Self-help for a negative body image: A comparison of components of a cognitive-behavioral program

Abstract

Cognitive-behavioral therapy (CBT) is an empirically supported treatment of body-image dissatisfaction and dysphoria, even when largely self-administered with only modest therapist contact. The present investigation compared the relative effectiveness of selected components of Cash's (1997) body-image CBT program administered in self-help modality. Participants were 89 body-dissatisfied persons who enrolled in the program and were randomly assigned to one of two 6-week, self-help conditions: (a) psychoeducation plus self-monitoring, or (b) this intervention combined with procedures to identify and alter dysfunctional body-image cognitions. All assessments and materials were distributed and returned by postal mail. Among program completers, both conditions produced statistically and clinically significant improvements in multiple facets of body image and psychosocial functioning. Despite high levels of program attrition (53%), results were confirmed by the more conservative intent-to-treat analyses. Predictors of attrition were identified. Further analyses ruled out several variables as moderators of program effectiveness. The unexpected lack of differential effectiveness between the two self-help conditions was possibly the result of low compliance with the added cognitive-change components. We discussed the limitations and implications of our findings vis-a-vis the clinical use and scientific study of components of body-image CBT in various modalities of program delivery.