Development and pilot evaluation of a culturally adapted CBT-based group intervention for body image dissatisfaction among at-risk Chinese college students

This study developed and pilot-tested a culturally adapted, 8-week cognitive behavioral therapy (CBT)-based group intervention targeting body image dissatisfaction among at-risk Chinese college students. The study evaluated its feasibility, acceptability, and preliminary effectiveness in a randomized controlled design. Seventeen female participants were randomized to an intervention group (n = 8) or a wait-list control group (n = 9). The intervention consisted of eight weekly sessions integrating CBT principles with culturally relevant content emphasizing mindful acceptance, emotion regulation, and body appreciation. Feasibility and acceptability were assessed by recruitment, retention, attendance, homework completion, and participant feedback. Secondary outcomes included body dissatisfaction (Body Shape Questionnaire, BSQ), body appreciation (Body Appreciation Scale-2, BAS-2), thin-ideal internalization (Ideal-Body Stereotype Scale-Revised, IBSS-R), eating disorder symptoms (Eating Disorder Examination Questionnaire 6.0, EDE-Q 6.0), depressive symptoms (Patient Health Questionnaire-9, PHQ-9), and anxiety symptoms (Generalized Anxiety Disorder-7, GAD-7), measured at baseline, post-intervention, and 3-month follow-up. The intervention demonstrated strong feasibility and acceptability, with 100% retention, high attendance, and positive participant feedback. Compared with controls, the intervention group showed significant improvements from baseline to post-intervention in body dissatisfaction, body appreciation, thin-ideal internalization, eating disorder symptoms, depression, and anxiety (ps < 0.05, rs = 0.39–0.63), with most effects maintained at the 3-month follow-up. No significant changes were observed in the wait-list control group. Findings provide preliminary evidence for the feasibility, acceptability, and potential effectiveness of a culturally adapted CBT-based group intervention addressing body image dissatisfaction among at-risk Chinese college women. Despite the small sample and modest recruitment, this pilot study highlights practical challenges associated with delivering psychological interventions in non-clinical university populations. The results offer an initial foundation for larger trials and for developing shorter or course-based formats to enhance accessibility and scalability in university settings. Many young people in China experience body dissatisfaction, which can affect their mood, self-esteem, and overall well-being. This study developed and tested an 8-week group program based on cognitive behavioral therapy (CBT) that was culturally adapted for Chinese college students. The program included discussions and exercises to help participants notice and challenge negative thoughts about appearance, reduce self-criticism, and build a more accepting and appreciative relationship with their bodies. Seventeen female students took part in the pilot study and were randomly assigned to the program or to a wait-list group. All participants who joined the program completed it, showing strong engagement and satisfaction. The results suggested improvements in body image and emotional well-being among those who received the program. Although only a small number of eligible students chose to participate, these early findings show that the program is feasible and may be useful for body image concerns. Future versions could be shorter or offered as a university course to reach more students.