A Controlled Randomized Preliminary Trial of a Modified Dissonance‐Based Eating Disorder Intervention Program

Green, M. A.; Willis, Mary S.; Fernandez-Kong, Kristen; Reyes, Shuhan; Linkhart, R.; Johnson, Maria; Thorne, Tyler; Lindberg, Jessica; Kroska, Emily B.; Woodward, Halley E.

doi:10.1002/jclp.22468

Cited by 9 publications

(4 citation statements)

References 53 publications

(75 reference statements)

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“…This might be interpreted as providing additional support for the intervention theory for dissonance-based eating disorder prevention programs because the intervention activities center on exploring the costs of pursuing the thin ideal. Table 2 reveal that the trials that observed the largest effects (d > .70) for eating disorder symptoms, arguably the most critical outcome, emerged for the prevention programs evaluated by Atkinson and Wade (2016), Green et al (2016), Green, Willis et al (2017), Krishna (2011), Machin (2008), Mitchell et al (2007), and Rohde et al, 2014) relative to minimal intervention control conditions. Given that the studies by Machin, Mitchell, and Green, and Rohde evaluated interventions that added unique exercises to the standard Body Project the pattern of findings suggest that these versions of dissonance-based eating disorder prevention programs might be good candidates for implementation.…”

Section: Summary Of Average Effect Sizesmentioning

confidence: 99%

Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects

Stice

Marti

Shaw

et al. 2019

Clinical Psychology Review

120

124

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Many trials have provided support for dissonance-based eating disorder prevention programs. This meta-analytic review characterized the average intervention effects and tested whether various intervention, participant, and facilitator features correlated with larger effects to guide implementation of optimally effective versions of this program. We identified 56 trials that evaluated 68 dissonance-based eating disorder prevention programs (7808 participants). Average intervention effect sizes (d) relative to minimal intervention control conditions and credible alternative interventions (respectively) were 0.57 and 0.31 for thin-ideal internalization, 0.42 and 0.18 for body dissatisfaction, 0.37 and 0.17 for dieting, 0.29 and 0.21 for negative affect, and 0.31 and 0.13 for eating disorder symptoms. As hypothesized, effects were larger for interventions with more dissonance-inducing activities, more group sessions, and larger group sizes, as well as when delivered in-person versus on-line, sessions were recorded, participation was voluntary, body dissatisfaction was required, participants were mid-adolescents or adults (versus older adolescence), there were more ethnic minority participants, groups were led by clinicians versus researchers and at least two facilitators, and when facilitators received more training and supervision. Unexpectedly from a dissonance-induction perspective, effects were larger when participants were compensated. Results offer directions for maximizing the benefits of implementation efforts with dissonance-based eating disorder prevention programs, and may hold lessons for preventing other public health problems with dissonance-based interventions.

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Section: Summary Of Average Effect Sizesmentioning

confidence: 99%

Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects

Stice

Marti

Shaw

et al. 2019

Clinical Psychology Review

120

124

View full text Add to dashboard Cite

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“…When the Body Project group is part of multidisciplinary treatment, as was the case in the present study, one may also think about integrating the Body Project group with for example psychomotor and drama therapy elements. Green et al [ 11 ] and Rohde et al [ 25 ] already added unique exercises to the standard treatment protocol, increasing engagement and adding focus on the costs of social comparison, producing large treatment effects.…”

Section: Discussionmentioning

confidence: 99%

Is a dissonance-based group intervention targeting thin-ideal internalization a successful potential add-on for specialized eating disorder care? A randomized feasibility and acceptability pilot study

2023

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Background Dissonance-based eating disorder programs have successfully targeted body dissatisfaction by challenging the thin beauty ideal in the preventive context and in groups of patients with a subthreshold and full threshold DSM-5 eating disorder. As there is a need for interventions specifically targeting thin-ideal internalization in (highly) specialized treatment centres, the present study adapted Stice’s et al.’s Body Project for its use as an add-on treatment for severe eating disorders with the aims to identify whether it was feasible and acceptable in this treatment context, to determine any necessary modifications with regard to the treatment and study procedures, and to test preliminary effectiveness. Methods The study was a randomized controlled pilot/feasibility trial. Thirty patients started in the Body Project group and 25 in the Psycho-education group. Measurements took place pre- and post-intervention, and at three and six months follow-up. Patients and staff evaluated treatment and study procedures, and patients completed questionnaires on thin-ideal internalization, body dissatisfaction, self-objectification, negative affect and eating disorder pathology. Results The Body Project group and Psycho-education group both proved highly feasible and acceptable, as well as preliminarily effective, based on quantitative scores and qualitative feedback. Preliminary analyses showed that treatment effects did not differ between treatment groups. As both groups were an add-on to standard treatment, treatment effects cannot be disentangled from effects resulting from standard treatment. Qualitative feedback for the Body Project group included several recommendations for future implementation: increasing the number of treatment sessions, creating homogeneous therapy groups, and optimizing timing of the treatment. Conclusions Future research should examine further modifications to the Body Project group for severe eating disorders, as well as for whom, and when in the course of treatment the intervention is most effective. The present study also showed the benefits of implementing a structured Psycho-education group. Plain English summary We tested the feasibility and acceptability of a group intervention targeting the thin beauty ideal (Body Project group) in patients with severe eating disorders and compared this intervention to a group intervention focusing on psycho-education about eating disorders (Psycho-education group). Both interventions were added to standard treatment. We adapted the protocol for patients with severe eating disorders. Both the Body Project group and the Psycho-education group were evaluated by patients as well as staff as highly feasible and acceptable, and effects were positive. Treatment effects did not differ between treatment groups. As both treatments were an add-on to standard treatment, treatment effects cannot be disentangled from effects resulting from standard treatment. The study suggested further modifications to the Body Project group. Future research should examine these modifications as well as for whom, and when in the course of treatment the intervention is most effective. The present study also showed the benefits of implementing a structured Psycho-education group.

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“…A novel dissonance-based intervention with university-aged couples involving interactive role plays, open discussion and interpersonal skills-building significantly reduced numerous key risk factors for EDs including environmental pressures to be thin, internalisation of the thin and athletic ideals, state body dissatisfaction, and actual-ideal body discrepancy [48]. Other smaller trials adapting this content to provide interactive interventions have also demonstrated CD's effectiveness at reducing ED symptomatology [49]. When delivered by trained facilitators to high school-aged females (i.e., ages 14-18 years), compared with the provision of education brochures, the 'Body Project' CD intervention was found to reduce body dissatisfaction in participants at up to three-years follow-up (FU) and decrease ED behaviours among girls considered 'high-risk' at one-year FU [41,42].…”

Section: Cognitive Dissonance-based Programsmentioning

confidence: 99%

Prevention and early intervention in eating disorders: findings from a rapid review

Le¹,

Aouad²,

Barakat³

et al. 2023

J Eat Disord

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Background Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs. Methods This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review. Results In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist. Conclusions Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary.

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A Controlled Randomized Preliminary Trial of a Modified Dissonance‐Based Eating Disorder Intervention Program

Abstract: Results provide preliminary support for the modified dissonance program.

Cited by 9 publications

References 53 publications

Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects

Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects

Is a dissonance-based group intervention targeting thin-ideal internalization a successful potential add-on for specialized eating disorder care? A randomized feasibility and acceptability pilot study

Prevention and early intervention in eating disorders: findings from a rapid review

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