An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls.

Efficacy trials indicate that an eating disorder prevention program involving dissonance-inducing activities that decrease thin-ideal internalization reduces risk for current and future eating pathology, yet it is unclear whether this program produces effects under real-world conditions. The present effectiveness trial tested whether this program produced effects when school staff recruit participants and deliver the intervention. Adolescent girls with body image concerns (N = 306; M age = 15.7, SD = 1.1) randomized to the dissonance intervention showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, dieting attempts, and eating disorder symptoms from pretest to posttest than did those assigned to a psychoeducational brochure control condition, with the effects for body dissatisfaction, dieting, and eating disorder symptoms persisting through 1-year follow-up. Effects were slightly smaller than those observed in a prior efficacy trial, suggesting that this program is effective under real-world conditions, but that facilitator selection, training, and supervision could be improved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing mediators hypothesized to account for the effects of a dissonance-based eating disorder prevention program over longer term follow-up.

Objective: Test the hypothesis that reductions in thin-ideal internalization and body dissatisfaction mediate the effects of a dissonance-based eating disorder prevention program on reductions in eating disorder symptoms over 1-year follow-up. Method: Data were drawn from a randomized effectiveness trial in which 306 female high school students (mean age = 15.7 years, SD = 1.1) with body image concerns were randomized to the 4-session dissonance-based prevention program or an educational brochure control condition, wherein school counselors and nurses were responsible for participant recruitment and intervention delivery. Results: Dissonance-intervention participants showed greater reductions in thin-ideal internalization, body dissatisfaction, and eating disorder symptoms; change in thin-ideal internalization predicted change in body dissatisfaction and symptoms; change in body dissatisfaction predicted change in symptoms; and all indirect effects were significant. Change in thin-ideal internalization fully mediated the effects of intervention condition on change in body dissatisfaction and partially mediated the effects on symptoms; change in body dissatisfaction partially mediated the effect of intervention condition on change in symptoms. Conclusions: Findings provided support for the intervention theory of this eating disorder prevention program over longer term follow-up, extending the evidence base for this effective intervention. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Dissonance and healthy weight eating disorder prevention programs: Long-term effects from a randomized efficacy trial.

Adolescent girls with body dissatisfaction (N = 481, SD = 1.4) were randomized to a dissonance-based thin-ideal internalization reduction program, healthy weight control program, expressive writing control condition, or assessment-only control condition. Dissonance participants showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment and lower risk for eating pathology onset through 2- to 3-year follow-up than did assessment-only controls. Dissonance participants showed greater decreases in thin-ideal internalization, body dissatisfaction, and psychosocial impairment than did expressive writing controls. Healthy weight participants showed greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment; less increases in weight; and lower risk for eating pathology and obesity onset through 2- to 3-year follow-up than did assessment-only controls. Healthy weight participants showed greater decreases in thin-ideal internalization and weight than did expressive writing controls. Dissonance participants showed a 60% reduction in risk for eating pathology onset, and healthy weight participants showed a 61% reduction in risk for eating pathology onset and a 55% reduction in risk for obesity onset relative to assessment-only controls through 3-year follow-up, implying that the effects are clinically important and enduring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High- and low-level dissonance-based eating disorder prevention programs with young women with body image concerns: An experimental trial.

Objective: As cognitive dissonance is theorized to contribute to the effects of dissonance-based eating disorder prevention programs, we evaluated a high-dissonance version of this program against a low-dissonance version and a wait-list control condition to provide an experimental test of the mechanism of intervention effects. Method: Female college students (N = 124, mean age = 20.9 years, SD = 3.9) with body image concerns were randomized to the 3 conditions. The high-dissonance program was designed to maximize dissonance induction, and the low-dissonance program was designed to minimize it; the substantive content of the 2 programs was matched. Results: Relative to controls, those in the high-dissonance condition showed significantly greater reductions in thin-ideal internalization, body dissatisfaction, dieting, and eating disorder symptoms by posttest, and those in the low-dissonance condition showed significantly greater reductions in the first 3 outcomes by posttest, with most of these effects persisting to 3-month follow-up. High-dissonance participants showed significantly greater reductions in eating disorder symptoms than low-dissonance participants did by posttest, but this effect was nonsignificant by 3-month follow-up. Conclusions: Results suggest that dissonance induction contributes to intervention effects but imply that the intervention content, nonspecific factors, and demand characteristics play a much more potent role in producing effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dissonance and healthy weight eating disorder prevention programs: A randomized efficacy trial.

