Enhancing self-esteem in adults with body dysmorphic symptoms: experimental testing and initial evaluation of a brief internet-based training

BACKGROUND

Low self-esteem is an important factor associated with body dysmorphic concerns. In treatment, self-esteem cannot always be adequately addressed. Internet-based interventions offer a low-threshold and cost-efficient possibility for treating body dysmorphic disorder (BDD).

AIMS

For this reason, we conducted two studies to explore the effectiveness of an internet-based intervention targeting improving self-esteem in adults with BDD symptoms.

METHOD

The first study investigated the differential effects of a 1-week self-esteem training compared with a 1-week attention-focus training. Two hundred twenty adults with elevated body dysmorphic symptoms were randomly assigned to one of the two trainings. Our second study (n = 58 adults with body dysmorphic symptoms) evaluated an extended 2-week stand-alone self-esteem training.

RESULTS

In the first study, self-esteem in different domains (appearance, performance and social), self-focused attention, and BDD symptom severity improved in both groups. Other-focused attention only increased in the attention training group. Participants' overall adherence was high. In the second study we observed significant improvements in self-esteem, BDD symptom severity, and other secondary outcomes, with additional improvements in most outcomes in the second week. Adherence was again high.

CONCLUSIONS

Together, these findings show that a brief internet-based intervention may be a highly accepted and effective way of improving self-esteem in people suffering from BDD symptoms.

Examining Teacher Concerns and Anxiety on the Implementation of a Universal Body Image Program

In the past 30 years, there have been numerous positive body image and eating disorder prevention programs targeting youth developed for school-based settings. Frequently, teachers are used as interventionists to increase dissemination, decrease costs relative to researchers, and increase scalability. However, little is known about teacher concerns and barriers that may hinder successful uptake and implementation. The current study recruited a total of 269 teachers who consented to implement a universal body image and appearance-related bullying and teasing prevention program in their classrooms as part of a randomized controlled trial. Teachers expressed some worry that they may say the wrong thing, and concern about feeling uncomfortable teaching the program due to their own body dissatisfaction. Teacher's ethnicity, gender, years teaching, dieting behaviors and other weight control behaviors, and self-efficacy were not associated with concerns related to teaching the curriculum. Teachers with lower body esteem reported higher concerns and anxiety related to teaching a body image curriculum. In free response items, teachers worried about handling student comments that were beyond the scope of the curriculum. Teacher self-efficacy was the only variable associated with the number of program sessions implemented. Findings suggest avenues to increase implementation.

Disordered eating, body image concerns, and weight control behaviors in primary school aged children: A systematic review and meta-analysis of universal-selective prevention interventions

OBJECTIVE

Body image concerns and extreme weight control behaviors frequently develop in childhood indicating an important age group for the implementation of universal-selective prevention approaches. This systematic review aimed to evaluate the effect of universal-selective prevention interventions addressing disordered eating, body image concerns, and/or extreme weight control behaviors in children aged 6-12 years.

METHOD

Nine databases were searched up to April 2021. Studies were included if they delivered a universal-selective prevention intervention to children aged 6-12 years and reported outcomes relating to body image, disordered eating, or weight control behaviors. The review was conducted in line with the PRISMA Guidelines.

RESULTS

A total of 42 articles describing 39 studies included in the review, with most (n = 24; 57%) classified as neutral quality. Thirty studies implemented an eating disorder specific universal-selective program and nine implemented lifestyle interventions plus content to address disordered eating risk factors. Meta-analysis (n = 16 studies) revealed an improvement in body image-related outcomes across all studies (standardized mean difference [SMD] 0.26 [95%CI 0.01, 0.51]); with a high level of heterogeneity (Î2 = 89.9%; p < .01). Meta-analysis according to gender revealed a general improvement in body image-related outcomes for girls (SMD 0.40 [95%CI 0.07, 0.73]), but not boys (SMD 0.23 [95%CI -0.24, 0.70]).

DISCUSSION

By investigating child, parental and teaching interventions and including outcomes such as weight control and disordered eating behaviors, a trend toward a reduction in eating disorder risk factors was observed, particularly body image-related outomes in girls. Future directions include embedded disordered eating prevention materials within existing lifestyle interventions and inclusion of more diverse samples.

Linking body esteem to eating disorders among adolescents: A moderated mediation model

This study explored the roles of social appearance anxiety and emotional intelligence in the relationship between body esteem and eating-disorder risk among adolescents. A total of 2509 high-school students were sampled to participate in the study. Statistical methods mainly involved descriptive statistics, Bootstrapping, and structural equation modeling analyses. The results showed that social appearance anxiety partially mediated the relationship between body esteem and eating-disorder risk among adolescents; meanwhile, emotional intelligence moderated the effects of body esteem on social appearance anxiety and eating-disorder risk among adolescents.

