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

Eric Stice, C Nathan Marti, Heather Shaw, Paul Rohde, Eric Stice, C Nathan Marti, Heather Shaw, Paul Rohde

Abstract

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.

Keywords: Dissonance; Eating disorder; Effect size moderators; Meta-analysis; Prevention programs.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Copyright © 2019 Elsevier Ltd. All rights reserved.

References

    1. Allen K, Byrne S, Oddy H, & Crosby R (2013). Eating Disorders in Adolescents: Prevalence, Stability, and Psychosocial Correlates in a Population-Based Sample of Male and Female Adolescents. Journal of Abnormal Psychology, 122, 720–732.
    1. Amaral A, Stice E, & Ferreira M (2018). Pilot trial of a dissonance-based eating disorder prevention program with Brazilian girls. Psychology: Research and Review. Submitted.
    1. American Group Psychotherapy Association (2007). Practice Guidelines for Group Psychotherapy. Science to Service Task Force Report.
    1. Aronson E, Fried C, & Stone J (1991). Overcoming denial and increasing the intention to use condoms through the induction of hypocrisy. American Journal of Public Health, 81, 1636–1637.
    1. Atkinson M, & Wade T (2016). Does mindfulness have potential in eating disorder prevention? A preliminary controlled trial with young adult women. Early Intervention in Psychiatry, 10, 234–245.
    1. Bauer DJ, & Curran PJ (2005). Probing interactions in fixed and multilevel regression: Inferential and graphical techniques. Multivariate Behavioral Research, 40, 373–400.
    1. Becker BJ (1988). Synthesizing standardized mean-change measures. British Journal of Mathematical and Statistical Psychology, 41, 257–278. doi: 10.1111/j.2044-8317.1988.tb00901.x
    1. Becker CB, Bull S, Schaumberg K, Cauble A, & Franco A (2008). Effectiveness of peer-led eating disorders prevention: A replication trial. Journal of Consulting and Clinical Psychology, 76, 347–354.
    1. Becker CB, McDaniel L, Bull S, Powell M, & McIntyre K (2012). Can we reduce eating disorder risk factors in female college athletes? A randomized exploratory investigation of two per-led interventions. Body Image, 9, 31–42.
    1. Becker CB, Smith LM, & Ciao AC (2006). Peer facilitated eating disorders prevention: A randomized effectiveness trial of cognitive dissonance and media advocacy. Journal of Counseling Psychology, 53, 550–555.
    1. Becker CB & Stice E (2008). Sorority Body Image Program: Group Leader Guide. New York: Oxford University Press.
    1. Becker CB, Wilson C, Williams A, Kelly M, McDaniel L, & Elmquist J (2010). Peer-facilitated cognitive dissonance versus healthy weight eating disorders prevention: A randomized comparison. Body Image, 7, 280–288.
    1. Begg S, Vos T, Baker B, Stevenson C, Stanley L, & Lopez A (2007). The burden of disease and injury in Australia 2003. Canberra: Australian Institute of Health and Welfaire.
    1. Berkman N, Lohr K, & Bulik C (2007). Outcomes of eating disorders: A systematic review of the literature. International Journal of Eating Disorders, 40, 293–309.
    1. Bernard H, Burlingame G, Flores P, Greene L, Joyce A, Kobos J et al. (2008). Clinical practice guidelines for group psychotherapy. International Journal of Group Psychology, 58, 455–542.
    1. Brown T, & Keel P (2015). A randomized controlled trial of a peer co-led dissonance-based eating disorder prevention program for gay men. Behaviour Research and Therapy, 74, 1–10.
    1. Buddeberg-Fischer B, Klaghofer R, Gnam G, & Buddeberg C (1998). Prevention of disturbed eating behaviour: A prospective intervention study in 14- to 19-year old Swiss students. Acta Psychiatrica Scandinavica, 98, 146–155.
    1. Cheng Z, Perko V, Fuller-Marashi L, Gau J, & Stice E (2018). Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women. Under review as a revise and resubmit.
