A randomized controlled trial of the unified treatment for emotion regulation and body image dissatisfaction in adolescents with subclinical eating-disorder symptoms

Abstract Objective Subclinical eating-disorder symptoms are common in adolescence and may increase the risk of eating pathology. Emotion regulation difficulties and body image dissatisfaction are key maintaining factors in disordered eating. This randomized controlled trial examined the effects of Unified Treatment (UT) on emotion regulation and body image dissatisfaction in adolescents with subclinical eating-disorder symptoms. Method Forty-eight adolescents with subclinical eating-disorder symptoms were randomly assigned to the intervention ( n = 24) or control ( n = 24) group. Assessments were conducted at baseline, post-treatment, and 1-month follow-up. Data were analyzed using generalized estimating equations. Results Significant Group × Time interactions indicated greater reductions in overall emotion regulation difficulties in the UT group compared with the control group at posttest (standardized between-group effect = -1.97, p < .001) and 1-month follow-up (standardized between-group effect = -1.58, p < .001). For body image dissatisfaction, UT was associated with a greater reduction than the control condition at posttest (standardized between-group effect = -0.32, p = .004), whereas the between-group difference was not statistically significant at 1-month follow-up (standardized between-group effect = -0.22, p = .087). Conclusion UT was associated with greater reductions in emotion regulation difficulties and a short-term reduction in body image dissatisfaction among adolescents with subclinical eating-disorder symptoms. These findings provide preliminary support for the potential benefit of UT in this population, while the lack of a statistically significant between-group difference in body image dissatisfaction at follow-up highlights the need for further investigation in larger trials with longer follow-up periods. Trial Registration Iranian Registry of Clinical Trials, IRCT20240813062749N1 registered 14 November 2024.