“That's not what we do”: Evidence that normative change is a mechanism of action in group interventions

The effectiveness of social-support-based weight-loss interventions-a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis examined the effectiveness of social-support-based weight-loss interventions in adult populations with excess weight or obesity.

METHODS

We performed a systematic review of randomized controlled trials that reported on the effectiveness of weight-loss interventions which incorporated a social connectedness component. To this end, we conducted a rigorous database search of MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, and PubMed for relevant articles. The quality of eligible trials was evaluated by the Cochrane Risk-of-Bias2 tool. Five meta-analyses on intervention effectiveness in terms of weight loss were executed at 2-4-month assessment, 6-month assessment, end of intervention, and 3- and 6-month follow-up.

RESULTS

Twenty-four trials involving couples or peers targeting weight loss in 4 919 adults with BMI ≥ 25 met inclusion criteria. Meta-analyses detected no significant effect of social-support-based weight-loss interventions at either 2-4 month or 6-month assessment. There were, however, significant effects at end of intervention [95% CI 0.39, p = 0.04] and at 3-month [95% CI 0.63, p < 0.01] and 6-month [95% CI 0.34, p = 0.05] follow-up.

CONCLUSIONS

There seem to be a significant effect at the end of intervention and 3- and 6-month follow-up. However, further high-quality studies are needed before drawing any clear conclusions.

TRIAL REGISTRATION

PROSPERO 2020 CRD42020173696.

A Social Media-Delivered Melanoma Prevention Program for Young Women Engaged in Frequent UV Tanning: Protocol for a Randomized Controlled Trial

BACKGROUND

Rates of melanoma have increased dramatically in the United States over the past 25 years, and it has become among the most prevalent cancers for young adult women. Intentional skin tanning leads to a pattern of intense and intermittent UV radiation exposure that is associated with increased risk of melanoma. Frequent tanning is most common among young women and is linked to a variety of sociocultural pressures that negatively impact body image and drive appearance control behaviors. Unfortunately, there are no established interventions designed for frequent tanners. This intervention addresses this gap with unique content informed by body image and acceptance-based interventions. The intervention is delivered using Facebook secret groups, an approach designed to support behavior change and ensure scalability.

OBJECTIVE

This study aims to describe the rationale and methodology of a randomized controlled trial of a melanoma prevention program targeting young women engaged in frequent indoor or outdoor UV tanning.

METHODS

Participants are women aged 18-25 years who report high-risk tanning (ie, at least 10 indoor tanning sessions in the past 12 months or 10 outdoor sessions in the previous summer). After recruitment and screening, participants completed a baseline survey and were randomly assigned to receive the intervention or an attention-matched control condition. Both conditions were 8-week-long Facebook groups (approximately 25 members each) with daily posting of content. Follow-up surveys are administered at 3, 8, and 18 months after baseline. The primary trial outcome is the combined number of indoor and outdoor tanning sessions reported at the 8-month follow-up. Hypothesized intervention mediators are assessed at the 3-month follow-up.

RESULTS

This project was funded by a National Cancer Institute award (R01 CA218068), and the trial procedures were approved by the University of Kentucky Institutional Review Board in February 2020. Trial recruitment and enrollment occurred in 6 waves of data collection, which started in February 2022 and closed in May 2023. The study is closed to enrollment but remains open for follow-ups, and this protocol report was prepared before data analyses. As of February 2024, all participants have completed the 8-month follow-up assessment, and data collection is scheduled to close by the end of 2024 after the collection of the 18-month follow-up.

CONCLUSIONS

This trial will contribute unique knowledge to the field of skin cancer prevention, as no fully powered trials have examined the efficacy of an intervention designed for frequent indoor or outdoor tanning. The trial may also contribute evidence of the value in translating principles of body image and acceptance-based interventions into the field of skin cancer prevention and beyond. If successful, the use of the Facebook platform is intended to aid in dissemination as it provides a way to embed the intervention into individuals' everyday routines.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03441321; https://clinicaltrials.gov/study/NCT03441321.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56562.

Peer effects and health impacts of different body cognitive biases in children: micro evidence from China

Background

In China, children commonly display body cognitive biases, which constitute a significant yet hidden public health issue. These biases potentially jeopardize children's well-being, hinder the cultivation of human capital, and impede societal progress. However, limited research employs theoretical analysis and econometric testing to investigate the formation of different body cognitive biases among Chinese children and their health impacts.

Methods

Based on a local average network model for theoretical analysis, this study utilizes a sample of 4,289 children from four phases of the China Health and Nutrition Survey (CHNS) conducted from 2004 to 2011. Utilizing Logit and IV Probit models, systematically evaluate the peer effect, heterogeneity of effects, and health impacts of children's different body cognitive biases.

Results

(1) The peer effect contributes to the development of light- and heavy-body cognitive biases in Chinese children. (2) The heterogeneity analysis shows that the peer effect of body cognitive biases is more significant in rural and female children. (3) The influence of heavy-body cognitive bias is more pronounced in adolescent children. (4) The "eating-activity balance" is disrupted by the two body cognitive biases in children, leading to deviations from normal body type. (5) Specifically, the light-body cognitive bias leads children to intake more and burn fewer calories, increasing their risk of obesity. (6) Conversely, the heavy-body cognitive bias prompts children to intake less and expend more calories, resulting in a higher prevalence of thinness.

Discussion

This study innovates by exploring peer effects on body cognitive biases in Chinese children, elucidating their direction and health implications. While overweight and obesity are recognized as overt health issues, the spread and impact of implicit issues like body cognitive biases should not be overlooked. Nevertheless, the issue is largely neglected in developing countries, such as China, where existing children's health policies are inadequate in addressing it. Promoting accurate body image perception and understanding of health prevention strategies among children requires adequate attention to peer effects.

