Comparing The Effectiveness of Healthy Body Image Package (HBIP) and Cash Cognitive-Behavioral Therapy (C-CBT) on Fear of Negative Evaluation in Dissatisfied Adolescents Aged 12 to 15

Document Type : Original Article

Authors

• Shiva Akhtarian ¹
• Mansoureh Bahramipour Isfahani ²
• Ghlolamreza Manshaee ³

¹ PhD in Psychology, Department of Psychology, Isf.C., Islamic Azad University, Isfahan, Iran.

² Assistant Professor, Department of Psychology, Isf.C., Islamic Azad University, Isfahan, Iran

³ Associate Professor, Department of Psychology, Isf.C., Islamic Azad University, Isfahan, Iran

10.22067/tpccp.2025.88221.1652

Abstract

Introduction
Adolescence represents a critical stage in psychosocial development, during which an individual seeks to form their social identity, a process accompanied by concerns regarding appearance and body perception. This period is characterized by widespread changes, including heightened exposure to peer pressure and the significance of social acceptance. Consequently, concerns such as body image dissatisfaction and the fear of negative evaluation become more prevalent during this phase, potentially exerting a considerable influence on adolescent mental health. Consequently, there is a need to assess the efficacy of psychological interventions targeting this target group. Addressing these issues can prevent the development of more severe disorders in the future. This underscores the importance of preventive interventions during this period to avert the establishment of deleterious thought and behavioral patterns.
The objective of this study was to compare the effectiveness of the Healthy Body Image Package and Cognitive-Behavioral Therapy on the fear of negative evaluation in dissatisfied adolescents aged 12 to 15 years. The selection of adolescents allowed for the evaluation of the effectiveness of these interventions at a critical stage of development and the acquisition of results that can be useful in future clinical and educational interventions.
 
Method
The present study employed a quasi-experimental design, incorporating a pre-test, post-test, and follow-up, with a control group. The statistical population comprised 60 adolescents aged 12 to 15 from secondary schools in Isfahan, who were selected through purposive sampling method. Following the administration of a pre-test and the random assignment of participants to one of three groups, the Healthy Body Image Package (Akhtarian, Bahramipour Isfahani, & Manshaee, 2024), Cash Cognitive Behavioral Therapy (Cash, 2010) were implemented over the course of eight sessions, each spanning 90 to 120 minutes. The control group did not receive any intervention during this period.
The 9-item subscale of the Body Area Segment Scale (BASS) (Cash, & et al., 1990) was utilized to measure body image dissatisfaction. The 12-item short form of the Larry (2021) questionnaire was employed to measure fear of negative evaluation. The resulting data were analyzed using repeated measures analysis of variance and Bonferroni post hoc test in SPSS-26.
 
Findings
The findings indicate that in the within-group effect, the time factor (F=251.871, df=1.130, p<0.01) and the interaction of time and group (F=72.41 8, df=2.260, p<0.01) indicate a statistically significant difference (p<0.01) in the fear of negative evaluation based on time and the interaction of time with group (across three research groups). The results suggest that for the time factor and the interaction of time and group, 84.3 and 75.5 percent of the variance in the fear of negative evaluation was associated with the independent variable, respectively. Due to the substantial interaction of time with the group, a Bonferroni post hoc test was conducted to examine the pairwise difference. The results indicated a statistically significant difference between the pre-test, post-test, and follow-up (p < 0.01). Additionally, a statistically significant difference was observed between the Healthy Body Image Package and the Cash’s Package (p < 0.05).
 
Discussion
The objective of this study was to ascertain the effectiveness of the healthy body image package and cognitive-behavioral therapy in reducing the fear of negative evaluation among adolescents with body image dissatisfaction. The findings indicated that the healthy body image package exhibited a more pronounced reduction in the scores of the fear of negative evaluation in adolescents when compared to the cognitive-behavioral therapy. This finding aligns with the outcomes of other studies that targeted the enhancement of self-esteem and the mitigation of perfectionism in adolescents (Akhtarian, Bahramipour Isfahani, & Manshaee, 2024). The present finding can be explained by the implementation of healthy body image education, which focuses on emotional techniques and skills. These techniques and skills include the teaching of self-compassion strategies in relation to the body and its functions, the teaching of strategies to deal with shame, and the strengthening of self-esteem. The implementation of these techniques and skills provides an opportunity for adolescents to improve their self-belief.
The findings are also somewhat consistent with the research conducted by Rahmati and Barjali (2020) on the effectiveness of cognitive and behavioral group therapy on emotion regulation in women with eating disorders, and with the study by Yu and Jia (2023) on the relationship between the treatment of body image problems and fear of negative evaluation. The efficacy of cognitive-behavioral therapy in addressing fear of negative evaluation is attributable to its utilization of strategies and techniques aimed at the cessation of anxiety-intensifying thoughts and beliefs. In this treatment modality, the presence of negative thoughts, beliefs, and behaviors directed towards one's own body plays a pivotal role in the development of excessive sensitivity to the evaluations of others (Yue & Jia, 2023).
It is recommended that education officials consider implementing measures to mitigate adolescents' fear of negative evaluation. This could be achieved by leveraging the expertise of specialists and engaging the services of psychologists specializing in body image. By doing so, educators can foster an environment conducive to enhancing not only individual performance but also learning outcomes.

Keywords

• HBIP
• CBT
• self-evaluation
• body dissatisfaction

Main Subjects

• Cognetive Psy

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References

Abbasi, M., Maleki, M., Romani, S., & Aalipour, K. (2020). The impact of group social skills training on classroom silence, fear of negative evaluation, and shyness in female students. Strides Dev Med Educ, 16(64), 306-315. http://edcbmj.ir/article-1-1585-en.html (In Persian)

Gabrys, K., & Wontorczyk, A. (2023). Sport Anxiety, Fear of Negative Evaluation, Stress and Coping as Predictors of Athlete's Sensitivity to the Behavior of Supporters. International journal of environmental research and public health, 20(12), 6084. https://doi.org/10.3390/ijerph20126084

Akhtarian, S. h., Bahramipour Isfahani, M., & Manshaee, G. R. (2024). Preparing a Healthy Body Image Package and Comparing its Effectiveness with Cash Cognitive-Behavioral Therapy on Beliefs about Appearance, Body Image Quality of Life, Fear of Negative Evaluation, Self-Esteem and Perfectionism of 12 to 15 Years Old Adolescents with Body Image Dissatisfaction. Avicenna J Neuro Psycho Physiology, 11(1), 32-38.
URL: http://ajnpp.umsha.ac.ir/article-1-476-en.html

Attar, S., Behniaasl, F., Heidari, Z., & Mahmoudi, N. (2020). The effectiveness of cognitive-behavioral therapy on increasing sexual intimacy and reducing body image concerns in women with sexual dysfunction attending counseling centers in Shiraz. Adv Behav Sci, 5(43), 13-25. URL: http://ijndibs.com/article-۱-۴۳۴-fa.html [In Persian].

Bavadi, B., Porsharifi, H., & Lotfi Kashani, F. (2016). The effectiveness of cognitive-behavioral therapy based on the 8-stage model on improving the psychological well-being of women with breast cancer. Breast Dis, 8(4), 41-51. URL: http://ijbd.ir/article-1-488-en.html

Cash, T. (2010). Body Image Guide (Psychology of Body Image). Danjeh Publications.

Cash, T. F., Mikulka, P. J., & Brown, T. A. (1990). Attitudinal body-image assessment: Factor analysis of the body-self relations questionnaire. Pers, 55, 135-144. DOI: 10.1080/00223891.1990.9674053

Davoodi, I., Salehian, A., & Vessi, F. (2012). Social anxiety and fear of positive evaluation. Mazandaran Univ Med Sci, 22(96), 80-88. URL: http://jmums.mazums.ac.ir/article-1-1699-en.html

Habibi Zanjani, N., Barazian, S., & Ahadi, H. (2022). The effectiveness of rational-emotional behavior therapy on body image, body mass index, and social anxiety reduction in overweight adolescents. Fam Couns Ther Appl. https://doi.org/10.61838/kman.aftj.3.4.8

Haji Yousef, H., Dehstani, M., & Darvishmolla, M. (2022). The role of emotion regulation difficulty in the relationship between harassment experience and dissatisfaction with body image in adolescent girls. Appl Psychol Res, 13(1), 327-344. 20.1001.1.22518126.1401.13.1.18.6

Hashemian, M., Aflak-Sir, A., Goodarzi, M. A., & Rahimi, C. (2021). The relationship between attachment style and body image attitudes in female middle school students: The mediating role of cultural-social appearance and self-acceptance. Res Psychol Behav Sci, 11(2), 1-26. 10.22108/CBS.2022.131524.1598

Kang, N. R., & Kwack, Y. S. (2020). An update on mental health problems and cognitive behavioral therapy in pediatric obesity. Pediatr Gastroenterol Hepatol Nutr, 23(1), 15-25. doi: 10.5223/pghn.2020.23.1.15

