Body-oriented therapy in the prevention of eating disorders. A systematic review

Abstract

Aim Despite the growing significance of body-oriented therapy and the broad applicability of psychotherapeutic methods that focus on the body, there is a general scarcity of systematic reviews analyzing the effectiveness of this therapeutic approach in addressing body image problems in persons with anorexia or at risk of anorexia. The above constitutes a barrier for practitioners, theoreticians who investigate the mechanisms underpinning therapeutic interventions, as well as educators who implement health promotion programs. The aim of this article was to review research studies analyzing the effects of different body-oriented interventions on body image perception in persons suffering from or at risk of eating disorders such as anorexia. Methods The review was conducted according to the PRISMA guidelines. Digital databases (ProQuest, PsychINFO, PubMed, ScienceDirect, Scopus, Web of Science) were searched for randomized control trials (RCT). A total of 425 records, including 69 full-length research articles, were critically analyzed. Fifteen trials that met all inclusion criteria were ultimately included in the analysis. Results The review revealed that body-oriented therapeutic programs are more effective in reducing risk factors and reinforcing protective factors in comparison with the control groups, and that the inclusion of body-oriented therapy in standard therapeutic practice could substantially minimize the symptoms of eating disorders. Conclusions Further research is needed to directly compare the effects of different types of interventions on risk factors and protective factors.

Full text

PRZEGLĄD PSYCHOLOGICZNY – THE REVIEW OF PSYCHOLOGY
2022, TOM 65, NR 1, 177–195
DOI: 10.31648/przegldpsychologiczny.8545
Body-oriented therapy
in the prevention of eating disorders
A systematic review
Emilia Korsak*1
Department of Clinical, Developmental and Educational Psychology,
University of Warmia and Mazury in Olsztyn
0000–0002–9677–3731
ABSTRACT
Aim
Despite the growing significance of body-oriented therapy and the broad applicability of psy-
chotherapeutic methods that focus on the body, there is a general scarcity of systematic reviews
analyzing the effectiveness of this therapeutic approach in addressing body image problems in
persons with anorexia or at risk of anorexia. The above constitutes a barrier for practitioners,
theoreticians who investigate the mechanisms underpinning therapeutic interventions, as well
as educators who implement health promotion programs. The aim of this article was to review
research studies analyzing the effects of different body-oriented interventions on body image
perception in persons suffering from or at risk of eating disorders such as anorexia.
Methods
The review was conducted according to the PRISMA guidelines. Digital databases (Pro-
Quest, PsychINFO, PubMed, ScienceDirect, Scopus, Web of Science) were searched for
randomized control trials (RCT). A total of 425 records, including 69 full-length research
articles, were critically analyzed. Fifteen trials that met all inclusion criteria were ulti-
mately included in the analysis.
Results
The review revealed that body-oriented therapeutic programs are more effective in reduc-
ing risk factors and reinforcing protective factors in comparison with the control groups,
and that the inclusion of body-oriented therapy in standard therapeutic practice could
substantially minimize the symptoms of eating disorders.
* Correspondence address: Emilia Korsak, Department of Clinical, Developmental
and Educational Psychology, Faculty of Social Sciences, University of Warmia and Mazury
in Olsztyn, Prawocheńskiego Street 13, 10-447 Olsztyn. E-mail: emilia.korsak@gmail.com.

178 EMILIA KORSAK
Conclusions
Further research is needed to directly compare the effects of different types of interven-
tions on risk factors and protective factors.
Keywords: body-oriented therapy, body image, eating disorders, anorexia, prevention
Introduction
Body-Oriented Psychotherapy
Physical exercise and body-oriented therapy are important attributes of health
and well-being, both physical (explored by health and medical sciences) and psy-
chological (explored by psychology and pedagogy). Somatic symptoms and expe-
riences have been long considered an important part of psychotherapy, and the
founders of psychoanalysis regarded somatic tension as a sign of psychological
conflict (Freud, Kempnerówna, & Zaniewicki, 2017). At present, the popularity
of body-oriented techniques, including mindfulness, yoga, and progressive mus-
cle relaxation, stems from the awareness that body-mind integration plays a key
role in wellness (Leitan & Murray, 2014). According to research, most patients
with psychological issues also experience somatic symptoms (Katon, Sullivan,
& Walker, 2001).
Body-oriented psychotherapy is highly effective. Despite the above, psycho-
therapeutic techniques that focus on the body are still disregarded in the scien-
tific discourse (Röhricht, 2009). A clear definition of body-oriented psychotherapy
has not been proposed to date. This is because body-oriented psychotherapy is
a very diverse field (Young, 2008), despite the fact that the common theme is the
connection between body and mind, and the assumption that attitudes towards
the self and others are rooted not only in the mind, but also in the body (Röhricht,
2009). One of the few existing definitions of this therapeutic approach has been
proposed by Michael Heller who argued that “body-oriented psychotherapy in-
terventions” is an umbrella term for all psychotherapies that “explicitly use body
techniques in order to enhance the developing dialogue between patient and psy-
cho-therapist about what is being experienced as well as perceived […]. In most
schools of body psychotherapy, the body is considered a means of communication
and exploration” (Heller, 2012).
Body-oriented therapeutic methods play an important role in the treatment
of many psychological problems, but they are particularly useful in resolving
psychosomatic issues, including eating disorders.
Body Image in Eating Disorders
Eating disorders are severe psychological and somatic disorders that affect 4.95%
of the female population and 2.24% of the male population (Duncan, Ziobrowski,
& Nicol, 2017). Anorexia nervosa (AN) is the most prevalent eating disorder with

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BODY-ORIENTED THERAPY IN THE PREVENTION OF EATING DISORDERS…
serious and often life-threatening somatic consequences (Fichter & Quadflieg,
2016), often accompanied by psychosocial dysfunctions (Zipfel, Giel, Bulik, Hay,
& Schmidt, 2015). The main symptoms of AN include underweight, fear of weight
gain, and body image disturbance (BID) (Carey & Preston, 2019). The character-
istic features and the mechanisms underlying BID have not been fully explained
to date, in particular in the context of sensory processing disorders and cogni-
tive-affective disorders (Dakanalis et al., 2016). Anorexic individuals’ perceptions
of the physical self need to be explored to improve the quality of therapy.
The body image is a multi-dimensional construct with cognitive, affective,
and behavioral components (Thompson, 2004). Dysfunctions involving one or
several components can lead to the overestimation of the size of body features
(Farrell, Lee, & Shafran, 2005), negative feelings and thoughts about the body
(Rekkers, Scheffers, van Busschbach, & van Elburg, 2021; Troisi, 2020), body
checking and body avoidance (Shafran, Fairburn, Robinson, & Lask, 2004). Re-
search has demonstrated that BID is positively correlated with negative psy-
chological well-being, including low self-esteem, depression, and anxiety (Cruz-
Sáez, Pascual, Wlodarczyk, & Echeburúa, 2020; Junne et al., 2019), higher risk
of suicide (Naivar Sen, Gurleyik, & Psouni, 2020), and anhedonia (Wang et al.,
2018), which often persist after recovery (Bachner-Melman, Zohar, & Ebstein,
2006). These dysfunctions are also predictors of an AN relapse (Carter, Black-
more, Sutandar-Pinnock, & Woodside, 2004), which is why the body-oriented
approach should be prioritized in therapeutic interventions to support recovery
(Glashouwer, van der Veer, Adipatria, Jong, & Vocks, 2019).
Therapeutic Programs and Prevention of Eating Disorders
Cognitive-behavioral therapy is the most popular therapeutic intervention in
the treatment of BID (Lewis-Smith, Diedrichs, & Halliwell, 2019). Cognitive-be-
havioral therapy involves efforts to change thinking patterns and behaviors
such as body checking, and to restructure cognitive processes (Alleva, Sheeran,
Webb, Martijn, & Miles, 2015). However, the efficacy of CBT is limited, and more
than 25% of the patients continue to suffer from eating disorders after therapy
(Omiwole, Richardson, Huniewicz, Dettmer, & Paslakis, 2019). Other popular
intervention methods include psychological education and fitness training which
promote a sense of self-worth through the acquisition of new competencies, recog-
nition of one’s strengths and potential, and modification of behaviors relating to
body image (Alleva et al., 2015).
Treatment programs targeting AN are expensive, and they lead to an im-
provement in the patient’s health, but not to a full remission (Schmidt et al.,
2016; Westmoreland, Krantz, & Mehler, 2016). This is because most therapeutic
methods are not highly effective (Bulik, Berkman, Brownley, Sedway, & Lohr,
2007), relapse and chronic relapse rates are high (Berkman, Lohr, & Bulik, 2007;
Keel, Dorer, Franko, Jackson, & Herzog, 2005), and many patients drop out of
treatment (Fassino, Pierò, Tomba, & Abbate-Daga, 2009). For this reason, pro-
grams aiming to prevent eating disorders should be developed based on scientific

180 EMILIA KORSAK
evidence. There are three types of eating disorder prevention programs: (1) uni-
versal psychological education programs, (2) universal prevention campaigns
in the mass media, and (3) interactive selective prevention programs. Their
efficacy in minimizing the risk of eating disorders has been estimated at 51%
(Stice, Shaw, & Marti, 2007). Most programs aim to reduce risk factors, although
research has demonstrated that the effectiveness of preventive measures can
be significantly improved by modifying the theoretical framework and shifting
the focus to protective factors, such as shaping a positive body image (Levine
& Smolak, 2016; Piran, 2015). A meta-analysis of the effectiveness of eating dis-
order prevention programs revealed a significant reduction in the risk of disease
(54–77%) (Stice, Onipede, & Marti, 2021).
Scientific Evidence and Research Aim
Research has demonstrated that body-oriented therapy is an effective approach
(Allmer, Ventegodt, Kandel, & Merrick, 2009) because it offers additional psy-
chotherapeutic tools in areas where talk therapy is insufficient (Röhricht, 2009).
There is numerous, but dispersed scientific evidence to indicate that body-
oriented therapy is effective in resolving various psychological problems, includ-
ing eating disorders. However, there is a general scarcity of systematic reviews
analyzing the efficiency of body-oriented therapy in overcoming body image is-
sues in patients suffering from or at risk of anorexia. The above constitutes a se-
rious barrier for practitioners, theoreticians who investigate the mechanisms
underpinning therapeutic interventions, as well as educators who implement
health promotion programs. Therapeutic approaches whose positive impact has
been empirically validated play an important role in therapeutic practice and
should be a part of a professional therapist’s toolkit. Solutions that are based on
scientific evidence should be promoted by both theoreticians and practitioners.
This article contributes to meeting these challenges.
The aim of this article was to review research studies analyzing the effects of
different body-oriented interventions on body image perception in persons suffer-
ing from or at risk of eating disorders such as anorexia. Two research questions
were formulated:
1. Which body-oriented therapeutic methods for AN prevention and treat-
ment are based on scientific evidence?
2. How effective are body-oriented therapeutic methods in preventing and
treating AN?
Method
A systematic literature review requires transparent procedures for reporting the
results of the search process. The PRISMA guidelines, which are most widely
used to report systematic reviews (Moher, Liberati, Tetzlaff, & Altman, 2009),

181
BODY-ORIENTED THERAPY IN THE PREVENTION OF EATING DISORDERS…
rely on the following types of information in database search: keywords, number
of identified records, number of excluded records, the applied inclusion/exclusion
criteria, and the screening process.
Identification of Records
Scientific studies were identified by screening ProQuest, PsychINFO, PubMed,
ScienceDirect, Scopus, and Web of Science databases on 4 April 2022. The key-
words relating to body image and eating disorders were combined with the key-
words relating to body-oriented therapy and used in database search according to
specific requirements. The resulting keywords were: “body image” AND (“eating
disorders” OR “anorexia nervosa”) AND (“body-oriented therapy” OR “body-ori-
ented psychotherapy” OR “body psychotherapy” OR “mind-body therapy” OR
“body-mind therapy”). In addition, the reference lists in the identified review
articles and of the European Body Psychotherapy Association were screened to
include further studies.
Inclusion and Exclusion Criteria
Studies that met the following criteria were included in the review: (1) random-
ized controlled clinical trials (RCT) with two factors, where the participants
were randomly assigned to groups; (2) interventions with components based on
body-oriented therapy; (3) interventions aiming to promote protective factors
and/or reduce risk factors associated with eating disorders; (4) interventions fo-
cusing on body image/body perception; (5) studies involving at least one stan-
dardized psychological measure in the experimental group and the control group;
(6) original peer-reviewed articles; (7) papers written in English or Polish. Poten-
tial effect measures included protective factors, such as body satisfaction, self-es-
teem, and self-compassion, as well as risk factors such as body dissatisfaction,
thin-ideal internalization, and subclinical eating disorder traits. The reviewed
articles were not screened for the place of treatment (outpatient clinic, hospital,
out of hospital) or the measures applied in the control group. The inclusion crite-
ria involved serious psychological or somatic disorders affecting eating behaviors.
Results
Selection of Research Articles for Review
The literature search yielded 421 publications in the indicated databases. Four
papers were additionally identified based on reference lists. A total of 425 articles
were identified, whereof 342 remained after duplicates were removed. During
a preliminary screening of titles and abstracts, 273 publications that lacked

182 EMILIA KORSAK
abstracts or where titles and abstracts did not meet the inclusion criteria were
eliminated. Sixty-nine full-length research articles were critically evaluated, and
54 of those failed to meet all inclusion criteria. Subjectivity should be controlled
during the selection of empirical research sources for a systematic review. The
databases were searched by the author, and the procedure was performed twice
to ensure objectivity. The first search was conducted to assess the scope of the
literature available in the analyzed databases. In the second stage, the litera-
ture was explored in detail based on the specified inclusion/exclusion criteria,
and specific records/articles were selected for analysis. Body-oriented therapy is
a relatively new topic of scientific inquiry, and the number of peer-reviewed ar-
ticles dedicated to this subject is limited. Finally, 15 RCTs that met all inclusion
criteria were chosen for a systematic review. The PRISMA flowchart describing
the selection process and reasons for exclusion is presented in Figure 1 (Moher
et al., 2009).
Figure 1. Flow of information through different stages of a systematic review
(Moher et al., 2009).
Identification of research studies with the use of databases and reference lists
Included
Publications included in the analysis
(n=15)
Identification
Records identified during database
search (n=421)
(ProQuest, PsychINFO, PubMed, Science-
Direct, Scopus, Web of Science)
Records identified during asearch of
other sources (n=4)
Eligibility
Evaluation of full-length articles for eligi-
bility (n=69)
Rejected full-length articles (n=54)
Reason: articles do not meet inclusion
criteria
Review
Screening abstracts and titles, removing
duplicates (n=342)
Records excluded (n=273)
Reason: lack of abstract, title or abstract
does not meet search criteria.
All records selected for review (n=425)

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BODY-ORIENTED THERAPY IN THE PREVENTION OF EATING DISORDERS…
Description of Research Studies Selected for Review
Most of the reviewed studies focused on prevention programs targeting youths or
young adults. Three studies evaluated universal prevention programs (items 1,
7, and 10 in Table 1); five studies explored selective prevention programs (items
3, 4, 12, 14, and 15 in Table 1); and seven studies analyzed indicated prevention
programs (items 2, 5, 6, 8, 9, 11, and 13 in Table 1, pp. 186–188).
The evaluated studies differed significantly in sample size which ranged
from 12 to 347 participants. Considerable variations were also noted in study
duration and the content of preventive programs. Group programs comprised 1 to
72 sessions. All papers were published in the previous 24 years (1997–2021), and
60% were published in the last 10 years (n = 9) (Table 1).
Description of Interventions in the Reviewed Research Studies
Eight different intervention techniques were evaluated in 15 studies. A protocol
based on mindfulness was applied in six studies (items 1, 3, 4, 7, 14, and 15 in
Table 1), and a protocol based on yoga was used in two studies (items 8 and 12 in
Table 1). In one study, yoga was implemented in addition to standard hospital
care (item 5 in Table 1); one study examined Dance Movement Therapy in com-
bination with the previous treatment (item 13 in Table 1); one study analyzed
a multimodal treatment program based on the Feldenkrais method (item 9 in Ta-
ble 1); one study explored cognitive-behavioral body image therapy and the Body
Perception Treatment protocol (item 2 in Table 1); one study investigated a stan-
dard outpatient treatment program in combination with the Basic Body Aware-
ness Therapy (item 6 in Table 1); one study analyzed relaxation techniques (item
11 in Table 1); and one study involved aerobic exercise (item 10 in Table 1).
Description of Measurement Tools in the Reviewed Research Studies
Twenty-eight different measurement tools were used in the analyzed research
studies.
Eating disorders were evaluated with eight different research tools (Table 1),
where the Eating Disorder Inventory (EDI, EDI-2, EDI-3) (N = 7) and the Eating
Disorder Examination Questionnaire (EDE-Q) (N = 5) were most frequently used.
The EDI consists of 64 items divided into eight subscales. Mean scores are
not computed for the entire scale. The eight subscales measure behavioral and
psychological factors in an eating disorder: (1) Drive for thinness, (2) Bulimia,
(3) Body dissatisfaction, (4) Ineffectiveness, (5) Perfectionism, (6) Interpersonal
distrust, (7) Interoceptive awareness, and (8) Maturity fears (Żechowski, 2008).
The Eating Disorder Examination Questionnaire (EDE-Q) is a 28-item self-re-
ported questionnaire adapted from the semi-structured Eating Disorder Examina-
tion (EDE) interview, which has been designed to assess the range and severity
of eating disorder symptoms. The EDE-Q consists of four subscales: (1) Restraint,
(2) Eating concern, (3) Weight concern, and (4) Shape concern (Carey et al., 2019).

