Evaluating the Effectiveness of Metacognitive Techniques in Reducing Body Dissatisfaction Among Pakistani Young Adults: A Pilot Randomized Controlled Trail

Authors

  • Manahil Naz BS Clinical Psychology, Department of Humanities and Social Science, GIFT University, Gujranwala, Punjab, Pakistan.
  • Areeba Asghar BS Clinical Psychology, Department of Humanities and Social Science, GIFT University, Gujranwala, Punjab, Pakistan.
  • Ather Mujitaba Lecturer, Department of Humanities and Social Science, GIFT University, Gujranwala, Punjab, Pakistan.
  • Seemab Shakoor BS Clinical Psychology, Department of Humanities and Social Science, GIFT University, Gujranwala, Punjab, Pakistan.

DOI:

https://doi.org/10.55737/rl.v5i1.26179

Keywords:

Metacognitive Intervention, Body Dissatisfaction, Body Cathexis Scale, Dropout Rate

Abstract

Body dissatisfaction among young adults is related with poor mental health, low self- esteem and eating disorders. Factors include unrealistic beauty standards, psychological factors, and distorted body image beliefs. This pilot randomized controlled trial examined the efficacy of metacognitive intervention in reducing body dissatisfaction in Pakistani undergraduates. Initially, 16 participants (age 18-25) were recruited, but after 6 dropouts, the final sample included 10 participants who completed all four sessions. There were 5 participants randomly assigned to each the MCT and Control group. The MCT group received a metacognitive intervention over two weeks, including mindfulness grounding, self-monitoring, diffusion, and acceptance strategies, based on Wells’ Metacognitive Model (2009). The Control group listened nature sounds without therapeutic input. Body dissatisfaction was measured pre- and post-intervention using the Body Cathexis Scale (BCS). Mann–Whitney U test was used to assess between-group difference, revealing no significant difference between pre-test scores (U = 8.00, p = .346), but significant improvement in post-test scores (U = 0.00, p = .009). A Wilcoxon Signed–Ranks was used to assess within-group differences that confirmed a significant pre-post-test difference (Z= -2.06, P= .039). The finding indicates that brief MCT can significantly decrease body dissatisfaction in young adults. Even with the limitation of small sample size and attrition, results show potential for affordable and sustainable mental health strategies. To validate additional studies with larger samples are suggested to assess long-term possessions.

Author Biography

  • Ather Mujitaba, Lecturer, Department of Humanities and Social Science, GIFT University, Gujranwala, Punjab, Pakistan.

    Corresponding Author: [email protected]

References

Abbasi, M. M. H., Khan, F., & Khan, M. (2024). Effects of negative body images on social media among youth in Pakistan. (2024). Pakistan Social Sciences Review, 8(I). https://doi.org/10.35484/pssr.2024(8-i)30

Arnett J. J. (2000). Emerging adulthood. A theory of development from the late teens through the twenties. The American psychologist, 55(5), 469–480. https://doi.org/10.1037//0003-066X.55.5.469

Ashfaq, M., Shahzadi, K., Zia, I., Ilyas, Z., & Bano, S. (2025). A Cross-Sectional Study of Body Image Dissatisfaction and Self-Esteem Among Breast Cancer Patients in Rawalpindi/Islamabad. Pakistan Journal of Humanities and Social Sciences, 13(1), 262-271. https://doi.org/10.52131/pjhss.2025.v13i1.2707

Atkinson, M. J., & Wade, T. D. (2012). Impact of metacognitive acceptance on body dissatisfaction and negative affect: Engagement and efficacy. Journal of Consulting and Clinical Psychology, 80(3), 416–425. https://doi.org/10.1037/a0028263

Beck, A. T. (1976). Cognitive therapy and emotional disorders. International Universities Press.

Boyle, S., Dorfan, N., & Sepehry, A. A. (2025). Acceptance and commitment therapy for body dissatisfaction: A systematic review and meta-analysis. Journal of Clinical Psychology, 81(11), 1031–1045. https://doi.org/10.1002/jclp.70021

Butt, A. I. (2025). Influence of body image perceptions on life satisfaction and emotional well-being among Undergraduate students of Lahore, Pakistan: A survey-based study (Doctoral dissertation, Department of Sociology, Forman Christian College (A Chartered University)).

Cash, T. F. (2012). Cognitive-behavioral perspectives on body image. In T. F. Cash (Ed.), Encyclopedia of body image and human appearance (Vol. 1, pp. 334–342). Academic Press.

Cash, T. F., & Szymanski, M. (2006). Development and validation of the Body Image Disturbance Questionnaire. Journal of Psychosomatic Research, 60(4), 507–515. https://doi.org/10.1207/s15327752jpa6403_6

Dondzilo, L., & Basanovic, J. (2023). Body dissatisfaction and selective attention to thin-ideal bodies: The moderating role of attentional control. Body Image, 46, 235–242. https://doi.org/10.1016/j.bodyim.2023.08.001

Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment. Behaviour research and therapy, 41(5), 509–528. https://doi.org/10.1016/s0005-7967(02)00088-8

Fang, S., Ding, D., Ji, P., et al. (2022). Cognitive defusion and psychological flexibility predict negative body image in Chinese students. Body Image, 42, 146–153. https://doi.org/10.3390/ijerph192416519

Grogan, S. (2006). Body image and health: Contemporary perspectives. Journal of health psychology, 11(4), 523-530. https://doi.org/10.1177/1359105306065013

Haseth, S., Grøtte, T., Hunstad, E., Güzey, I. C., & Solem, S. (2024). Metacognitive therapy for body dysmorphic disorder: A consecutive case series. Journal of Cognitive Psychotherapy, 39(1), 5–21. https://doi.org/10.1891/JCP-2023-0014

Havnen, A., Anyan, F., & Nordahl, H. (2024). Metacognitive strategies mediate the association between metacognitive beliefs and perceived quality of life. Scandinavian Journal of Psychology, 65(4), 656–664. https://doi.org/10.1111/sjop.13015

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.

Heider, N., Spruyt, A., & De Houwer, J. (2018). Body dissatisfaction revisited: On the importance of implicit beliefs about actual and ideal body image. Psychologica Belgica, 57(4), 158. https://doi.org/10.5334/pb.362

Jones, D. C. (1993). Body image among adolescent girls and boys: A longitudinal study. Journal of Research on Adolescence, 3(4), 509–534. https://doi.org/10.1037/0012-1649.40.5.823

Juarascio, A. S., Forman, E. M., & Herbert, J. D. (2010). Acceptance and commitment therapy versus cognitive therapy for the treatment of comorbid eating pathology. Behavior modification, 34(2), 175-190. https://doi.org/10.1177/0145445510363472

Katyal, S., & Fleming, S. M. (2024). The future of metacognition research: Balancing construct breadth with measurement rigor. Cortex; a journal devoted to the study of the nervous system and behavior, 171, 223–234. https://doi.org/10.1016/j.cortex.2023.11.002

Keery, H., van den Berg, P., & Thompson, J. K. (2004). An evaluation of the Tripartite Influence Model of body dissatisfaction and eating disturbance with adolescent girls. Body image, 1(3), 237–251. https://doi.org/10.1016/j.bodyim.2004.03.001

Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: a review of empirical studies. Clinical psychology review, 31(6), 1041–1056. https://doi.org/10.1016/j.cpr.2011.04.006

Khan, R. J. ., Bibi, H. ., Naz, S. ., & Afsar, F. K. . (2023). Body Surveillance and Body Dissatisfaction among Pakistani Young Females: Social Comparison as Moderator. Human Nature Journal of Social Sciences, 4(1), 16-26. https://doi.org/10.71016/hnjss/nc0e0c32

Klump, K. L., Burt, S. A., McGue, M., & Iacono, W. G. (2007). Changes in genetic and environmental influences on disordered eating across adolescence: a longitudinal twin study. Archives of general psychiatry, 64(12), 1409–1415. https://doi.org/10.1001/archpsyc.64.12.1409

Knowles, G., Ling, F. C. M., Thomas, G. N., Adab, P., & McManus, A. M. (2015). Body size dissatisfaction among young Chinese children in Hong Kong: a cross-sectional study. Public Health Nutrition, 18(6), 1067–1074. https://doi.org/10.1017/S1368980014000810

Levin, M. E., MacLane, C., Daflos, S., Seeley, J. R., Hayes, S. C., Biglan, A., & Pistorello, J. (2014). Examining psychological inflexibility as a transdiagnostic process across psychological disorders. Journal of contextual behavioral science, 3(3), 155-163. https://doi.org/10.1016/j.jcbs.2014.06.003

Lillis, J., Hayes, S. C., Bunting, K., & Masuda, A. (2009). Teaching acceptance and mindfulness to improve the lives of the obese: a preliminary test of a theoretical model. Annals of Behavioral Medicine, 37(1), 58–69. https://doi.org/10.1007/s12160-009-9083-x

Liu, W., Lin, R., Guo, C., Xiong, L., Chen, S., & Liu, W. (2019). Prevalence of body dissatisfaction and its effects on health-related quality of life among primary school students in Guangzhou, China. BMC Public Health, 19(1), 213. https://doi.org/10.1186/s12889-019-6519-5

Mandavia, A., Gragnani, A., & Mancini, F. (2015). The application of a cognitive diffusion technique to negative body image thoughts: A preliminary analogue investigation. Journal of Cognitive Psychotherapy, 29(3), 211–224. https://doi.org/10.1016/j.jcbs.2015.02.003

Margolis, S. E., & Orsillo, S. M. (2016). Acceptance and commitment therapy for body dissatisfaction: A brief intervention for college women. International Journal of Eating Disorders, 49(4), 373–382. https://doi.org/10.1002/eat.22477

Masuda, A., Twohig, M. P., Stormo, A. R., Feinstein, A. B., Chou, Y. Y., & Wendell, J. W. (2010). The effects of cognitive defusion and thought distraction on emotional discomfort and believability of negative self-referential thoughts. Journal of Behavior Therapy and Experimental Psychiatry, 41(1), 11-17. https://doi.org/10.1016/j.jbtep.2009.08.006

Mehmood, T., Raza, S., Naeem, M. H., Mohammad, A., & Fatima, N. (2023). Perceived sociocultural pressure and body dissatisfaction among female university students. Journal of Health and Rehabilitation Research, 3(2), 908–920. https://doi.org/10.61919/jhrr.v3i2.269

Neff, K. D. (2011). Self-compassion, self-esteem, and well-being. Social and Personality Psychology Compass, 5(1), 1–12. https://doi.org/10.1111/j.1751-9004.2010.00330.x

Neumark-Sztainer, D., Paxton, S. J., Hannan, P. J., Haines, J., & Story, M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 39(2), 244–251. https://doi.org/10.1016/j.jadohealth.2005.12.001

Normann, N., & Morina, N. (2018). The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis. Frontiers in psychology, 9, 2211. https://doi.org/10.3389/fpsyg.2018.02211

Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Administration and policy in mental health, 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y

Ramzan, I. & Barerah Siddiqui. (2021). The Effectiveness of Cognitive Behavioral Therapy for Managing Body Image Dissatisfaction. PJPPRP, 12(2). https://doi.org/10.62663/pjpprp.v12i2.41

Rashid, Z., Arzeen, N., & Shah, M. (2021). Body image and psychological distress among university students. Journal of Postgraduate Medical Institute, 35(3), 181-184. https://doi.org/10.54079/jpmi.35.3.2695