    1. Cheung MWL (2015a). Meta-analysis: A structural equation modeling approach. New York, NY: Wiley.
    1. Cheung MWL (2015b). metaSEM: An R package for meta-analysis using structural equation modeling. Frontiers in Psychology, 5. doi: 10.3389/fpsyg.2014.01521 Retrieved from Retrieved from .
    1. Chithambo TP & Huey SJ (2017). Internet-delivered eating disorder prevention: A randomized controlled trial of dissonance-based and cognitive-behavioral interventions. International Journal of Eating Disorders, 50:1142–1151.
    1. Ciao A, Latner J, Brown K, Ebneter D, & Becker C (2015). Effectiveness of a peer-delivered dissonance-based program in reducing eating disorder risk factors in high school girls. International Journal of Eating Disorders, 48, 779–784.
    1. Cochran WG (1954). The combination of estimates from different experiments. Biometrics, 10, 101–129. doi: 10.2307/3001666
    1. Cooper J & Axsom D (1982). Effort justification in psychotherapy In Weary G and Mirels H (Eds.), Integrations of clinical and social psychology (pp. 98–121). New York, NY: Oxford.
    1. Corrieri S, Heider D, Conrad I, Blume A, Konig H, & Riedel-Heller S (2014). School-based prevention programs for depression and anxiety in adolescence: A systematic review. Health Promotion International, 29, 427–441.
    1. Crow S, & Smiley N (2010). Costs and cost-effectiveness in eating disorders In Agras WS (Ed.), The Oxford Handbook of Eating Disorders (pp. 480–485). Oxford: Oxford University Press.
    1. Festinger L (1957). A theory of cognitive dissonance. Stanford, CA: Stanford University Press.
    1. Ghaderi A, & Scott B (2001). Prevalence, incidence and prospective risk factors for eating disorders. Acta Psychiatrica Scandinavica, 104, 122–130.
    1. Green M, Scott N, Diyankova I, Gasser C, & Pederson E (2005). Eating disorder prevention: An experimental comparison of high-level dissonance, low level dissonance, and no-treatment control. Eating Disorders, 13, 157–169.
    1. Green M, Willis M, Fernandez-Kong K, Reyes S, Linkhart R, Johnson M, et al., (2016). Dissonance-based eating disorder program reduces cardiac risk: A preliminary trial. Health Psychology, 36, 346–355.
    1. Green MA, Willis M, Fernandez-Kong K, Reyes S, Linkhart R, Johnson M, et al., (2017). A controlled randomized preliminary trial of a modified dissonance-based eating disorder intervention program. Journal of Clinical Psychology, 73, 1612–1628.
    1. Halliwell E, & Diedrichs P (2014). Brief report: Testing a dissonance body image intervention among young girls. Healthy Psychology, 33, 201–204.
    1. Halliwell E, Jarman H, McNamara A, Risdon H, & Jankowski G (2015). Dissemination of evidence-based body image interventions: A pilot study into the effectiveness of using undergraduate students as interventionists in secondary schools. Body Image, 14, 1–4.
    1. Hay P (2013). A systematic review of evidence for psychological treatments in eating disorders: 2005–2012. International Journal of Eating Disorders, 46, 462–469.
    1. Hays WL (1994). Statistics. Fort Worth, TX: Harcourt Brace College Publishers.
    1. Hedges LV (1982). Estimation of effect size from a series of independent experiments. Psychological Bulletin, 92, 490–499. doi: 10.1037/0033-2909.92.2.490.
    1. Hox JJ (2010). Multilevel analysis: Techniques and applications (2nd ed.). New York, NY: Routledge.
    1. Ioannidis JPA, Munafò MR, Fusar-Poli P, Nosek BA, & David SP (2014). Publication and other reporting biases in cognitive sciences: detection, prevalence and prevention. Trends in Cognitive Sciences, 18(5), 235–241. 10.1016/j.tics.2014.02.010.
    1. Jacobi C, Fittig E, Bryson SW, Wilfley D, Kraemer HC, & Taylor CB (2011). Who is really at risk? Identifying risk factors for subthreshold and full syndrome eating disorders in a high-risk sample. Psychological Medicine, 41, 1939–1949.
    1. Jilka K (2002). The effects of a cognitive dissonance-based eating disorder prevention program in a sorority population. (Honors thesis). Trinity University.
