Effect of acceptance and commitment therapy on body image flexibility and body awareness in patients with psychosomatic disorders

A randomized clinical trial

Authors

  • Abdollah Omidi Ph.D. of Clinical Psychology, Associate Professor, Department of Clinical Psychology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan Iran , Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Keywords:

Acceptance and commitment therapy, Body image flexibility, Body awareness, psychosomatic disorders

Abstract

Objective: The aim of this research was to examine the effectiveness of the acceptance and commitment therapy (ACT) for body image flexibility and body awareness in these patients. Methods: A randomized clinical trial was conducted at Kashan University of Medical Sciences clinics in Kashan, Iran, from December 1, 2017 to March 30, 2018. A sample of 75 patients with psychosomatic disorders was selected by convenience sampling. The selected patients were randomly divided into three 25-member groups. The experimental group received medicinal treatment combined with the (ACT). The active control group received the usual treatment plus psycho education in general psychology, and the treatment group solely received the medicinal treatment usually used in the treatment centers. The results were obtained using the following scales in the pretest and posttest phases and the two-month follow-up: the demographic questionnaire; Shields’ body awareness questionnaire; and Sandoz’s body image flexibility questionnaire. The data were analyzed using the descriptive statistics tests (mean and standard deviation) and the repeated measures analysis of variance and chi-square tests in IBM-SPSS version 21. Results: There was no significant difference among the three groups in terms of body image flexibility, body awareness, somatic symptoms, and demographic variables. The results of the posttest and follow-up examinations suggested that the ACT group more effectively and significantly improved body image flexibility and body awareness as compared to both of the control groups (p=0.02).  Conclusions: The ACT successfully improves body image flexibility and body awareness in patients with psychosomatic disorders. Clinical trial registration: This research was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2017092532057N2. Funding: Research and Technology Department of Kashan University of Medical Sciences funded the study (Ref: 96053).

 

References

Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric

Pub; 2013.

Cosci F, Fava GA. The clinical inadequacy of the DSM-5 classification of somatic symptom and related

disorders: an alternative trans-diagnostic model. CNS Spectr. 2016;21(4):310-7. doi:

1017/S1092852915000760.

Fava GA, Cosci F, Sonino N. Current psychosomatic practice. Psychother Psychosom. 2017;86(1):13-30.

PMID: 27884006.

Kaplan BJ. Kaplan and Sadock’s Synopsis of Psychiatry. Behavioral Sciences/Clinical Psychiatry.

Tijdschrift voor Psychiatrie. 2016;58(1):78-9.

Cohane GH, Pope HG. Body image in boys: A review of the literature. Int J Eat Disord. 2001;29(4):373-9.

PMID: 11285574.

Kockerling, E., J. Breckenkamp, and B. Hesse, [Relationship Between The Use of Psychosomatic

Rehabilitation and Regional Capacities for Medical and Psychotherapeutic Treatment of Mental Disorders

in Westphalia]. Gesundheitswesen, 2018. PMID: 29758574, doi: 10.1055/a-0600-2662.

Desai KM, Kale AD, Shah PU, Rana S. Psychosomatic Disorders: A Clinical Perspective and Proposed

Classification System. Arch Iran Med. 2018;21(1):44. PMID: 29664670

Deter H-C, Kruse J, Zipfel S. History, aims and present structure of psychosomatic medicine in Germany.

Biopsychosoc Med. 2018;12(1):1. PMID: 29434655, doi: 10.1186/s13030-017-0120-x

Ferrari S, Poloni N, Diefenbacher A, Barbosa A, Cosci F. From hysteria to somatic symptom disorders:

searching for a common psychopathological ground. Official Journal of the Italian Society of

Psychopathology Organo Ufficiale della Società Italiana di Psicopatologia. 1989;46:372-9.

