Project Body Neutrality: Piloting a digital single-session intervention for adolescent body image and depression

Abstract

Objective: Eating disorders (EDs) and depression are impacting youth at alarming rates, yet most adolescents do not access treatment. Single-session interventions (SSIs) can reach youth in need. This pilot examines the acceptability and short-term utility of an SSI designed to help adolescents adopt a body neutrality mindset. Method: Pre- to post-intervention data was collected, and within-group effect sizes and 95% confidence intervals were computed, to evaluate the immediate effects of the SSI on hopelessness, functionality appreciation, and body dissatisfaction. Patterns of use, demographics, program feedback, and responses from within the SSI were also collected. Results: The SSI and all questionnaires were completed by 75 adolescents (ages 13-17, 74.70% White/Caucasian, 48.00% woman/girl) who reported elevated body image and mood problems. Analyses detected significant pre-post improvements in hopelessness (dav = 0.60, 95% CI 0.35, 0.84; dz = 0.77, 95% CI 0.51, 1.02), functionality appreciation (dav = 0.72, 95% CI 0.46, 0.97; dz = 0.94, 95% CI 0.67, 1.21), and body dissatisfaction (dav = 0.61, 95% CI 0.36, 0.86; dz = 0.76, 95% CI 0.50, 1.02). The SSI was rated as highly acceptable, with a mean overall score of 4.34/5 (SD = 0.54). Qualitative feedback suggested adolescents' endorsement of body neutrality as a personally-relevant, helpful target for intervention. Discussion: This evaluation supports the acceptability and preliminary effectiveness of a body neutrality-focused SSI for adolescents with body image and mood concerns.

Realizing the untapped promise of single‐session interventions for eating disorders

“…We therefore propose single‐session interventions (SSIs) as a highly promising but virtually untapped opportunity to catalyze innovation in the design and implementation of accessible, effective ED supports. Our team at the Lab for Scalable Mental Health has written extensively about the promise of SSIs, for a diversity of mental health problems (Schleider, Dobias, Sung, & Mullarkey, 2020); indeed, more than 60 clinical trials with tens of thousands of participants now support their clinical utility for diverse mental health problems—including certain ED symptoms and risk factors, such as restrictive eating (Schleider et al, 2022) and negative body image (Smith et al, Forthcoming). However, there have been no efforts to formally introduce SSI research to the ED field, nor to outline how ED treatment and prevention research may capitalize on the SSI approach to increase access to targeted, evidence‐based interventions.…”

“…As one example, our research team piloted a transdiagnostic SSI intended to mitigate proximal risk factors for both EDs and depression in adolescents: Body dissatisfaction (Becker et al, 2014; Jacobi & Fittig, 2010). Our resulting program, “Project Body Neutrality,” is a digital, self‐guided SSI designed to alleviate body dissatisfaction through encouraging users to adopt a “body neutrality” mindset, whereby youth are encouraged to value their body based on the functions it performs, even if they are not always satisfied with its physical appearance (Smith et al, Forthcoming). The hypothesized theory of change for this SSI, reproduced from a manuscript describing results from a recent pilot of Project Body Neutrality (Smith et al, Forthcoming), is presented here as Figure 1.…”

“…Our resulting program, “Project Body Neutrality,” is a digital, self‐guided SSI designed to alleviate body dissatisfaction through encouraging users to adopt a “body neutrality” mindset, whereby youth are encouraged to value their body based on the functions it performs, even if they are not always satisfied with its physical appearance (Smith et al, Forthcoming). The hypothesized theory of change for this SSI, reproduced from a manuscript describing results from a recent pilot of Project Body Neutrality (Smith et al, Forthcoming), is presented here as Figure 1. Body neutrality diverges from the popular “body positivity” movement, which advocates and scientists have criticized for excluding marginalized communities (Cwynar‐Horta, 2016; Darwin & Miller, 2021; Miller, 2016) and for its appearance‐centered message, which may not resonate with those who feel unable to love the way their body looks (e.g., gender‐diverse young adults experiencing gender dysphoria linked to their physicality; Hartman‐Munick et al, 2021; Legault & Sago, 2022; Rodgers et al, 2022; Lazuka et al, 2020; McGuire et al, 2016).…”

“…The body neutrality concept draws from the academic literature on functionality appreciation research (Alleva & Tylka, 2021), and holds a culturally relevant, inclusive framing that explicitly rejects using appearance satisfaction to inform self‐worth. There is preliminary evidence for the effectiveness of Project Body Neutrality among adolescents reporting co‐occurring depressive symptoms and body dissatisfaction (i.e., significant post‐intervention decreases in body dissatisfaction, increases in functionality appreciation, and decreases in hopelessness) (Smith et al, Forthcoming), and the SSI may provide a source of support for individuals with limited access to or negative experiences with other ED treatments. By addressing a modifiable, transdiagnostic risk factor, Project Body Neutrality is a potentially effective, easily‐disseminable SSI that, like other ED‐focused SSIs, could diversify ED treatment and prevention options.…”

“…Despite the severity and societal cost of EDs, funding for ED research is low compared to other psychiatric disorders (Murray et al, 2017). Although a broader recognition that EDs are “not niche” disorders will be needed to address the root causes of inadequate investment in ED treatment (Haynos et al, Forthcoming), a more immediate path to expanding funding opportunities might involve capitalizing on the transdiagnostic utility of SSIs (e.g., for EDs and depression, per Schleider et al, 2022; Smith et al, Forthcoming). Transdiagnostic interventions have been considered a “best buy” due to their broad clinical scope and relative cost‐effectiveness (Kazdin et al, 2017); likewise, SSIs' potential for scalability is well‐suited to addressing large‐scale public health needs.…”