    1. Johnson F, & Wardle J (2005). Dietary restraint, body dissatisfaction, and psychological distress: A prospective analysis. Journal of Abnormal Psychology, 114, 119–124. doi:10.1037/0021-843X.114.1.119
    1. Kilpela L, Blomquist K, Verzijl C, Wilfred S, Beyl R, & Becker C (2016). The Body Project 4 All: A pilot randomized controlled trial of a mixed-gender dissonance-based body image program. International Journal of Eating Disorders.
    1. Kilpela L, DeBoer L, Alley M, Presnell K, McGinley J, & Becker CB (2015). Distributed and condensed versions of a cognitive dissonance program: comparative effects on eating disorder risk factors and symptoms. Advances in Eating Disorders, 3, 34–47.
    1. Kilpela L, Hill K, Kelly M, Elmquist J, Ottoson P, Keith D et al., (2014). Reducing eating disorder risk factors: A controlled investigation of a blended task-shifting/train-the-trainer approach to dissemination and implementation. Behaviour Research and Therapy, 63, 70–82.
    1. Krishna M (2011). The effectiveness of peer-led eating disorder prevention programs within the Dartmouth College sorority system. (Senior honors thesis). Dartmouth College.
    1. Linville D, Cobb E, Lenee-Bluhm T, Lopez-Zeron G, Gau J, & Stice E (2015). The effectiveness of an eating disorder prevention intervention in primary care medical settings. Behaviour Research and Therapy, 75, 32–39.
    1. Maas CJ, Hox JJ, & Lensvelt-Mulders GJ (2004). Longitudinal meta-analysis. Quality and Quantity, 38, 381–389.
    1. Machin AL (2008). Reducing the risk of disordered eating among female college students: A test of alternative interventions. (Doctoral dissertation). University of North Texas.
    1. Magnuson A (2012). Evaluation of an eating disorders prevention curriculum on eating attitudes and behaviors of female college students. Dissertation Abstracts International, 72.
    1. Matusek JA, Wendt SJ, & Wiseman CV (2004). Dissonance thin-ideal and didactic healthy behavior eating disorder prevention programs: Results from a controlled trial. International Journal of Eating Disorders, 36, 376–388.
    1. McKnight I (2003). Risk factors for the onset of eating disorders in adolescent girls: Results of the McKnight longitudinal risk factor study. American Journal of Psychiatry, 160, 248–254.
    1. McMillan W, Stice E, & Rohde P (2011). High- and low-level dissonance-based eating disorder prevention programs with young women with body image concerns: An experimental trial. Journal of Consulting and Clinical Psychology, 79, 129–134.
    1. Mitchell KS, Mazzeo SE, Rausch SM, & Cooke KL (2007). Innovative interventions for disordered eating: Evaluating dissonance-based and yoga interventions. International Journal of Eating Disorders, 40, 120–128.
    1. Morris SB (2008). Estimating effect sizes from pretest-posttest-control group designs. Organizational Research Methods, 11, 364–386. doi: 10.1177/1094428106291059.
    1. Pennesi J & Wade TD (2017). Imagery rescripting and cognitive dissonance: A randomized controlled trial of two brief online interventions for women at risk of developing an eating disorder. International Journal of Eating Disorders, 51, 439–448.
    1. Rodriguez R, Marchand E, Ng J, & Stice E (2008). Effects of a cognitive-dissonance-based eating disorder prevention program are similar for Asian American, Hispanic, and White participants. International Journal of Eating Disorders, 41, 618–625.
    1. Rohde P, Stice E, & Marti N (2015). Development and predictive effects of eating disorder risk factors during adolescence: Implications for prevention efforts. International Journal of Eating Disorders, 48, 187–198.
    1. Santonastaso P, Friederici S, Favaro A. 1999. Full and partial syndromes in eating disorders: A 1-year prospective study of risk factors among female students. Psychopathology, 32, 50–56.
    1. Scott-Sheldon L, Carey K, Elliott J, Garey L, & Carey M (2014). Efficacy of alcohol interventions for first-year college students: A meta-analytic review of randomized controlled trials. Journal of Consulting and Clinical Psychology, 82, 177–188.
