Comparing the Effectiveness of Mentalization-Based Therapy and Acceptance and Commitment Therapy on Self-esteem of Women Aged 18 to 30 with Body Dysmorphic Disorder Seeking Cosmetic Surgery

Hashemi Najafabadi , Saeideh-alsadat; Lali, Mohsen; Sajjadian , Parinaz Sadat; Dehghani , Akram

Volume 15 - Articles-1404 MEJDS (2025) 15: 17 | Back to browse issues page

Ethics code: IR.IAU.KHSH.REC.1403.257

Clinical trials code: 0009-0005-5354-3505

Mendeley

Zotero

RefWorks

Hashemi Najafabadi S, Lali M, Sajjadian P S, Dehghani A. Comparing the Effectiveness of Mentalization-Based Therapy and Acceptance and Commitment Therapy on Self-esteem of Women Aged 18 to 30 with Body Dysmorphic Disorder Seeking Cosmetic Surgery. MEJDS 2025; 15 (0) :17-17
URL: http://jdisabilstud.org/article-1-3561-en.html

Comparing the Effectiveness of Mentalization-Based Therapy and Acceptance and Commitment Therapy on Self-esteem of Women Aged 18 to 30 with Body Dysmorphic Disorder Seeking Cosmetic Surgery

Saeideh-alsadat Hashemi Najafabadi¹

, Mohsen Lali ^*²

, Parinaz Sadat Sajjadian³

, Akram Dehghani³

1- PhD Student in Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran
2- Assistant Professor, Department of Educational Sciences, Farhangian University, Isfahan, Iran
3- Assistant Professor, Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran

Abstract: (232 Views)

Abstract
Background & Objectives: One of the main needs of women in the modern era is to look beautiful. Therefore, cosmetic surgeries are among the most common surgeries today. One of these aspects is body dysmorphic disorder. This disorder is a mental preoccupation with an imaginary defect in a person's appearance, which causes significant problems in functioning. For this reason, these people are the main applicants for these surgeries. Also, due to the psychological origin of this disorder, after cosmetic surgeries, the symptoms intensify and can lead to depression and suicide. Therefore, reducing effective psychological problems in this field is an important issue. One of the common problems of women with body dysmorphic disorder is a lack of self–esteem. In this context, two interventions, mentalization therapy and acceptance and commitment therapy, seem to be applicable. Therefore, the purpose of this study was to compare the effectiveness of mentalization therapy and acceptance and commitment therapy on the self–esteem of women aged 18 to 30 with body dysmorphic disorder who are candidates for cosmetic surgery.
Methods: The research was quasi–experimental with a pretest–posttest and a three–month follow–up design with a control group. The research population was women with dysmorphic disorder who were applying for cosmetic surgery and referred to specialized centers in Isfahan City, Iran, in 2023. From the population mentioned above, 54 people were selected purposively and randomly divided into two experimental groups and a control group, and a pretest was administered. The inclusion criteria for the subjects in the study were as follows: having body dysmorphic (confirmed by a clinical psychologist), a score of more than 20 on the Yale–Brown Obsessive–Compulsive Scale Modified for BDD (BDD–YBOCS) (Phillips et al., 1997), an age range of 18 to 30 years, lacking acute or chronic mental disorders (confirmed by a clinical psychologist), not using concurrent psychological treatments, not taking psychiatric medications for the previous three months (asked by the patients), and not having physical illnesses that prevented participation in the research project. The exclusion criteria for the subjects from the study were having cosmetic surgery, not cooperating, not completing assigned tasks in the sessions, and missing more than two sessions. The research instruments were the Rosenberg Self–Esteem Scale (Rosenberg, 1965) and the Yale–Brown Obsessive–Compulsive Scale Modified for BDD (BDD–YBOCS) (Phillips et al., 1997). The first experimental group underwent mentalization therapy, and the second experimental group underwent acceptance and commitment therapy in the form of twenty 45–minute sessions twice a week. The control group did not receive any intervention during this period. The research groups were re–evaluated after completing the sessions and three months after implementing the interventions. Analysis of variance and Chi–square test were used to examine the homogeneity of the studied groups, and analysis of variance with repeated measures and Bonferroni post hoc test were used in SPSS software version 26. The significance level of statistical tests was 0.05.
Results: The results of the research showed that the effect of the time factor (F=41.196), the effect of the group (F=9.748), and the effect of the interaction of time and group (F=14.358) on the self–esteem variable were significant (p<0.001). Also, in the posttest and follow–up, there was no significant difference in the mean of the self–esteem variable between the two treatment groups (p=0.926). However, a significant difference was observed between mentalization–based therapy and acceptance and commitment therapy in the control group (p<0.001).
Conclusion: Based on the findings, mentalization–based therapy and acceptance and commitment therapy are effective interventions in increasing the self–esteem of women with body dysmorphic disorder who are seeking cosmetic surgery. Therefore, it is suggested that psychologists, clinical counselors, and therapists use these two treatments to increase the self–esteem of these women and to reduce unnecessary surgeries in this group.