In this trial, adolescent girls with body dissatisfaction (N = 481, M age = 17 years) were randomized to an eating disorder prevention program involving dissonance-inducing activities that reduce thin-ideal internalization, a prevention program promoting healthy weight management, an expressive writing control condition, or an assessment-only control condition. Dissonance participants showed significantly greater reductions in eating disorder risk factors and bulimic symptoms than healthy weight, expressive writing, and assessment-only participants, and healthy weight participants showed significantly greater reductions in risk factors and symptoms than expressive writing and assessment-only participants from pretest to posttest. Although these effects faded over 6-month and 12-month follow-ups, dissonance and healthy weight participants showed significantly lower binge eating and obesity onset and reduced service utilization through 12-month follow-up, suggesting that both interventions have public health potential. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Food, mood, and attitude: Reducing risk for eating disorders in college women.

Food, Mood, and Attitude (FMA) is a CD-ROM prevention program developed to decrease risk for eating disorders in college women. Female 1st-year students (N = 240) were randomly assigned to the intervention (FMA) or control group. Equal numbers of students at risk and of low risk for developing an eating disorder were assigned to each condition. Participants in the FMA condition improved on all measures relative to controls. Significant 3-way interactions (Time × Condition × Risk Status) were found on measures of internalization of sociocultural attitudes about thinness, shape concerns, and weight concerns, indicating that at-risk participants in the intervention group improved to a greater extent than did low-risk participants. At follow-up, significantly fewer women in the FMA group reported overeating and excessive exercise relative to controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of an Internet-based program for reducing risk factors for eating disorders.

This study evaluated an Internet-delivered computer-assisted health education (CAHE) program designed to improve body satisfaction and reduce weight/shape concerns—concerns that have been shown to be risk factors for the development of eating disorders in young women. Participants were 60 women at a public university randomly assigned to either an intervention or control condition. Intervention participants completed the CAHE program Student Bodies. Measures of body image and disordered eating attitudes were assessed at baseline, postintervention, and 3-month follow-up. At follow-up, intervention participants, compared with controls, reported a significant improvement in body image and a decrease in drive for thinness. This program provides evidence for the feasibility and effectiveness of providing health education by means of the Internet. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy trial of a brief cognitive–behavioral depression prevention program for high-risk adolescents: Effects at 1- and 2-year follow-up.

Objective: To evaluate the effects of a brief group cognitive–behavioral (CB) depression prevention program for high-risk adolescents with elevated depressive symptoms at 1- and 2-year follow-up. Method: In this indicated prevention trial, 341 at-risk youths were randomized to a group CB intervention, group supportive expressive intervention, CB bibliotherapy, or educational brochure control condition. Results: Significantly greater reductions in depressive symptoms were shown by group CB participants relative to brochure control participants by 1-year follow-up and bibliotherapy participants by 1- and 2-year follow-up but not relative to supportive expressive participants. Supportive expressive participants showed greater symptom reduction than CB bibliotherapy participants did at 2-year follow-up. Risk for onset of major or minor depression over the 2-year follow-up was significantly lower for group CB participants (14%; odds ratio = 2.2) and CB bibliotherapy participants (3%; odds ratio = 8.1) than for brochure controls (23%). Conclusions: Results indicate that this group CB intervention reduces initial symptoms and risk for future depressive episodes, although both supportive expressive therapy and CB bibliotherapy also produce intervention effects that persist long term. Indeed, CB bibliotherapy emerged as the least expensive method of reducing risk for future episodes of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do adherence variables predict outcome in an online program for the prevention of eating disorders?

