricPub;2013. https://doi.org/10.1176/appi.books.9780890425596
https://doi.org/10.1176/appi.books.9780890425596
 
5.Bedford O, Hwang KK. Guilt and shame in Chinese culture: A cross‐cultural framework from the perspective of morality and identity. Journal for the Theory of Social Behaviour.2003;33(2):127-44. https://doi.org/10.1111/1468-5914.00210
https://doi.org/10.1111/1468-5914.00210
 
6.Birkett M, Newcomb ME, Mustanski B. Does it get better? A longitudinal analysis of psychological distress and victimization in lesbian, gay, bisexual, transgender, and questioning youth. Journal of Adolescent Health. 2015;56(3):280-5. https://doi.org/10.1016/j.jadohealth.2014.10.275
https://doi.org/10.1016/j.jadohealth.2014.10.275
PMid:25586226 PMCid:PMC4339410
 
7.Caspi A, Amiaz R, Davidson N, Czerniak E, Gur E, Kiryati N, Harari D, Furst M, Stein D. Computerized assessment of body image in anorexia nervosa and bulimia nervosa: comparison with standardized body image assessment tool. Archives of women's mental health.2017;20(1):139-47. https://doi.org/10.1007/s00737-016-0687-4
https://doi.org/10.1007/s00737-016-0687-4
PMid:27796596
 
8.Cicmil N, Eli K. Body image among eating disorder patients with disabilities: A review of published case studies.Bodyimage.2014;11(3):266-74. https://doi.org/10.1016/j.bodyim.2014.04.001
https://doi.org/10.1016/j.bodyim.2014.04.001
PMid:24958662
 
9.Cooper MJ, Rose KS, Turner H. Core beliefs and the presence or absence of eating disorder symptoms and depressive symptoms in adolescent girls. International Journal of Eating Disorders. 2005;38(1):60-4. https://doi.org/10.1002/eat.20157
https://doi.org/10.1002/eat.20157
PMid:15971249
 
10.De Klerk N, Abma TA, Bamelis LL, Arntz A. Cognitive behavior therapy for personality disorders: A qualitative study of patients' and therapists' perspectives. Behavioural and cognitive psychotherapy. 2017 Jan;45(1):31-45. https://doi.org/10.1017/S1352465816000357
https://doi.org/10.1017/S1352465816000357
PMid:27573409
 
11.Fairburn CG, Cooper D Phil, Dip Psych Z, Doll D Phil HA, O'Connor ME, Bohn D Phil, Dip Psych K, Hawker DM, Wales JA, Palmer RL. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry. 2009;166(3):311-9. https://doi.org/10.1176/appi.ajp.2008.08040608
https://doi.org/10.1176/appi.ajp.2008.08040608
PMid:19074978 PMCid:PMC3035831
 
12.Fichter MM, Quadflieg N. Mortality in eating disorders‐results of a large prospective clinical longitudinal study. International Journal of Eating Disorders.2016;49(4):391-401. https://doi.org/10.1002/eat.22501
https://doi.org/10.1002/eat.22501
PMid:26767344
 
13.Frostad S, Danielsen YS, Rekkedal GÅ, Jevne C, Dalle Grave R, Rø Ø, Kessler U. Implementation of enhanced cognitive behaviour therapy (CBT-E) for adults with anorexia nervosa in an outpatient eating-disorder unit at a public hospital. Journal of eating disorders. 2018;6(1):12. https://doi.org/10.1186/s40337-018-0198-y
https://doi.org/10.1186/s40337-018-0198-y
PMid:29854400 PMCid:PMC5975410
 
14.Griffiths S, Mond JM, Murray SB, Touyz S. Positive beliefs about anorexia nervosa and muscle dysmorphia are associated with eating disorder symptomatology. Australian & New Zealand Journal of Psychiatry. 2015 Sep;49(9):812-20. https://doi.org/10.1177/0004867415572412
https://doi.org/10.1177/0004867415572412
PMid:25690746
 
15.Hughes ML, Hamill M, van Gerko K, Lockwood R, Waller G. The relationship between different levels of cognition and behavioural symptoms in the eating disorders. Eating behaviors. 2006 May 1;7(2):125-33. https://doi.org/10.1016/j.eatbeh.2005.09.001
https://doi.org/10.1016/j.eatbeh.2005.09.001
PMid:16600841
 
16.Jenkins PE, Morgan C, Houlihan C. Outpatient CBT for underweight patients with eating disorders: effectiveness within a National Health Service (NHS) eating disorders service. Behavioural and cognitive psychotherapy.2019;47(2):217-29. https://doi.org/10.1017/S1352465818000449
https://doi.org/10.1017/S1352465818000449
PMid:30070185
 