Examining the individual and relational impacts of varying responses to negative body talk within college women's female friendships

Many college women make self-disparaging comments about their appearance to others. This "fat talk" (negative body talk) is a causal risk factor for body image disturbance, which in turn predicts eating disorders and depression. Research is needed to identify effective responses to negative body talk; namely, those that reduce negative body talk without shaming its initiator or damaging the relationship. The current study examined the impact of different responses to negative body talk on the likelihood of future negative body talk and on individual and relationship factors. College women (N = 160) recalled a situation using negative body talk with a female friend. Participants listened to audio recordings of four responses (Deny/Reassure, Challenge, Empathize/Reciprocate, Ignore) and rated appearance satisfaction, shame, friendship support, and likelihood of future negative body talk after each. Linear mixed models indicated that the Deny/Reassure response followed closely by the Challenge response were most beneficial for individual and relationship factors; however, participants reported being least likely to use future negative body talk after the Ignore response. Recommendations for developing promising responses to negative body talk include combining responses to balance validation (Deny/Reassure) and change (Challenge), and studying the contribution of other relationships and varying body dissatisfaction levels.

Aspirational leaders help us change: Ingroup prototypicality enables effective group psychotherapy leadership

OBJECTIVES

Research suggests that leaders are effective when they are ingroup prototypical (represent the identity of the group they seek to lead). However, it is unclear whether leaders should represent the group's current identity ("who we are") or aspired identity ("who we want to be"). This study investigated which of these forms of prototypicality best predicted leadership effectiveness in group psychotherapy.

DESIGN

Longitudinal study.

METHODS

519 questionnaire responses were obtained from 112 women attending a four-session body acceptance program. Focal measures included participant ratings of how often they thought their psychotherapy leaders and fellow group members would (a) engage in dieting thoughts and behaviours and (b) approve of dieting. Given the program's body acceptance focus, leader prototypicality was conceptualized as the difference between participants' perceptions of how often their leaders, versus group members, would diet at the start of therapy. Leadership effectiveness was conceptualized as reductions in perceived group approval of dieting across therapy. Two therapeutic outcomes were considered: body satisfaction and dieting intentions.

RESULTS

A mixed-effects repeated measures analysis indicated that group approval of dieting decreased more rapidly when participants perceived their leaders to be aspirational (thought that group leaders dieted less frequently than group members) than when they perceived them to be exemplary (thought that group leaders dieted as frequently as group members). Changes in group approval of dieting mediated the relationship between leader prototypicality and improved therapeutic outcomes.

CONCLUSIONS

Findings suggest that group psychotherapy leaders may increase their effectiveness by striving to embody their group's aspired identity.

Facebook Intervention for Young-Onset Melanoma Survivors and Families: Protocol for a Randomized Controlled Trial

BACKGROUND

Individuals diagnosed with melanoma before the age of 40 years (young-onset melanoma survivors) and their first-degree relatives (FDRs) are a growing population at risk for developing recurrent melanoma or new melanomas. Regular surveillance using clinical skin examination (CSE) and skin self-examination (SSE) and engagement in preventive behaviors including sun protection are recommended. Given the growing population of survivors and their families who are at increased risk, it is surprising that no behavioral interventions have been developed and evaluated to improve risk-reduction behaviors.

OBJECTIVE

We describe the rationale and methodology for a randomized controlled trial evaluating the efficacy of a Facebook intervention providing information, goal setting, and peer support to increase CSE, SSE, and sun protection for young-onset melanoma survivors and their FDRs.

METHODS

Overall, 577 survivors and 577 FDRs will be randomly assigned to either the Young Melanoma Family Facebook Group or the Melanoma Family Healthy Lifestyle Facebook Group condition. Participants will complete measures of CSE, SSE, and sun protection, and mediator measures of attitudes and beliefs before and after the intervention. The primary aim is to evaluate the impact of the Young Melanoma Family Facebook intervention versus the Melanoma Family Healthy Lifestyle Facebook intervention on CSE, SSE frequency and comprehensiveness, and sun protection among FDRs. The secondary aims examine the efficacy of the Young Melanoma Family Facebook intervention on survivors' SSE frequency and comprehensiveness and sun protection behaviors and mechanisms of intervention efficacy for intervention impact on FDR and survivor outcomes. The exploratory aim is to evaluate the efficacy of the 2 interventions on perceived stress, physical activity, and healthy eating.

RESULTS

This project was funded by the National Institutes of Health (R01CA221854). The project began in May 2018, and recruitment started in January 2019. We anticipate completing enrollment by November 2023. Power calculations recommended a sample size of 577 survivors and 577 FDRs. Multilevel modeling treating family as the upper-level sampling unit and individual as the lower-level sampling unit will be the primary data analytic approach. Fixed effect predictors in these models will include condition, role, sex, all 2- and 3-way interactions, and covariates.

CONCLUSIONS

The Young Melanoma Family Facebook intervention aims to improve primary and secondary skin cancer prevention for young-onset melanoma survivors and their family members. The intervention's delivery via a popular, freely available social media platform increases its impact because of the potential for dissemination in many contexts. If efficacious, this program could be disseminated by dermatologist practices, public health or nonprofit organizations focused on melanoma, and existing melanoma and skin cancer Facebook groups, thereby expanding its reach. This project will produce a content library of posts and a moderation guide for others.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03677739; https://clinicaltrials.gov/ct2/show/NCT03677739.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39640.

Determinants of Proactive Low-Carbon Consumption Behaviors: Insights from Urban Residents in Eastern China

Proactive low-carbon consumption behaviors (PLCBs) are crucial to achieving carbon neutrality and identifying motivations for PLCBs is indispensable to changing individual consumption patterns. This study establishes a model by incorporating individual-group-level factors with psychological empowerment perception. The ordinary least-squares regression model was applied to identify the influencing factors of PLCBs with data collected from 1732 urban residents in eastern China. Results show that PLCBs are positively influenced by normative internalization, learning capacity, symbol concern, expertise level, and an environmentalism culture. In particular, the effect of learning capacity is the largest, with an influence coefficient of 0.271. A negative impact is observed between the consumerism culture and PLCBs. Moreover, psychological empowerment perception partly medicated the association between individual-group-level factors and PLCBs, and the maximum ratio of mediating effect to the full impact is 62.64%. The study sheds light on low-carbon-related behavioral management, and recommendations to promote PLCBs are further proposed.

