According to the results, the CBT program could improve appearance evaluation. Since this microscale has been designed for the overall evaluation of appearance (29) and assesses feelings of physical attractiveness and satisfaction, it can be effective in improving feelings; this finding is in accordance with a study by Raygan (30). In addition, the results revealed that this program enhanced appearance orientation, which refers to the relative importance of various aspects of body image and ways of seeing these features (31). It is in fact what was utilized in step 7, i.e., encouraging individuals to perform activities which create a more positive feeling about their appearance. The individuals’ tendency to perform these activities draws our attention to the present results, which are in line with a similar study by Parizadeh (23).
Another improved subscale was fitness evaluation, which is an overall evaluation of fitness (11). The subscale of fitness orientation deals with appearance and focuses on eliminating avoidance behaviors related to appearance, encountering these behaviors, and refraining from intemperate behaviors; the results indicate that these actions have not been taken properly. Another subscale with no positive between-group change was subjective weight. This microscale assesses concerns about weight and diet (11). This finding is in accordance with studies by Raygan and Parizadeh (23, 30).
In addition, therapy caused a positive change in body areas satisfaction. This step deals with a part of individual’s body, which causes dissatisfaction; it includes regular mirror desensitization and fosters positive self-talk. In general, the results revealed that CBT enhances the body image of infertile women in the posttest stage and 1-month follow-up. This finding is in agreement with the results of previous studies, focusing on the effect of CBT on groups with a negative body image (24, 32–35), Iranian female students (30), and women undergoing mastectomy (16).
In addition, studies have been performed on the effects of CBT on patients with body dysmorphic disorder (17, 19, 21, 36, 37), burns (15), and eating disorders (18, 20). In this program, individuals focus on their perceptions, thoughts, and feelings about body image and recognize how they have been developed (38). Since infertility causes low self-esteem, negative emotions, inefficiency, and negative body image, dealing with this condition and providing proper treatment seem essential (39).
From a cognitive behavioral point of view, body image disorder occurs when an individual experiences a distortion in his/her perceptions, behaviors, cognition, or sentiments in relation to weight and body shape (38). Therefore, in this treatment, distortions are addressed comprehensively. CBT encourages individuals to pay less attention to the differences between the real and ideal self. This training is provided through monitoring and improving self-efficacy through cognitive restructuring. In this way, individuals can enhance their self-concept and remove threatening factors by challenging and replacing their irrational thoughts (40); these results are in line with other studies (9, 13).
Research shows high vulnerability and sensitivity of women about their body image and self-acceptance; therefore, any harms could cause mental disorders, such as anxiety and depression (22). The proposed treatment can prevent mental disorders in infertile women through enhancing their body image. It is obvious that presence of resources, experts, or a group of specialists in fertility clinics plays an important role in reducing their problems.
The novelty of this clinical randomized trial is its main strength. To the best of our knowledge, no other study has been performed on the effects of an intervention on body image in infertile women. However, application of a self-report questionnaire is a limitation of our study; as a result, the participants might have hidden their private thoughts about their body image.
5.1. Conclusion
The results revealed that CBT based on the 8-step program by Cash can be effective in improving infertile women’s body image. We suggest longer follow-up sessions to ensure long-term effectiveness of the intervention in future studies. Evaluation of the patients’ socioeconomic status may provide more accurate results.
