Cognitive dissonance-based eating disorder prevention: pilot study of a cultural adaptation for the Orthodox Jewish community

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Objectives: E-mental health (digital) interventions can help overcome existing barriers that stand in the way of people receiving help for an eating disorder (ED). Although e-mental health interventions for treating and preventing EDs have been met with enthusiasm, earlier reviews brought attention to poor quality of evidence, and offered solutions to enhance their evidence base. To assess developments in the field, we conducted an updated meta-analysis on the efficacy of e-mental health interventions for treating and preventing EDs, paying attention to whether trial quality and outcomes have improved in recent trials. We also assessed whether user-centered design principles have been implemented in existing digital interventions. Method: Four databases were searched for RCTs of digital interventions for treating and preventing EDs. Thirty-six RCTs (28 prevention- and 8 treatment-focused) were included. Results: Some evidence that study quality improved in recent prevention-focused trials was found. Few trials involved the end-user in the design or development stage of the intervention. Issues with intervention engagement were noted, and 1 in 4 participants dropped out from prevention- and treatment-focused trials. Digital interventions were more effective than control conditions in reducing established risk factors and symptoms in prevention- (g’s = 0.19 to 0.43) and treatment-focused trials (g’s = 0.29 to 0.69), respectively. Effect sizes have not increased in recent trials. Few trials compared a digital intervention with a face-to-face intervention. Whether digital interventions can prevent ED onset is unclear. Conclusion: Digital interventions are a promising approach to ED treatment and prevention, but improvements are still needed. Three key recommendations are provided.

Section: Prevention-focused Trialsmentioning

confidence: 99%

E-mental health interventions for the treatment and prevention of eating disorders: An updated systematic review and meta-analysis.

Linardon

Shatte

Messer

et al. 2020

110

“…Further, the Body Project is the only eating disorder prevention program that has been shown to affect objective measures, which also provides evidence that intervention effects are not driven by expectancies and demand characteristics: In controlled trials, it has reduced brain reward region response to thin models (Stice et al, 2015), positive implicit attitudes toward thin models (Kant et al, 2019), and attentional bias for thin models (Tobin et al, 2022). Finally, it is the only eating disorder prevention program that has shown efficacy for various racial and ethnic groups in numerous countries, for heterosexual and sexual minority females and males, and for a broad range of ages (e.g., AlShebali et al, 2021; Brown & Keel, 2015; Brown et al, 2017; Casasnovas et al, 2021; Rohde et al, 2017; Rodriguez et al, 2008; Shaw et al, 2020; Stice et al, 2021; Unikel-Santoncini et al, 2019), implying that it might be a particularly good candidate for broad implementation.…”

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confidence: 99%

Efficacy of virtual delivery of a dissonance-based eating disorder prevention program and evaluation of a donation model to support sustained implementation.

Stice

Bohon

Shaw

et al. 2023

Self Cite

Objective: Evaluate whether the Body Project prevention program reduces eating disorder risk factors and symptoms when implemented via synchronous video telepsychiatry, which could markedly increase the reach of this intervention and test whether a pay-it-forward donation model could support sustained implementation of this intervention. Method: Young women at high risk for eating disorders because of body image concerns (N = 75; age range 16-27) were randomized to Body Project groups delivered virtually by peer educators or a waitlist control condition; participants who completed the Body Project for free because of past donations were encouraged to donate money so that this intervention could be provided for free to others. Results: Participants randomized to virtually delivered Body Project groups showed significantly or marginally greater pretest-toposttest reductions in pursuit of the thin ideal, body dissatisfaction, dieting, negative affect, and eating disorder symptoms than controls. The average effect was large (d = .79), which was 49% larger than the average effect observed previously for in-person peer-educator-delivered Body Project groups (d = .53; [.76−.53 = .23/.53 = 49%]). However, only 3.6% of participants donated money to support future implementation of this intervention. Conclusions: The evidence that the Body Project produced large reductions in eating disorder risk factors and symptoms when implemented virtually and that the effects were larger than for in-person Body Project groups suggests it would be useful to implement this prevention program virtually, which could expand the reach of this intervention. Future studies should evaluate alternative methods for supporting sustained implementation of this prevention program. What is the public health significance of this article?The Body Project, a dissonance-based eating disorder prevention program, produced large reductions in eating disorder risk factors and symptoms when implemented virtually via synchronous video telepsychiatry compared to waitlist controls in this randomized trial. The average pretest-to-posttest effect for virtually delivered Body Project groups was 49% larger than the parallel effect for groups that were delivered in-person, providing encouraging evidence that virtual delivery may increase the efficacy of this prevention program. Results suggest that a pay-it-forward donation model is not an effective approach to support sustained implementation of this prevention program, implying it will be important to evaluate alternative approaches to sustaining broad implementation of this prevention program.

“…To our knowledge, it is the only prevention program that has reduced future onset of a psychiatric disorder, produced effects in both efficacy and effectiveness trials, produced effects that persist for 3 years, outperformed credible alternative interventions, and produced independently replicated effects (Stice et al, 2019). It is also the only eating disorder prevention program that has significantly reduced eating disorder risk factors and symptoms in randomized trials for various racial and ethnic groups in several countries, heterosexual and nonheterosexual females and males, and participants ranging in age from 11 to 64 in trials at middle schools, high schools, and universities (AlShebali et al, 2021;Brown & Keel, 2015;Brown et al, 2017;Casasnovas et al, 2019;Rodriguez et al, 2008;Rohde et al, 2014Rohde et al, , 2017Shaw et al, 2020;Stice et al, 2021;Unikel-Santoncini et al, 2019). These results imply that it might be a particularly good candidate for broad implementation.…”

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confidence: 99%

Implementation factors that predict larger effects from a peer educator delivered eating disorder prevention program at universities.

Stice¹,

Rohde

Gau

et al. 2023

Self Cite

Objective: Identify implementation factors, including intervention, facilitator, participant, and college factors, that were associated with larger reductions in eating disorder symptoms for undergraduates who completed a dissonance-based eating disorder prevention program delivered by peer educators in an implementation support trial. The goal was to determine how to maximize the effects of this prevention program in future implementation efforts. Method: We recruited 63 universities with peer educator programs and randomly assigned them to three levels of implementation support for delivery of an evidence-based eating disorder prevention program (the Body Project). The present report investigated whether several intervention, facilitator, participant, and college characteristics were associated with the magnitude of reductions in eating disorder symptoms among 1,387 undergraduates who completed the Body Project. Results: Significantly greater reductions in eating disorder symptoms were found for the four-session versus two-session version of the Body Project (d = −.36), when Body Project groups were delivered virtually versus in-person (d = −.22), when observation-based supervision was provided to peer educators during intervention implementation versus when it was not (d = −.15), and for larger versus smaller universities (d = −.24). Although effects were small, the additive effect was medium (d = −.50). Conclusions: Results suggest that if the goal is to optimize the effects of the Body Project, peer educator programs at universities should implement the full four-session version of the prevention program that contains all of the dissonance-inducing activities and home exercises, implement this prevention program virtually, and provide supervision to facilitators implementing this prevention program.