Keywords: Body dysmorphic disorder, Mentalization–based therapy, Acceptance and commitment therapy, Self–esteem

Full-Text [PDF 287 kb] (109 Downloads)

Type of Study: Original Research Article | Subject: Psychology

References

1. Wu Y, Mulkens S, Alleva JM. Body image and acceptance of cosmetic surgery in China and the Netherlands: a qualitative study on cultural differences and similarities. Body Image. 2022;40:30–49. [DOI]

2. Rounagh Sheshkelani M, Panah Ali A, Lofti A, Ghavimi MA, Ahmadpour Pournaki F. Comparison of body image and life satisfaction in applicants cosmetic and those surgical operated of oral and maxillofacial and cosmetic surgery part at the education and health care of Imam Reza hospital in Tabriz. Razi Journal of Medical Sciences. 2018;25(8):12–23. [Persian] [Article]

3. General Medical Council. Cosmetic interventions [Internet]. 2020 [cited 2025 Mar 26]; Available from: [Article]

4. Hajiabllo K, Hallajzadeh H, Masoudnia E. Comparison of social capital among the two groups of women with a history of cosmetic surgery and without performing cosmetic surgeries in Rasht. Journal of Applied Sociology. 2018;29(4):167–82. [Persian] [DOI]

5. Khabbaz Sabet S, Keykhosrovani M, Poladi Rishehri A, Bahrani MR. Relationship between tendency to cosmetic surgery with attitudes to fashion and negative body image of women applying for cosmetic surgery based on the type of surgery: the mediating role of cognitive emotion regulation. Social Psychology Research. 2022;12(46):37–60. [Persian] [DOI]

6. Sarwer DB, Siminoff LA, Gardiner HM, Spitzer JC. The psychosocial burden of visible disfigurement following traumatic injury. Front Psychol. 2022;30(13):979574. [DOI]

7. Ganji M. Psychopathology based on DSM–5. Tehran: Savalan Pub; 2024. [Persian]

8. Sansone RA, Sansone LA. Cosmetic surgery and psychological issues. Psychiatry. 2007;4(12):65-8. [Article]

9. Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. Rezaei F. (Persian translator). Tehran: Arjmand Pub; 2022.

10. Griffiths C, Williamson H, Zucchelli F, Paraskeva N, Moss T. A systematic review of the effectiveness of acceptance and commitment therapy (ACT) for body image dissatisfaction and weight self–stigma in adults. J Contemp Psychother. 2018;48(4):189–204. [DOI]

11. Wang C, Sun T, Zhu L, Zhang Y, Wang X. Emotional disorder syndrome after cosmetic facial injection. J Cosmet Dermatol. 2020;19(9):2273–6. [DOI]

12. Azam Rajabian A, Asghari Ebrahimabad MJ, Aghamohammadian Sharbaf H, Rasoolzadeh Tabatabaei SK. Investigating the causes of body dysmorphic disorder in women: content analysis. Journal of Arak University of Medical Sciences. 2022;25(3):484–99. [Persian] [DOI]

13. Zare H, Hasani Estalkhi F, Dosti R. Comparison of explicit and implicit self–esteem in applicants for nose surgery and normal women. Health Psychology. 2019;8(30):133–44. [Persian] [DOI]

14. Bassak Nejad S, Aarefi N, Arshadi N. Testing a model of emotional eating, emotional dysregulation, self–esteem, and impulsivity in food addiction among students. Health Psychology. 2018;7(26):132–45. [Persian] [Article]

15. Khunger N, Pant H. Cosmetic procedures in adolescents: what's safe and what can wait. Indian Journal of Paediatric Dermatology. 2021;22(1):12–20.

16. Walker CE, Krumhuber EG, Dayan S, Furnham A. Effects of social media use on desire for cosmetic surgery among young women. Current Psychology: A Journal for Diverse Perspectives on Diverse Psychological Issues. 2021;40(7):3355–64. [DOI]

17. Shams S, Ghelichkhan N, Yousefi N, Alijani S. Comparison of the effectiveness of short–term intensive dynamic psychotherapy and mentalization–based therapy on emotional dysregulation, defense mechanisms and insecure attachment styles in women who have experienced the trauma of marital infidelity. Iranian Journal of Psychiatric Nursing. 2022;10(1):106–21. [Persian] [DOI]

18. De Oliveira C, Rahioui H, Smadja M, Gorsane MA, Louppe F. Mentalization based treatment and borderline personality disorder. Encephale. 2017;43(4):340–5. [DOI]

19. Bateman A, Fonagy P. Mentalization–based treatment for personality disorders: a practical guide. New York, NY, US: Oxford University Press; 2016. [DOI]

20. Löf J, Clinton D, Kaldo V, Rydén G. Symptom, alexithymia and self–image outcomes of Mentalisation–based treatment for borderline personality disorder: a naturalistic study. BMC Psychiatry. 2018;18(1):185. [DOI]

21. Griffiths H, Duffy F, Duffy L, Brown S, Hockaday H, Eliasson E, et al. Efficacy of mentalization–based group therapy for adolescents: the results of a pilot randomised controlled trial. BMC Psychiatry. 2019;19(1):167. [DOI]

