Mindfulness-based eating disorder prevention programs: A systematic review and meta-analysis

The mediator role of mindfulness in the relationship between the listening skills and anger management skills of emergency health care professionals

BACKGROUND

Effective communication plays a crucial role in establishing strong relationships and providing essential support in clinical situations. This study was conducted to investigate the mediator role of mindfulness in the relationship between the listening skills and anger management skills of healthcare professionals working in the emergency department (ED).

METHOD

This was a cross-sectional study, which was conducted with 230 emergency department healthcare professionals (EHCPs) working in adult EDs in Turkey. Sociodemographic Characteristics Data Collection Form, Mindful Attention Awareness Scale (MAAS), Listening Skills Assessment Scale (LSAS), and Anger Management Scale (AMS) were used for data collection. Descriptive statistics included frequency and percentage; t test and ANOVA test were used for statistical analyses, as was "Process Macro 3.5 Model 4", which was used to study the effect of mediator variables.

RESULTS

The participants had a mean MAAS score of 57.71 ± 12.38, a mean LSAS score of 45.36 ± 6.23, and a mean AMS score of 17.93 ± 3.39. There were significant positive correlations between LSAS and MAAS (r = 0.197, p < 0.001), between AMS and MAAS (r = 0.233p < 0.001), and between AMS and LSAS r = 0.24p < 0.001). In addition, the process model analysis results supported that MAAS had a partial mediator role in the correlation between LSAS and AMS, and that its indirect effects were predicted by LSAS and AMS. It was determined that 5.75 % of total change on AMS was predicted by LSAS (F = 13.918; p < 0.001).

CONCLUSION

The results of this study indicate that as the mindfulness level of EHCPs increases, their listening and anger management skills increased. Therefore, reinforcing mindfulness by integrating mindfulness interventions into in-service training and applying strategies that promote EHCPs' listening skills and anger management skills would make it possible to provide quality health care with employees who are more efficient in conflict management and enjoy a higher level of satisfaction.

Mindfulness Meditation Training Reduces Gaming Cravings by Reshaping the Functional Connectivity Between the Default Mode Network and Executive Control-Related Brain Regions

BACKGROUND

Internet gaming disorder (IGD) can lead to psychological problems and cause behavioral problems in individuals. Traditional interventions have been ineffective in treating IGD. Meanwhile, mindfulness meditation (MM) is an emerging method that has proven to be effective for treating psychiatric disorders. In this study, MM was used to intervene in IGD and to explore its neural mechanism.

METHODS

Eighty participants were recruited through advertisements. Eventually, 61 completed the 1-month training (MM group, n = 31; progressive muscle relaxation [PMR] group, n = 30), including a pretest, 8 training sessions, and a posttest. Regional homogeneity and degree centrality were calculated, and the tests (pre- and post-) and group (MM and PMR) analysis of variance was performed. The overlapping results were obtained as region of interest for functional connectivity (FC) analyses. Behavioral data and neurotransmitter availability maps were correlated with FC.

RESULTS

Compared with PMR, MM decreased the severity of addiction and game craving in IGD. Brain imaging results showed that the FC between and within the executive control and default mode networks/reward-related regions were enhanced. Significant negative correlations were observed between FC and dopamine receptor D2, dopamine transporter, and vesicular acetylcholine transporter. Significant positive correlations were observed between FCs and serotonin and aminobutyric acid receptors.

CONCLUSIONS

This study confirmed the effectiveness of MM in treating IGD. MM altered the default mode and enhanced top-down control over game cravings. These findings were revealed by the correlations between brain regions and behavioral and biochemical effects. The results show the neural mechanism of MM in reducing IGD and lay the foundation for future research.

A controlled trial assessing the acceptability and efficacy of a yoga-based eating disorder prevention program among division I athletes: Eat Breathe Thrive (EBT)

OBJECTIVE

This study evaluated the acceptability and effectiveness of the Eat Breathe Thrive (EBT) program as an eating disorder prevention intervention among women collegiate athletes.