Comparing the efficacy of a brief self-esteem and self-compassion intervention for state body dissatisfaction and self-improvement motivation

This study explored the efficacy of reflective writing tasks for reducing state body dissatisfaction and improving self-improvement motivation. Participants (N = 153) were exposed to a threatening body image scenario, after which they reported their state body dissatisfaction. Following randomisation to one of three interventions (self-esteem, self-compassion, or positive distraction control), participants completed the state body dissatisfaction measures again along with a measure of self-improvement motivation. At post-intervention, state weight dissatisfaction and appearance dissatisfaction were significantly lower and self-improvement motivation was significantly higher in the self-compassion group than in both the self-esteem and control groups. Trait body dissatisfaction moderated the efficacy of the intervention whereby the benefit of the self-compassion intervention became evident at moderate levels of trait body dissatisfaction, and was most apparent at high levels of body dissatisfaction. Self-compassion was a robust and efficacious method through which to promote immediate improvements to bodily feelings and desire to self-improve.

Achieving body confidence for young children: Development and pilot study of a universal teacher-led body image and weight stigma program for early primary school children

Negative body image attitudes develop in early childhood and there is a need for school-based resources during the early school years, but no teacher-delivered curriculum-based resources exist to mitigate these attitudes in young children. Achieving Body Confidence for Young Children (ABC-4-YC), a universal body dissatisfaction and weight stigma prevention program, was developed and then delivered in a pilot study. Fifty-one 5- to 8-year-old children completed pre- and post-intervention interviews assessing body image attitudes, and seven teachers provided feedback. Significant improvement in body esteem and positive teacher feedback were found. The results provide preliminary support for ABC-4-YC to improve children's body image attitudes, but extensive evaluation is needed.

Individual-level factors related to better mental health outcomes following child maltreatment among adolescents

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative adult samples. To address these limitations, the current study investigated the relationship between individual-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample. The objectives of the present study were to: 1) compute the prevalence of mental health indicators by child maltreatment types, 2) estimate the prevalence of overall good, moderate, and poor mental health by child maltreatment types; and 3) examine the relationship between individual-level factors and overall mental health status of adolescents with and without a history of maltreatment. Data were from the National Comorbidity Survey of Adolescents (NCS-A; n = 10,123; data collection 2001-2004); a large, cross-sectional, nationally representative sample of adolescents aged 13-17 years from the United States. All types of child maltreatment were significantly associated with increased odds of having poor mental health (adjusted odds ratios ranged from 3.2 to 9.5). The individual-level factors significantly associated with increased odds of good mental health status included: being physically active in the winter; utilizing positive coping strategies; having positive self-esteem; and internal locus of control (adjusted odds ratios ranged from 1.7 to 38.2). Interventions targeted to adolescents with a history of child maltreatment may want to test for the efficacy of the factors identified above.

The effectiveness of self-compassion and self-esteem writing tasks in reducing body image concerns

This study investigated whether single-session self-compassion and self-esteem writing tasks ameliorate the body image concerns evoked by a negative body image induction. Ninety-six female university students aged 17-25 years (M_age=19.45, SD=1.84) were randomly assigned to one of three writing treatment groups: self-compassion, self-esteem, or control. After reading a negative body image scenario, participants completed scales measuring state body appreciation, body satisfaction, and appearance anxiety. They then undertook the assigned writing task, and completed the three measures again, both immediately post-treatment and at 2-week follow-up. The self-compassion writing group showed higher post-treatment body appreciation than the self-esteem and control groups, and higher body appreciation than the control group at follow-up. At post-treatment and follow-up, self-compassion and self-esteem writing showed higher body satisfaction than the control. The groups did not differ on appearance anxiety. Writing-based interventions, especially those that enhance self-compassion, may help alleviate certain body image concerns.

The Development of Body Image and Weight Bias in Childhood

Negative body image attitudes are related to the onset of disordered eating, poor self-esteem, general mental health problems, and obesity. In this chapter, we will review the nature of body image attitudes in girls and boys in early (approximately 3-7 years old) and later childhood (approximately 8-11 years old). The body image attitudes explored in this chapter include body image attitudes related to the self, with a focus on body dissatisfaction, and body image attitudes related to others, with a focus on weight bias. Issues of measurement of body image and weight bias will first be explored. In light of measurement considerations, the prevalence and predictors of body dissatisfaction and related concerns, and weight bias will be examined. The chapter will conclude with a review of promising directions in the prevention of body dissatisfaction and weight bias in children.

Thinking big: the effect of sexually objectifying music videos on bodily self-perception in young women

The present study investigated the effect of sexually objectifying music video exposure on young women's implicit bodily self-perception and the moderating role of self-esteem. Fifty-six college women of normal weight were either exposed to three sexually objectifying music videos or three neutral music videos. Perceived and ideal body size were measured both before and after video exposure, using horizontally stretched and compressed photographs of the participant's own body in swimming garment. As expected, only women low (but not high) in self-esteem were negatively affected by the sexually objectifying content of the music videos: they perceived themselves as bigger and showed an increased discrepancy between their perceived and ideal body size after video exposure. The neutral music videos did not influence women's bodily self-perceptions. These findings suggest that body image is a flexible construct, and that high self-esteem can protect women against the adverse effects of sexually objectifying media.