5 - (OP22) The CBT Therapist's Described Experiences in Addressing Perfectionism, Body Image, and Eating Disorders

Eating disorders (EDs)—among the most fatal of mental illnesses—affect nearly 30 million Americans annually, presenting a critical public health crisis characterized by high relapse rates and limited treatment efficacy. Despite decades of clinical research, key mechanisms driving ED pathology remain insufficiently understood, underscoring the urgent need for more effective, targeted, and culturally responsive interventions. Guided by cognitive behavioral theory and the three-factor model, the aim of this qualitative descriptive study was to explore how therapists describe the influence of cognitive behavioral techniques on perfectionism and body image in women of diverse backgrounds with eating disorders. A purposive sample of CBT clinicians (N = 22) participated in 14 individual interviews and two focus groups. Data were inductively analyzed using Braun and Clarke’s thematic analysis approach and MAXQDA software. Seven themes revealed the pervasive societal reinforcement of perfectionism and body image ideals, the paradoxical rigidity of perfectionism obstructing recovery, and the need to dismantle body image distortions that perpetuate self-criticism and shame. Therapists emphasized integrating cultural humility, self-compassion, and cognitive restructuring to replace maladaptive ED functions with adaptive coping mechanisms and emotional regulation strategies that foster body acceptance—while honoring culturally shaped meanings of the body, identity, and aesthetic ideals. The complex interplay of biological, psychological, environmental, and sociocultural factors—amplified by social media, globalization, and systemic disparities—underscores the limitations of standardized interventions. Findings highlight the heterogeneous complexity of eating disorders and call for advocacy, media literacy, and broader access to specialized care. Grounded in therapist perspectives, this study advances an affirming and equity-oriented framework for adapting CBT in ways that respect cultural diversity while maintaining scientific rigor. This study contributes a therapist-informed framework illustrating how CBT principles can be refined to address perfectionism and body image concerns more flexibly, bridging the gap between structured treatment protocols and the lived experiences of diverse populations. Future research should prioritize culturally attuned interventions and validated tools to assess cognitive shifts in body image perception, advancing more personalized and effective recovery pathways.