    1. Seidel A, Presnell K, & Rosenfield D (2009). Mediators in the dissonance eating disorder prevention program. Behaviour Research and Therapy, 47, 645–653.
    1. Shaw H, Rohde P, & Stice E (2016). Participant feedback from peer-led, clinician-led, and Internet-delivered eating disorder prevention interventions. International Journal of Eating Disorders, 49, 1087–1092,
    1. Smith A, & Petrie T (2008). Reducing the risk of disordered eating among female athletes: A test of alternative interventions. Journal of Applied Sport Psychology, 20, 392–407.
    1. Stewart DA, Carter JC, Drinkwater J, Hainsworth J, & Fairburn CG (2001). Modification of eating attitudes and behavior in adolescent girls: A controlled study. International Journal of Eating Disorders, 29, 107–118.
    1. Stice E, Butryn M, Rohde P, Shaw H, & Marti N (2013). An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students. Behaviour Research and Therapy, 51, 862–871.
    1. Stice E, Chase A, Stormer S, & Appel A (2001). A randomized trial of a dissonance-based eating disorder prevention program. International Journal of Eating Disorders, 29, 247–262.
    1. Stice E, Durant S, Rohde P & Shaw H (2014). Effects of a Prototype Internet Dissonance-Based Eating Disorder Prevention Program at 1- and 2-Year Follow-Up. Health Psychology, 33, 1558–1567. doi: 10.1037/hea0000090
    1. Stice E, Gau J, Rohde P, & Shaw H (2017). Risk factors that predict future onset of each DSM-5 eating disorder: Predictive specificity in high-risk adolescent females. Journal of Abnormal Psychology, 126, 38–51.
    1. Stice E, Marti CN, & Cheng ZH (2014). Effectiveness of a dissonance-based eating disorder prevention program for ethnic groups in two randomized controlled trials. Behaviour Research and Therapy, 55, 54–64.
    1. Stice E, Marti CN, & Rohde P (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122, 445–457.
    1. Stice E, Marti N, Shaw H, & O’Neil K (2008). General and program-specific moderators of two eating disorder prevention programs. International Journal of Eating Disorders, 41, 611–617.
    1. Stice E, Marti CN, Spoor S, Presnell K, & Shaw H (2008). Dissonance and healthy weight eating disorder prevention programs: Long-term effects from a randomized efficacy trial. Journal of Consulting and Clinical Psychology, 76, 329–340.
    1. Stice E, Mazotti L, Weibel D, & Agras WS (2000). Dissonance prevention program decreases thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms: A preliminary experiment. International Journal of Eating Disorders, 27, 206–217.
    1. Stice E, Presnell K, Gau J, & Shaw H (2007). Testing mediators of intervention effects in randomized controlled trials: An evaluation of two eating disorder prevention programs. Journal of Consulting and Clinical Psychology, 75, 20–32.
    1. Stice E, Rohde P, Butryn ML, Shaw H & Marti CN (2015). Effectiveness trial of a selective dissonance-based eating disorder prevention program with female college students: Effects at 2-and 3-year follow-up. Behaviour Research and Therapy, 71, 20–26. doi: 10.1016/j.brat.2015.05.012
    1. Stice E, Rohde P, Durant S, & Shaw H (2012). A preliminary trial of a prototype Internet dissonance-based eating disorder prevention program for young women with body image concerns. Journal of Consulting and Clinical Psychology, 80, 907–916.
    1. Stice E, Rohde P, Durant S, Shaw H, & Wade E (2013). Effectiveness of peer-led dissonance eating disorder prevention groups: Results from two randomized trials. Behaviour Research and Therapy, 51, 197–206.
    1. Stice E, Rohde P, Gau J, & Shaw H (2009). An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. Journal of Consulting and Clinical Psychology, 77, 825–834.
    1. Stice E, Rohde P, Gau J, & Shaw H (2012). Effect of a dissonance-based prevention program on risk for eating disorder onset in the context of eating disorder risk factors. Prevention Science, 13, 129–139.
