Comparing the Effectiveness of Group Cognitive-Behavioral Therapy and Mindfullness-Based Stress Reduction Therapy on Body Image, Anxiety, and Overeating in Obese Women

Obesity can create physical and mental disabilities in social interactions and communication skills. One of the factors affecting obesity is body image, i.e., mental representation of body size, shape and form. Body image comprises cognitive, emotional and behavioral components. Also, obesity may cause anxiety. Overeating is another psychological factor that can affect obese women. Cognitive–behavioral therapy is one of the treatment techniques that may positively affect the psychological status of obese women. Group cognitive–behavioral therapy is a type of psychotherapy that combines cognitive and learning theories with therapeutic techniques derived from cognitive therapy and group behavioral therapy. Another helpful therapy is mindfulness–based reduction stress therapy. It is one of the psychological approaches that may be effective in reducing psychological disorders in obese women. This study aimed to compare the effectiveness of these two stress reductive approaches on improving the body image, anxiety, and overeating among obese women.

The present research is a quasi–experimental study with a pretest–posttest and follow–up design with a control group. The statistical population included all obese women (n=492) referred to counseling centers in Malayer City, Iran, during 2018 and 2019. Of them, 45 women (3 groups of 15 women, including 2 experimental and 1 control groups) were selected as the study samples using the available non–random sampling method. The inclusion criteria for the study participants were having a body mass index of 30 or above, being interested in participating in the counseling course, and not receiving other psychological therapies (for the experimental groups). Subjects responded to the Multidimensional Body–Self Relations Questionnaire (MBSRQ) (Kash, 2000), Beck Anxiety Inventory (Beck et al., 1988), and Binge Eating Scale (Gormally et al., 1982) before and immediately after the intervention and then at the follow–up phase (three months after the intervention). One experimental group received group cognitive behavioral therapy (White, 2001) in eight 90–min sessions and the other experimental group underwent the mindfulness–based stress reduction program (Kabat–Zinn et al., 1992) in another eight 90–min sessions. For the control group, no intervention was presented. The study data were analyzed by descriptive (mean and standard deviation) and inferential statistics (repeated measures analysis of variance and LSD post hoc test) in SPSS software version 21. The significance level of statistical tests was considered at 0.05.

The pretest mean scores of body image of the group cognitive–behavioral and mindfulness–based stress reduction therapies increased from 165.14 and 165.95 to 205.47 and 209.53 in the posttest, respectively. The follow–up mean scores of the body image for the group cognitive–behavioral and mindfulness–based stress reduction therapies were 205.5 and 204.47, respectively. Compared to the posttest scores, these scores show the stability of changes over time. The pretest mean scores of anxiety of the group cognitive–behavioral and mindfulness–based stress reduction therapies decreased from 44.73 and 46.16 to 33.53 and 36.33 in the posttest, respectively. The follow–up mean scores of the anxiety for the group cognitive–behavioral and mindfulness–based stress reduction therapies were 33.73 and 34.67, respectively. Compared to the posttest scores, these results show the stability of the outcomes over time. The pretest mean scores of the overeating of the group cognitive–behavioral and mindfulness–based stress reduction therapies decreased from 32.04 and 31.93 to 17.47 and 17.27 in the posttest, respectively. The follow–up mean scores of the overeating for the group cognitive–behavioral and mindfulness–based stress reduction therapies were 16.47 and 19.47, respectively. Also, compared to the posttest scores, these scores show the stability of the intervention effect over time. However, in all three variables of body image, anxiety and overeating, the mean scores of the control group did not change significantly between the pretest, posttest, and follow–up. The effects of time (p<0.001) and group (p<0.001) on all three variables of body image, anxiety, and overeating were significant. There were no significant differences between group cognitive–behavioral therapy and mindfulness–based stress reduction therapy regarding the variables of body image (p=0.662), anxiety (p=0.158), and overeating (p=0.201). Nevertheless, in all three dependent variables, significant differences were observed between the two experimental groups and the control group (p<0.001).

Based on the study results, group cognitive–behavioral therapy and mindfulness–based stress reduction therapy are both equally effective in improving psychological problems of obese women.