Watanabe J, Watanabe M, Yamaoka K, Adachi M, Nemoto A, Tango T. Effect of School-Based Home- Collaborative Lifestyle Education on Reducing Subjective Psychosomatic Symptoms in Adolescents: A

Cluster Randomised Controlled Trial. PloS one. 2016;11(10):e0165285. PMID: 27780251, doi:

1371/journal.pone.0165285

Ebert D, Hannig W, Tarnowski T, Sieland B, Götzky B, Berking M. Web-based rehabilitation aftercare

following inpatient psychosomatic treatment. Rehabilitation (Stuttg). 2013;52(3):164-72. PMID: 23761205,

DOI:10.1055/s-0033-1345191

Rief W, Mewes R, Martin A, Glaesmer H, Brähler E. Evaluating new proposals for the psychiatric

classification of patients with multiple somatic symptoms. Psychosom Med. 2011;73(9):760-8. PMID:

, DOI: 10.1097/PSY.0b013e318234eff6

Creed F, Barsky A. A systematic review of the epidemiology of somatisation disorder and hypochondriasis.

J Psychosom Res. 2004;56(4):391-408. PMID: 15094023, DOI: 10.1016/S0022-3999(03)00622-6

King IC. Body image in paediatric burns: a review. Burns Trauma. 2018;6(1):12. PMID: 29744373, DOI:

1186/s41038-018-0114-3

Yazdani N, Hosseini SV, Amini M, Sobhani Z, Sharif F, Khazraei H. Relationship between Body Image

and Psychological Well-being in Patients with Morbid Obesity. Int J Community Based Nurs Midwifery.

;6(2):175. PMID: 29607346

Grossman SL, Campagna B, Brochu H, Odermatt M, Annunziato RA. Improving body image and sexual

health behaviors among college women. J Am Coll Health. 2018(just-accepted):1-15. PMID: 29565752,

DOI: 10.1080/07448481.2018.1454927

Schmidt U, Treasure J. Anorexia nervosa: Valued and visible. A cognitive-interpersonal maintenance

model and its implications for research and practice. Br J Clin Psychol. 2006;45(3):343-66. PMID:

Grant A, Townend M, Mills J, Cockx A. Assessment and case formulation in cognitive behavioural

therapy: Sage; 2008.

Wendell JW, Masuda A, Le JK. The role of body image flexibility in the relationship between disordered

eating cognitions and disordered eating symptoms among non-clinical college students. Eat

Behav.2012;13(3):240-5. PMID: 22664403, DOI: 10.1016/j.eatbeh.2012.03.006

Grogan S. Body image: Understanding body dissatisfaction in men, women and children: Taylor & Francis;

Murakami M, Nakai Y. Current state and future prospects for psychosomatic medicine in Japan.

Biopsychosoc Med. 2017;11(1):1. PMID: 28105067, DOI: 10.1186/s13030-017-0088-6

Harvie RM, Chisholm AW, Bisanz JE, Burton JP, Herbison P, Schultz K, et al. Long-term irritable bowel

syndrome symptom control with reintroduction of selected FODMAPs. World J Gastroenterol.

;23(25):4632. PMID: 28740352, DOI: 10.3748/wjg.v23.i25.4632

Seferiadis A, Ohlin P, Billhult A, Gunnarsson R. Basic body awareness therapy or exercise therapy for the

treatment of chronic whiplash associated disorders: a randomized comparative clinical trial. Disabil

Rehabil. 2016;38(5):442-51. PMID: 25955823, DOI: 10.3109/09638288.2015.1044036

Garbarini F, Pia L. Bimanual coupling paradigm as an effective tool to investigate productive behaviors in

motor and body awareness impairments. Front Hum Neurosci. 2013;7:737. PMID: 24204339, DOI:

3389/fnhum.2013.00737

Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: A

review of meta-analyses. Cognit Ther Res. 2012;36(5):427-40. PMID: 23459093, DOI: 10.1007/s10608- 012-9476-1

Matsuoka H, Chiba I, Sakano Y, Toyofuku A, Abiko Y. Cognitive behavioral therapy for psychosomatic

problems in dental settings. Biopsychosoc Med. 2017;11(1):18. PMID: 28630646, DOI: 10.1186/s13030- 017-0102-z

Cayoun BA. Mindfulness-integrated CBT for well-being and personal growth: Four steps to enhance inner

calm, self-confidence and relationships: John Wiley & Sons; 2014.

Yazdanimehr R, Omidi A, Sadat Z, Akbari H. The effect of mindfulness-integrated cognitive behavior

therapy on depression and anxiety among pregnant women: a randomized clinical trial. J Caring Sci.

;5(3):195. PMID: 27752485, DOI: 10.15171/jcs.2016.021

Cayoun BA. Mindfulness-integrated CBT: Principles and practice: John Wiley & Sons; 2011.

