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Body Project

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The Body Project is a body acceptance group-based class that has reduced body dissatisfaction, negative feelings, unhealthy weight control behaviors, eating disordered behaviors, and future onset of eating disorders in numerous controlled trials. In the Body Project young women with body image concerns voluntarily critique the thin ideal promoted by the mass media in verbal, written, and behavioral exercises (Stice, Mazotti, Weibel, & Agras, 2000)[1]. For instance, participants generate costs associated with pursuing the thin-ideal, complete role-plays in which they talk facilitators out of pursuing the thin ideal, and engage in acts of body activism that challenge the thin-ideal (write a letter to the editor of a fashion magazine asking them to use models who vary in weight). Criticizing the thin ideal publically in this group-based intervention theoretically produces cognitive dissonance that motivates participants to reduce their adherence to the beauty ideal because people strive to keep their attitudes consistent with their behaviors (Festinger, 1957)[2]. Reduced subscription to the thin ideal theoretically decreases body dissatisfaction, unhealthy weight control behaviors, negative feelings, and eating disorder symptoms, as well future eating disorder onset.

Research on Efficacy

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Efficacy trials show that the Body Project has produced greater reductions in thin-ideal internalization, body dissatisfaction, reported dieting, negative affect, eating disorder symptoms, functional impairment, and eating disorder onset over a 3-year follow-up relative to assessment-only or alternative intervention control conditions (Stice, Chase, Stormer, & Appel, 2001[3]; Stice, Marti, Spoor, Presnell, & Shaw, 2008[4]; Stice et al., 2000[5]; Stice, Shaw, Burton, & Wade, 2006[6]; Stice, Trost, & Chase, 2003[7]). Efficacy trials conducted by independent research teams have also found that dissonance-based eating disorder prevention programs produce greater reductions in these outcomes than assessment-only control conditions (Halliwell & Diedrichs, 2013[8]; Matusek, Wendt, & Wiseman, 2004[9]; Mitchell, Mazzeo, Rausch, & Cooke, 2007[10]) and alternative interventions (Becker, Smith, & Ciao, 2005[11]). It is the only prevention program that has reduced future eating disorder onset, produced effects through 3-year follow-up, outperformed alternative body acceptance classes, and produced positive effects that have replicated in trials conducted by independent research teams.

Research on Effectiveness

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Effectiveness trials have also confirmed that the Body Project produces similar effects when high school and college counselors deliver the intervention under real world conditions relative to participants in educational brochure and educational video control conditions, including significant reductions in eating disorder symptoms that persist through 3-year follow-up (Stice, Rohde, Durant, & Shaw, 2012[12]; Stice, Rohde, Gau, & Shaw, 2009[13]; Stice, Rohde, Shaw, & Gau, 2011[14]). Effectiveness trials have also found that when undergraduate peer leaders deliver the Body Project it produces larger reductions in these outcomes relative to educational brochure controls (Stice, Rohde, Durant, Shaw, & Wade, 2013[15]) and an alternative intervention (Becker, Wilson, Williams, Kelly, McDaniel, & Elmquist, 2010[16]).

Intervention Theory

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In support of the intervention theory for this body acceptance class, reductions in thin-ideal internalization appear to mediate the intervention effects on change in the other outcomes (Seidel, Presnell, & Rosenfield, 2009[17]; Stice, Presnell, Gau, & Shaw, 2007[18]). In line with the notion that dissonance induction contributes to intervention effects, participants assigned to high-versus low-dissonance versions of this program showed significantly greater reductions in eating disorder symptoms (Green, Scott, Divankova, Gasser, & Pederson, 2005[19]; McMillan, Stice, & Rohde, 2011[20]). The Body Project also produced larger eating disorder symptom reductions for youth with initially elevated thin-ideal internalization, consistent with the thesis that they experience greater dissonance (Stice et al., 2008b[21]) and eliminated the negative effect of exposure to thin models on body dissatisfaction in young girls observed in controls (Halliwell & Diedrichs, 2014[22]), suggesting it alters the effects of thin-ideal images thought to play a role in the etiology of eating disorders. One study found that participation in this prevention program offset the risk conveyed by the most potent eating disorder risk factor in one trial - denial of the costs of pursuing the thin ideal (Stice, Rohde, Gau, & Shaw, 201[23]2): participants who initially denied the costs of pursuing the thin ideal who then completed the dissonance intervention showed an eating disorder incidence of 0% over 3-year follow-up, relative to 18% for those who completed two alternative interventions, and 50% for assessment-only controls. Research has also found a dose-response effect for the Body Project, in that participants who show higher attendance of the group sessions show greater reductions in out comes (Serdar, 2011[24]). An fMRI study found that participants who completed the Body Project showed a significant reduction in reward region response to images of thin models, which did not occur in educational brochure controls, providing objective biological evidence that this body acceptance class reduces neural responsivity to the thin images that contribute to body dissatisfaction and eating disordered behaviors (Stice & Yokum, 2014[25]). It is important to note that the Body Project has been found to be similarly effective for a broad range of ethnic groups (Rodriguez, Marchand, Ng, & Stice, 2008[26]; Serdar, 2011[27]; Stice, Marti, & Cheng, 2014[28]).

Implementation

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The Body Project or adapted versions of this body acceptance class are currently being delivered in 70 countries around the world, primarily via a dissemination effort by Dove. In addition, the Body Project is being offered in over 120 universities in the US, as well as in dozens of high schools. Free information on how to deliver the Body Project is available at http://www.bodyprojectsupport.org.



References

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  1. ^ Stice, E., Mazotti, L., Weibel, D., & Agras, W.S. (2000). Dissonance prevention program decreases thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms: A preliminary experiment. International Journal of Eating Disorders, 27, 206-217.
  2. ^ Festinger, L. (1957). A theory of cognitive dissonance. Stanford, CA: Stanford University Press.
  3. ^ Stice, E., Chase, A., Stormer, S., & Appel, A. (2001). A randomized trial of a dissonance-based eating disorder prevention program. International Journal of Eating Disorders, 29, 247-262.
  4. ^ Stice, E., Marti, C. N., Spoor, S., Presnell, K., & Shaw, H. (2008). Dissonance and healthy weight eating disorder prevention programs: Long-term effects from a randomized efficacy trial. Journal of Consulting and Clinical Psychology, 76, 329-340.
  5. ^ Stice, E., Mazotti, L., Weibel, D., & Agras, W.S. (2000). Dissonance prevention program decreases thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms: A preliminary experiment. International Journal of Eating Disorders, 27, 206-217.
  6. ^ Stice, E., Shaw, H., Burton, E., & Wade, E. (2006). Dissonance and healthy weight eating disorder prevention programs: A randomized efficacy trial. Journal of Consulting and Clinical Psychology, 74, 263-275.
  7. ^ Stice, E., Trost, A., & Chase, A. (2003). Healthy weight control and dissonance-based eating disorder prevention programs: Results from a controlled trial. International Journal of Eating Disorders, 33, 10-21.
  8. ^ Halliwell, E., & Diedrichs, P. (2013). Brief report: Testing a dissonance body image intervention among young girls. Healthy Psychology.
  9. ^ Matusek, J. A., Wendt, S. J., & Wiseman, C. V. (2004). Dissonance thin-ideal and didactic healthy behavior eating disorder prevention programs: Results from a controlled trial. International Journal of Eating Disorders, 36, 376-388.
  10. ^ Mitchell, K. S., Mazzeo, S. E., Rausch, S. M., & Cooke, K. L. (2007). Innovative interventions for disordered eating: Evaluating dissonance-based and yoga interventions. International Journal of Eating Disorders, 40, 120-128.
  11. ^ Becker, C. B., Smith, L., & Ciao, A. C. (2005). Reducing eating disorder risk factors in sorority members: A randomized trial. Behavior Therapy, 36, 245-254.
  12. ^ Stice, E., Rohde, P., Durant, S., & Shaw, H. (2012). A preliminary trial of a prototype Internet dissonance-based eating disorder prevention program for young women with body image concerns. Journal of Consulting and Clinical Psychology, 80, 907-916.
  13. ^ Stice, E., Rohde, P, Gau, J., & Shaw, H. (2009). An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. Journal of Consulting and Clinical Psychology, 77, 825-834.
  14. ^ Stice, E., Rohde, P., Shaw, H., & Gau, J. (2011). An effectiveness trial of a selected dissonance-based eating disorder prevention program for female high school students: Long-term effects. Journal of Consulting and Clinical Psychology, 79, 500-508.
  15. ^ Stice, E., Rohde, P., Durant, S., Shaw, H., & Wade, E. (2013). Effectiveness of peer-led dissonance eating disorder prevention groups: Results from two randomized trials. Behaviour Research and Therapy, 51, 197-206.
  16. ^ Becker, C., Wilson, C., Williams, A., Kelly, M., McDaniel, L., & Elmquist, J. (2010). Peer-facilitated cognitive dissonance versus healthy weight eating disorders prevention: A randomized comparison. Body Image, 7, 280-288.
  17. ^ Seidel, A., Presnell, K., & Rosenfield, D. (2009). Mediators in the dissonance eating disorder prevention program. Behaviour Research and Therapy, 47, 645-653.
  18. ^ Stice, E., Presnell, K., Gau, J., & Shaw, H. (2007). Testing mediators of intervention effects in randomized controlled trials: An evaluation of two eating disorder prevention programs. Journal of Consulting and Clinical Psychology, 75, 20-32.
  19. ^ Green, M., Scott, N., Diyankova, I., Gasser, C., & Pederson, E. (2005). Eating disorder prevention: An experimental comparison of high level dissonance, low level dissonance, and no-treatment control. Eating Disorders, 13, 157-169.
  20. ^ McMillan, W., Stice, E., & Rohde, P. (2011). High- and low-level dissonance-based eating disorder prevention programs with young women with body image concerns: An experimental trial. Journal of Consulting and Clinical Psychology, 79, 129-134.
  21. ^ Stice, E., Marti, C. N., Spoor, S., Presnell, K., & Shaw, H. (2008). Dissonance and healthy weight eating disorder prevention programs: Long-term effects from a randomized efficacy trial. Journal of Consulting and Clinical Psychology, 76, 329-340.
  22. ^ MISSING
  23. ^ Stice, E., Rohde, P., Gau, J., & Shaw, H. (2012). Effect of a dissonance-based prevention program on risk for eating disorder onset in the context of eating disorder risk factors. Prevention Science, 13, 129-139.
  24. ^ MISSING
  25. ^ MISSING
  26. ^ Rodriguez, R., Marchand, E., Ng, J., & Stice, E. (2008). Effects of a cognitive-dissonance-based eating disorder prevention program are similar for Asian American, Hispanic, and White participants. International Journal of Eating Disorders, 41, 618-625.
  27. ^ MISSING
  28. ^ MISSING
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