The Effects of Group Acceptance and Commitment Therapy on Clinical Symptoms and Body Image in Women with Bulimia Nervosa with a Family History of Type 2 Diabetes in Mashhad

</span> Bulimia nervosa is a type of eating disorder characterized by overeating and purging. It is a multifactorial disorder in which concerns about weight and body image play an important role in causing and exacerbating it. Eating Disorders are one of the most common, severe, and debilitating mental health syndromes that are likely to become chronic and resistant to treatment. Studies show a significant increase in the risk of type 2 diabetes in patients with bulimia nervosa. Also, the prevalence of type 2 diabetes is higher in these people than in non-eating disorders. Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia due to insulin secretion, insulin activity, or both. People with one parent with type 2 diabetes are at higher risk for diabetes. Bulimia nervosa is associated with both the proportion of existing cases of type 2 diabetes (prevalence) and the emergence of new cases (incidence) of type 2 diabetes and is one of the most important reasons for poor blood sugar control and weight gain in diabetics, which complicates weight loss & worsens the complications of diabetes. Given that eating disorders affect body weight and tend to occur years before the onset of type 2 diabetes, it can be expected that eating disorders can improve the risk of type 2 diabetes. Eating disorders are exceptionally difficult to treat. These disorders tend to be ego-syntonic, with many individuals presenting for treatment with extreme ambivalence. Some studies with the control group have shown Cognitive behavioral therapy (CBT) as the most effective treatment for this disorder. However, CBT, despite its dramatic effects, has been moderate in achieving therapeutic success. One possible reason for the high failure rate of treatment for eating disorders is that existing therapies do not adequately address the important aspects of the disorder, such as high empirical avoidance, empirical lack of awareness, and lack of motivation. These variables are the explicit goals of Acceptance and commitment therapy. Research evidence shows that Acceptance and commitment therapy is effective in reducing Bulimia nervosa and body image in people with Bulimia nervosa. Acceptance and Commitment Therapy is one of several models based on the Acceptance of CBT, whose main goal is to create psychological flexibility. This study aimed to evaluate the effectiveness of group acceptance and commitment therapy on the symptoms of Bulimia Nervosa and body image in patients with Bulimia Nervosa and a family history of diabetes.</span></span>

The present study was quasi-experimental with a pretest-posttest design and follow-up with a control group. Using the purposive sampling method, 25 women from the statistical population, including women aged 18 to 43 years with (BN) in Mashhad in 2019, were selected and randomly assigned to two experimental group (11 people) and control group (14 people). The study's inclusion criteria were that the participant must be a female suffering from anorexia nervosa, have a family history of diabetes, and not have a history of hospitalization or participation in other treatments for anorexia nervosa. On the other hand, exclusion criteria included absence from more than two sessions or unwillingness to continue with the sessions. The experimental group participated in ten sessions of two and a half hours a week of group (ACT), and the control group did not receive any intervention. All subjects answered the Eating Disorder Diagnostic Scale (Stice et al., 2000) and the Multidimensional Body-Self Relations Questionnaire (Thomas & Cash, 2000) before and after the intervention and at a 4-month follow-up. The data were analyzed using SPSS version 24 software and the method of analysis of variance with repeated measurements was employed. A significance level of 0.05 was used for statistical tests.</span>

</span> Group acceptance and commitment therapy effectively reduces all binge eating symptoms in people with anorexia nervosa (p<0.001). The treatment of acceptance and commitment can help in reducing the variable components of body image including indicators of appearance evaluation (p<0.001), fitness evaluation (p<0.001), tendency to fitness (p=0.002), health evaluation (p<0.001), the scale of satisfaction with body areas, and preoccupation with overweight. This treatment has been found to be effective. However, the effect of treatment on the components of appearance orientation, health orientation, illness orientation, and weight self-categorization was not significant.</span></span>

</span>Group (ACT) is effective in improving the symptoms of overeating and body image of people with Bulimia nervosa due to the role of Bulimia nervosa in significantly increasing the risk of type 2 diabetes and given that diabetes has no definitive treatment. The best way to deal with it is prevention and timely treatment, Acceptance and commitment therapy can be a good treatment option for Bulimia nervosa and reducing the risk of developing diabetes in people who have a high chance of developing diabetes due to a family history of diabetes.</span></span></span>