22. Hauschild S, Kasper L, Volkert J, Sobanski E, Taubner S. Mentalization–based treatment for adolescents with conduct disorder (MBT–CD): a feasibility study. Eur Child Adolesc Psychiatry. 2023;32(12):2611–22. [DOI]

23. Pourfarahani M, Shareh H, Haji Arbabi F. Comparing the effectiveness of acceptance and commitment therapy and schema therapy based on acceptance and commitment on body image and sexual self–esteem in dialysis women. Research in Clinical Psychology and Counseling. 2023;13(1):102–22. [Persian] [DOI]

24. Mahmoudfakhe H, Hasanzadeh N, Shiri H. The effectiveness of acceptance and commitment therapy on feelings of inferiority, fear of body image, and feeling of self–worth in cosmetic surgery applicants. Journal of Research in Psychopathology. 2023;4(12):31–8. [Persian] [DOI]

25. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25. [DOI]

26. Soleimanpour Moghaddam H, Saeedi A, Mehdian H. Comparison of the effectiveness of compassion and acceptance and commitment–based education (ACT) on academic self-efficacy and achievement motivation. Islamic Lifestyle Based on Health. 2022;5(4):234–44. [Persian]

27. Hayes SC. Acceptance and commitment therapy: state of the evidence. Colloquium presented to the University of Toronto. Toronto, Ontario; 2016.

28. Hayes S. C, Strosahl K. D & Wilson K. G. Acceptance and commitment therapy: an experiential approach to behavior change. New York, NY, US: Guilford Press 1999.

29. Ghorbani E, Barati H, Zakerfard M. The effect of acceptance and commitment therapy on depression, self–efficacy and self–esteem of divorced women. In: Iran's 2nd National Psychotherapy Conference [Internet]. Ardabil, Iran: Civilica; 2023. [Persian] [Article]

30. Moradi Bidhandi D. The effectiveness of treatment based on acceptance and commitment on the self–esteem of adolescent girls with symptoms of social anxiety. In: The 7th National Conference on New Researches in the Field of Educational Sciences and Psychology of Iran [Internet]. Tehran, Iran: Civilica; 2022. [Persian] [Article]

31. Hosseinzadeh Oskooei A, Samadi Kashan S, Zamani Zarchi MS, Asadi Asadabad R, Bakhtiari M. The efficacy of group–based acceptance and commitment therapy on cognitive flexibility and self–esteem in women who have experienced the trauma of infidelity. Journal of Applied Psychological Research. 2022;13(4):203–16. [Persian] [DOI]

32. Farahzadi M, Maddahi ME, Khalatbari J. Comparison the effectiveness of group therapy based on acceptance and commitment and cognitive–behavioral group therapy on the body image dissatisfaction and interpersonal sensitivity in women with the body image dissatisfaction. Research in Clinical Psychology and Counseling. 2018;7(2):69–89. [Persian] [DOI]

33. Delavar A. Research method in psychology and educational sciences. Tehran: Virayesh Pub; 2022. [Persian]

34. Phillips KA, Hollander E, Rasmussen SA, Aronowitz BR, DeCaria C, Goodman WK. A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale–Brown Obsessive Compulsive Scale. Psychopharmacol Bull. 1997;33(1):17–22.

35. Rosenberg M. Society and the adolescent self–image. Princeton, NJ: Princeton University Press; 1965.

36. Mayordomo T, Gutierrez M, Sales A. Adapting and validating the Rosenberg self–esteem scale for elderly Spanish population. Int Psychogeriatr. 2020;32(2):183–90. [DOI]

37. Rajabi G, Bahloul N. Assessing the reliability and validity of the Rosenberg self–esteem scale among first–year students of Shahid Chamran University. Educational and Psychological Research. 2007;3(2):33–48. [Persian]

38. Gholami S, Omidi Moghadam E, Ghadampour E, Bayat Mazlaghani M. Psychometric properties of the revised yale–brown obsessive compulsive disorder scale for body dysmorphic disorder in transgenders. Iranian Journal of Psychiatric Nursing. 2025;13(1):79–92. [Persian] [Article]

39. Basharpoor S, Einy S. The effectiveness of mentalization–based therapy on emotional dysregulation and impulsivity in veterans with post–traumatic stress disorder. The Neuroscience Journal of Shefaye Khatam. 2020;8(3):10–9. [Persian] [DOI]

40. Fonagy P, Target M. The mentalization–focused approach to self pathology. J Pers Disord. 2006;20(6):544–76. [DOI]

41. McCracken LM, Gutiérrez–Martínez O. Processes of change in psychological flexibility in an interdisciplinary group–based treatment for chronic pain based on acceptance and commitment therapy. Behav Res Ther. 2011;49(4):267–74. [DOI]

42. Flaxman PE, Bond FW. A randomised worksite comparison of acceptance and commitment therapy and stress inoculation training. Behav Res Ther. 2010;48(8):816–20. [DOI]