1
|
Mahon C, Hamburger D, Yager Z, Almaraz M, Mooney J, Tran T, O'Dowd O, Bauert L, Smith KG, Gomez-Trejo V, Webb JB. Pilot feasibility and acceptability trial of BE REAL's BodyKind: A universal school-based body image intervention for adolescents. Body Image 2023; 47:101636. [PMID: 37812940 DOI: 10.1016/j.bodyim.2023.101636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
Body dissatisfaction is prevalent among adolescents and a primary risk factor for eating disorders, yet there are few body image interventions for older adolescents that support development of positive body image. Therefore, we assessed the feasibility, acceptability and preliminary effectiveness of BodyKind, a four-lesson, mixed gender, teacher-led, school-based curriculum for older adolescents, that combines principles of self-compassion, compassion for others, cognitive dissonance, and social activism to address contemporary adolescent body image concerns (i.e., appearance bias, comparisons on social media) and strengthen positive body image development. The sample contained 147 adolescents, predominantly racial/ethnic minorities (>95%), 54.8% male, 41.5% female and 4.1% gender-minority students aged 15-18 years (M=16.24, SD=.96) from a low-income, inner-city high school in the Midwestern US. Two teachers received training and delivered the curriculum to students. This single arm, mixed methods trial assessed student and teacher acceptability, teacher fidelity and student intervention outcomes. Despite reasonable teacher fidelity, recruitment/attendance rates, post-intervention data loss (35% attrition) limited evaluations of program effectiveness and study feasibility. Important learnings regarding study feasibility will inform optimisation for future school-based trials. Findings demonstrate high acceptability of BodyKind among teachers and adolescents in a lower socioeconomic school setting, and further randomized controlled effectiveness trials are required.
Collapse
Affiliation(s)
- Ciara Mahon
- School of Psychology, University College Dublin (UCD), Ireland.
| | | | | | - Mayra Almaraz
- Anti-Bias, Antiracist (ABAR) Facilitator, Education Consultant at Critical Learning Collaborative, USA
| | - Jan Mooney
- Department of Psychological Science, Health Psychology Ph.D. Program, University of North Carolina at Charlotte (UNC Charlotte), USA
| | - Tran Tran
- Department of Psychological Science, Health Psychology Ph.D. Program, University of North Carolina at Charlotte (UNC Charlotte), USA
| | - Orlagh O'Dowd
- School of Psychology, University College Dublin (UCD), Ireland
| | - Lia Bauert
- Department of Psychological Science, Health Psychology Ph.D. Program, University of North Carolina at Charlotte (UNC Charlotte), USA
| | - K G Smith
- Department of Public Health Sciences, Master of Health Administration Program, University of North Carolina at Charlotte (UNC Charlotte), USA
| | | | - Jennifer B Webb
- Department of Psychological Science, Health Psychology Ph.D. Program, University of North Carolina at Charlotte (UNC Charlotte), USA
| |
Collapse
|
2
|
Mahon C, Hamburger D, Webb JB, Yager Z, Howard E, Booth A, Fitzgerald A. Protocol of a cluster randomised trial of BodyKind: a school-based body image programme for adolescents. BMC Public Health 2023; 23:2246. [PMID: 37964252 PMCID: PMC10647142 DOI: 10.1186/s12889-023-17002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Poor body image is prevalent among adolescents and associated with several negative outcomes for their physical and psychological health. There is a pressing need to address this growing public health concern, yet there are few evidence-informed universal programmes for older adolescents that address contemporary body image concerns (i.e., social media). BodyKind is a four lesson, school-based, teacher led, universal body image programme that incorporates empirically supported principles of cognitive dissonance, self-compassion, compassion for others and social activism, to support positive body image development. Building on previous pilot trials in the USA, this paper outlines the protocol for a cluster randomised control trial (cRCT) and implementation evaluation of the BodyKind programme which was culturally adapted for the Irish cultural context. METHODS We aim to recruit 600 students aged 15-17 years in Transition Year (4th year) across 26 second-level schools in Ireland. Using minimisation, schools will be randomly assigned to receive BodyKind (intervention condition, n=300) or classes as usual (waitlist control, n=300). Teachers in intervention groups will receive training and deliver the programme to students over four weeks, at a rate of one lesson per week. Primary outcomes of body appreciation, body dissatisfaction and psychological wellbeing and secondary outcomes of self-compassion, compassion for others, body ideal internalisation, social justice motives and appearance-based social media use will be assessed at pre-, post- and 2 month follow up. Mediation and moderation analyses will be conducted to identify how and for whom the intervention works best. An implementation evaluation will assess the quality of programme implementation across schools and how this may influence intervention outcomes. Waitlist control schools will receive the programme after the 2-month follow up. CONCLUSION This study will be the first to implement a cRCT and an implementation evaluation to assess the impact of this multicomponent school-based body image programme designed to support healthy body image development. If shown to be effective, BodyKind will have the potential to improve adolescent body image and wellbeing and inform efforts to implement sustainable and scalable programmes in schools. TRIAL REGISTRATION The trial was retrospectively registered on 10/10/2023 on ClinicalTrials.gov NCT06076993 .
Collapse
Affiliation(s)
- Ciara Mahon
- School of Psychology, University College Dublin (UCD), Newman Building, Belfield, Dublin 4, Ireland.
| | | | - Jennifer B Webb
- Department of Psychological Science, Health Psychology Ph.D. Program, University of North Carolina at Charlotte (UNC Charlotte), Charlotte, USA
| | - Zali Yager
- Embrace Collective NFP, Adelaide, Australia
| | - Emma Howard
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Ailbhe Booth
- School of Psychology, University College Dublin (UCD), Newman Building, Belfield, Dublin 4, Ireland
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Amanda Fitzgerald
- School of Psychology, University College Dublin (UCD), Newman Building, Belfield, Dublin 4, Ireland
| |
Collapse
|
3
|
Addiss DG, Richards A, Adiabu S, Horwath E, Leruth S, Graham AL, Buesseler H. Epidemiology of compassion: A literature review. Front Psychol 2022; 13:992705. [DOI: 10.3389/fpsyg.2022.992705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
Psychology and neuroscience have contributed significantly to advances in understanding compassion. In contrast, little attention has been given to the epidemiology of compassion. The human experience of compassion is heterogeneous with respect to time, place, and person. Therefore, compassion has an epidemiology, although little is known about the factors that account for spatial or temporal clustering of compassion or how these factors might be harnessed to promote and realize a more compassionate world. We reviewed the scientific literature to describe what is known about “risk factors” for compassion towards others. Studies were included if they used quantitative methods, treated compassion as an outcome, and used measures of compassion that included elements of empathy and action to alleviate suffering. Eighty-two studies met the inclusion criteria; 89 potential risk factors were tested 418 times for association with compassion. Significant associations with compassion were found for individual demographic factors (e.g., gender, religious faith); personal characteristics (e.g., emotional intelligence, perspective-taking, secure attachment); personal experience (e.g., previous adversity); behaviors (e.g., church attendance); circumstantial factors during the compassion encounter (e.g., perceptions of suffering severity, relational proximity of the compassion-giver and -receiver, emotional state of the compassion-giver); and organizational features. Few studies explored the capacity to receive, rather than give, compassion. Definitions and measures of compassion varied widely across disciplines; 87% of studies used self-report measures and 39% used a cross-sectional design. Ten randomized clinical trials documented the effectiveness of compassion training. From an epidemiologic perspective, most studies treated compassion as an individual host factor rather than as transmissible or influenced by time or the environment. The causal pathways leading from suffering to a compassionate response appear to be non-linear and complex. A variety of factors (acting as effect modifiers) appear to be permissive of—or essential for—the arising of compassion in certain settings or specific populations. Future epidemiologic research on compassion should take into account contextual and environmental factors and should elucidate compassion-related dynamics within organizations and human systems. Such research should be informed by a range of epidemiologic tools and methods, as well as insights from other scientific disciplines and spiritual and religious traditions.