Reddy, S. D., & Crowther, J. H. (2007). Teasing, acculturation, and cultural conflict: psychosocial correlates of body image and eating attitudes among South Asian women. Cultural diversity & ethnic minority psychology, 13(1), 45–53. https://doi.org/10.1037/1099-9809.13.1.45

Sandoz, E. K., Wilson, K. G., & Merwin, R. M. (2013). Assessment of body image flexibility: The Body Image Acceptance and Action Questionnaire. Journal of Contextual Behavioral Science, 2(1–2), 39–48. https://doi.org/10.1016/j.jcbs.2013.03.002

Secord, P. F., & Jourard, S. M. (1953). The appraisal of body-cathexis: Body-cathexis and the self. Journal of Consulting Psychology, 17(5), 343-347. https://doi.org/10.1037/h0060689

Shafran, R., Fairburn, C. G., Robinson, P., & Lask, B. (2004). Body checking and its avoidance in eating disorders. The International journal of eating disorders, 35(1), 93–101. https://doi.org/10.1002/eat.10228

Stice, E., Rohde, P., & Shaw, H. (2012). The body project: A dissonance-based eating disorder prevention intervention. Oxford University Press.

Tajbakhsh, R., Haddadi, S., & Zeighami Mohammadi, S. (2023). Effect of metacognitive therapy and acceptance and commitment therapy on body image concerns of female hemodialysis patients. Jundishapur Journal of Chronic Disease Care, 12(3). https://doi.org/10.5812/jjcdc-135680

Thompson, J. K., Heinberg, L. J., Altabe, M. N., & Tantleef-Dunn, S. (1999). Theory assessment, and treatment of body image disturbance. Thomson JK, Heinberg LJ, Altabe MN, Tantlee-Dunn. Exacting beauty: theory, assessment, and treatment of body image disturbance. Washington, DC: American Psychological Association, 10312-000.

Tiggemann, M., & Slater, A. (2013). NetGirls: The Internet, Facebook, and body image concern in adolescent girls. International Journal of Eating Disorders, 46(6), 630-633. https://doi.org/10.1002/eat.22141

Tylka, T. L., & Wood-Barcalow, N. L. (2015). The Body Appreciation Scale-2: item refinement and psychometric evaluation. Body image, 12, 53-67. https://doi.org/10.1016/j.bodyim.2014.09.006

Watson, R. (2022). Appearance-focused Social Media Use, Unrealistic Beauty Ideals, and Body Image Dissatisfaction. Journal of Research in Gender Studies, 12(1), 114–129. https://doi.org/10.22381/JRGS12120228

Weis, J. F., Krach, S., Paulus, F. M., & Stolz, D. S. (2025). Self-compassion is linked to positive affect and buffers declines in self-esteem in low performers. bioRxiv, 2025-11. https://doi.org/10.1101/2025.11.11.687618

Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford Press.

Yablonska, T., & Kacheniuk, A. (2022). The Role of Cognitive Distortions in Young Women’s Body Image Perception. Scientific Bulletin of Mukachevo State University. Series “Pedagogy and Psychology, 8(4), 33-42. https://doi.org/10.52534/msu-pp.8(4).2022.33-42

Zainab, W., Ahmed, S., Kumar, A., & Ali, S. (2023). The effect of body dissatisfaction on disordered eating attitudes: The mediating role of negative affects in adolescents. Journal of Pakistan Psychiatric Society, 20(02). https://doi.org/10.63050/jpps.20.02.272

Downloads

Published

2026-03-03

How to Cite

Naz, M., Asghar, A., Mujitaba, A., & Shakoor, S. (2026). Evaluating the Effectiveness of Metacognitive Techniques in Reducing Body Dissatisfaction Among Pakistani Young Adults: A Pilot Randomized Controlled Trail. Regional Lens, 5(1), 166-178. https://doi.org/10.55737/rl.v5i1.26179