Linde J, Rück C, Bjureberg J, Ivanov VZ, Djurfeldt DR, Ramnerö J. Acceptance-based exposure therapy

for body dysmorphic disorder: A pilot study. Behav Ther. 2015;46(4):423-31. PMID: 26163707, DOI:

1016/j.beth.2015.05.002

Silverstein RG, Brown A-CH, Roth HD, Britton WB. Effects of mindfulness training on body awareness to

sexual stimuli: implications for female sexual dysfunction. Psychosom Med. 2011;73(9):817. PMID:

, DOI: 10.1097/PSY.0b013e318234e628

Davoudi M, Omidi A, Sehat M, Sepehrmanesh Z. The Effects of Acceptance and Commitment Therapy on

Man Smokers’ Comorbid Depression and Anxiety Symptoms and Smoking Cessation: A Randomized

Controlled Trial. Addict Health. 2017;9(3):129. PMID: 29657693

Blackledge JT, Ciarrochi J, Deane FP. Acceptance and commitment therapy: contemporary theory research

and practice: Australian Academic Press; 2009.

Abbasi M, Porzoor P, Moazedi K, Aslani T. The Effectiveness of Acceptance and Commitment Therapy on

Improving Body Image of Female Students with Bulimia Nervosa. J Ardabil Univ Med Sci. 2015; 15 (1)

:15-24

Callaghan GM, Duenas JA, Nadeau SE, Darrow SM, Van der Merwe J, Misko J. An empirical model of

body image disturbance using behavioral principles found in Functional Analytic Psychotherapy and

Acceptance and Commitment Therapy. Int J Behav Consult Ther. 2012;7(2-3):16. PMID: 23997716

Stewart TM. Light on body image treatment: Acceptance through mindfulness. Behav Modif.

;28(6):783-811. PMID: 15383686, DOI: 10.1177/0145445503259862

Vowles KE, Fink BC, Cohen LL. Acceptance and Commitment Therapy for chronic pain: A diary study of

treatment process in relation to reliable change in disability. J Contextual Behav Sci. 2014;3(2):74-80.

PMID: 27818931, DOI: 10.1016/j.jcbs.2014.04.003

Izaadi A, Karimi J, Rahmani M. Psychometric Analysis of Persian Version of Body Image flexibility

Questionnaire (BI-AAQ) among University students. Hayat. 2013; 19 (3) :56-69.

Sandoz EK, Wilson KG, Merwin RM, Kellum KK. Assessment of body image flexibility: the body image- acceptance and action questionnaire. J Contextual Behav Sci. 2013;2(1-2):39-48.

Taherifar Z, Ferdowsi S, Mootabi F, Mazaheri MA, Fata L. The mediating role of emotion dysregulation

strategies on the relationship between negative emotion intensity and safety motivation with generalized

anxiety symptoms. Contemporary psychol. 2016;10(2):51-66.

Selby CL. Acceptance and Commitment Therapy for Body Image Dissatisfaction: A Practitioner's Guide to

Using Mindfulness, Acceptance and Values-Based Behavior Change Strategies: by Adria N. Pearson,

Michelle Heffner, and Victoria M. Follette. Oakland, CA: New Harbinger Publications, 2010, Taylor &

Francis; 2011.

Fogelkvist M, Parling T, Kjellin L, Gustafsson SA. A qualitative analysis of participants’ reflections on

body image during participation in a randomized controlled trial of acceptance and commitment therapy. J

Eat Disord. 2016;4(1):29. PMID: 27999670, DOI: 10.1186/s40337-016-0120-4

de Jong M, Lazar SW, Hug K, Mehling WE, Hölzel BK, Sack AT, et al. Effects of mindfulness-based

cognitive therapy on body awareness in patients with chronic pain and comorbid depression. Front Psychol.

;7:967. PMID: 27445929, DOI: 10.3389/fpsyg.2016.00967

del CQ-BL, Gonzalez-Ramirez MT, Cebolla A, Soler J, Garcia-Campayo J. Body awareness and

mindfulness: validation of the Spanish version of the Scale of Body Connection. Actas Esp Psiquiatr.

;42(2):57-67. PMID: 24715363

Published

2021-12-24

Issue

Section

Articles