Unlike traditional interventions, Internet interventions allow for objective tracking and examination of the usage of program components. Student Bodies (SB), an online eating disorder (ED) prevention program, significantly reduced ED attitudes/behaviors in college-aged women with high body image concerns, and reduced the development of EDs in some higher risk subgroups. The authors investigated how adherence measures were associated with ED attitudes and behaviors after treatment. Female SB participants (n = 209) completed the Eating Disorders Examination-Questionnaire (EDE-Q; C. G. Fairburn & S. J. Beglin, 1994) at baseline, posttreatment, and 1-year follow-up. Total weeks participation and frequency of utilizing the online Web pages/journals predicted pre- to posttreatment changes in EDE-Q Restraint but not in other ED symptoms. In participants with some compensatory behaviors, discussion board and booster session use were associated with increased weight/shape concerns during follow-up. In overweight participants, higher online Web page/journal use was related to decreased EDE-Q Eating Concern scores during follow-up. This is the first study to investigate the relationship between adherence to specific program components and outcome in a successful Internet-based intervention. Results can be used to inform future development and tailoring of prevention interventions to maximize effectiveness and facilitate dissemination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of peer-led eating disorders prevention: A replication trial.

The aim of this study was to replicate and extend results of a previous trial that investigated the effectiveness of 2 peer-led eating disorders prevention interventions in reducing eating disorder risk factors in undergraduate women (C. B. Becker, L. M. Smith, & A. C. Ciao, 2006). To extend findings from the previous study by allowing for investigation of differential response, the authors randomly assigned a larger sample of both higher and lower risk sorority members (N = 188; age M = 18.64 years, range = 18-21; 20% minority) to either a cognitive dissonance (CD) or a media advocacy (MA) intervention under naturalistic conditions. Interventions were delivered by trained sorority peer leaders and consisted of two 2-hr group sessions. Participants completed questionnaires that assessed eating disorder risk factors at pretreatment, posttreatment, 7-week follow-up, and 8-month follow-up. Results indicate that both interventions reduced thin-ideal internalization, body dissatisfaction, dietary restraint, and bulimic pathology at 8 months, although higher and lower risk participants responded somewhat differently. Both CD and MA generally appeared effective for higher risk participants; only CD, however, appeared to benefit lower risk participants. Results further support the viability of using peer leaders in dissonance-based prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inhibition by gonadotropins of interleukin-1 production by rabbit granulosa and theca cells: effects on gonadotropin-induced progesterone production

BACKGROUND: School-based drug prevention programs have been criticized on methodologic grounds because the unit of analysis is often not the unit of randomization, thus increasing the likelihood of Type I errors. Application of multilevel analytic strategies appropriately corrects this biasing tendency. This study demonstrates the practical use of such analysis. METHODS: Data from 2,370 seventh-grade students participating in a substance use prevention trial were analyzed using a multilevel strategy. We examined the effectiveness of a social pressure resistance training and a normative education (NORM) intervention against an information-only control group. RESULTS: The NORM condition revealed 1-year program effects for cigarette and marijuana use with individuals as the unit of analysis and only marginal effects with classroom as the unit of analysis. No program effects were found using school as the analysis unit. A multilevel strategy revealed program effects for cigarettes and marijuana with both class and school as grouping levels. The effect for alcohol use was significant at the 2-year follow-up. CONCLUSIONS: Interventions establishing conservative drug use norms in classrooms may be an effective strategy in reducing substance use onset among adolescents. Utilization of appropriate analytic strategies is important in the analysis and interpretation of data containing nested structures.     

Reducing risk factors for eating disorders: Comparison of an Internet- and a classroom-delivered psychoeducational program.

This controlled trial compared Internet- (Student Bodies [SB]) and classroom-delivered (Body Traps [BT]) psychoeducational interventions for the reduction of body dissatisfaction and disordered eating behaviors/attitudes with a control condition. Participants were 76 women at a private university who were randomly assigned to SB, BT, or a wait-list control (WLC) condition. Measures of body image and eating attitudes and behaviors were measured at baseline, posttreatment, and 4-month follow-up. At posttreatment, participants in SB had significant reductions in weight/shape concerns and disordered eating attitudes compared with those in the WLC condition. At follow-up, disordered behaviors were also reduced. No significant effects were found between the BT and WLC conditions. An Internet-delivered intervention had a significant impact on reducing risk factors for eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peer-facilitated eating disorder prevention: A randomized effectiveness trial of cognitive dissonance and media advocacy.