Attitudes towards cosmetic surgery among women in China and the Netherlands

Around the world, an increasing number of people, predominantly women, are choosing to undergo cosmetic surgery-despite the associated health risks. This study aimed to promote a better cross-cultural understanding of the correlates and predictors of favorable attitudes toward cosmetic surgery among women in China (an Eastern country where cosmetic surgery is increasing most rapidly) and the Netherlands (a Western country). Questionnaire data were obtained from 763 adult women; 245 were Chinese women in China (Mage = 29.71), 265 were Chinese women in the Netherlands (Mage = 25.81), and 253 were Dutch women (Mage = 29.22). Facial appearance concerns and materialistic belief were significant predictors of favorable attitudes towards cosmetic surgery for all three cultural groups. Body appreciation was a significant positive predictor among Chinese women in both China and the Netherlands, whereas age and beauty-ideal internalization were significant positive predictors only among Chinese women in China. The findings and their implications are discussed with respect to the characteristics of Chinese culture that could explain the identified differences between Chinese and Dutch women.

Body image and acceptance of cosmetic surgery in China and the Netherlands: A qualitative study on cultural differences and similarities

There is an established relationship between acceptance of cosmetic surgery and psychological factors, including body image. However, qualitative research among diverse cultural groups is needed to provide a more fine-grained understanding of the influences on women's attitudes towards cosmetic surgery. In this study, 20 Chinese and 20 Dutch women aged 18-50 years (M_Chinese = 34.20; M_Dutch = 34.70) participated in one-on-one semi-structured interviews. Data were analyzed using reflexive thematic analysis. We identified three themes that captured the factors that women perceived to foster favorable attitudes towards cosmetic surgery: (a) sociocultural pressures (e.g., normalization of cosmetic surgery, appearance-focused peers); (b) intrapersonal characteristics (e.g., beauty-ideal internalization, social comparison); and (c) benefits of beauty (e.g., attracting men, socioeconomic benefits). Conversely, two themes captured the factors perceived to reduce favorable attitudes towards cosmetic surgery: (a) intrapersonal characteristics (e.g., unconditional body acceptance, self-confidence); and (b) external considerations (e.g., health risks, financial costs). Overall, Chinese and Dutch participants shared many similarities in their opinions about what might affect cosmetic surgery consideration. The most striking cross-cultural differences concerned perceived socioeconomic benefits of beauty (mainly Chinese women) and women's conceptualization of body appreciation. This study may enable a more comprehensive understanding about the factors influencing Chinese and Dutch women's attitudes towards cosmetic surgery, and the nuances in these relationships across these cultures.

United States Normative Attitudes for Pursuing Parenthood as a Function of Gender, Sexual Orientation, and Age

Decisions about whether or not to become a parent are significant parts of normative human development. Many studies have shown that married different-sex couples are expected to become parents, and that many social pressures enforce this norm. For same-sex couples, however, much less is known about social norms surrounding parenthood within marriage. This study examined injunctive norms and descriptive norms for the pursuit of parenthood as a function of age, gender, and sexual orientation. Participants in an internet survey included 1020 (522 heterosexual, 498 lesbian/gay) cisgender people from across the United States Findings showed that norms, especially descriptive norms, for the pursuit of parenthood for heterosexual people were much stronger than those for lesbian women and gay men, and that norms for lesbian women were stronger than those for gay men. These differences were more pronounced for older, heterosexual, and male participants. However, lesbian and gay participants, especially gay men, reported that lesbian and gay people ought to become parents to the same extent as heterosexual people. Overall, the results indicated that, regardless of sexual orientation, adults report that lesbian and gay married people ought to become parents, but that they expect only a minority of these couples will pursue parenthood. This research provided a glimpse into how Americans are envisioning family formation among same-sex couples today.

Identity processes and eating disorder symptoms during university adjustment: a cross-sectional study

BACKGROUND

Young people with eating disorders (EDs) and ED symptoms are at risk during university adjustment, suggesting a need to protect their health. The social identity approach proposes that people's social connections - and the identity-related behaviour they derive from them - are important for promoting positive health outcomes. However, there is a limited understanding as to how meaningful everyday connections, supported by affiliative identities, may act to reduce ED symptoms during a life transition.

METHODS

Two hundred eighty-one first year university students with an ED or ED symptoms completed an online survey during the first month of university. Participants completed self-reported measures of affiliative identity, social support, injunctive norms and ED symptoms. Path analysis was used to test a hypothesised mediated model, whereby affiliative identity has a significant indirect relation with ED symptoms via social support and injunctive norms.

RESULTS

Results support the hypothesised model. We show that affiliative identity predicts lower self-reported ED symptoms, because of its relation with social support and injunctive norms.

CONCLUSIONS

The findings imply that affiliative identities have a positive impact on ED symptoms during university adjustment, because the social support derived from affiliative identity is associated with how people perceive norms around disordered eating. Our discussion emphasises the possibility of identity processes being a social cure for those at risk of ED symptoms.

Preadolescents' healthy eating behavior: peeping through the social norms approach

BACKGROUND

The rising childhood obesity rate is a major public health challenge. The objective of this study is to examine key underlying mechanisms for peer-related social influence on preadolescents' healthy eating behavior by including factors closely linked with the quality of preadolescents' relationship with peers.

METHODS

A cross-sectional study was conducted in a convenience sample of 278 Lithuanian preadolescents, recruited from a public school. A questionnaire containing sociodemographic questions, questions about food intake, peer-related social norms of healthy eating, social self-efficacy, vegetable preference, need for peer approval and feeling of belonging were applied. Data was analyzed using structural equation modeling.