METHOD

Change over time in eating disorder risk and competencies of positive embodiment were examined in 94 women (n = 48 EBT participants and n = 46 matched-controls) from one National Collegiate Athletic Association (NCAA) Division I-classified university in the United States. Eating disorder risk factors were measured using the Eating Disorder Examination Questionnaire (EDE-Q) and State Trait Anxiety Inventory (STAI). Aspects of positive embodiment were measured using the Multidimensional Assessment of Interoceptive Awareness (MAIA) and The Mindful Self-Care Scale (MSCS). Data were collected through participants' completion of online surveys across three time-points.

RESULTS

Repeated measures ANOVAS revealed EBT participants reported experiencing significantly less state anxiety and greater interoceptive body trusting over time relative to matched-controls. No other significant interactions were found. Respondents found the EBT program acceptable.

DISCUSSION

Acceptability and partial support for integrative, yoga-based, interventions targeting Division I student-athletes is indicated.

Mindfulness-based interventions for body image dissatisfaction among clinical population: A systematic review and meta-analysis

PURPOSE

Mindfulness-based interventions (MBIs) are well-validated interventions to enhance the favourable body image of individuals. Despite their wide application, the efficacy of MBIs in reducing body image dissatisfaction (BID) among various clinical populations remains unclear. This study aims to expand the literature on MBIs for BID and identify effective types of MBIs for reducing BID in diverse clinical populations for future research and practice.

METHODS

A systematic search for studies published in English on the effectiveness of MBIs for BID among the clinical population was done on APA PsycNet, PubMed, Science Direct, Web of Science and Google Scholar databases in August 2023. Of the 1962 articles initially identified, 17 were found eligible and evaluated based on the JBI checklist.

RESULTS

Random effects meta-analyses on six MBIs revealed their effectiveness in reducing BID among the clinical population (SMD = -.59 and 95% CI = -1.03 to -.15, p = .009), with Acceptance and Commitment Therapy (ACT) (SMD = -1.29, 95% CI = -2.06 to -.52, p = .001) and My Changed Body (MyCB) (SMD = -.24, 95% CI = -.46 to -.01, p = .04) reporting significant effect sizes. Among the patients with breast cancer, MyCB (SMD = -.24, 95% CI = -.46 to -.01, p = .04) showed a significant effect size.

CONCLUSIONS

MBIs appear to be promising interventions in reducing BID among the clinical population. However, findings should be considered cautiously due to the possible publication bias, high heterogeneity and fewer available studies.

Student opinions of body appreciation week: Openness to alternatives to a weight-centric model of health

Objective: Body image issues are common among young adult women on college campuses and are correlated with several negative outcomes. Only recently have universities begun to deliver Health at Every Size (HAES) education to university students to promote holistic health. Method: A sample of students who attended events for Body Appreciation Week (BAW) 2022 (N = 42) completed a Qualtrics survey collected by a student health promotion department at a large, southeastern university. I used this data to assess student openness to HAES and other alternatives to weight-centric approaches to health. Results: Overall, students who responded to the survey were pleased with programming that challenged diet culture and introduced the HAES model of health. Conclusion: Student feedback, along with previous research on college student programming interventions, suggests organizing similar events for future BAW and more frequent programming during the academic year to properly assess of the impact of these events on student health.

Task shifting eating disorders prevention: A pilot study of selective interventions adapted for teacher-led universal delivery in secondary schools

OBJECTIVE

Increasing effectiveness and sustainability of universal school-based eating disorder prevention is needed. This study adapted two existing selective prevention programmes for universal delivery, investigating feasibility, acceptability, and preliminary effects when delivered by trained teachers to classes of mixed-gender adolescents.

METHOD

A three-arm controlled pilot study with Year 9 students (N = 288; Mage  = 13.61 SDage  = .50). Three schools in south Wales and south-west England were allocated to mindfulness-based intervention (MBI), dissonance-based intervention (DBI), or classes-as-usual (CAU) control. Self-reported eating disorder risk factors were collected at baseline, 6-week post-intervention, and 2-month follow-up. Focus groups were conducted post-intervention.

