Skip to main content

Cognitive Behavioral Therapy for Body Image and Self-Care (CBT-BISC) Among Sexual Minority Men Living with HIV: Skills-Based Treatment Mediators


Individuals develop coping skills in response to body image distress; however, the degree to which body image improvements are mediated by skill acquisition is unknown. The current study assessed skills-based mediators of CBT-BISC (n = 22) versus enhanced treatment-as-usual (n = 22) for sexual minority men with HIV and body image disturbance. Skills-based mediators included avoidance, appearance fixing, and acceptance and cognitive reappraisal. Results revealed that CBT-BISC significantly reduced body image disturbance and improved coping skills. Latent difference score mediation indicated that changes in acceptance and cognitive reappraisal significantly predicted body image disturbance changes (b = −.96, p = .001). These strategies may, therefore, have a unique role in reducing body image disturbance in sexual minority men with HIV. Clinicians may wish to prioritize these strategies in CBT-BISC. Future treatment research, with methodologically rigorous mediation designs, is needed to assess mechanisms of change and consequently improve efficacy.

This is a preview of subscription content, access via your institution.

Fig. 1


Download references


This research was supported by K23MH096647, awarded to Dr. Aaron J. Blashill. Author time for Dr. Steven A. Safren was supported by K24DA040489. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Aaron J. Blashill.

Ethics declarations

Conflict of Interest

Patrycja Klimek, Sabine Wilhelm, Steven A. Safren, Aaron J. Blashill declare that they have no conflicts of interest.

Research Involving Human and Animal Participants

The current study involved secondary data analysis from a randomized controlled trial approved by the Institutional Review Boards of Fenway Health and San Diego State University. All procedures of the randomized controlled trial involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

The following study involved a secondary data analysis and was IRB exempt from requiring informed consent, as no identifying information was available for secondary data analysis. However, informed consent was obtained from all individual participants at the time of original data collection.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Klimek, P., Wilhelm, S., Safren, S.A. et al. Cognitive Behavioral Therapy for Body Image and Self-Care (CBT-BISC) Among Sexual Minority Men Living with HIV: Skills-Based Treatment Mediators. Cogn Ther Res 44, 208–215 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Body image
  • Coping
  • Sexual minority
  • HIV
  • Cognitive behavioral therapy