RESULTS

The results of the SEM showed that social self-efficacy predicts feeling of belonging to the peer group and need for peer approval. Feeling of belonging and need for peer approval predict actual intake of vegetables via injunctive norms of healthy eating. However, neither feeling of belonging nor need for peer approval predicted descriptive norms of healthy eating. Contrary to our expectations, descriptive norms were found to be unrelated with actual intake of vegetables, though vegetable preference predicted actual intake of vegetables. Vegetable preference was not predicted by injunctive or descriptive peers' social norms of healthy eating.

CONCLUSIONS

The findings of this study offer insight for informing parents, teachers and for social norms marketing interventions by stressing the importance of social relations when the aim is to encourage healthy eating among preadolescents.

Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: Effectiveness of these delivery modalities through 4-year follow-up

OBJECTIVE

Independent trials have found that the dissonance-based Body Project eating disorder prevention program is efficacious and effective; the present trial provided the first test of whether delivery could be task-shifted from clinician-delivery to peer educator-delivery or Internet-delivery without loss of effectiveness through 4-year follow-up.

METHOD

Young women at high-risk for eating disorders because of body image concerns (N = 680, Mage = 22.2) recruited at 3 colleges were randomized to clinician-led Body Project groups, peer-led Body Project groups, the Internet-based eBody Project, or educational video control.

RESULTS

Participants in clinician- and peer-led Body Project groups and the eBody Project generally showed larger reductions in risk factors and eating disorder symptoms versus controls through 1- and 2-year follow-up (d = .16-.59), with some effects persisting through 3- and 4-year follow-ups (d = .28-.58). Peer-led Body Project participants showed greater reductions in some risk factors than eBody Project participants (d = .18-.19), but no other contrasts between Body Project interventions differed. Eating disorder onset over 4-year follow-up was significantly lower for peer-led Body Project participants (8.1%) than control participants (17.6%) and clinician-led Body Project participants (19.3%), and marginally lower than eBody Project participants (15.5%).

CONCLUSIONS

The evidence that all three Body Project interventions outperformed educational video controls, peer-led groups outperformed the Internet-based intervention, and peer-led groups showed lower eating disorder onset over 4-year follow-up than the other conditions are novel. Results imply that it might be optimal to task-shift Body Project delivery to peer-leaders to address implementation barriers associated with clinician-led delivery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Cognitive-behavioral roots of body image therapy and prevention

The existing array of evidence-based body image prevention and intervention approaches has evolved over time. However, the majority originated directly or indirectly from a cognitive-behavioral conceptualisation of body image pioneered by Thomas F. Cash. In this way, it is difficult to overstate the impact Tom Cash has had on body image intervention research and practice. His ground-breaking work, building on the work of Schilder and Fisher, was the first to provide a comprehensive model of body image that reflected the broad range of influences and consequences of body image. His differentiation of the components of body image as a construct and between body image traits and states allowed us to identify and influence targets for intervention. Moreover, the intervention strategies that Tom Cash employed are still used today and laid the foundations for contemporary intervention programs. There is a gap of more than 15 years between the first and last of us receiving our PhDs, yet Cash's work has been an important influence on us all. We are extremely grateful for the theoretical and practical tools that he has given to our field. In this paper, we will outline how Cash's work has informed contemporary body image intervention and prevention. We will describe Cash's theory and intervention tools before discussing how this work paved the way for subsequent research and practice.

A feminist approach to dating violence prevention: Creating change towards safety, equality and mutuality

The effectiveness of dating violence prevention programs in changing behaviors, attitudes and knowledge related to perpetration and victimization has been well documented in the literature. However, little attention has been paid to the question of how such positive outcomes have been obtained, and the debate continues as to their underlying theoretical rationale. The present study aimed to fill this gap by designing a dating violence prevention program from a feminist approach and to investigate the processes of change with a constructivist grounded theory methodology. Towards this goal, 56 Turkish college students completed the program and later participated in semi-structured individual interviews. The analysis showed that the program initiated a gradual move towards safety, equality and mutuality in dating and intimate relations through four processes: changing perspectives and norms, learning from peers, reflecting on self, and acting differently. Some of the processes were experienced differently depending on the nature of prior or current dating experiences and the strength of sexist beliefs. The present study argues that a feminist approach proves to be a useful framework for dating violence prevention efforts and concludes with recommendations for future preventive work.

Identifying change processes in group-based health behaviour-change interventions: development of the mechanisms of action in group-based interventions (MAGI) framework

Group-based interventions are widely used to promote health-related behaviour change. While processes operating in groups have been extensively described, it remains unclear how behaviour change is generated in group-based health-related behaviour-change interventions. Understanding how such interventions facilitate change is important to guide intervention design and process evaluations. We employed a mixed-methods approach to identify, map and define change processes operating in group-based behaviour-change interventions. We reviewed multidisciplinary literature on group dynamics, taxonomies of change technique categories, and measures of group processes. Using weight-loss groups as an exemplar, we also reviewed qualitative studies of participants' experiences and coded transcripts of 38 group sessions from three weight-loss interventions. Finally, we consulted group participants, facilitators and researchers about our developing synthesis of findings. The resulting 'Mechanisms of Action in Group-based Interventions' (MAGI) framework comprises six overarching categories: (1) group intervention design features, (2) facilitation techniques, (3) group dynamic and development processes, (4) inter-personal change processes, (5) selective intra-personal change processes operating in groups, and (6) contextual influences. The framework provides theoretical explanations of how change occurs in group-based behaviour-change interventions and can be applied to optimise their design and delivery, and to guide evaluation, facilitator training and further research.

