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Table 4 Participant’s descriptions of perceived changes in their body image after the intervention

From: A qualitative analysis of participants’ reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy

Category Summary Quotation Comments
Different evaluation of body The body is described more objectively, less critically. Evaluations do not have the same kind of impact. Greater awareness of how the body is objectified by self-scrutiny. I’ve learned that you don’t have to evaluate all the time, see it as a description. (AN, 18)
I don’t evaluate my body only as bad and ugly but still feel that I am too fat. (AN, 26)
Being less judgmental does not mean that the participants are automatically happy about the appearance of their body.
New insights have been acquired or new ways of thinking Greater understanding of the body, ways of thinking and the ED. Awareness of thinking errors. Insight into devaluation of self. Insight into how well-being declines when feelings focus on the body and how this can be influenced. I have learned so much about the basis for why I think as I do and then it is easier to know what to do to like my body. (AN, 18)
I have understood that irrespective of whether we are slim or fat we have similar thoughts and feelings. And that I’m the one that devalues myself, I am my own ‘hooligans’. (BED, 29)
Participants describe how they have become more aware of different factors that both sustain and resolve their views, which in its turn creates possibilities of more flexible action.
Acquired help to change behaviors Tested things previously avoided through fear. Lifestyle changes. Discovering alternative behaviors for all the evasions I had previously focused on. (BN, 28)
Plus I have become better at doing things even though they go against the grain and I don’t feel comfortable with my body. (BN, 22)
Participants describe a wider repertoire of behaviors even though they feel uncomfortable.
Greater distance to thoughts and feelings Beneficial to see thoughts as thoughts or feelings as feelings. Importance of being in the here and now and not being bogged down in old patterns of repetitive thinking. That I don’t allow my feelings to magnify things so much, a feeling is “only” a feeling and a thought is “only” a thought. Nothing is true until I allow it to be. (AN, 40)
I have really learned that I don’t have to like my thoughts but they can still be there anyhow. (BN, 28)
Participants describe how they still have the same thoughts as before but have learned a new relationship to them when they crop up. This also creates possibilities of more flexible actions.
The work on values is described as having helped to shift focus to the important things in life Values are embraced and influence choice of behaviors. … realize instead that it’s things like work/studies, friendship, relationships etc. that make all the difference to how I feel and what kind of life I lead. (UFED, 24) Participants describe how working with values has helped them to focus on other things in their lives than ED.
A change in the relationship to their bodies Greater appreciation of the body. Good enough as they are. No longer as self-destructive. More attention paid to bodily needs. I have to a great extent stopped being “nasty” and making “awful comments to myself. (BN, 26)
I listen more to what my body needs and show it what appreciation I can. (BN, 19)
Participants describe a change in both the way they think about and behave toward their bodies.