A qualitative analysis of participants' reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy

Maria Fogelkvist, Thomas Parling, Lars Kjellin, Sanna Aila Gustafsson, Maria Fogelkvist, Thomas Parling, Lars Kjellin, Sanna Aila Gustafsson

Abstract

Background: Negative body image is a risk factor for development and relapse in eating disorders (ED). Many patients continue to be dissatisfied with their body shape or weight after treatment. This study presents a qualitative analysis of written reflections on body image from patients with an ED and a negative body image before and after an Acceptance and Commitment Therapy group treatment at a specialized ED-unit.

Method: Before and after the treatment participants (n = 47) answered a questionnaire with open ended questions on their thoughts on body image. Data were analyzed through conventional content analysis.

Results: Body image meant different things for different participants. For some it had to do with how you evaluate your body, whereas others focused on whether their body image was realistic or not. Some emphasized their relationship with their body, while some described body image as strongly related to global self-esteem. These different views on the concept of body image affected the participants' descriptions of their own body image, and how they wanted it to change. Body image was considered a state that fluctuated from day to day. After treatment the participants described changes in their body image, for instance perceiving oneself as less judgmental towards one's body, and a shift in focus to the important things in life.

Conclusions: The participants had different views on body image and how they wished it to change. Thus treatment interventions targeting negative body image needs to address various aspects of this complex construct.

Trial registration: This study is part of an RCT registered 02/06/2014 in Clinical Trials, registration number: NCT02058121.

Keywords: Acceptance and commitment therapy; Body dissatisfaction; Body image; Content analysis; Eating disorders; Qualitative research.

