Psychological Flexibility as a Mediator of Body Image Acceptance: Findings from a Multi-User Virtual Reality Early-Intervention for Individuals at High-risk for Eating Disorders

Abstract

Increased psychological flexibility has been investigated as an outcome of Acceptance and Commitment Therapy (ACT) prevention and intervention efforts for eating disorders (Manlick, Cochran & Koon, 2013, Bluett et al., 2016). Psychological flexibility has not yet been examined as to whether it is indeed the mechanism via which intervention effects occur. The purpose of this study is to investigate whether psychological flexibility serves as a mediator between outcomes of a multi-user virtual reality intervention based on Acceptance and Commitment Therapy (values clarification and exposure therapy) and body image acceptance, in a sample of young women (n = 41, 18-25 years old; Mage = 20.65, SD = 1.62) identified at risk for developing an eating disorder. It was hypothesized that the ACT intervention group (values-based) will exhibit a lower risk of presenting an ED in the next 4 years, which will be mediated by changes in psychological flexibility. There were no significant differences by group or time, nor a mediation effect of psychological flexibility. However, it was found that psychological flexibility, values-based behavior and body image acceptance were generally correlated with one another. Additionally, both increased psychological flexibility and body image acceptance was associated with a lower EDs risk for the ACT intervention group during the follow-up phase. Findings could pave the way for further research on effective interventions based on user-friendly technology for preventing eating disorders and promoting the acceptance of body image and values-driven behavior, potentially through the cultivation of psychological flexibility as a mechanism of change.