The relationships between socially prescribed perfectionism, in-group affect, negative urgency, and disordered eating in women

Socially prescribed perfectionism (SPP) is often considered as a key risk factor for disordered eating (DE). However, current conceptualizations of SPP largely assume that this perfectionism pressure is non-specific (i.e., a global pressure), despite research indicating that for females experiencing DE, female-dominated groups impose this pressure (as a perceived norm). Furthermore, this relationship may be mediated by a negative reaction to this pressure, in the form of impulsivity (or negative urgency). To date, no research has investigated whether the relationship between SPP and DE is mediated by negative urgency, nor has there been research clarifying how in-group identification relates to DE, independent of SPP and negative urgency. To address these gaps, we assessed these variables in 147 female dieters (M_age  = 25.12 years, SD = 3.08) using a cross-sectional design. Consistent with our hypotheses, negative urgency fully mediated the link between female-based SPP and disordered eating, while female-based in-group affect (identification) was predictive of disordered eating (although the latter relationship was not sustained in a multiple regression model). These findings suggest that the SPP from other women may relate to DE through increasing negative urgency, and that the link between in-group (female) affect and DE may be better explained by SPP's link to DE.

Disordered eating among Australian adolescents: Prevalence, functioning, and help received

OBJECTIVE

To estimate the prevalence of disordered eating (DE) among Australian adolescents and examine associations with clinical mental health problems, problems with functioning, and help received.

METHOD

We analyzed data from the Young Minds Matter survey (n = 2,298, 13-17 years). We derived an index of DE severity with four levels: (1) no DE; (2) subclinical DE; (3) suspected eating disorder; and (4) lifetime eating disorder diagnosis.

RESULTS

In 2013-2014, 31.6% (95%CI 35.5-39.9) of Australian adolescents experienced DE, comprising 25.7% (95%CI 23.9-37.6) with subclinical DE, 11.0% (95%CI 9.7-12.6) with a suspected eating disorder, and 0.9% (95%CI 0.6-1.3) with a lifetime eating disorder diagnosis. DE was more common among girls (41.4%, 95%CI 37.9-44.4) than boys (34.0%, 95%CI 31.1-37.0; p = .002). Adolescents with DE, compared to those without, were more likely to experience clinical mental health problems and problems with functioning. Most adolescents with DE reported help-seeking in the past year, commonly self-help; around 40% used school-based, primary care or specialist services (i.e., formal services). In multivariate analyses, the use of more specialized and intensive services was associated with more severe DE, greater problems with functioning, female gender, and 12-month mental disorder or subthreshold mental disorder symptoms.

DISCUSSION

The implementation of mental health promotion and prevention efforts for DE, and screening for DE in school and primary care settings, may facilitate detection and appropriate help-seeking among adolescents with DE.

Do thoughts about dieting matter? Testing the relationship between thoughts about dieting, body shape concerns, and state self-esteem

BACKGROUND AND OBJECTIVES

Dieters are likely primed to think about their diet throughout the day (e.g., as they feel hungry). However, prior research has not tested whether and how thinking about dieting might have negative effects, like poor self-esteem and body shape concerns.

METHODS

We experimentally primed dieters' thoughts about their diets and tested whether: 1) dieting thoughts are related to poor state self-esteem through body shape concerns; and 2) dieting thoughts are related to body shape concerns through poor state self-esteem. Dieting participants (N = 225) were randomly assigned to complete a dieting or neutral prime.

RESULTS

Unexpectedly, there was a different pattern of results across male (n = 72) and female (n = 144) dieters. When accounting for body shape concerns, males primed to think about dieting (vs. neutral condition) reported greater state self-esteem. Further, the dieting prime indirectly led to lower body shape concerns through greater state global self-esteem. However, for females, the dieting prime indirectly led to poorer state self-esteem through its effects on body shape concerns.

LIMITATIONS

The sample was collected online and was predominantly female and Caucasian. Other limitations include self-report of dieting status and body mass index.

CONCLUSIONS

The findings suggest that for males, thoughts about dieting may actually be associated with greater state self-esteem, which may indirectly predict lower body shape concerns. In contrast, for females, when thoughts about dieting activate body shape concerns, poorer state self-esteem may follow. These results highlight important, potentially gender-specific relationships between thoughts about dieting, body shape concerns, and state self-esteem.

Evidence That Frame of Reference Effects Can Reduce Socially Prescribed Perfectionism

Socially prescribed perfectionism appears to drive disordered eating behaviour in young women, usually via messages from fellow women. Social psychological research suggests that framing effects can be manipulated to reduce the effect of unhealthy messages. This research used contrasting messages about perfectionism to reduce perfectionism among female dieters. We recruited 147 female dieters (M age = 25.11) for a between-subjects experimental study. While completing an online questionnaire, participants were exposed to one of three sets of blog posts, which varied in content and source. These three conditions always had one anti-perfectionism message from a woman. This was presented along with either a high perfection message from a man, a high perfectionism message from a woman, or both of these messages. After reading the blog posts, women were asked to fill out a scale assessing their levels of socially prescribed perfectionism. When participants were exposed to an anti-perfectionism message from a woman, paired with a high-perfectionism message from a man, participants showed lower socially prescribed perfectionism than when both high and anti-perfectionism messages came from two women. These findings imply that strategies designed to reduce socially prescribed perfectionism may benefit from including contrasting messages, as this may shift perceived perfectionism norms. Implications for social interventions are discussed.

From efficacy to effectiveness to broad implementation: Evolution of the Body Project

OBJECTIVE

At the turn of the millennium, eating disorders (EDs) prevention was largely nonexistent. No program had reduced future onset of EDs in even a single trial, and most had not reduced ED symptoms. Sixteen years later, the ED prevention field has translated basic risk factor research into interventions, with demonstrated efficacy and effectiveness in reducing ED risk factors and symptoms, as well as future ED onset in some trials. This article reviews the aforementioned progress focusing on a model intervention (i.e., the Body Project [BP]).

METHOD

The article is a qualitative review of the existing BP literature.