References

    1. Cash TF, Pruzinsky T, editors. Body Image: A Handbook of Theory, Research, and Clinical Practice. New York: Guilford Press; 2002.
    1. Stice E. Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull. 2002;128:825–48. doi: 10.1037/0033-2909.128.5.825.
    1. Keel PK, Dorer DJ, Franko DL, Jackson SC, Herzog DB. Postremission predictors of relapse in women with eating disorders. Am J Psychiatry. 2005;162:2263–8. doi: 10.1176/appi.ajp.162.12.2263.
    1. Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375:583–93. doi: 10.1016/S0140-6736(09)61748-7.
    1. Brown TA, Keel PK. Current and emerging directions in the treatment of eating disorders. Subst Abus Res Treatment. 2012;6:33–61.
    1. Bardone-Cone AM, Harney MB, Maldonado CR, Lawson MA, Robinson DP, Smith R, Tosh A. Defining recovery from an eating disorder: conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity. Behav Res Ther. 2010;48:194–202. doi: 10.1016/j.brat.2009.11.001.
    1. Stice E, Ng J, Shaw H. Risk factors and prodromal eating pathology. J Child Psychol Psychiatry. 2010;51:518–25. doi: 10.1111/j.1469-7610.2010.02212.x.
    1. Latner JD, Mond JM, Vallance JK, Gleaves DH, Buckett G. Quality of life impairment and the attitudinal and behavioral features of eating disorders. J Nerv Ment Dis. 2013;201:592–7. doi: 10.1097/NMD.0b013e3182982bbe.
    1. Cash TF. Body image: past, present, and future. Body image. 2004;1:1–5. doi: 10.1016/S1740-1445(03)00011-1.
    1. Cash TF, Deagle EA., 3rd The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: a meta-analysis. Int J Eat Disord. 1997;22:107–25. doi: 10.1002/(SICI)1098-108X(199709)22:2<107::AID-EAT1>;2-J.
    1. Tury F, Gulec H, Kohls E. Assessment methods for eating disorders and body image disorders. J Psychosom Res. 2010;69:601–11. doi: 10.1016/j.jpsychores.2009.05.012.
    1. Espeset EM, Nordbo RH, Gulliksen KS, Skarderud F, Geller J, Holte A. The concept of body image disturbance in anorexia nervosa: an empirical inquiry utilizing patients’ subjective experiences. Eat Disord. 2011;19:175–93. doi: 10.1080/10640266.2011.551635.
    1. Espeset EM, Gulliksen KS, Nordbo RH, Skarderud F, Holte A. Fluctuations of body images in anorexia nervosa: patients’ perception of contextual triggers. Clin Psychol Psychother. 2012;19:518–30. doi: 10.1002/cpp.760.
    1. National Institute for Clinical Excellence (NICE). Eating disorders—core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. 2004. . Accessed 5 Feb 2016.
    1. Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, Touyz S, Ward W, Royal A. New Zealand College of P. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry. 2014;48:977–1008. doi: 10.1177/0004867414555814.
    1. Fairburn CG, Cooper Z, Doll HA, O’Connor ME, Bohn 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. Am J Psychiatry. 2009;166:311–9. doi: 10.1176/appi.ajp.2008.08040608.
    1. Fairburn CG, Cooper Z, Doll HA, O’Connor ME, Palmer RL, Dalle Grave R. Enhanced cognitive behaviour therapy for adults with anorexia nervosa: a UK-Italy study. Behav Res Ther. 2013;51:R2–8. doi: 10.1016/j.brat.2012.09.010.
    1. Calugi S, Dalle Grave R, Sartirana M, Fairburn CG. Time to restore body weight in adults and adolescents receiving cognitive behaviour therapy for anorexia nervosa. J Eat Disord. 2015;3:21. doi: 10.1186/s40337-015-0057-z.
    1. Vanderlinden J. Many roads lead to Rome: Why does cognitive behavioural therapy remain unsuccessful for many eating disorder patients? Eur Eat Disord Rev. 2008;16:329–33. doi: 10.1002/erv.889.
    1. Hayes SC, Strosahl K, Wilson KG. Acceptance and commitment therapy: the process and practice of mindful change. 2. New York: Guilford Press; 2012.
    1. Juarascio A, Shaw J, Forman E, Timko CA, Herbert J, Butryn M, Bunnell D, Matteucci A, Lowe M. Acceptance and commitment therapy as a novel treatment for eating disorders: an initial test of efficacy and mediation. Behav Modif. 2013;37:459–89. doi: 10.1177/0145445513478633.
    1. Juarascio AS, Forman EM, Herbert JD. Acceptance and commitment therapy versus cognitive therapy for the treatment of comorbid eating pathology. Behav Modif. 2010;34:175–90. doi: 10.1177/0145445510363472.
    1. Hill ML, Masuda A, Melcher H, Morgan JR, Twohig MP. Acceptance and commitment therapy for women diagnosed with binge eating disorder: a case-series study. Cogn Behav Pract. 2015;22:367–78. doi: 10.1016/j.cbpra.2014.02.005.
    1. Lillis J, Hayes SC, Levin ME. Binge eating and weight control: the role of experiential avoidance. Behav Modif. 2011;35:252–64. doi: 10.1177/0145445510397178.
