Comparing the Effectiveness of Compassion-Focused Therapy and Metacognitive Psychotherapy on Body Shame in Women Seeking Cosmetic Surgery
Keywords:
Cosmetic surgery, compassion-focused therapy, metacognitive psychotherapy, body shameAbstract
Objective: This study aimed to compare the effectiveness of compassion-focused therapy (CFT) and metacognitive psychotherapy (MCT) in reducing body shame among women seeking cosmetic surgery.
Methods and Materials: This quasi-experimental study employed a three-group pretest–posttest design with a follow-up assessment and a control group. The statistical population consisted of women seeking cosmetic surgery who attended plastic surgery clinics and hospitals in Tehran during the summer and autumn of 2023. Using purposive sampling and predefined inclusion and exclusion criteria, 45 eligible participants were recruited and randomly assigned to a compassion-focused therapy group (n = 15), a metacognitive psychotherapy group (n = 15), or a control group (n = 15). Participants in all three groups completed the Body Image Shame Scale developed by Duarte et al. at the pretest, posttest, and follow-up assessments. The intervention groups received their respective therapeutic protocols, whereas the control group received no psychological intervention during the study period. Data were analyzed using repeated-measures analysis of variance in SPSS version 26 to examine within-group changes over time and between-group differences in body shame.
Findings: Repeated-measures analysis of variance indicated a significant effect of time on body shame and a significant time-by-group interaction, demonstrating that changes in body shame differed across the three groups. Both compassion-focused therapy and metacognitive psychotherapy produced significantly greater reductions in body shame from pretest to posttest and follow-up compared with the control condition. Furthermore, pairwise comparisons showed that the reduction in body shame was significantly greater in the compassion-focused therapy group than in the metacognitive psychotherapy group, indicating a comparatively stronger therapeutic effect of compassion-focused therapy.
Conclusion: Both compassion-focused therapy and metacognitive psychotherapy appear effective for reducing body shame in women seeking cosmetic surgery; however, compassion-focused therapy may provide greater improvement and can be considered a particularly relevant psychological intervention for this population.
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References
Ahangar, A., Asadi, F., & Salamat, S. (2020). Effectiveness of Metacognitive Therapy on Intolerance of Uncertainty in Students with Obsessive-Compulsive Symptoms. Women and Family Studies, 13(47), 71-91.
Azad, M., Bagherzadeh Golmakani, Z., Mansouri, A., & Doustkam, M. (2021). Effectiveness of Metacognitive Therapy on Body-Image Concern, Anxiety, and Depression in Patients with Psoriasis. Journal of Health Psychology, 10(40), 151-164.
Babakhannlou, A., Haghighat, S. A., Moradi-Manesh, F., & Dehghani, A. (2020). Emotional Eating and Self-Compassion in Obese Individuals: The Mediating Role of Emotional Processing. Developmental Psychology, 17(66), 205-216.
Carter, A., Gilbert, P., & Kirby, J. N. (2023). A Systematic Review of Compassion-Based Interventions for Individuals Struggling with Body Weight Shame. Psychology & Health, 38(1), 94-124. https://doi.org/10.1080/08870446.2021.1955118
Cash, T. F. (2017). The Body Image Workbook. New Harbinger Publications.
Cepni, A. B., Ma, H. Y., Irshad, A. M., Yoe, G. K., & Johnston, C. A. (2024). Addressing Shame through Self-Compassion. American Journal of Lifestyle Medicine, 15598276241292993. https://doi.org/10.1177/15598276241292993
Di Gesto, C., Nerini, A., Policardo, G. R., & Matera, C. (2022). Predictors of Acceptance of Cosmetic Surgery: Instagram Images-Based Activities, Appearance Comparison and Body Dissatisfaction among Women. Aesthetic Plastic Surgery, 46(1), 502-512. https://doi.org/10.1007/s00266-021-02546-3
Dias, B. S., Ferreira, C., & Trindade, I. A. (2020). Influence of Fears of Compassion on Body Image Shame and Disordered Eating. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 25, 99-106. https://doi.org/10.1007/s40519-018-0523-0
Duarte, C., Pinto-Gouveia, J., Ferreira, C., & Batista, D. (2015). Body Image as a Source of Shame: A New Measure for the Assessment of the Multifaceted Nature of Body Image Shame. Clinical Psychology & Psychotherapy, 22(6), 656-666. https://doi.org/10.1002/cpp.1925
Gilbert, P. (2022). Compassion Focused Therapy. In Spirituality and Psychiatry (pp. 262). https://doi.org/10.1017/9781911623311.027
Gillen, M. M., & Markey, C. H. (2021). Body Image, Weight Management Behavior, and Women's Interest in Cosmetic Surgery. Psychology, Health & Medicine, 26(5), 621-630. https://doi.org/10.1080/13548506.2020.1776890
Haseth, S., Grøtte, T., Hunstad, E., Güzey, I. C., & Solem, S. (2025). Metacognitive Therapy for Body Dysmorphic Disorder: A Consecutive Case Series. Journal of Cognitive Psychotherapy, 39(1), 5-21. https://doi.org/10.1891/JCP-2023-0014
Ibrahim Mohammed, D., & Ibrahim, R. (2023). Exploring the Impact of Psychological Factors on Cosmetic Surgery Acceptance: A Cross-Sectional Study. Informatics in Medicine Unlocked. https://doi.org/10.1016/j.imu.2023.101231
Khanjani, S., Gharraee, B., Farani, A. R., & Foroughi, A. (2020). Psychometric Properties of Persian Version of Body Image Shame Scale: A Study in Cosmetic Surgery Clinics. Iranian journal of psychiatry and behavioral sciences, 14(2). https://doi.org/10.5812/ijpbs.99492
Kim, S. (2022). What Factors Encourage the Acceptance of Cosmetic Surgery? Differences in Sociopsychological Influences Contingent upon Cosmetic Surgery Experience. Fashion and Textiles, 9, 42. https://doi.org/10.1186/s40691-022-00318-4
Linde, J., Luoma, J. B., Rück, C., Ramnerö, J., & Lundgren, T. (2023). Acceptance and Compassion-Based Therapy Targeting Shame in Body Dysmorphic Disorder: A Multiple Baseline Study. Behavior Modification, 47(3), 693-718. https://doi.org/10.1177/01454455221129989
Mansouri Nik, A., Davoodi, I., Mehrabizadeh Honarmand, M., Nisi, A. K., & Tamanaifar, M. R. (2018). The Relationship between Body Discrepancy and Maladaptive Coping Strategies for Body Image in Female Students: The Mediating Role of Self-Compassion and Body Shame. Research in Psychological Health, 12(4), 1-15.
Menon, A. V. (2023). Refashioning Race: How Global Cosmetic Surgery Crafts New Beauty Standards. University of California Press. https://doi.org/10.1525/9780520386730
Moritz, S., Woodward, T. S., & Hauschildt, M. (2019). Practical and Clinical Guide to Metacognitive Psychotherapy for Psychosis: First Treatment Manual in the Metacognitive Psychotherapy Series. Donyaye Daroon Publications.
Nejati, S., Rezaei, A. M., Moradi, M., & Rajazi Isfahani, S. (2017). Metacognitive Beliefs and Emotion-Regulation Strategies: Obese Women with Negative and Positive Body Images. Journal of Health Research, 7(3), 826-833. http://jrh.gmu.ac.ir/article-1-924-fa.html
Nerini, A., Matera, C., Di Gesto, C., Policardo, G. R., & Stefanile, C. (2019). Exploring the Links between Self-Compassion, Body Dissatisfaction, and Acceptance of Cosmetic Surgery in Young Italian Women. Frontiers in psychology, 10, 2698. https://doi.org/10.3389/fpsyg.2019.02698
Salamat Varjovi, S., Hazami Jebeli, Z., Ketabforoush Badri, N., & Esmikhani Akbarinejad, H. (2023). Comparison of Mindfulness-Based Cognitive Therapy and Compassion-Focused Therapy on Internalized Shame and Self-Esteem in Patients with Vitiligo. Quarterly Journal of Medical Sciences, Islamic Azad University, Tehran Medical Sciences Branch, 33(2), 183-194.
Selgi, Z., & Hosseini, M. (2021). Effectiveness of Metacognitive Therapy on Rumination, Intolerance of Uncertainty, and Perceived Worry in Students with Social Anxiety Disorder. School Counseling, 1(2), 1-18.
Waring, S. V., & Kelly, A. C. (2020). Relational Body Image: Preliminary Evidence That Body Image Varies within a Person from One Specific Relationship to Another. Body Image, 34(221), 232. https://doi.org/10.1016/j.bodyim.2020.06.006
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