RESULTS

Although clinical psychology has struggled with bridging the research practice gap and translating efficacy and effectiveness research into clinical implementation, researchers, clinicians, and community stakeholders working with the BP have made significant progress in addressing barriers to scalability, large-scale implementation, and sustainability, reaching 3.5 million girls and young women in 125 countries.

CONCLUSION

The successful evolution of the BP from basic research to traversing the efficacy-to-effectiveness-to-dissemination/implementation continuum has yielded significant public health impact and is thus a fitting case for this special issue commemorating the 125th anniversary of the American Psychological Association. The BP example may help others broadly implement efficacious interventions for other mental health problems. (PsycINFO Database Record

How do Small Groups Promote Behaviour Change? An Integrative Conceptual Review of Explanatory Mechanisms

BACKGROUND

Small groups are used to promote health, well-being, and personal change by altering members' perceptions, beliefs, expectations, and behaviour patterns. An extensive cross-disciplinary literature has articulated and tested theories explaining how such groups develop, function, and facilitate change. Yet these theoretical understandings are rarely applied in the development, description, and evaluation of health-promotion, group-based, behaviour-change interventions.

METHODS

Medline database, library catalogues, search engines, specific journals and reference lists were searched for relevant texts. Texts were reviewed for explanatory concepts or theories describing change processes in groups, which were integrated into the developing conceptual structure. This was designed to be a parsimonious conceptual framework that could be applied to design and delivery.

RESULTS

Five categories of interacting processes and concepts were identified and defined: (1) group development processes, (2) dynamic group processes, (3) social change processes, (4) personal change processes, and (5) group design and operating parameters. Each of these categories encompasses a variety of theorised mechanisms explaining individual change in small groups.

CONCLUSION

The final conceptual model, together with the design issues and practical recommendations derived from it, provides a practical basis for linking research and theory explaining group functioning to optimal design of group-based, behaviour-change interventions.

A pilot controlled trial of a cognitive dissonance-based body dissatisfaction intervention with young British men

This pilot study evaluated a body image intervention for men, Body Project M. Seventy-four British undergraduate men took part in two 90-min intervention sessions, and completed standardised assessments of body image, bulimic pathology, and related outcomes at baseline, post-intervention, and 3-month follow-up. Fifty-three other men completed the questionnaires as an assessment-only control group. Per-protocol analysis showed that Body Project M improved men's dissatisfaction with body fat and muscularity, body appreciation, muscularity enhancing behaviours, appearance comparisons, and internalization (ds=0.46-0.80) at post-intervention. All except dissatisfaction with muscularity and internalization were sustained at 3-month follow-up. No effects were found for bulimic pathology. Post-intervention effects for dissatisfaction with muscularity and internalization only were retained under intention-to-treat analysis. Participants were favourable towards the intervention. This study provides preliminary evidence for the acceptability and post-intervention efficacy of Body Project M. Further development of the intervention is required to improve and sustain effects.

A Social Identity Approach to Understanding and Promoting Physical Activity

Against the backdrop of a global physical inactivity crisis, attempts to both understand and positively influence physical activity behaviours are characterized by a focus on individual-level factors (e.g. cognitions, attitudes, motivation). We outline a new perspective, drawn from an emerging body of work exploring the applicability of social identity and self-categorization theories to domains of sport and health, from which to understand and address this pervasive problem. This social identity approach suggests that the groups to which people belong can be, and often are, incorporated into their sense of self and, through this, are powerful determinants of physical activity-related behaviour. We start by reviewing the current state of physical activity research and highlighting the potential for the social identity approach to help understand how social factors influence these behaviours. Next, we outline the theoretical underpinnings of the social identity approach and provide three key examples that speak to the analytical and practical value of the social identity approach in physical activity settings. Specifically, we argue that social identity (1) can be harnessed to promote engagement in physical activity, (2) underpins exercise group behaviour, and (3) underpins effective leadership in exercise settings. We conclude by identifying prospects for a range of theory-informed research developments.

Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: Acute effectiveness of these delivery modalities

OBJECTIVE

Because independent trials have provided evidence for the efficacy and effectiveness of the dissonance-based Body Project eating disorder prevention program, the present trial tested whether clinicians produce the largest intervention effects, or whether delivery can be task-shifted to less expensive undergraduate peer educators or to Internet delivery without effect size attenuation, focusing on acute effects.

METHOD

In this study, 680 young women (Mage = 22.2 years, SD = 7.1) recruited at colleges in 2 states were randomized to clinician-led Body Project groups, peer-led Body Project groups, the Internet-based eBody Project, or an educational video control condition.

RESULTS

Participants in all 3 variants of the Body Project intervention showed significantly greater reductions in eating disorder risk factors and symptoms than did educational video controls. Participants in clinician-led and peer-led Body Project groups showed significantly greater reductions in risk factors than did eBody Project participants, but effects for the 2 types of groups were similar. Eating disorder onset over 7-month follow-up was significantly lower for peer-led Body Project group participants versus eBody Project participants (2.2% vs. 8.4%) but did not differ significantly between other conditions.

CONCLUSIONS

The evidence that all 3 dissonance-based prevention programs outperformed an educational video condition, that both group-based interventions outperformed the Internet-based intervention in risk factor reductions, and that the peer-led groups showed lower eating disorder onset over follow-up than did the Internet-based intervention is novel. These acute-effects data suggest that both group-based interventions produce superior eating disorder prevention effects than does the Internet-based intervention and that delivery can be task-shifted to peer leaders. (PsycINFO Database Record

From Efficacy to Global Impact: Lessons Learned About What Not to Do in Translating Our Research to Reach

Although members of the Association for Behavioral and Cognitive Therapies have made significant strides toward the collective goals outlined in our mission statement, we routinely acknowledge that our ability to develop empirically supported treatments exceeds our success in improving dissemination and implementation of said interventions. Further, as noted by Kazdin and Blase (2011), even if we succeeded in having every clinician worldwide administer our best treatments with excellent competency, we still would be unsuccessful in markedly impacting the worldwide burden of mental illness because most treatments require intensive labor by expensive providers. To this end, Kazdin and Blase and others call for increased use of alternative strategies. Examples include increased attention toward prevention; use of lower-cost, simplified interventions; task shifting; train-the-trainer models; community participatory research methodology; and identification of novel funding sources. The Body Project is an empirically supported, cognitive dissonance-based prevention intervention that targets body image, a well-established risk factor for eating disorders, negative affect, unhealthy weight control behaviors, smoking behavior, and decreased physical activity. Supported by a global village of researchers, community activists, and organizational partners, the Body Project is currently being implemented in 125 countries. The aim of this paper is to share lessons our team has learned in taking a prevention intervention from early testing to widespread implementation and connect these back to broader conversations occurring in our field regarding the importance of scalability and new directions in improving global mental health.

