The Effectiveness of Enhanced Cognitive Behavioral Therapy (CBT-E) on Body Image and Self-Criticism in Overweight Adolescents Without a Formal Diagnosis of Eating Disorders

Abstract

Purpose: This study aimed to evaluate the effectiveness of Enhanced Cognitive Behavioral Therapy (CBT-E) in reducing body image dissatisfaction and self-criticism among overweight adolescents without a formal diagnosis of eating disorders.Methods and Materials: A randomized controlled trial was conducted with 60 Iranian adolescents aged 13–17 years who were classified as overweight (BMI ≥ 85th percentile). Participants were randomly assigned to receive either 20 sessions of CBT-E or standard CBT, each delivered individually on a weekly basis by trained clinical psychologists. CBT-E followed a modular, transdiagnostic format targeting body dissatisfaction, perfectionism, and self-critical thinking. Outcomes were measured at baseline, post-treatment, and a three-month follow-up using two validated self-report instruments: the Body Shape Questionnaire-34 (BSQ-34) for body image dissatisfaction and the Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS) for self-criticism. Data were analyzed using repeated-measures ANOVA, effect size calculations, and Bonferroni post-hoc tests.Findings: The CBT-E group showed significantly greater reductions in both body image dissatisfaction and self-criticism compared to the standard CBT group. ANOVA revealed significant time × group interaction effects for both BSQ-34 (F = 14.21, p < .001, η² = .178) and FSCRS (F = 17.49, p < .001, η² = .184). Post-hoc analyses confirmed that improvements in the CBT-E group were maintained at the three-month follow-up. Effect sizes were large for CBT-E on both outcomes (body image: d = 1.28; self-criticism: d = 1.16), indicating clinically meaningful gains.Conclusion: CBT-E is a highly effective intervention for reducing body dissatisfaction and self-criticism in overweight adolescents without a formal eating disorder diagnosis. The findings support the application of CBT-E as a preventive and early-intervention strategy in youth at risk for developing more severe psychological conditions.