The Effectiveness of Emotion-Focused Therapy and Schema Therapy on Physical Appearance Perfectionism in Women with Obesity

Background: Obesity, defined as a Body Mass Index (BMI) ≥ 30 kg/m2, is a significant global health issue associated with psychological challenges, including intense concerns about physical appearance. Objectives: This study aimed to evaluate and compare the effectiveness of emotion-focused therapy (EFT) and schema therapy (ST) in mitigating physical appearance perfectionism (PAP) among women diagnosed with obesity. Methods: A randomized, controlled trial design involving three distinct groups (EFT, ST, and control) was implemented. The study participants comprised women with obesity seeking treatment at clinics and community health centers in Ahvaz, Iran, during 2023 - 2024. A sample of 60 eligible women were randomly assigned, with 20 participants allocated to each of the EFT, ST, and control groups. Both intervention groups received 12 weekly 90-minute sessions of their respective therapies, while the control group received standard care or a waitlist condition. The Physical Appearance Perfectionism Scale (PAPS) was utilized to collect data at pre-intervention, post-intervention, and a two-month follow-up. The collected data were analyzed using repeated measures analysis of variance (ANOVA) with post-hoc Bonferroni tests. Results: At post-intervention and the two-month follow-up, the findings indicated that both the EFT and ST groups experienced statistically significant reductions in overall PAP scores, as well as on its hope for perfection and worry about imperfection subscales, compared to the control group (P < 0.001). The improvements observed in both active treatment groups were maintained at the two-month follow-up. Conclusions: Both EFT and ST are effective interventions for reducing PAP in women with obesity, suggesting their potential integration into comprehensive obesity treatment programs to address psychological barriers to well-being.