Table 13 Dissonance based programs for emerging adults (ages 18–25)

Stice et al. [63]

RCT

Females with high body image and/or body dissatisfaction concerns

n = 173 Clinician-led Body Project

n = 162 Peer-led Body Project

n = 184 eBody Project

n = 161 Control

Clinician-led Body Project: in-person group and led by clinician

Peer-led Body Project: in -person group and led by peers

eBody Project: six 40-min modules (overall same timing as clinician- and peer-led groups) involving user-driven educational activities and games (e.g., texting role-plays) that parallel the in-person group program (e.g. in group, engaged in exercises critiquing thin beauty ideal)

Educational Video Control: watched 55 min video “Dying to be Thin”

Thin-Ideal Internalization scale, Satisfaction and Dissatisfaction with Body Parts Scale, DRES (frequency of dieting), PANAS-X, EDDI

Participants in clinician- and peer-led Body Project groups and the eBody Project generally showed larger reductions in risk factors and ED symptoms vs controls through 1- and 2-year follow-up, with some effects persisting through 3- and 4-year follow-ups (no other Internet-delivered prevention program has reduced ED symptoms, produced greater reductions in outcomes than an alternative educational intervention, or produced effects that have persisted through 4-year follow-up). Peer-led Body Project participants showed greater reductions in some ED risk factors than eBody Project participants. Might be optimal to task-shift Body Project delivery to peer-leaders

Rohde et al. [64]

RCT

Females with high body image and/or body dissatisfaction concerns

n = 173 Clinician-led Body Project

n = 162 Peer-led Body Project

n = 184 eBody Project

n = 161 Control

Clinician-led Body Project: in-person group and led by clinician

Peer-led Body Project: in -person group and led by peers

eBody Project: six 40-min modules (overall same timing as clinician- and peer-led groups) involving user-driven educational activities and games (e.g., texting role-plays) that parallel the in-person group program (e.g., in group, engaged in exercises critiquing thin beauty ideal)

Educational Video Control: watched 55 min video “Dying to be Thin”

Thin-Ideal Internalization Scale, Satisfaction and Dissatisfaction with Body Parts Scale, DRES (frequency of dieting), EDDI, SAS

Attrition: 10% at post-test and 16% at follow-up. Interactions indicated that age moderated the intervention effects, such that group- based programs were superior to the Internet-delivered version in terms of ED symptom reductions for women up to age 20

Stice et al. [65]

RCT

Females with high body image and/or body dissatisfaction concerns

n = 173 (clinician-led)

n = 162 (peer-led)

n = 184 (eBody Project)

n = 161 (control)

Clinician-led Body Project: in-person group and led by clinician

Peer-led Body Project: in -person group and led by peers

eBody Project: six 40-min modules (overall same timing as clinician- and peer-led groups) involving user-driven educational activities and games (e.g., texting role-plays) that parallel the in-person group program (e.g. in group, engaged in exercises critiquing thin beauty ideal)

Educational Video Control: watched 55 min video “Dying to be Thin”

Thin-Ideal Internalization Scale Satisfaction and Dissatisfaction with Body Parts Scale sadness, guilt, and fear/anxiety subscales from the PANAS-X, semi-structured EDDI

Attrition 9% at posttest and 11% at 6-month-follow up. eBody Project participants showed significantly greater reductions in all 4 continuous outcomes (thin-ideal internalization, body dissatisfaction, negative affect, ED symptoms) by posttest compared to controls. The effects for thin-ideal internalization and ED symptoms were still significant by 6- month follow-up compared to controls. Participants in clinician-led and peer-led Body Project groups showed significantly greater reductions in ED risk factors than eBody Project participants

Chithambo and Huey [67]

RCT

Females at high-risk for EDs

n = 90 DBI-I

n = 88 CBI-I

n = 93 No intervention

DBI-I: 4 internet-delivered weekly sessions with activities to argue against thin-ideal (content from Body Project)

CBI-I: 4 internet-delivered weekly sessions based on model positing that negative body image thoughts and assumptions sustain disturbed body evaluation and maladaptive eating (content from The Body Image Workbook, a self-help manual for body dissatisfaction)

BSQ, IBSS, EAT, DRES, BDI-II

At postintervention, DBI-I and CBI-I led to greater reductions in body dissatisfaction, thin-ideal internalization, and depression than no intervention (no differences between CBI-I and DBI-I). CBI-I was effective at reducing dieting and composite eating pathology relative to no intervention

Haderlein et al. [68]

Secondary analysis of Chithambo & Huey 2017 RCT

Females at high-risk for EDs (≥ 34 WCS score)

n = 88 DBI-I

n = 94 CBI-I

n = 96 no intervention

DBI-I: 4 internet-delivered weekly sessions with activities to argue against thin-ideal (content from Body Project)

CBI-I: 4 internet-delivered weekly sessions based on model positing that negative body image thoughts and assumptions sustain disturbed body evaluation and maladaptive eating (content from The Body Image Workbook, a self-help manual for body dissatisfaction)

RED scale

DBI-I was associated with significantly greater reductions in reward-based eating drive (RED scores) over time vs. the no intervention group. CBT-I had no effect on reward-based eating drive. There was no time x condition effect between DBI-I and CBT-I, nor for CBT-I and no intervention

Shaw et al. [66]

Qualitative Study

Females with high body image and/or body dissatisfaction concerns

n = 173 Clinician-led Body Project

n = 162 Peer-led Body Project

n = 184 eBody Project

n = 161 Control

Clinician-led Body Project: in-person group and led by clinician

Peer-led Body Project: in -person group and led by peers

eBody Project: six 40-min modules (overall same timing as clinician- and peer-led groups) involving user-driven educational activities and games (e.g., texting role-plays) that parallel the in-person group program (e.g., in group, engaged in exercises critiquing thin beauty ideal)

Educational Video Control: watched 55 min video “Dying to be Thin”

Participants completed exit surveys with 4 open ended questions addressing: valuable and less valuable aspects of the program, aspects of the program that made it work either better or worse and making the program more interesting and enjoyable for future participants

90% of group participants and 98% of eBody Project participants completed surveys. Clinician and peer-led group participants reported the group setting, feeling that they were not alone, and the letter exercise as most valuable. The most common response to what was most valuable for eBody Project participants was letters (19%), learning about the thin-ideal (12%), increased body image awareness (8%), the mirror exercise and role-plays (each 7%), the convenience (6%). To make eBody Project more interesting and enjoyable: having more support (20%), incorporating videos (13%), including more facts about EDs (6%) and having more engaging video- games and modules (5%)

Serdar et al. [69]

RCT

Females at high-risk for EDs

n = 107 (face-to-face DB

n = 112 (online DB)

n = 114 controls

Face-to-face DB: 3, 1-h sessions, program based off manual includes interactive exercises that guide participants toward taking a stance against the thin-ideal

Online DB: accessed via a website with content similar to the manual, three 1-h group discussions exclusively via text; moderated and synchronous; also had asynchronous components

Control: completed measures but received no other materials

EDDS, IBSS-R, BES

Participants in both conditions manifested less body dissatisfaction at post-test compared with assessment-only participants; there were no significant differences in outcomes between the two modes of program delivery. No changes in thin-ideal internalization or ED symptoms among members of either active condition

Stice et al. [62]

RCT

Females with high body image and/or body dissatisfaction concerns

n = 39 Body Project group n = 19 eBody Project

n = 29 educational video control n = 20 educational brochure control

eBody Project: 6 online modules with activities designed to critique the thin-ideal over the course of 3 weeks; each module took between 30–40 min to complete

Group Body Project: facilitator-led group sessions with exercises in which they critiqued the thin-ideal for four 1-h group sessions held on a weekly basis and in home exercises. Educational video condition: watched Dying to be Thin (55 min documentary)

Educational brochure control condition: participants received a 2-page brochure by NEDA

IBSS-R, Satisfaction and Dissatisfaction with Body Parts Scale, DRES, BDI, EDDI

Internet participants showed reductions in ED risk factors and symptoms relative to the 2 control conditions at 1- and 2-year follow-up, but effects for in-person BP were greater than for eBP. The Internet intervention produced large weight gain prevention effects relative to the two control conditions at 1- and 2-year follow-up. Although the effects for the Internet versus group intervention were similar at post-test, results suggest that the effects faded more quickly for the Internet intervention

Stice et al. [61]

RCT

Females with high body image and/or body dissatisfaction concerns

n = 39 Body Project group n = 19 eBody Project

n = 29 educational video control n = 20 educational brochure control

eBody Project: 6 online modules with activities designed to critique the thin-ideal over the course of 3 weeks, 30–40 min per module

Group Body Project: exercises critiquing the thin-ideal ideal during 4, 1-h group sessions held on a weekly basis and with homework

Educational video: Dying to be Thin (55 min video)

Educational brochure control condition: received a 2-page brochure by NEDA

IBSS-R, Satisfaction and Dissatisfaction with Body Parts Scale, DRES, BDI, EDDI

Internet and group BP participants showed greater pre-post reductions in ED risk factors and symptoms than video controls (M d = .47 and .54 respectively) and brochure controls (M d = .75 and .72, respectively), with many effects reaching significance. Effects did not differ significantly for Internet (eBody Project) versus group (Body Project group) participants. Acceptability of the Internet prototype was high, with 17/19 users (89%) completing all 6 modules. eBody project only produced a moderate reduction in thin-ideal internalization and ED symptoms (not significant) compared to brochure or video controls