184 EMILIA KORSAK
Table 1
Description of research studies included in the systematic review
Item Authors Population Intervention Control group Assessment
methods
Results
1. Albertson,
Neff, Dill-
-Shackleford,
2014
Adult women
(N = 228): experimen-
tal group (N = 98),
control group
(N = 130)
One 20-minute mindful-
ness podcast per day over
a period of 3 weeks
Waiting list BSQ, BAS,
SCS
↑ self-compassion
↑ body appreciation
↑ self-esteem and self-effi-
cacy
↓ body dissatisfaction
↓ shame
↓ self-esteem based on body
image
2. Artoni et al.,
2021
Patients with eating
disorders (N = 182):
experimental group
(N = 91), control
group (N = 91)
A therapeutic and reha-
bilitation program involv-
ing a 60-minute Cogni-
tive-Behavioral Body
Image group therapy
session per week + par-
ticipation in the Body
Perception Treatment
protocol
A therapeutic and
rehabilitation
program involv-
ing a 60-minute
Cognitive-Behav-
ioral Body Image
group therapy
session per week
(observations of
body sensations,
breathing control)
SCL-90,
EDI-3, BUT
↑ general psychological
well-being
↓ body-related anxiety
3. Atkinson,
Wade, 2015
Adolescent girls
(N = 347): experimen-
tal group 1 (N = 138),
experimental group 2
(N = 108), control
group (N = 97)
The Body Project devel-
oped by Stice, includ-
ing the key features of
mindfulness and accep-
tance-based therapy, in
particular with regard to
body image. Some exer-
cises were adapted from
the MBCT
Standard school
class
EDE-Q,
DEBQ-R,
SATAQ−3,
PANAS-X
↓ preoccupation with body
weight and shape
↓ symptoms leading to eat-
ing disorders

185
BODY-ORIENTED THERAPY IN THE PREVENTION OF EATING DISORDERS…
Item Authors Population Intervention Control group Assessment
methods
Results
4. Atkinson,
Wade, 2016
Adolescent girls
(N = 50): experimen-
tal group 1 (N = 17),
experimental group 2
(N = 16), control
group (N = 17)
The Body Project
developed by Stice
et al., including the key
features of mindfulness
and acceptance-based
therapy, in particular
with regard to body
image. Some exercises
were adapted from the
MBCT
Standard school
class
EDE-Q,
DEBQ-R,
SATAQ−3,
PANAS-X
↓ preoccupation with body
weight and shape
↓ symptoms leading to eat-
ing disorders
↓ social anxiety
5. Carei,
Fyfe-
-Johnson,
Breuner,
Brown, 2010
Patients with eating
disorders (N = 53):
experimental group
(N = 26), control
group (N = 27)
Standard hospital
care + yoga twice a week
for 8 weeks
Standard hospital
care
EDE, BMI,
BDI, STAI
Food Pre-
occupation
Question-
naire
↓ behaviors associated with
eating disorders
↓ fear of eating after a yoga
session
6. Catalan-
-Matamoros,
Helvik-
-Skjaerven,
Labajos-
-Manzanares,
Martínez-de-
-Salazar-
-Arboleas,
Sánchez-
-Guerrero,
2011
Female patients with
eating disorders in
an outpatient clinic
(N = 28): experimen-
tal group (N = 14),
control group (N = 14)
Standard outpatient
treatment + 12 Basic
Body Awareness Therapy
sessions over a period
of 7 weeks (the program
involved simple exercises
to improve postural bal-
ance and coordination by
grounding the body and
freeing the breathing)
Standard outpa-
tient treatment
EDI-2 IA,
BAT, EAT-
40
↓ body dissatisfaction
↓ negative perception of
body size
continuation of Table 1

