Body image in patients with residual eating disorder symptoms : treatment effects of acceptance and commitment therapy and participants' reflections

The overall aim of this thesis was to evaluate an acceptance and commitment (ACT) group intervention targeting body image in patients with residual eating disorder (ED) symptoms, including treatment effects and participants’ reflections on body image and the intervention. Studies I, II and III are based on a randomized controlled trial including 99 patients that were randomized to the ACT intervention or to continue treatment as usual (TAU). Different self-assessment questionnaires were administered before and after the intervention and at follow up by one and two years. Study IV is based on interviews with patients that had completed the intervention, and did not participate in the trial. From written evaluations in study I body image was shown to mean different things for different individuals. This was also shown by different expectations on treatment. Study II showed that the ACT intervention was superior to TAU in reducing ED symptoms and body dissatisfaction, while care consumption was lower. In addition, ratings of dropout was low. In study III, it was shown that symptom improvement from the ACT intervention rather than TAU was more pronounced in participants with restrictive ED psychopathology. Participants who displayed binge eating and/or purging ED psychopathology, showed improvement on ED symptoms regardless of intervention. Participants younger than 25, and with lower ratings at baseline, showed no improvement on ED symptoms if continuing with TAU. From interviews with participants in study IV, the intervention was described as demanding, and participants described the importance of their own efforts. Specific processes of the intervention were helpful and the context of the group and context outside of treatment could facilitate or hinder progress. Perceived changes in body image differed between participants in study I, showing the potential breadth of the intervention. Conclusions from this thesis was that an intervention based on ACT targeting body image was suitable and helpful for patients with residual EDsymptoms. Though the intervention was demanding, dropout was low, and specific processes were described as helpful