17.Junne F, Zipfel S, Wild B, Martus P, Giel K, Resmark G, Friederich HC, Teufel M, de Zwaan M, Dinkel A, Herpertz S. The relationship of body image with symptoms of depression and anxiety in patients with anorexia nervosa during outpatient psychotherapy: Results of the ANTOP study. Psychotherapy. 2016;53(2):141. https://doi.org/10.1037/pst0000064
https://doi.org/10.1037/pst0000064
PMid:27267500
 
18.Loumidis K, Wells A. Exercising for the wrong reasons: Relationships among eating disorder beliefs, dysfunctional exercise beliefs and coping. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice. 2001;8(6):416-23. https://doi.org/10.1002/cpp.298
https://doi.org/10.1002/cpp.298
 
19.Bradford R, Rutherford D. The eating disorder belief questionnaire: In-patient adolescent scores. Clinical child psychology and psychiatry. 2001;6(4):513-8. https://doi.org/10.1177/1359104501006004005
https://doi.org/10.1177/1359104501006004005
 
20.Koochaki GM, Charkazi A, Hasanzadeh A, Saedani M, Qorbani M, Marjani A. Prevalence of stress among Iranian medical students: a questionnaire survey. Eastern Mediterranean Health Journal. 2011;17(7):593-8. https://doi.org/10.26719/2011.17.7.593
https://doi.org/10.26719/2011.17.7.593
PMid:21972483
 
21.Littleton HL, Axsom D, Pury CL. Development of the body image concern inventory. Behaviour Research and therapy. 2005;43(2):229-41.
https://doi.org/10.1016/j.brat.2003.12.006
PMid:15629752
 
22.Ghadakzadeh S, Ghazipour A, Khajeddin N, Karimian N, Borhani M. Body Image Concern Inventory (BICI) for identifying patients with BDD seeking rhinoplasty: using a Persian (Farsi) version. Aesthetic plastic surgery. 2011;35(6):989-94.
https://doi.org/10.1007/s00266-011-9718-8
PMid:21491168
 
23.Frostad S, Danielsen YS, Rekkedal GÅ, Jevne C, Dalle Grave R, Rø Ø, Kessler U. Implementation of enhanced cognitive behaviour therapy (CBT-E) for adults with anorexia nervosa in an outpatient eating-disorder unit at a public hospital. Journal of eating disorders. 2018 Dec;6(1):1-8.
https://doi.org/10.1186/s40337-018-0198-y
PMid:29854400 PMCid:PMC5975410
 
24.Jenkins PE, Morgan C, Houlihan C. Outpatient CBT for underweight patients with eating disorders: effectiveness within a National Health Service (NHS) eating disorders service. Behavioural and cognitive psychotherapy. 2019;47(2):217-29.
https://doi.org/10.1017/S1352465818000449
PMid:30070185
 
25.Fairburn CG, Cooper D Phil, Dip Psych Z, Doll D Phil HA, O'Connor ME, Bohn D Phil, Dip Psych K, Hawker DM, Wales JA, Palmer RL. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry. 2009 Mar;166(3):311-9.
https://doi.org/10.1176/appi.ajp.2008.08040608
PMid:19074978 PMCid:PMC3035831
 
26.Murphy CM, Stojek MK, MacKillop J. Interrelationships among impulsive personality traits, food addiction, and body mass index. Appetite. 2014;73:45-50. https://doi.org/10.1016/j.appet.2013.10.008
https://doi.org/10.1016/j.appet.2013.10.008
PMid:24511618 PMCid:PMC4859335
 
27.Rodgers RF, Paxton SJ, McLean SA, Massey R, Mond JM, Hay PJ, Rodgers B. Stigmatizing attitudes and beliefs toward bulimia nervosa: The importance of knowledge and eating disorder symptoms. The Journal of nervous and mental disease. 2015;203(4):259-63. https://doi.org/10.1097/NMD.0000000000000275
https://doi.org/10.1097/NMD.0000000000000275
PMid:25751709
 
28.Stice E, Presnell K, Spangler D. Risk factors for binge eating onset in adolescent girls: a 2-year prospective investigation. Health psychology. 2002;21(2):131.https://doi.org/10.1037/0278-6133.21.2.131
https://doi.org/10.1037/0278-6133.21.2.131
PMid:11950103
 
29.George L, Thornton C, Touyz SW, Waller G, Beumont PJ. Motivational enhancement and schema‐focused cognitive behaviour therapy in the treatment of chronic eating disorders. Clinical Psychologist. 2004;8(2):81-5.
https://doi.org/10.1080/13284200412331304054
 
https://doi.org/10.1080/13284200412331304054
https://doi.org/10.1080/13284200412331304054
Razavi International Journal of Medicine
Volume 10, Issue 3
September 2022
Pages 62-68

Files

Share

How to cite

Statistics