Collapse
|
4
|
Ekbäck E, Blomqvist I, Dennhag I, Henje E. Psychometric properties of the Swedish version of the Reynolds Adolescent Depression Scale second edition (RADS-2) in a clinical sample. Nord J Psychiatry 2022; 77:383-392. [PMID: 36332154 DOI: 10.1080/08039488.2022.2128409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Observed and predicted increases in the global burden of disease caused by major depressive disorder (MDD) highlight the need for psychometrically robust multi-dimensional measures to use for clinical and research purposes. Reynolds Adolescent Depression Scale second edition (RADS-2) is an internationally well-validated scale measuring different dimensions of adolescent depression. The Swedish version has previously only been evaluated in a normative sample.Methods: We collected data from patients in child and adolescent psychiatry and primary care and performed: (1) Confirmatory factor analysis (CFA) to evaluate the established four-factor structure, (2) Analyses of reliability and measurement invariance, (3) Analyses of convergent and discriminant validity using the Montgomery-Asberg Depression Rating Scale, the depression subscales of the Beck Youth Inventories and the Revised Child Anxiety and Depression Scale, as well as the Patient Reported Outcome Measurements Information System, peer-relationships and physical activity item banks.Results: Recruited participants (n = 536, 129 male and 407 female, mean age 16.45 years, SD = 2.47, range 12 - 22 years) had a variety of psychiatric diagnoses. We found support for the four-factor structure and acceptable to good reliability for the subscale and total scores. Convergent and discriminant validity were good. Measurement invariance was demonstrated for age, sex, and between the present sample and a previously published normative sample. The RADS-2-scores were significantly higher in the present sample than in the normative sample. In this clinical study, the Swedish RADS-2 demonstrated good validity and acceptable to good reliability. Our findings support the use of RADS-2 in Swedish clinical and research contexts.
Collapse
Affiliation(s)
- Erik Ekbäck
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Ida Blomqvist
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Inga Dennhag
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Eva Henje
- Department of Clinical Science, Umeå University, Umeå, Sweden
| |
Collapse
|
5
|
Carnelius F, Dennhag I. The association between gender, sexual harassment, and self-compassion on depressive symptoms in adolescents. Nord J Psychiatry 2022; 77:256-265. [PMID: 35736792 DOI: 10.1080/08039488.2022.2089231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM The study aims to identify the prevalence of bullying and sexual harassment as well as possible risk and protective factors for depression among adolescents. We focus on the association of different types of sexual harassment, gender, bullying, and self-compassion to depression criteria according to DSM 4. METHODS This cross-sectional study included 318 adolescents aged 15-20 years, from Sweden. Participants answered the self-assessment scales Reynolds Adolescent Depression Scale, Second Edition, and Compassionate Engagement and Action Scales for Youth, as well as questions about sexual harassment and bullying. Regression analyses were conducted to examine the association between bullying, sexual harassment, self-compassion, and gender with depressive symptoms. RESULTS Few students had been subjected to bullying, whereas sexual harassment was more common. About 32.7% of students had been subjected to verbal harassment and girls were more frequently exposed. Both bullying and sexual harassment were associated with depressive symptoms, and gender patterns were observed. For boys, verbal harassment and bullying correlated with negative self-evaluation and somatic complaints. For girls, bullying correlated with all depressive symptoms. Higher levels of self-compassion were associated with less depression, and the correlation was especially strong among boys. CONCLUSION Boys and girls express different types of depressive symptoms when subjected to bullying and sexual harassment. Not asking boys about negative self-evaluation or somatic complaints could lead to missing depression. However, for girls, all four symptoms are equally important to inquire about. Self-compassion is a possible protective factor against depression and future studies will show if teaching this to adolescents could lead to less depression.
Collapse
Affiliation(s)
- Filippa Carnelius
- Department of Clinical Science, Child- and Adolescent Psychiatry, Umeå University, Umeå, Sweden
| | - Inga Dennhag
- Department of Clinical Science, Child- and Adolescent Psychiatry, Umeå University, Umeå, Sweden
| |
Collapse
|
6
|
Ari E, Cesur-Soysal G, Basran J, Gilbert P. The Compassionate Engagement and Action Scales for Self and Others: Turkish Adaptation, Validity, and Reliability Study. Front Psychol 2022; 13:780077. [PMID: 35496178 PMCID: PMC9046699 DOI: 10.3389/fpsyg.2022.780077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/09/2022] [Indexed: 01/09/2023] Open
Abstract
Aim This study aims to translate the Compassionate Engagement and Action Scales (CEAS) into Turkish and to test their subsequent validity, reliability, and psychometric properties. Turkey is one of the blended cultures with eastern and western elements under the influence of traditional religion. This cultural diversity brings about a rich context to study compassion and its relationship to mental health. The scales assess the ability to be sensitive to suffering and engage and then take helpful actions in compassion. The motivation for compassionate engagement and action is measured at three 'flows' as follows: (1) compassion for others; (2) compassion from others; and (3) compassion for self. Methods The sample consists of 525 college students aged 18 years or older. The participants completed the CEAS Turkish Form for Others, Self and from Others, Self-Compassion Scale Short Form, Compassionate Love Scale, and Self-Criticism Scale. Results The confirmatory factor analyses were conducted using AMOS version 27 to examine the validity of the three scales with two different factor structures each. All the three models show good fits to the data. The Cronbach's alpha coefficient for the CEAS for Others and for Self and from Others are good to excellent (between 0.70 and 0.95 for all subscales). Compassion for self, compassion for others, and compassion from others correlated modestly. Conclusion It can be concluded that the Turkish version of the Compassionate Engagement and Action Scales for Others and Self and from Others has sufficient psychometric properties and can be used as a reliable and valid measure to assess compassionate engagement and action.
Collapse
Affiliation(s)
- Ela Ari
- Department of Psychology, Istanbul Medipol University, Istanbul, Turkey
| | | | - Jaskaran Basran
- Centre for Compassion Research and Training, College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| | - Paul Gilbert
- Centre for Compassion Research and Training, College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| |
Collapse
|
7
|
Ekbäck E, Granåsen G, Svärling R, Blomqvist I, Henje E. Clinical Effectiveness of Training for Awareness Resilience and Action Online Compared to Standard Treatment for Adolescents and Young Adults With Depression: Study Protocol and Analysis Plan for a Pragmatic, Multi-Center Randomized Controlled Superiority Trial. Front Psychiatry 2021; 12:674583. [PMID: 34707516 PMCID: PMC8542661 DOI: 10.3389/fpsyt.2021.674583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/10/2021] [Indexed: 01/21/2023] Open
Abstract
Depression in adolescents and young adults is an increasing global health concern. Available treatments are not sufficiently effective and relapse rates remain high. The novel group-treatment program "Training for Awareness, Resilience and Action" (TARA) targets specific mechanisms based on neuroscientific findings in adolescent depression. TARA is framed within the National Institute of Mental Health's Research Domain Criteria and has documented feasibility and preliminary efficacy in the treatment of adolescent depression. Since neurodevelopment continues well into the mid-twenties, age-adapted treatments are warranted also for young adults. Patients 15-22 years old, with either major depressive disorder (MDD) or persistent depressive disorder (PDD) according to the DSM-IV/5 or a rating >40 on the clinician rating scale Children's Depression Rating Scale-Revised (CDRS-R), will be recruited from specialized Child and Adolescent Psychiatry and local Youth-Clinics and randomized to either TARA or standard treatment, including but not limited to antidepressant medication and/or psychotherapy. Outcome measures will be obtained before randomization (T0), after 3 months of treatment (T1) and at 6-months- (T2) and 24-months- (T3) follow-up. Additionally, dose-response measures will be obtained weekly in the TARA-arm and measures for mediation-analysis will be obtained halfway through treatment (T0.5). Primary outcome measure is Reynolds Adolescent Depression Scale (RADS-2) score at T1. Secondary outcome measures include RADS-2 score at T2, Multidimensional Anxiety Scale for Children at T1 and T2, and CDRS-R at T1. Additional outcome measures include self-report measures of depression-associated symptoms, systemic bio-indicators of depression from blood and hair, heartrate variability, brain magnetic resonance imaging, as well as three-axial accelerometry for sleep-objectivization. Qualitative data will be gathered to reach a more comprehensive understanding of the factors affecting adolescents and young adults with depression and the extent to which the different treatments address these factors. In summary, this article describes the design, methods and statistical analysis plan for pragmatically evaluating the clinical effectiveness of TARA. This will be the first RCT to examine the effects of TARA compared to standard treatment for adolescents and young adults with MDD or PDD. We argue that this study will extend the current knowledgebase regarding the treatment of depression. NCT Registration: identifier [NCT04747340].
Collapse
Affiliation(s)
- Erik Ekbäck
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Gabriel Granåsen
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Rachel Svärling
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Ida Blomqvist
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Eva Henje
- Department of Clinical Science, Umeå University, Umeå, Sweden
| |
Collapse
|