The authors investigated the effectiveness of 2 interventions in reducing eating disorder risk factors under naturalistic conditions in sororities. On the basis of previous research, the campus sororities chose to implement a semimandatory, 2-session eating disorder prevention program to all new sorority members (N = 90) during sorority orientation. To facilitate evaluation, sororities agreed to random assignment of new members to either a cognitive dissonance or a media advocacy intervention. Undergraduate peer facilitators ran the groups. Although both interventions had an effect, cognitive dissonance generally was superior at 8-month follow-up. Results further support the utility of cognitive dissonance in reducing eating disorder risk factors and suggest that nondoctoral-level leaders can deliver the program. Results also indicate that a semimandatory format does not reduce effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The YouthMood Project: A cluster randomized controlled trial of an online cognitive behavioral program with adolescents.

The aim in the current study was to investigate the effectiveness of an online, self-directed cognitive–behavioral therapy program (MoodGYM) in preventing and reducing the symptoms of anxiety and depression in an adolescent school-based population. A cluster randomized controlled trial was conducted with 30 schools (N = 1,477) from across Australia, with each school randomly allocated to the intervention or wait-list control condition. At postintervention and 6-month follow-up, participants in the intervention condition had significantly lower levels of anxiety than did participants in the wait-list control condition (Cohen’s d = 0.15–0.25). The effects of the MoodGYM program on depressive symptoms were less strong, with only male participants in the intervention condition exhibiting significant reductions in depressive symptoms at postintervention and 6-month follow-up (Cohen’s d = 0.27–0.43). Although small to moderate, the effects obtained in the current study provide support for the utility of universal prevention programs in schools. The effectiveness of booster sessions should be explored in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Manipulation of thinness and restricting expectancies: Further evidence for a causal role of thinness and restricting expectancies in the etiology of eating disorders.

To test the eating disorder expectancy theory contention that expectancies for reinforcement from thinness play a causal role in body dissatisfaction and eating disorder symptoms, the authors manipulated expectancies in 2 studies. Participants were exposed to either a psychoeducational intervention or an experimental manipulation of thinness and restricting expectancies. Study 1 participants were symptomatic college women who attended 3 experimental sessions and 1 follow-up session, each 1 week apart. Study 2 participants were high school girls who received the 3 experimental sessions clustered into 2 meetings; they completed symptom measures at baseline and at follow-up. In both samples, the thinness expectancy manipulation produced greater declines in thinness expectancies and body dissatisfaction than did the psychoeducational intervention. For high school girls, the thinness expectancy manipulation also produced a greater decline in overall eating-disordered attitudes. These results provide further support for the role of expectancies in the etiology of eating-disordered behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are two interventions worse than none? Joint primary and secondary prevention of eating disorders in college females.

Prevention programs for eating disorders attempt to simultaneously prevent new cases from arising (primary prevention) and encourage students who already have symptoms to seek early treatment (secondary prevention), even though ideal strategies for these 2 types of prevention may be incompatible with each other. In the present study, an eating disorder prevention program was evaluated in a sample of female college freshmen. In the intervention, classmates who had recovered from eating disorders described their experiences and provided information about eating disorders. At follow-up, intervention participants had slightly more symptoms of eating disorders than did controls. The program may have been ineffective in preventing eating disorders because by reducing the stigma of these disorders (to encourage students with problems to seek help), the program may have inadvertently normalized them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An Interactive Psychoeducational Intervention for Women at Risk of Developing an Eating Disorder.

This study evaluated a synchronous Internet-delivered intervention (chat room) for improving eating habits and body image in college-age women at risk for developing an eating disorder. Sixty at-risk women (mean age = 18.9, SD = 2.4; 65.0% Caucasian, 19% Latino/Hispanic, 8% Asian/Pacific Islander, 3% African American, 5% other; mean body mass index = 25.6, SD = 5.7) were randomly assigned to intervention (n = 30) or control (n = 30) groups. Once a week for 8 weeks, participants used a private chat room for a 1-hr moderated discussion focused on improving body image and eating behaviors. Additional treatment components included psychoeducation, asynchronous support, homework, and summaries. Assessments were conducted at baseline, posttreatment, and 10 weeks after posttreatment. Participants indicated high satisfaction with the intervention mode. Intervention participants significantly reduced eating pathology and improved self-esteem over controls at follow-up. These findings suggest that synchronous, Internet-delivered programs are efficacious and have potential to reduce problematic attitudes and behaviors that may lead to eating disorders among college-age women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: A randomized efficacy trial.

In this depression prevention trial, 341 high-risk adolescents (mean age = 15.6 years, SD = 1.2) with elevated depressive symptoms were randomized to a brief group cognitive-behavioral (CB) intervention, group supportive-expressive intervention, bibliotherapy, or assessment-only control condition. CB participants showed significantly greater reductions in depressive symptoms than did supportive-expressive, bibliotherapy, and assessment-only participants at posttest, though only the difference compared with assessment controls was significant at 6-month follow-up. CB participants showed significantly greater improvements in social adjustment and reductions in substance use at posttest and 6-month follow-up than did participants in all 3 other conditions. Supportive-expressive and bibliotherapy participants showed greater reductions in depressive symptoms than did assessment-only controls at certain follow-up assessments but produced no effects for social adjustment and substance use. CB, supportive-expressive, and bibliotherapy participants showed a significantly lower risk for major depression onset over the 6-month follow-up than did assessment-only controls. The evidence that this brief CB intervention reduced risk for future depression onset and outperformed alternative interventions for certain ecologically important outcomes suggests that this intervention may have clinical utility. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

AIDS education in Tanzania: promoting risk reduction among primary school children

OBJECTIVES: The purpose of this study was to test the effects of an education program in Tanzania designed to reduce children's risk of human immunodeficiency virus (HIV) infection and to improve their tolerance of and care for people with acquired immunodeficiency syndrome (AIDS). METHODS: A randomized controlled community trial including baseline and 12-month follow-up surveys was employed. Public primary schools in the Arusha and Kilimanjaro regions of Tanzania were stratified according to location and randomly assigned to intervention (n = 6) or comparison (n = 12) conditions. Of the 1063 sixth-grade students (average age: 13.6 years) who participated at baseline, 814 participated in the follow-up survey. RESULTS: At follow-up, statistically significant effects favoring the intervention group were observed for exposure to AIDS information and communication, AIDS knowledge, attitudes toward people with AIDS, and subjective norms and behavioral intentions toward having sexual intercourse. A consistent positive but nonsignificant trend was seen for attitudes toward having sexual intercourse and for initiation of sexual intercourse during the previous year (7% vs 17%). CONCLUSIONS: It is feasible and effective to train local teachers and health workers to provide HIV/AIDS education to Tanzanian primary school children.     

Planning to lose weight: Randomized controlled trial of an implementation intention prompt to enhance weight reduction among overweight and obese women.

Objective: The trial investigates the effects of augmenting an established weight-reduction intervention with implementation intention prompts. Design: Fifty-five overweight or obese women (ages 18 to 76 years; body mass index from 25.28 to 48.33) enrolled in a commercial weight reduction program were randomly assigned to either an implementation intention prompt or a control condition. Data were collected twice, with a time gap of 2 months. Main Outcome Measures: The primary outcome was participants' change in weight and body mass index from preintervention to follow-up. Results: Repeated measures analysis of variance revealed a significant Time = Condition interaction: On average, implementation intention prompt participants lost 4.2 kg (95% confidence interval = 3.19, 5.07), whereas control participants lost 2.1 kg (95% confidence interval = 1.11, 3.09). The change in frequency of planning mediated the effects of the intervention on weight and body mass index change. Conclusion: Among obese or overweight women participating in a commercial weight loss program, those who learn to form implementation intentions can achieve greater weight reduction. Planning facilitation is a key mechanism explaining enhanced weight loss generated by implementation intention formation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)