186 EMILIA KORSAK
Item Authors Population Intervention Control group Assessment
methods
Results
7. Johnson,
Burke,
Brinkman,
Wade, 2016
School students
(N = 308): experimen-
tal group (N = 132),
control group
(N = 176)
8 mindfulness sessions
over a period of 8 weeks
Standard school
class
EDE-Q,
DASS−21,
SCS
no significant improvement
in any parameter after the
intervention or at the end
of the observation period
8. Karlsen,
Vrabel,
Bratland-
-Sanda,
Ulleberg,
Benum, 2018
Persons with diag-
nosed BN or EDNOS
(N = 38): experimen-
tal group (N = 18),
control group (N = 12)
Yoga sessions twice
a week over a period of
11 weeks
Group sessions in-
volving nutrition
advice, physical
exercise, and ED
EDE, EDI-2 ↑ general psychological
well-being
9. Laumer,
Bauer,
Fichter, Milz,
1997
Patients of an eat-
ing disorder clinic
(N = 30): experimen-
tal group (N = 15),
control group (N = 15)
9 Awareness Through
Movement therapeu-
tic sessions based on
the Feldenkrais meth-
od over a period of
5 weeks + a multimodal
therapy program in a psy-
chosomatic clinic
Multimodal ther-
apy program in
a psychosomatic
clinic
BCS, BPSS,
FKE,
EMI-B,
ANIS, EDI
↑ satisfaction with body
areas that are particular-
ly problematic in eating
disorders (e.g. hips/thighs,
buttocks)
↑ experiencing movement
and body acceptance
↑ positive attitudes towards
own body and health
↑ mature behavior and tak-
ing responsibility
↓ regression to dependent
behavior from childhood
10. Maurer et al.,
2020
Healthy subjects
(N = 26): experimen-
tal group (N = 16),
control group (N = 10)
Aerobic exercise 3 times
a week over a period of
6 months
No regular aero-
bic exercise, eval-
uation only
FKKS,
PANAS,
WPT, HPT,
PTol
↑ physical fitness
↑ mood
↑ pain threshold
↑ positive body image
continuation of Table 1

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BODY-ORIENTED THERAPY IN THE PREVENTION OF EATING DISORDERS…
Item Authors Population Intervention Control group Assessment
methods
Results
11. McComb,
Clopton, 2003
Bulimic women
(N = 12): experimen-
tal group (N = 6), con-
trol group (N = 6)
8 weekly 90-minute
group therapy
sessions involving
exercise, relaxation
techniques, and
autogenic training
No therapy, eval-
uation only
EDI-BD,
EDI-DT,
STAI, CSEI
↓ anxiety
12. Mitchell,
Mazzeo,
Rausch,
Cooke, 2007
Women with a dis-
torted body image
(N = 93): experimen-
tal group 1 (N = 33),
experimental group 2
(N = 30), control
group (N = 30)
6 weekly 45-minute ses-
sions: dissonance-based
interventions or yoga and
meditation
No therapy, eval-
uation only
EDDS, BES,
EDI-BD,
EDI-DT,
STAI
no significant differ-
ences between the yoga
group and the control
group;
significant reduction in
eating disorders, drive for
thinness, body dissatis-
faction, and anxiety in the
dissonance group relative
to the yoga group and the
control group
13. Savidaki,
Demirtoka,
Rodríguez-
-Jiménez,
2020
Female patients
with eating disorders
(N = 14): experimen-
tal group (N = 7), con-
trol group (N = 7)
Dance Movement Thera-
py + previous therapy
Previous therapy TAS-20,
MBSRQ
↑ positive body image
↑ body awareness
↑ building a healthy body
image
↓ preoccupation with body
image
↑ self-esteem and self-effi-
cacy
↓ anxiety
↓ stress
continuation of Table 1