    1. Heffner M, Sperry J, Eifert GH, Detweiler M. Acceptance and commitment therapy in the treatment of an adolescent female with anorexia nervosa: a case example. Cogn Behav Pract. 2002;9:232–6. doi: 10.1016/S1077-7229(02)80053-0.
    1. Berman MI, Boutelle KN, Crow SJ. A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosa. Eur Eat Disord Rev. 2009;17:426–34. doi: 10.1002/erv.962.
    1. Fairburn CG. Cognitive behavior therapy and eating disorders. New York: Guilford Press; 2008.
    1. Tuschen-Caffier B, Pook M, Frank M. Evaluation of manual-based cognitive-behavioral therapy for bulimia nervosa in a service setting. Behav Res Ther. 2001;39:299–308. doi: 10.1016/S0005-7967(00)00004-8.
    1. Mountford VA, Brown A, Bamford B, Saeidi S, Morgan JF, Lacey H. BodyWise: evaluating a pilot body image group for patients with anorexia nervosa. Eur Eat Disord Rev. 2015;23:62–7. doi: 10.1002/erv.2332.
    1. Bhatnagar KA, Wisniewski L, Solomon M, Heinberg L. Effectiveness and feasibility of a cognitive-behavioral group intervention for body image disturbance in women with eating disorders. J Clin Psychol. 2013;69:1–13. doi: 10.1002/jclp.21909.
    1. Trentowska M, Bender C, Tuschen-Caffier B. Mirror exposure in women with bulimic symptoms: how do thoughts and emotions change in body image treatment? Behav Res Ther. 2013;51:1–6. doi: 10.1016/j.brat.2012.03.012.
    1. Stice E, Rohde P, Butryn M, Menke KS, Marti CN. Randomized controlled pilot trial of a novel dissonance-based group treatment for eating disorders. Behav Res Ther. 2015;65:67–75. doi: 10.1016/j.brat.2014.12.012.
    1. Morgan JF, Lazarova S, Schelhase M, Saeidi S. Ten session body image therapy: efficacy of a manualised body image therapy. Eur Eat Disord Rev. 2014;22:66–71. doi: 10.1002/erv.2249.
    1. Marco JH, Perpina C, Botella C. Effectiveness of cognitive behavioral therapy supported by virtual reality in the treatment of body image in eating disorders: one year follow-up. Psychiatry Res. 2013;209:619–25. doi: 10.1016/j.psychres.2013.02.023.
    1. Trottier K, Carter JC, MacDonald DE, McFarlane T, Olmsted MP. Adjunctive graded body image exposure for eating disorders: a randomized controlled initial trial in clinical practice. Int J Eat Disord. 2015;48:494–504. doi: 10.1002/eat.22341.
    1. Cook-Cottone CP. Incorporating positive body image into the treatment of eating disorders: a model for attunement and mindful self-care. Body image. 2015;14:158–67. doi: 10.1016/j.bodyim.2015.03.004.
    1. Jansen A, Voorwinde V, Hoebink Y, Rekkers M, Martijn C, Mulkens S. Mirror exposure to increase body satisfaction: should we guide the focus of attention towards positively or negatively evaluated body parts? J Behav Ther Exp Psychiatry. 2016;50:90–6. doi: 10.1016/j.jbtep.2015.06.002.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4. Washington, DC: American Psychiatric Association; 2000.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5. Arlington: American Psychiatric Association; 2013.
    1. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88. doi: 10.1177/1049732305276687.
    1. Gardner RM, Brown DL. Body size estimation in anorexia nervosa: a brief review of findings from 2003 through 2013. Psychiatry Res. 2014;219:407–10. doi: 10.1016/j.psychres.2014.06.029.
    1. Kelly AC, Vimalakanthan K, Miller KE. Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility. Body image. 2014;11:446–53. doi: 10.1016/j.bodyim.2014.07.005.
    1. Hepworth NS. A mindful eating group as an adjunct to individual treatment for eating disorders: a pilot study. Eat Disord. 2011;19:6–16. doi: 10.1080/10640266.2011.533601.
    1. Butryn ML, Juarascio A, Shaw J, Kerrigan SG, Clark V, O’Planick A, Forman EM. Mindfulness and its relationship with eating disorders symptomatology in women receiving residential treatment. Eat Behav. 2013;14:13–6. doi: 10.1016/j.eatbeh.2012.10.005.
    1. Espel HM, Goldstein SP, Manasse SM, Juarascio AS. Experiential acceptance, motivation for recovery, and treatment outcome in eating disorders. Eating and weight disorders: EWD. 2015;2:205-10.
    1. Tantleff-Dunn S, Barnes RD, Larose JG. It’s not just a “woman thing:” the current state of normative discontent. Eat Disord. 2011;19:392–402. doi: 10.1080/10640266.2011.609088.
    1. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44:1–25. doi: 10.1016/j.brat.2005.06.006.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться