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)     

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)     

An effectiveness trial of a selected dissonance-based eating disorder prevention program for female high school students: Long-term effects.

Objective: Efficacy trials found that a dissonance-based eating disorder prevention program in which female high school and college students with body image concerns critique the thin ideal reduced eating disorder risk factors, eating disorder symptoms, and future eating disorder onset. The present effectiveness trial tested whether this program produces effects through long-term follow-up when high school clinicians recruit students and deliver the intervention under real-world conditions. Method: Female high school students with body image concerns (N = 306; M age = 15.7 years, SD = 1.1) were randomized to the dissonance intervention or an educational brochure control condition and completed assessments through 3-year follow-up. Results: Dissonance participants showed significantly greater decreases in body dissatisfaction at 2-year follow-up and eating disorder symptoms at 3-year follow-up than controls; effects on other risk factors, risk for eating disorder onset, and other outcomes (e.g., body mass) were marginal or nonsignificant. Conclusions: Although it was encouraging that some key effects persisted over long-term follow-up, effects were on average smaller in this effectiveness trial than previous efficacy trials, which could be due to (a) facilitator selection, training, and supervision; (b) the lower risk status of participants; or (c) the use of a control condition that produces some effects. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The thin ideal and body image: An experimental study of implicit attitudes.

Thin-ideal internalization is a core construct in body dissatisfaction, central to eating disorders and generally assessed with explicit measures. To compare implicit and explicit measures of thin-ideal internalization and their relationship to body image, the authors developed a thin-ideal implicit association test (IAT). Although the IAT revealed a strong cognitive bias toward fat as negative (differences in response latencies: t[85]=9.829, p     

Risk factors for body dissatisfaction in adolescent girls: A longitudinal investigation.

Because few prospective studies have examined predictors of body dissatisfaction--an established risk factor for eating disorders--the authors tested whether a set of sociocultural, biological, interpersonal, and affective factors predicted increases in body dissatisfaction using longitudinal data from adolescent girls (N=496). Elevated adiposity, perceived pressure to be thin, thin-ideal internalization, and social support deficits predicted increases in body dissatisfaction, but early menarche, weight-related teasing, and depression did not. There was evidence of 2 distinct pathways to body dissatisfaction--1 involving pressure to be thin and 1 involving adiposity. Results support the contention that certain sociocultural, biological, and interpersonal factors increase the risk for body dissatisfaction, but suggest that other accepted risk factors are not related to this outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective test of the dual-pathway model of bulimic pathology: Mediating effects of dieting and negative affect.

Because there have been few longitudinal investigations of integrative etiological theories of bulimia nervosa, this study prospectively tested the dual-pathway model using random regression growth curve models and data from a 3-wave community sample of adolescent girls (N?=?231). Initial pressure to be thin and thin-ideal internalization predicted subsequent growth in body dissatisfaction, initial body dissatisfaction predicted growth in dieting and negative affect, and initial dieting and negative affect predicted growth in bulimic symptoms. There was prospective evidence for most of the hypothesized mediational effects. Results are consistent with the assertion that pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and negative affect are risk factors for bulimic pathology and provide support for the dual-pathway model. (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)     

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)     

Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: A growth curve analysis.

Using data from a longitudinal community study (N?=?231), the authors tested whether body-image and eating disturbances might partially explain the increase in depression observed in adolescent girls. Initial pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and bulimic symptoms, but not body mass, predicted subsequent increases in depressive symptoms, as did increases in these risk factors over the study. There was also prospective support for each of the hypothesized mediational relations linking these risk factors to increases in depressive symptoms. Effects remained significant when other established gender-nonspecific risk factors for depression (social support and emotionality) were statistically controlled. Results provide support for the assertion that body-image and eating disturbances, operating above and beyond gender-nonspecific risk factors, contribute to the elevated depression in adolescent girls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the media in body image concerns among women: A meta-analysis of experimental and correlational studies.

Research suggests that exposure to mass media depicting the thin-ideal body may be linked to body image disturbance in women. This meta-analysis examined experimental and correlational studies testing the links between media exposure to women's body dissatisfaction, internalization of the thin ideal, and eating behaviors and beliefs with a sample of 77 studies that yielded 141 effect sizes. The mean effect sizes were small to moderate (ds = -.28, -.39, and -.30, respectively). Effects for some outcome variables were moderated by publication year and study design. The findings support the notion that exposure to media images depicting the thin-ideal body is related to body image concerns for women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective relations of body image, eating, and affective disturbances to smoking onset in adolescent girls: How Virginia slims.

This study tested whether body image, eating, and affective disturbances prospectively predicted onset of cigarette smoking in adolescent girls (N=496). Elevated body dissatisfaction and eating pathology, as well as elevated negative affectivity, showed significant univariate relations to subsequent onset of smoking. In the multivariate model, the effect for body image and eating disturbances remained significant, but the effect for negative affectivity did not. Results support the theory that body image and eating disturbances markedly increase risk for smoking initiation in adolescent girls and further establish the clinical significance of these disturbances. Results also support the theory that negative affect is a risk factor for smoking initiation but suggest that the self-medication model may have less predictive power than previously concluded. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of adolescent dieting behaviors: A longitudinal study.

Research suggests that dieting is a risk factor for bulimia nervosa, yet little is known about the predictors of dieting. Accordingly, this study examined the correlates and prospective predictors of dieting in a community sample of 320 adolescent females (aged 16–19 yrs). Results indicate that body mass, pressure to be thin, thin-ideal internalization, body dissatisfaction, and binge eating were positively correlated with dieting. Moreover, body mass, pressure to be thin, body dissatisfaction, and binge eating prospectively predicted increased dieting over a 9-mo period. Multivariate analyses revealed that this set of predictors accounted for significant variance in concurrent and subsequent dieting, although only some of the unique effects were significant in the full models. Not only do these findings identify several risk factors for dieting, but they also suggest that dieting may be a response to bulimic pathology. (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)     

Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder.

The authors investigated prospectively assessed eating pathology (body image dissatisfaction and bulimia nervosa symptoms) among an ethnically and socioeconomically diverse sample of adolescent girls with attention-deficit/hyperactivity disorder--combined type (ADHD--C; n=93), ADHD--inattentive type (ADHD--I; n=47), and a comparison group (n=88). The sample, initially ages 6-12 years, participated in a 5-year longitudinal study (92% retention rate). After statistical control of relevant covariates, girls with ADHD--C at baseline showed more eating pathology at follow-up than did comparison girls; girls with ADHD--I were intermediate between these two groups. Baseline impulsivity symptoms, as opposed to hyperactivity and inattention, best predicted adolescent eating pathology. With statistical control of ADHD, baseline peer rejection and parent- child relationship problems also predicted adolescent eating pathology. The association between punitive parenting in childhood and pathological eating behaviors in adolescence was stronger for girls with ADHD than for comparison girls. Results are discussed in terms of the expansion of longitudinal research on ADHD to include female-relevant domains of impairment, such as eating pathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Body image dissatisfaction among women with scleroderma: Extent and relationship to psychosocial function.

Body image dissatisfaction and its relationship to psychosocial function were investigated in 127 women with scleroderma. Results indicated elevated body image dissatisfaction, with participants reporting higher levels than a sample of patients with severe burn injuries. Age, skin tightening above the elbows, and functional disability were related to heightened body image dissatisfaction, suggesting that younger patients with more severe disease may be at greatest risk for developing body image concerns. Path analysis revealed that depression mediated the relationship between body image dissatisfaction and psychosocial function. Results suggest that body image dissatisfaction is a significant concern in women with scleroderma and should be assessed routinely. Early identification and treatment of body image dissatisfaction may help prevent the development of depression and psychosocial impairment in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for binge eating onset in adolescent girls: A 2-year prospective investigation.

Because little is known about the predictors of binge eating (a risk factor for obesity), a set of putative risk factors for binge eating was investigated in a longitudinal study of adolescent girls. Results verified that binge eating predicted obesity onset. Elevated dieting, pressure to be thin, modeling of eating disturbances, appearance overvaluation, body dissatisfaction, depressive symptoms, emotional eating, body mass, and low self-esteem and social support predicted binge eating onset with 92% accuracy, Classification tree analysis revealed an interaction between appearance overvaluation, body mass, dieting, and depressive symptoms, suggesting qualitatively different pathways to binge eating and identifying subgroups at extreme risk for this outcome. Results support the assertion that these psychosocial and biological factors increase risk for binge eating. (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)     

Testing mediators of intervention effects in randomized controlled trials: An evaluation of two eating disorder prevention programs.

The authors investigated mediators hypothesized to account for the effects of 2 eating disorder prevention programs using data from 355 adolescent girls who were randomized to a dissonance or a healthy weight intervention or an active control condition. The dissonance intervention produced significant reductions in outcomes (body dissatisfaction, dieting, negative affect, bulimic symptoms) and the mediator (thin-ideal internalization), change in the mediator correlated with change in outcomes and usually occurred before change in outcomes, and intervention effects became significantly weaker when change in the mediator was partialed, providing support for the hypothesized mediators and this new approach to testing mediation in randomized trials. Findings provide somewhat less support for the hypothesis that change in healthy eating and exercise would mediate the healthy weight intervention effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bias for the (un)attractive self: On the role of attention in causing body (dis)satisfaction.

Objective: Body dissatisfaction plays a key role in the maintenance of eating disorders, and selective attention might be crucial for the origin of body dissatisfaction. A. Jansen, C. Nederkoorn, and S. Mulkens (2005) showed that eating disorder patients attend relatively more to their own unattractive body parts, whereas healthy controls attend relatively more to their own attractive body parts. In 2 studies, we investigated whether this bias in selective attention is causal to body dissatisfaction and whether an experimentally induced bias for attractive body parts might lead to increased body satisfaction in women who are highly dissatisfied with their bodies. Design: We used a between-subjects design in which participants were trained to attend to either their self-defined unattractive body parts or their self-defined attractive body parts by use of an eye tracker. Main Outcome Measures: State body and weight satisfaction. Results: Inducing a temporary attentional bias for self-defined unattractive body parts led to a significant decrease in body satisfaction and teaching body-dissatisfied women to attend to their own attractive body parts led to a significant increase in body satisfaction. Conclusion: Selective attention for unattractive body parts can play a role in the development of body dissatisfaction, and changing the way one looks may be a new way for improving body dissatisfaction in women. (PsycINFO Database Record (c) 2011 APA, all rights reserved)