The importance of social identities in the management of and recovery from 'Diabulimia': A qualitative exploration

INTRODUCTION

A significant barrier to recovery for individuals with co-morbid eating disorders and type 1 diabetes is the way in which group members self-categorise. Nonetheless, identity issues are neglected during the recovery process. The aim of this paper is to explore how group memberships (and the associated identities) both contribute to and hinder recovery in this cohort.

METHOD

Transcripts from five online focus groups with 13 members of an online support group for individuals with 'Diabulimia' were thematically analysed.

RESULTS

Findings suggested that those with whom one shares a recovery identity can be well placed to provide psychological resources necessary for successful recovery although such connections can be damaging if group norms are not managed. Members recognised that other important relationships (including family and friends and health professionals) are also key to recovery; these other group memberships (and the associated identities) can be facilitated through the recovery identity group membership, which allows for external validation of the recovery identity, provides encouragement to disclose the illness to supportive others, and provides information to facilitate positive service interactions.

CONCLUSIONS

While clinical interventions typically focus on eliminating disordered behaviours, we suggest that these should also include strengthening important group memberships that promote recovery.

Somewhere I belong: Long-term increases in adolescents' resilience are predicted by perceived belonging to the in-group

This study sought to examine the role of belonging in the increases in resilience observed following an adventure education programme (AEP). First, we demonstrate that group belonging makes a significant contribution to the improvement in resilience participants' experienced over the course of the AEP. Second, we demonstrate that this increase in resilience is maintained 9 months following the AEP and that group belonging maintained a significant contribution when controlling for participants' initial resilience level and other psychosocial variables (i.e., centrality of identity and social support). Our findings accord well with recent research on the Social Cure or Social Identity Approach to Health and add to a growing body of work identifying the mechanisms underlying this phenomenon.

The desire to belong: Social identification as a predictor of treatment outcome in social anxiety disorder

OBJECTIVE

Perception of personal identity cannot be separated from the perception of the social context and one's social identity. Full involvement in group psychotherapy may require not only the awareness of personal impairment, but also social identification. The aim of the current study was to examine the association between social identification and symptom improvement in group-based psychotherapy.

METHOD

169 participants received 12 sessions of group-based cognitive behavioral therapy for social anxiety disorder. Social identification, the extent to which a person identifies with those who suffer from the same psychological problem as themselves and/or with those lacking psychopathology (non-sufferers), and clinical outcome were assessed at baseline, mid-and posttreatment, and 1, 3, and 6-months follow-up.

RESULTS

At baseline, patients aspired for closeness with non-sufferers, and viewed themselves as distant from fellow sufferers and non-sufferers. After treatment, participants viewed not only themselves, but also other individuals with social anxiety, as closer to both non-sufferers and fellow sufferers. These ratings were related to clinical outcomes.

CONCLUSIONS

The increase in closeness to both sufferers and non-sufferers across treatment may reflect a movement towards a more tolerant, less dichotomous and rigid, separation of ill and healthy that occurs with successful social anxiety treatment.

The body project 4 all: A pilot randomized controlled trial of a mixed-gender dissonance-based body image program

OBJECTIVE

The Body Project is a cognitive dissonance-based body image improvement program with ample research support among female samples. More recently, researchers have highlighted the extent of male body dissatisfaction and disordered eating behaviors; however, boys/men have not been included in the majority of body image improvement programs. This study aims to explore the efficacy of a mixed-gender Body Project compared with the historically female-only body image intervention program.

METHOD

Participants included male and female college students (N = 185) across two sites. We randomly assigned women to a mixed-gender modification of the two-session, peer-led Body Project (MG), the two-session, peer-led, female-only (FO) Body Project, or a waitlist control (WL), and men to either MG or WL. Participants completed self-report measures assessing negative affect, appearance-ideal internalization, body satisfaction, and eating disorder pathology at baseline, post-test, and at 2- and 6-month follow-up.

RESULTS

Linear mixed effects modeling to estimate the change from baseline over time for each dependent variable across conditions were used. For women, results were mixed regarding post-intervention improvement compared with WL, and were largely non-significant compared with WL at 6-month follow-up. Alternatively, results indicated that men in MG consistently improved compared with WL through 6-month follow-up on all measures except negative affect and appearance-ideal internalization.

DISCUSSION

Results differed markedly between female and male samples, and were more promising for men than for women. Various explanations are provided, and further research is warranted prior to drawing firm conclusions regarding mixed-gender programming of the Body Project. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:591-602).

Groups 4 Health: Evidence that a social-identity intervention that builds and strengthens social group membership improves mental health

BACKGROUND

Social isolation and disconnection have profound negative effects on mental health, but there are few, if any, theoretically-derived interventions that directly target this problem. We evaluate a new intervention, Groups 4 Health (G4H), a manualized 5-module psychological intervention that targets the development and maintenance of social group relationships to treat psychological distress arising from social isolation.

METHODS

G4H was tested using a non-randomized control design. The program was delivered to young adults presenting with social isolation and affective disturbance. Primary outcome measures assessed mental health (depression, general anxiety, social anxiety, and stress), well-being (life satisfaction, self-esteem) and social connectedness (loneliness, social functioning). Our secondary goal was to assess whether mechanisms of social identification were responsible for changes in outcomes.

RESULTS

G4H was found to significantly improve mental health, well-being, and social connectedness on all measures, both on program completion and 6-month follow-up. In line with social identity theorizing, analysis also showed that improvements in depression, anxiety, stress, loneliness, and life satisfaction were underpinned by participants' increased identification both with their G4H group and with multiple groups.

LIMITATIONS

This study provides preliminary evidence of the potential value of G4H and its underlying mechanisms, but further examination is required in other populations to address issues of generalizability, and in randomized controlled trials to address its wider efficacy.

CONCLUSIONS

Results of this pilot study confirm that G4H has the potential to reduce the negative health-related consequences of social disconnection. Future research will determine its utility in wider community contexts.

Creating psychological connections between intervention recipients: development and focus group evaluation of a group singing session for people with aphasia

OBJECTIVES

The study sought to identify key design features that could be used to create a new framework for group-based health interventions. We designed and tested the first session of a group intervention for stroke survivors with aphasia which was aimed at nurturing new psychological connections between group members.

SETTING

The intervention session, a participant focus group and interviews with intervention facilitators were held in a local community music centre in the South West of England.

PARTICIPANTS

A convenience sample of 10 community-dwelling people with poststroke aphasia participated in the session. Severity of aphasia was not considered for inclusion.

INTERVENTION

Participants took part in a 90-min group singing session which involved singing songs from a specially prepared song book. Musical accompaniment was provided by the facilitators.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants and group facilitators reported their experiences of participating in the session, with a focus on activities within the session related to the intervention aims. Researcher observations of the session were also made.

RESULTS

Two themes emerged from the analysis, concerning experiences of the session ('developing a sense of group belonging') and perceptions of its design and delivery ('creating the conditions for engagement'). Participants described an emerging sense of shared social identity as a member of the intervention group and identified fixed (eg, group size, session breaks) and flexible (eg, facilitator responsiveness) features of the session which contributed to this emergence. Facilitator interviews and researcher observations corroborated and expanded participant reports.

CONCLUSIONS

Engagement with health intervention content may be enhanced in group settings when intervention participants begin to establish positive and meaningful psychological connections with other group members. Understanding and actively nurturing these connections should be a core feature of a general framework for the design and delivery of group interventions.

An experimental investigation of the consequences and social functions of fat talk in friendship groups

OBJECTIVE

Fat talk is a form of self-degrading, thin-ideal endorsing communication that occurs within female friendship groups. Previous studies have suggested negative associations with wellbeing, but have been predominantly correlational and based on self-report. This study aimed to assess the causal relationship between fat talk and the correlates of disordered eating (thin-ideal internalization, body dissatisfaction, negative affect, and dieting intentions) by experimentally manipulating fat talk in existing friendship groups and measuring naturalistic expression of fat talk and its effects.

METHODS

Participants were 85 women aged 17-25 who completed the experiment in friendship pairs. They were randomly assigned to a condition in which their friend expressed fat talk, positive body talk, or neutral talk.

RESULTS

This study found evidence of a causal link between listening to friends fat talk and increased correlates of disordered eating. The negative effects of listening to fat talk were fully mediated by fat talk expression. This study also revealed a social function of fat talk, whereby participants rated their friends more positively when they were perceived to behave consistently with group norms, either pro- or anti-fat talk. Positive body talk showed none of the negative effects of fat talk, and was considered socially acceptable regardless of existing friendship group norms.

DISCUSSION

These findings indicate that fat talk is a mechanism through which the thin ideal is transmitted between individuals. Interventions at the level of the friendship group to challenge norms and communication styles may break the link between societal risk factors and individual risk of eating disorders.

"Depression is who I am": Mental illness identity, stigma and wellbeing

BACKGROUND

Previous research has found that in the face of discrimination, people tend to identify more strongly with stigmatized groups. Social identification can, in turn, buffer wellbeing against the negative consequences of discrimination. However, this rejection identification model has never been tested in the context of mental illness identity.

METHODS

A survey was conducted with 250 people with diagnosed depression or current symptoms of at least moderate clinical severity.

RESULTS

Experiencing mental illness stigma was associated with poorer wellbeing. Furthermore, people who had experienced such stigma were more likely to identify as a depressed person. Social identification as depressed magnified, rather than buffered, the relationship between stigma and reduced wellbeing. This relationship was moderated by perceived social norms of the depressed group for engaging in depressive thoughts and behaviors.

CONCLUSIONS

These findings suggest that mental illness stigma is a double-edged sword: as well as the direct harms for wellbeing, by increasing identification with other mental illness sufferers, stigma might expose sufferers to harmful social influence processes.

Social Identities as Pathways into and out of Addiction

There exists a predominant identity loss and "redemption" narrative in the addiction literature describing how individuals move from a "substance user" identity to a "recovery" identity. However, other identity related pathways influencing onset, treatment seeking and recovery may exist, and the process through which social identities unrelated to substance use change over time is not well understood. This study was designed to provide a richer understanding of such social identities processes. Semi-structured interviews were conducted with 21 adults residing in a drug and alcohol therapeutic community (TC) and thematic analysis revealed two distinct identity-related pathways leading into and out of addiction. Some individuals experienced a loss of valued identities during addiction onset that were later renewed during recovery (consistent with the existing redemption narrative). However, a distinct identity gain pathway emerged for socially isolated individuals, who described the onset of their addiction in terms of a new valued social identity. Almost all participants described their TC experience in terms of belonging to a recovery community. Participants on the identity loss pathway aimed to renew their pre-addiction identities after treatment while those on the identity gain pathway aimed to build aspirational new identities involving study, work, or family roles. These findings help to explain how social factors are implicated in the course of addiction, and may act as either motivations for or barriers to recovery. The qualitative analysis yielded a testable model for future research in other samples and settings.