    1. Stice E, Rohde P, Shaw H, & Gau J (2011). An effectiveness trial of a selected dissonance-based eating disorder prevention program for female high school students: Long-term effects. Journal of Consulting and Clinical Psychology, 79, 500–508.
    1. Stice E, Rohde P, Shaw H, & Gau J (2017). An experimental therapeutics test of whether adding dissonance-induction activities improves the effectiveness of a selected obesity and eating disorder prevention program. International Journal of Obesity.
    1. Stice E, Rohde P, Shaw H, & Gau J (2017). Clinician-led, peer-led, and Internet-delivered dissonance-based eating disorder prevention programs: Acute effectiveness of these delivery modalities. Journal of Consulting and Clinical Psychology, 85, 883–895.
    1. Stice E, Rohde P, Shaw H, & Marti CN (2012). Efficacy trial of a selected prevention program targeting both eating disorder symptoms and unhealthy weight gain among female college students. Journal of Consulting and Clinical Psychology, 80, 164–170.
    1. Stice E, Rohde P, Shaw H, & Marti CN (2013). Efficacy trial of a selective prevention program targeting both eating disorders and obesity among female college students: 1- and 2-year follow-up effects. Journal of Consulting and Clinical Psychology, 81, 183–189.
    1. Stice E, Shaw H, & Marti CN (2007). A meta-analytic review of eating disorder prevention programs: Encouraging Findings. Annual Review of Clinical Psychology, 3, 233–257.
    1. Stice E, Shaw H, Burton E, & Wade E (2006). Dissonance and healthy weight eating disorder prevention programs: A randomized efficacy trial. Journal of Consulting and Clinical Psychology, 74, 263–275.
    1. Stice E, Trost A, & Chase A (2003). Healthy weight control and dissonance-based eating disorder prevention programs: Results from a controlled trial. International Journal of Eating Disorders, 33, 10–21.
    1. Stice E, & Van Ryzin M (2019). A prospective test of the temporal sequencing of risk factor emergence in the dual pathway model of eating disorders. Journal of Abnormal Psychology, 128, 119–128.
    1. Stice E, Yokum S, & Waters A (2015). Dissonance-based eating disorder prevention program reduces reward region response to thin models: How actions shape valuation. PLOS ONE. DOI: 10.1371/journal.pone.0144530
    1. Swanson SA, Crow SJ, le Grange D, Swendsen J, & Merikangas KR (2011). Prevalence and correlates of eating disorders in adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry, 68, 714–723.
    1. Turk MW, Yang K, Hravnak M, Sereika SM, Ewing LJ, & Burke LE (2009). Randomized clinical trials of weight loss maintenance: a review. Journal of Cardiovascular Nursing, 24, 58–80.
    1. Viechtbauer W (2010). Conducting meta-analyses in R with the metafor package. Journal of Statistical Software, 36, 1–48. Retrieved from .
    1. Wade T, George W, & Atkinson M (2009). A randomized controlled trial of brief interventions for body dissatisfaction. Journal of Consulting and Clinical Psychology, 77, 845–854.
    1. Warren C, Gleaves D, Cepeda-Benito A, Fernandez M, & Rodriguez RS (2005). Ethnicity as a protective factor against internalization of a thin ideal and body dissatisfaction. International Journal of Eating Disorders, 37, 241–249.
    1. Watson HJ, Joyce T, French E, Willan V, Kane RT, Tanner-Smith E, … Egan SJ(2016). Prevention of eating disorders: A systematic Review of randomized, controlled trials. International Journal of Eating Disorders. Advance on-line publication DOI: 10.1002/eat.22577
    1. Weiss KR, & Wertheim EH (2005). An evaluation of a primary prevention program for disordered eating in adolescent girls: Examining responses of high- and low-risk girls. Eating Disorders, 13, 143–156.
    1. Wiseman CV, Sunday SR, Bortolotti F, & Halmi KA (2004). Primary prevention of eating disorders through attitudinal change: A two country comparison. Eating Disorders, 12, 241–250.
    1. Wolfe JL (1992). Applying cognitive dissonance within a personal health curriculum to reduce risk factors associated with the development of eating disorders in a university population (Doctoral Dissertation). University of Georgia.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever