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

Khozeimeh, Mahta; Toozandeh Jani, Hassan; Taheri, Elham; Zande Del, Ahmad

Volume 13 - Articles-1402 MEJDS (2023) 13: 105 | Back to browse issues page

Ethics code: IR.IAU.NEYSHABUR.REC.008.1399

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Khozeimeh M, Toozandeh Jani H, Taheri E, Zande Del A. 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. MEJDS 2023; 13 :105-105
URL: http://jdisabilstud.org/article-1-2354-en.html

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

Mahta Khozeimeh¹

, Hassan Toozandeh Jani ^*²

, Elham Taheri³

, Ahmad Zande Del⁴

1- PhD Student in Psychology, Khorasan Razavi, University of Science and Research, Neishabour, Iran
2- Associate Professor, Department of Psychology, Faculty of Humanities, Islamic Azad University of Neishabour, Iran
3- Assistant Professor, Department of Clinical Psychology, Mashhad University of Medical Sciences, Mashhad, Iran
4- Assistant Professor, Department of Statistics, Faculty of Basic Sciences, Islamic Azad University of Neishabour, Iran

Abstract: (963 Views)

Abstract
Background & Objectives: 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.
Methods: 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.
Results: 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.
Conclusion: 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.

Keywords: Acceptance and Commitment Therapy, Clinical Symptoms of Bulimia Nervosa, Body Image, Type 2 Diabetes

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Type of Study: Original Research Article | Subject: Psychology

References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edition. American Psychiatric Association; 2013. [DOI]

2. Cooper M, Reilly EE, Siegel JA, Coniglio K, Sadeh-Sharvit S, Pisetsky EM, et al. Eating disorders during the Covid-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention. J Eat Disord. 2022;30 (1):54–76. [DOI]

3. Nieto-Martínez R, González-Rivas JP, Medina-Inojosa JR, Florez H. Are eating disorders risk factors for type 2 diabetes? a systematic review and meta-analysis. Curr Diab Rep. 2017;17 (12):138. [DOI]

4. Dias Santana D, Mitchison D, Gonzalez-Chica D, Touyz S, Stocks N, Appolinario JC, et al. Associations between self-reported diabetes mellitus, disordered eating behaviours, weight/shape overvaluation, and health-related quality of life. J Eat Disord. 2019;7 (1):35. [DOI]

5. Mohan V, Shanthirani CS, Deepa R. Glucose intolerance (diabetes and IGT) in a selected South Indian population with special reference to family history, obesity and lifestyle factors--the Chennai Urban Population Study (CUPS 14). J Assoc Physicians India. 2003;51:771–7.

6. Mond JM. Classification of bulimic-type eating disorders: from DSM-IV to DSM-5. J Eat Disord. 2013;1 (1):33. [DOI]

7. Levinson CA, Zerwas S, Calebs B, Forbush K, Kordy H, Watson H, et al. The core symptoms of bulimia nervosa, anxiety, and depression: a network analysis. J Abnorm Psychol. 2017;126 (3):340–54. [DOI]

8. Raevuori A, Suokas J, Haukka J, Gissler M, Linna M, Grainger M, et al. Highly increased risk of type 2 diabetes in patients with binge eating disorder and bulimia nervosa: type 2 diabetes in eating disorders. Int J Eat Disord. 2015;48 (6):555–62. [DOI]

9. Ivarsson T, Svalander P, Litlere O, Nevonen L. Weight concerns, body image, depression and anxiety in Swedish adolescents. Eating Behaviors. 2006;7 (2):161–75. [DOI]

10. Linardon J, Wade T, De La Piedad Garcia X, Brennan L. Psychotherapy for bulimia nervosa on symptoms of depression: a meta-analysis of randomized controlled trials. Int J Eat Disord. 2017;50 (10):1124–36. [DOI]

11. Cash TF. Body image: past, present, and future. Body Image. 2004;1 (1):1–5. [DOI]

12. De Sousa PML. Body-image and obesity in adolescence: a comparative study of social-demographic, psychological, and behavioral aspects. Span J Psychol. 2008;11 (2):551–63. [DOI]

13. Juarascio A, Shaw J, Forman E, Timko CA, Herbert J, Butryn M, et al. Acceptance and commitment therapy as a novel treatment for eating disorders: an initial test of efficacy and mediation. Behavior Modification. 2013;37 (4):459–89. [DOI]

14. Boloorsaz-Mashhadi H. The effectiveness of acceptance and commitment therapy (ACT) on bulimia symptoms, depression and body image in bulimia nervosa patients. Journal of Clinical Psychology. (2017);9 (3):13–22. [Persian] [Article]

15. Zettle RD, Hayes SC. Brief ACT treatment of depression. In: Bond FW, Dryden W; editors. Handbook of brief cognitive behaviour therapy. John Wiley & Sons; 2004. [DOI]

16. Hayes SC, Masuda A, Bissett R, Luoma J, Guerrero LF. DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies? Behav Ther. 2004;35 (1):35–54. [DOI]

17. Johnson JG, Spitzer RL, Williams JBW. Health problems, impairment and illnesses associated with bulimia nervosa and binge eating disorder among primary care and obstetric gynaecology patients. Psychol Med. 2001;31 (8):1455–66. [DOI]

18. García-Mayor RV, García-Soidán FJ. Eating disoders in type 2 diabetic people: brief review. Diabetes Metab Syndr. 2017;11 (3):221–4. [DOI]

19. De Jonge P, Alonso J, Stein DJ, Kiejna A, Aguilar-Gaxiola S, Viana MC, et al. Associations between DSM-IV mental disorders and diabetes mellitus: a role for impulse control disorders and depression. Diabetologia. 2014;57 (4):699–709. [DOI]

20. Azizi F, Hatami H, Janghorbani M. Epidemiology va control bimari haye shaye dar iran [Epidemiology and control of common diseases in Iran]. Tehran: Eshtiagh Pub; 2000. [Persian]

21. Joshi S, Shrestha S. Diabetes mellitus: a review of its associations with different environmental factors. Kathmandu Univ Med J. 1970;8 (1):109–15. [DOI]

22. Sanderson CA. Health psychology. Jomehri F, Meschi F, Sodagar Sh, Moradimanesh F, Bayazi M, Sobhi A, et al. (Persian translator). Tehran: Sarfaraz Pub; 2013.

