Body dissatisfaction is a prevalent problem in our society, especially among women, and is clearly associated with a range of psychosocial difficulties and disorders. In the psychotherapeutic treatment of a negative body image, several controlled studies confirm the efficacy of cognitive behavioral therapy (CBT) relative to no or minimal treatment. The present investigation involving 23 extremely body-dissatisfied women compared the effectiveness of Cash's (1991) body image CBT administered in group therapy versus a self-directed format having only modest therapist contact. The two equally credible, 11-session treatments produced statistically and clinically significant improvements in affective/evaluative, size/weight-related, and cognitive behavioral aspects of body image. Favorable outcomes generalized to multiple facets of psychosocial functioning and were sustained at a 2-month follow-up. There was no evidence of differential efficacy of group and modest contact treatments. The utility of body image CBT warrants further research with more diverse populations, varying formats, and longer follow-ups.