Leary, R. M. (1983). A brief version of the Fear of  Negative Evaluation Scale. Personality and Social Psychology Bulletin, 371-375. https://doi.org/10.1177/0146167283093007

Lewis-Smith, H., Garbett, K. M., Chaudhry, A., Dhillon, M., Shroff, H., White, P., & Diedrichs, P. C. (2023). Evaluating a body image school-based intervention in India: A randomized controlled trial. Body Image, 44, 148-156. https://doi.org/10.1016/j.bodyim.2022.12.006

McCabe, M. P., Ricciardelli, L. A., & Karantzas, G. (2010). Impact of a healthy body image program among adolescent boys on body image, negative affect, and body change strategies. Body Image, 7(2), 117-123.  DOI: 10.1016/j.bodyim.2009.10.007

Mohammadi, N., & Sajadi Nezhad, M. (2008). The relationship between body image concern, fear of negative evaluation, and self-esteem with social anxiety. New Psychol Res, 2(5), 55-70. https://psychologyj.tabrizu.ac.ir/article_4374_en.html (In Persian)

Norouzi, A., Maleki, A., Parsamehr, M., & Ghasemi, H. (2019). The effect of body image and body management on the sports participation of women in Ilam province. Appl Sociol, 29(4), 99-122. 10.22108/JAS.2018.104379.1117 (In Persian)

Porfarahani, M., Zamani Nia, F., Arian Moghadam, Z., & Aghamohammadian Shahrbaaf, H. R. (2021). The effectiveness of eight-stage cognitive-behavioral group therapy on body image and marital commitment. Fam Couns Psychother, 4(1), 63-76.  https://doi.org/10.30473/sc.2020.55553.2611 (In Persian)

Rahmati, S., & Barjali, A. (2020). The effectiveness of cognitive-behavioral group therapy on body image, attachment style, and emotion regulation in women with eating disorders. Appl Psychol Res, 12(4), 175-196. 10.22059/JAPR.2022.317446.643734 (In Persian)

Raygan, N., Shaeiri, M. R., & Asghari Moghadam, M. A. (2007). The effectiveness of cognitive-behavioral therapy based on the 8-stage model on negative body image of female university students. Clin Psychol Person, 4(2), 11-22. https://cpap.shahed.ac.ir/article_2565.html

Sabokbari, K., Abbasi, R., & Gholamibakr, N. (2022). The effectiveness of schema therapy on fear of negative evaluation in girls with social anxiety. Clin Psychol Stud, 11(2), 95-112. 10.22067/TPCCP.2022.72888.1182  (In Persian)

Sadock, B. J., Sadock, V., & Ruiz, P. (2015). Summary of Psychiatry: Behavioral Sciences-Clinical Psychiatry. 1. https://www.amazon.com/Kaplan-Sadocks-Synopsis-Psychiatry-Behavioral/dp/1609139712

Saleh Mirhosseini, V., Rafieepour, A., & Alavi, S. (2020). Cognitive-behavioral therapy, body dysmorphic disorder: A review study. Royesh. 9(8). URL: http://frooyesh.ir/article-1-1974-fa.html

Shekari, O., Garavand, F., Nakhsh, Z., Alitarokhan, R., & Payizi, M. (2008). Psychometric properties of the short form of the Fear of Negative Evaluation Scale. Psychiatry Clin Psychol, 14(3), 316-325. URL: http://ijpcp.iums.ac.ir/article-1-574-en.html

Sohrabi, Z., Dortaj, F., & Saadipour, I. (2020). The effectiveness of self-compassion training on cognitive slipping and fear of negative evaluation. Iranian Psychologists, 16(64), 401-410.  https://www.sid.ir/paper/1071273/fa

Taylor, J. (2019). The Body Image Workbook for Teens: Activities to Help Girls Develop a Healthy Body Image in an Image-Obsessed World. Link

Will, D., & Naziroglu, F. (2020). Body dysmorphic disorder: A treatment guide. Translated by Mohsen Ahmadi Tahoor-Soltani and Mostafa Peymbari. Arjmand Publications. [Link]

Yousefi, A., Taher, M., Aghaee, H., & Baqeri Nia, H. (2022). A comparison of the effectiveness of individual psychotherapy and cognitive-behavioral therapy on the body image of women referring to cosmetic surgery centers. Sabzevar Univ Med Sci, 29(2), 281-290. https://www.sid.ir/paper/1089044/en (In Persian)

Yue, Y., & Jia, Y. (2023). Fear of negative evaluation: A cross-sectional study among undergraduate nursing students. NurseEducToday, 121, 105678. https://doi.org/10.1016/j.nedt.2022.105678