23. Graham JE, Stoebner-May DG, Ostir GV, Al Snih S, Peek MK, Markides K, et al. Health related quality of life in older Mexican Americans with diabetes: a cross-sectional study. Health Qual Life Outcomes. 2007;5 (1):39. [DOI]

24. Keyser J, Pastelak N, Sharma P, Choi J, Bender R, Alloy L. Specificity of emotion awareness to disordered eating in undergraduate females. In Association for Behavioral and Cognitive Therapies Meeting, New York, NY 2009.

25. Delavar A. Educational and psychological research. Tehran: Virayesh Pub; 2015. [Persian]

26. Stice E, Telch CF, Rizvi SL. Development and validation of the eating disorder diagnostic scale: a brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychol Assess. 2000;12 (2):123–31. [DOI]

27. Zimmerman M. Guideline of clinical interview based on DSM-5. Tavakoli E, Fadai F. (Persian translator). Ibn Sina Publications; 2015.

28. Stice E, Fisher M, Martinez E. Eating disorder diagnostic scale: additional evidence of reliability and validity. Psychol Assess. 2004;16 (1):60–71. [DOI]

29. Oehlhof M. Self-objectification among overweight and obese women: an application of structural equation modeling [PhD dissertation]. College of Bowling Green State University; 2011.

30. Khabir L, Mohamadi N, Rahimi G. The validation of Eating Disorder Diagnosis Scale (EDDS). Journal of Kermanshah University of Medical Sciences. 2014:18 (2):100–107. [Persian] [DOI]

31. Cash TF. Cognitive-Behavioral Perspectives on Body Image. In: Cash TF; editor. Encyclopedia of body image and human appearance. Elsevier; 2012. [DOI]

32. Cash TF. Cognitive-behavioral perspectives on body image. In: Cash TF, Pruzinsky T; editors. Body image: a handbook of theory, research, and clinical practice. New York: Guilford Press; 2002. [DOI]

33. Khodabandeloo Y, Fat’h-Abadi J, Motamed-Yeganeh N, Yadollahi S. Factor structure and psychometric properties of the multidimensional body-self relations questionnaire (MBSRQ) in female Iranian university students. Pract Clin Psychol. 2019;187–96. [Persian] [DOI]

34. Shemshadi H, Shams A, Sahaf R, Shamsipour Dehkordi P, Zareian H, Moslem AR. Psychometric properties of Persian version of the multidimensional body-self relations questionnaire (MBSRQ) among Iranian elderly. Salmand J. 2020;15 (3):298–311. [Persian] [DOI]

35. Harris R. ACT made simple: an easy-to-read primer on acceptance and commitment therapy. Aminzadeh A. (Persian translator). Tehran: Arjmand pub; 2017.

36. Bach P, Moran DJ. ACT in Practice: case conceptualization in acceptance and commitment therapy. New Harbinger Publications. Kamali N, Kianrad N. (Persian translator). Tehran: Arjmand pub; 2015.

37. Hayes SC, Strosahl C. A Practice Guide to Acceptance & Commitment Therapy. Alizadeh Mousavi E, Pirjavid F. (Persian translator). Fara Angizesh; 2015.

38. 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. [Persian] [Article]

39. Ahmadi Khoshbakht S, Mirzamani SM, Alimadadi Z. The effectiveness of group training of acceptance and commitment therapy (ACT) symptoms of adults suffering from eating disorders. Journal of Excellence in Counseling and Psychotherapy. 2016;5 (17):73–91. [Persian] [Article]

40. Juarascio AS, Forman EM, Herbert JD. Acceptance and commitment therapy versus cognitive therapy for the treatment of comorbid eating pathology. Behav Modif. 2010;34 (2):175–90. [DOI]

41. Juarascio AS, Manasse SM, Schumacher L, Espel H, Forman EM. Developing an acceptance-based behavioral treatment for binge eating disorder: rationale and challenges. Cogn Behav Pract. 2017;24 (1):1–13. [DOI]

42. Manlick CF, Cochran SV, Koon J. Acceptance and commitment therapy for eating disorders: rationale and literature review. J Contemp Psychother. 2013;43 (2):115–22. [DOI]

43. Mobbs O, Ghisletta P, Van Der Linden M. Clarifying the role of impulsivity in dietary restraint: a structural equation modeling approach. Pers Individ Dif. 2008;45 (7):602–6. [DOI]

44. Vanderlinden J. Many roads lead to Rome: why does cognitive behavioural therapy remain unsuccessful for many eating disorder patients? Eur Eat Disorders Rev. 2008;16 (5):329–33. [DOI]

45. Fulton JJ, Lavender JM, Tull MT, Klein AS, Muehlenkamp JJ, Gratz KL. The relationship between anxiety sensitivity and disordered eating: the mediating role of experiential avoidance. Eating Behaviors. 2012;13 (2):166–9. [DOI]

46. Merwin RM, Timko CA, Moskovich AA, Ingle KK, Bulik CM, Zucker NL. Psychological inflexibility and symptom expression in anorexia nervosa. Eating Disorders. 2010;19 (1):62–82. [DOI]

47. 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. [DOI]