188 EMILIA KORSAK
Item Authors Population Intervention Control group Assessment
methods
Results
14. Toole,
Craighead,
2016
Women with a dis-
torted body image
(N = 80): experimen-
tal group (N = 40),
control group (N = 40)
Daily 25-minute medita-
tion for 1 week
No meditation,
evaluation only
BSQ, BAS,
SCS
↑ positive body image
15. Wade,
George,
Atkinson,
2009
Female university
students (N = 100):
experimental group
(N = 20), control
group 1 (N = 20), con-
trol group 2 (N = 20),
control group 3
(N = 20), control
group 4 (N = 20)
One 5-minute mindful-
ness session
(1) evaluation
only,
(2) ruminative
attention control,
(3) cognitive dis-
sonance,
(4) distraction
EDI-BD ↑ appearance satisfaction
Legend. Measurement methods: ANIS = Anorexia Nervosa Inventory for Self-Rating; BAS = Body Appreciation Scale; BAT = Body Attitude Test;
BES = Body Esteem Scale; BDI = Beck Depression Inventory; BMI = Body Mass Index; BPSS = Body Parts Satisfaction Scale; BSQ = Body Shape Ques-
tionnaire; BUT = Body Uneasiness Test; CSEI = Coopersmith Self-Esteem Inventory; DASS−21 = Depression Anxiety Stress Scale; DEBQ-R = Dutch
Eating Behavior Questionnaire – Restraint; EAT-40 = Eating Attitude Test-40; EDDS = Eating Disorder Diagnostic Scale; EDE-Q = Eating Disor-
der Examination Questionnaire; EDI, EDI-2, EDI-3 = Eating Disorder Inventory; EDI-2 IA Eating Disorder Inventory – Interoceptive Awareness;
EDI-BD = Eating Disorder Inventory III – Body Dissatisfaction; EDI-DT = Eating Disorder Inventory III – Drive for Thinness; EMI-B = Emotionali-
tätsinventar; FKE = Fragebogen zum Körperleben; HPT-WPT = warmth and heat pain thresholds; MBSRQ = Multidimensional Body-Self Relations
Questionnaire; PANAS = Positive and Negative Affect Schedule; PANAS-X = Positive and Negative Affect Schedule – Expanded; PTol = pain tolerance;
SATAQ−3 = Socio-cultural Attitudes Toward Appearance Scale; SCL-90 = Symptom Checklist-90; SCS = Self-compassion Scale; STAI = Spielberger’s
State-Trait Anxiety Inventory; TAS-20 = Toronto Alexithymia Scale.
continuation of Table 1

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BODY-ORIENTED THERAPY IN THE PREVENTION OF EATING DISORDERS…
In the analyzed studies, BID was evaluated with the use of 12 different tools
(Table 1). The Eating Disorder Inventory – Body Dissatisfaction (EDI-BD) sub-
scale was most widely used (N = 3). The EDI-BD consists of 10 items for assess-
ing dissatisfaction with the shape and size of body parts that are particularly
important for patients with an eating disorder (stomach, hips, thighs, buttocks)
(Castellano et al., 2021).
The associated emotional and mood disorders were evaluated with 10 dif-
ferent research tools (Table 1). The Spielberger State-Trait Anxiety Inventory
(STAI) (N = 3) was most frequently used in the analyzed studies. This tool con-
sists of two subscales that evaluate a person’s state anxiety (X-1) and trait anxi-
ety (X-2). Each subscale contains 20 separate questions (Julian, 2011).
Two research tools were also used to measure the intensity of sensory input:
heat pain threshold and warmth perception threshold (HPT-WPT), and pain tol-
erance detection threshold (PTol).
Effectiveness of Body-Oriented Therapeutic Methods in the Analyzed
Research Studies
In the group of the analyzed papers, 87% (13 out of 15) demonstrated a consider-
able reduction in at least one risk factor associated with an eating disorder or an
improvement in at least one protective factor.
Personality traits and behaviors correlated with eating disorders. The eva l u at ed
studies reported changes in the participants’ psychological state relative to their
personality traits. The most frequently described changes involved a reduction
in dysfunctional eating behaviors, improvement in self-esteem and self-efficacy,
and a decrease in anxiety and stress levels. These change trends are presented
in detail in Table 1.
Body image – body acceptance. The most frequently reported changes
concerned a healthy body image, manifested by improved body awareness and
body acceptance. The analyzed studies demonstrated that body-oriented therapy
is effective in reducing body dissatisfaction and body image preoccupation. These
change trends are presented in detail in Table 1.
Discussion
General Conclusions
The aim of the present review was to evaluate the effectiveness of body-oriented
therapeutic methods in treating eating disorders, reducing risk factors and en-
hancing protective factors. Universal prevention programs, selective prevention

190 EMILIA KORSAK
programs, and indicated prevention programs were considered in the analysis,
and their efficacy was compared with the control groups.
The evaluated interventions featured a body image component which in-
fluences therapeutic efficacy and the risk of relapse in patients with eating dis-
orders. The analyzed studies involved the following therapeutic methods and
protocols: mindfulness, yoga, Dance Movement Therapy, Feldenkrais method,
Body Perception Treatment protocol, Basic Body Awareness Therapy, relaxation
techniques, and aerobic exercise.
The review demonstrated that body-oriented therapy was effective in reduc-
ing risk factors (negative body image and negative affect) and promoting pro-
tective factors (body appreciation) relative to the control groups. The reviewed
studies indicate that the incorporation of body-oriented methods into standard
therapeutic programs (cognitive-behavioral therapy and/or pharmacotherapy)
or the use of body-oriented therapy as a stand-alone therapeutic or preventive
method can substantially reduce symptoms of eating disorders. However, further
research is needed to explore the underlying mechanisms.
Limitations
Different body-oriented techniques have been proposed to date, and this type of
intervention is relatively new in the prevention and treatment of eating disor-
ders. Therefore, this preliminary review involved a limited number of research
studies, and the results should be interpreted with caution.
Body-oriented psychotherapy involves various approaches and protocols
whose efficacy is difficult to compare. As a result, the offered therapies cannot
be easily standardized. The compared intervention programs differ in content,
duration, population size, and research tools for measuring the same parameters.
Many of these interventions are also implemented and conducted in a different
manner, which has significant implications for the form of the applied thera-
peutic programs. In addition, scientific evidence supporting the efficacy of the
analyzed interventions was provided by individual studies which have not been
replicated. It should also be noted that the efficacy of the assessed therapies was
evaluated after the intervention, and it was not validated by long-term observa-
tions. A larger number of high-quality research studies are needed to better un-
derstand the way in which body-oriented therapeutic methods can be effectively
used in the prevention and treatment of eating disorders.
Directions for Further Research
According to Röhricht (Röhricht, 2009), the effectiveness of popular therapeutic meth
-
ods should be supported by empirical evidence, regardless of the practitioners’ pref-
erences. Further research is needed to expand our understanding of body-oriented
therapy and to implement this approach in a clinical setting on par with recognized
modalities such as psychodynamic psychotherapy and cognitive-behavioral therapy.

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BODY-ORIENTED THERAPY IN THE PREVENTION OF EATING DISORDERS…
In the future, the influence of specific interventions on risk factors and pro-
tective factors should be directly compared. In addition, the rising popularity of
integrated therapies (such as CBT + body-oriented therapy) suggests that future
studies should evaluate the efficacy of these types of programs. Such studies
should assess the long-term efficacy of integrated therapy programs. Most im-
portantly, research on body-oriented therapy should rely on knowledge from both
social and medical sciences because studies based on research concepts and tools
that are derived from a single scientific discipline disregard the methodological
contributions made by other disciplines.
Conclusions
This literature review provides evidence for the efficacy of body-oriented thera-
peutic methods in the prevention and treatment of eating disorders. Only limited
conclusions can be drawn due to a general scarcity of published studies, but the
reviewed papers suggest that body-oriented therapeutic programs can reduce
risk factors and enhance protective factors in the treatment of eating disorders.
Further research is needed to identify interventions that are most effective for
treating specific patient groups, and to describe the mechanisms underlying the
efficacy of these therapies.
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