RESULTS

Delivery and evaluation were feasible, allowing for flexibility in scheduling, with good retention. Student and teacher ratings indicated moderate acceptability of both interventions, with recommendations for refinement. Mixed model analyses, controlling for baseline, showed significant effects of condition across post-intervention and follow-up for body esteem (DBI > CAU; Cohen's d = .34) and positive affect (MBI > CAU, d = .58). For girls only, both MBI and DBI improved body satisfaction and internalization, and the MBI additionally resulted in improved weight and shape concerns, negative affect, and life disengagement (d's = .39-1.12), across post-intervention and follow-up.

DISCUSSION

Selective eating disorder prevention programmes based on cognitive dissonance and mindfulness can be delivered universally in schools, by teachers, allowing for appropriate flexibility necessary for real world implementation. Moderate acceptability indicates areas for improving content and delivery; positive effects on key outcomes are encouraging. These findings provide support for further robust evaluation.

PUBLIC SIGNIFICANCE

Existing universal eating disorder prevention is limited by small effects and reliance on highly trained facilitators. This study is the first to adapt mindfulness- and dissonance-based interventions for delivery by teachers, to adolescents of all genders in a classroom setting. Delivery was largely feasible and acceptable, and both interventions showed significant effects across key risk factors for eating disorders, with larger effect sizes than found previously. This underpins further robust evaluation.

Why Do Women with Disordered Eating Engage in Sex? The Mediating Role of Sexual Motivations in the Association Between Disordered Eating Behaviors and Attitudes and Sexual Dysfunction

Although there is growing evidence of an association between disordered eating and sexual dysfunction, the mechanism underlying this association is still unclear. In the current study, we sought to examine the mediating role of sexual motivation between disordered eating and sexual dysfunction. We used a multi-path mediation model to examine the mediating role of sexual motivation between disordered eating and sexual functioning among a sample of 341 non-clinical women in a steady relationship. Analysis revealed two significant mediation paths associating disordered eating with sexual functioning: (1) a high level of disordered eating was significantly linked with higher motivation for partner approval via sex and sexuality which, in turn, was associated with lower sexual functioning and (2) a high level of disordered eating was significantly linked with lower enhancement sexual motivation which, in turn, was associated with lower sexual functioning. This study extends the existing knowledge by offering an explanation for the relation between disordered eating and sexual dysfunction via sexual motives. Findings from the current study suggest women with disordered eating utilized sex for self-affirmation, for coping with negative emotions, for partner approval, and to increase intimacy. Also, these women were not likely to engage in sex for enhancement reasons.

Complementary and Integrative Medicine and Eating Disorders in Youth: Traditional Yoga, Virtual Reality, Light Therapy, Neurofeedback, Acupuncture, Energy Psychology Techniques, Art Therapies, and Spirituality

Eating disorders (EDs) are a non-heterogeneous group of illnesses with significant physical and mental comorbidity and mortality associated with maladaptive coping. With the exception of lisdexamfetamine (Vyvanse) for binge eating disorder, no medications have been effective for the core symptoms of ED. ED requires a multimodal approach. Complementary and integrative medicine (CIM) can be helpful as an adjunct. The most promising CIM interventions are traditional yoga, virtual reality, eye movement desensitization and reprocessing, Music Therapy, and biofeedback/neurofeedback.

Prevention and early intervention in eating disorders: findings from a rapid review

BACKGROUND

Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs.

METHODS

This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review.

RESULTS

In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist.

CONCLUSIONS

Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary.

The role of emotion regulation in the relationship between mindfulness and risk factors for disordered eating: A longitudinal mediation analysis

OBJECTIVE

Evidence suggests mindfulness may reduce risk factors for disordered eating. However, mechanisms of change in this relationship are unclear. This longitudinal study tested whether emotion regulation mediates the prospective associations between mindfulness and two proximal risk factors for disordered eating: weight and shape concerns, and negative affect.

METHOD

This study is a secondary analysis of data collected within an eating disorder prevention trial. Adolescent girls (N = 374, M_age  = 15.70, SD = 0.77) completed self-report measures of mindfulness, emotion regulation, weight and shape concerns, and negative affect at baseline, 2 months following baseline, and 7 months following baseline. Path analyses were computed to test hypothesized indirect effects using confidence intervals based on 5000 bootstrap samples.

RESULTS

Higher baseline mindfulness predicted lower weight and shape concerns and negative affect at 7 months via a mediator of better emotion regulation at 2 months. This effect remained while controlling for earlier measurements of the mediator and outcome in the model of negative affect but not weight and shape concerns.

DISCUSSION

Emotion regulation may be an important mechanism explaining how mindfulness influences negative affect. Efforts should be made to intervene on mindfulness and emotion regulation in prevention and early intervention programmes for eating disorders and other psychiatric conditions.

PUBLIC SIGNIFICANCE

Research has shown that mindfulness can help to reduce some of the risk of developing an eating disorder. This study explored whether mindfulness reduces some of this risk by helping people to better manage their emotions. Understanding this process can help us to develop better mindfulness-based strategies to support people who are at risk of developing an eating disorder.

Exploring the Potential Impact of a Virtual Body Scan Meditation Exercise Conducted With Pet Dogs on Recipients and Facilitators

Numerous recent studies have shown that COVID-19 and the accompanying mandated lifestyle changes have resulted in significant negative effects on people's mental health. To meet the increased need for mental health support, while also maintaining physical safety, a variety of telehealth services have been created or expanded. A body scan mindfulness program is an intervention that can easily be modified to be offered virtually. This study was designed to determine if a virtual body scan mindfulness exercise, with participants' holding their dog or a pillow/blanket, could reduce their stress and anxiety as well as that of the facilitators. Significant differences in pre/post-State Anxiety Assessment scores for participants and facilitators were found. These results are discussed within the framework of the human animal bond and the potential of this form of intervention as a useful virtual tool for participants and facilitators alike.

Mindfulness-based interventions: an overall review

INTRODUCTION

This is an overall review on mindfulness-based interventions (MBIs).

SOURCES OF DATA

We identified studies in PubMed, EMBASE, CINAHL, PsycINFO, AMED, Web of Science and Google Scholar using keywords including 'mindfulness', 'meditation', and 'review', 'meta-analysis' or their variations.

AREAS OF AGREEMENT

MBIs are effective for improving many biopsychosocial conditions, including depression, anxiety, stress, insomnia, addiction, psychosis, pain, hypertension, weight control, cancer-related symptoms and prosocial behaviours. It is found to be beneficial in the healthcare settings, in schools and workplace but further research is warranted to look into its efficacy on different problems. MBIs are relatively safe, but ethical aspects should be considered. Mechanisms are suggested in both empirical and neurophysiological findings. Cost-effectiveness is found in treating some health conditions.

AREAS OF CONTROVERSY

Inconclusive or only preliminary evidence on the effects of MBIs on PTSD, ADHD, ASD, eating disorders, loneliness and physical symptoms of cardiovascular diseases, diabetes, and respiratory conditions. Furthermore, some beneficial effects are not confirmed in subgroup populations. Cost-effectiveness is yet to confirm for many health conditions and populations.

GROWING POINTS

Many mindfulness systematic reviews and meta-analyses indicate low quality of included studies, hence high-quality studies with adequate sample size and longer follow-up period are needed.

AREAS TIMELY FOR DEVELOPING RESEARCH

More research is needed on online mindfulness trainings and interventions to improve biopsychosocial health during the COVID-19 pandemic; Deeper understanding of the mechanisms of MBIs integrating both empirical and neurophysiological findings; Long-term compliance and effects of MBIs; and development of mindfulness plus (mindfulness+) or personalized mindfulness programs to elevate the effectiveness for different purposes.

Examining the efficacy of video-based microinterventions for improving risk and protective factors for disordered eating among young adult women

OBJECTIVE

Brief self-guided activities designed for focused and immediate benefits, termed microinterventions, have the potential to aid reach and engagement in mental health interventions; however further validation is needed. This study evaluated effects of two microinterventions for responding to appearance-ideal media on risk and protective factors for disordered eating.

METHOD

Undergraduate women (N = 202, M_age = 19.90, SD = 2.75) were allocated quasi-randomly to one of three 15-min video-based microinterventions (mindfulness, cognitive dissonance, educational control) in the lab and assessed on state outcomes at baseline and immediate posttest. One week later, trait factors were assessed and participants underwent an appearance-ideal media exposure task.

RESULTS

Both mindfulness and dissonance groups reported significant immediate benefits to state appearance-ideal internalization, perceived sociocultural pressures and related distress, and mood, compared to educational control (Glass's Δ effect sizes = .40-.94), but not state weight or appearance satisfaction. At 1-week follow-up, mindfulness and dissonance groups demonstrated improved trait appearance-ideal internalization (Δ = .40 and .42), weight and shape concerns (Δ = .27 [ns] and .44), and body appreciation (Δ = .39 and .46) compared to the educational control. There were no effects on trait perceived pressures, negative affect, or body image psychological flexibility, and no differential changes in state outcomes from premedia to postmedia exposure.

DISCUSSION

Microinterventions using mindfulness and dissonance techniques show promise for improving some risk and potential protective factors for disordered eating in the immediate and short-term. Further research is required to substantiate their place within the spectrum of eating disorder prevention, early intervention and treatment techniques.

Intuitive eating mediates the relationship between interoceptive accuracy and eating disorder risk

Research supports an association between altered interoceptive accuracy, or the ability to accurately monitor sensations from the body, and disordered eating. However, the behavioral mechanism through which interoceptive accuracy may influence eating behaviors is unclear. Intuitive eating, the ability to regulate food intake according to visceral cues of hunger and satiety, is positively related to interoceptive accuracy and negatively related to disordered eating. Therefore, we hypothesized that interoceptive accuracy would be negatively associated with intuitive eating which would, in turn, influence eating disorder risk. A mediation analysis was performed to test this hypothesis in a sample of 41 undergraduate women who completed a heartbeat counting task to assess interoceptive accuracy, followed by self-report measures of intuitive eating ability and eating disorder risk. We found that eating for physical rather than emotional reasons and reliance on hunger and satiety cues, two aspects of intuitive eating, mediated the relationship between interoceptive accuracy and eating disorder risk. Although further research is necessary, it is possible that findings regarding the association between interoceptive accuracy and intuitive eating may inform the development of eating disorder prevention efforts.

Dissemination of a dissonance-based body image promotion program in church settings: A preliminary controlled pilot study with adult women

Adult women report significant body dissatisfaction yet are often overlooked in body image promotion programs. Although few venues afford opportune settings for intervening with adult women, the church serves as a regular meeting place for many in the South of the United States. This study tested a dissonance-based body image program, Reclaiming Beauty (RB), adapted for adult women in church settings. Six groups (n = 30) were led by two trained church leaders (peer-led) and three groups (n = 21) were led by a trained peer leader and a researcher (researcher-co-led). RB participants, aged 30-77 years (M = 53.1 ± 12.7), completed assessments pre-intervention, immediately post-intervention, and 6 months post-intervention. Waitlist-controls (n = 31) completed assessments at time intervals consistent with intervention participants. RB participants reported significantly decreased thin-ideal internalization, body surveillance, and eating psychopathology at post-intervention and at 6 months post-intervention relative to controls. RB participants also reported significantly increased body satisfaction immediately post-intervention relative to controls, but this was not significant at 6 months post-intervention. Peer-led groups outperformed researcher-co-led groups on body surveillance at 6 months, but RB conditions did not otherwise differ. Our findings provide preliminary support for the dissemination of a culturally-modified dissonance-based body image program to adult women in church settings.

Mindfulness-based group therapy for in-patients with schizophrenia spectrum disorders - Feasibility, acceptability, and preliminary outcomes of a rater-blinded randomized controlled trial

BACKGROUND

A Growing body of literature indicates therapeutic effectiveness of mindfulness for mental disorders. Only few trials have been conducted with schizophrenia spectrum disorders (SSD), mostly in outpatient settings. Primary objective was to assess feasibility, acceptability, and preliminary outcomes of mindfulness-based group therapy (MBGT) for in-patients with SSD.

METHODS

A pre-registered randomized controlled trial was conducted to assess feasibility and acceptability of the MBGT. The primary outcome was mindfulness measured with the Southampton Mindfulness Questionnaire (SMQ). Secondary outcomes were rater-blinded positive- and negative symptoms, depression, social functioning, and self-reported mindfulness, depression, anxiety, psychological flexibility, quality of life, and medication regime at baseline, post-intervention, and follow-up (Clinical Trails NCT03671005).

RESULTS

40 participants received either treatment-as-usual (TAU; n=19) or (MBGT+TAU; n = 21) for four weeks. At post-intervention, protocol adherence was 95.2%, and retention rate was 95%. ANCOVA revealed significant improvements in the MBGT+TAU for the primary outcome SMQ as well as negative symptoms at post-intervention between groups. In exploratory analyses, secondary outcomes showed medium-to-large pre-to-post-intervention effects on mindfulness, positive-, negative-, and depressive symptoms, psychological flexibility, quality of life, and social functioning for MBGT+TAU and small-to-moderate changes on positive symptoms and social functioning for TAU. No serious adverse effects were reported.

CONCLUSIONS

MBGT appears feasible and acceptable for in-patient settings, with high protocol adherence and retention rates. Preliminary findings highlight a proof of concept of MBGT and various improvements in clinical- and process dimensions. A fully powered trial is warranted to determine efficacy, cost-efficiency, and longitudinal changes based on these promising outcomes.

Mindfulness-based interventions for adolescent health

PURPOSE OF REVIEW

Mindfulness, the practice of paying attention to the present moment, purposefully and nonjudgmentally, has been gaining popularity as adjunct treatment for adolescents with a range of physical and mental health problems. Research conducted in adults and emerging research conducted in adolescents has shown that mindfulness-based interventions can improve outcomes in several areas. The purpose of this review is to discuss recent research on the effects of mindfulness and suggest exercises that primary care clinicians can offer to their adolescent patients.

RECENT FINDINGS

Research has shown positive effects of mindfulness across several health conditions commonly encountered during adolescence. Mindfulness-based Interventions can reduce symptoms of anxiety and depression. The application of mindfulness can help with the prevention and treatment of binge eating, over-eating, and restrictive eating disorders. In the treatment of substance use disorders, mindfulness can improve emotion regulation and reduce symptoms of withdrawal and craving. Mindfulness can also lead to improvement in overall quality of life for patients suffering from chronic pain. Lastly, mindfulness can be useful for adolescents with ADHD, sleep problems, chronic illness, and stress related to performance sports.

SUMMARY

Although research in adolescents remains limited, mindfulness holds promise in the treatment of a range of health conditions in adolescents.

Prevention of eating disorders: 2018 in review

This article reviews the 10 prevention-related publications in Eating Disorders: The Journal of Treatment & Prevention during 2018. Two models frame this analysis. This first is the Mental Health Intervention Spectrum from health promotion → types of prevention → case identification and referral → treatment (recovery). The second parses the phases of prevention into rationale, theory, and methodology → clarification of risk factors, including very high risk, shading into warning signs → implications for specific preventive interventions → design innovation and feasibility (pilot) research → efficacy and effectiveness research → program dissemination. Collectively, the articles illustrate how complex and demanding the field of prevention is, with respect to, for example, phases of program development, the multidimensional ecology of interventions, and methodological requirements for demonstrating that a program deserves to be designated "evidence-based." A subset of the articles also illustrates how far the increasingly broad and dynamic field of prevention has advanced. Examples include models of eating disorder development in high-risk populations such as people with type 1 diabetes; prevention programming for young children; and after-school preventive interventions that combine dissonance-based lessons with empowering participation in community advocacy and activism.