The benefits of expressive writing on sleep difficulty and appearance concerns for college women

The college years represent an important developmental period in the lives of young women, who report health-related difficulties such as sleep disturbance and body/eating concerns. This study explored whether expressive writing (EW) can decrease health-relevant complaints among college women. College females (n?=?111) were randomised into an EW condition (writing about body concerns) or a control writing condition and completed three 15-min writing sessions. Results indicate that participants in the EW condition reported less sleep difficulty and less body-focused upward social comparison at 8-week follow-up, relative to control participants. For individuals who reported higher perceived stress at baseline, the EW condition resulted in less eating disturbance and less social comparison, relative to the control condition. The effect of EW on eating disturbance for those who were high in stress was partially mediated by the change in upward social comparisons focused on one's body. These findings suggest that EW about body image and appearance concerns may positively influence the trajectory of risk for, or resilience against, future complications as a result of sleep difficulty, eating disturbance and body dissatisfaction.     

Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial

BackgroundWomen reporting initial eating disorder (ED) symptoms are at highest risk for the development of an eating disorder. Preventive interventions should, therefore, be specifically tailored for this subgroup.AimsTo adapt and evaluate the effects of the Internet-based prevention program “Student Bodies?” for women with symptoms of disordered eating and/or subthreshold eating disorder (ED) syndromes.Method126 women, reporting subthreshold ED symptoms (high weight and shape concerns and below threshold bingeing, purging, chronic dieting or several of these symptoms) were randomly assigned to a Student Bodies?+ (SB+) intervention or a wait-list control group and assessed at pre-intervention, post-intervention, and 6-month follow-up. “Student Bodies?” was adapted to be suitable for subthreshold EDs. Main outcome measures were attitudes and symptoms of disordered eating. Pre-follow-up data were analyzed by ANCOVAS with mixed effects.ResultsAt 6-month follow-up, compared to participants in the control group, participants in the intervention group showed significantly greater improvements on ED-related attitudes. Intervention participants also showed 67% (95% CI = 20–87%) greater reductions in combined rates of subjective and objective binges, and 86% (95% CI = 63–95%) greater reduction in purging episodes. Also, the rates of participants abstinent from all symptoms of disordered eating (restrictive eating, binge eating and any compensatory behavior) were significantly higher in the intervention group (45.1% vs. 26.9%). Post-hoc subgroup analyses revealed that for participants with binge eating the effect on EDE-Q scores was larger than in the pure restricting subgroup.ConclusionThe adapted “SB+” program represents an effective intervention for women with subthreshold EDs of the binge eating subtype.     

A Treatment for College Women at Risk for Bulimia: A Controlled Evaluation

Twenty-nine college women evidencing low body esteem, repeated dieting efforts, and other dysfunctional eating behaviors or attitudes were randomly assigned to group treatment or control conditions. At posttest and follow-up, participants who received the intervention reported significantly improved levels of self-esteem and body satisfaction, as well as reductions in their reliance on potentially dangerous methods of weight management compared with controls. They also reported fewer fears of negative evaluation by others and endorsed fewer stereotypes about thinness and attractiveness. Finally, participants in the treatment condition showed significantly reduced levels of perfectionism at posttest, but this change was not maintained at follow-up. Clinical implications and research recommendations are discussed.     

An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students

Objective

Efficacy trials indicate that a dissonance-based prevention program in which female high school and college students with body image concerns critique the thin-ideal reduced risk factors, eating disorder symptoms, and future eating disorder onset, but weaker effects emerged from an effectiveness trial wherein high school clinicians recruited students and delivered the program under real-world conditions. The present effectiveness trial tested whether a new enhanced dissonance version of this program produced larger effects when college clinicians recruited students and delivered the intervention using improved procedures to select, train, and supervise clinicians.

Method

Young women recruited from seven universities across the US (N = 408, M age = 21.6, SD = 5.64) were randomized to the dissonance intervention or an educational brochure control condition.

Results

Dissonance participants showed significantly greater decreases in risk factors (thin-ideal internalization, body dissatisfaction, dieting, negative affect) and eating disorder symptoms versus controls at posttest and 1-year follow-up, resulting in medium average effect size (d = .60). Dissonance participants also reported significant improvements in psychosocial functioning, but not reduced health care utilization or unhealthy weight gain.

Conclusions

This novel multisite effectiveness trial with college clinicians found that the enhanced dissonance version of this program and the improved facilitator selection/training procedures produced average effects that were 83% larger than effects observed in the high school effectiveness trial.     

Media literacy as a prevention intervention for college women at low- or high-risk for eating disorders

This study examined whether the media literacy program, ARMED, is an effective prevention intervention for college women at low- or high-risk for an eating disorder. Changes in eating disorder risk factors were assessed in low- (n = 26) and high-risk (n = 19) women participating in a two-session media literacy intervention as compared to low- (n = 31) and high-risk (n = 16) controls. Women at high-risk for an eating disorder reported significant decreases in body dissatisfaction, drive for thinness, feelings of ineffectiveness, and internalization of societal standards of beauty after participating in ARMED, whereas control participants did not. No significant decreases in perfectionism, physical appearance comparisons, or awareness of societal standards of beauty were reported among high-risk participants. Changes in eating disorder risk factors were not found among low-risk participants, regardless of treatment condition. Findings suggest that media literacy may be an effective secondary prevention intervention for eating disorders.     

A Brief Group Cognitive-Behavioral Program for the Prevention of Depressive Symptoms in Chinese College Students

Depression is a problem among college students in China. Yet the use of preventative group cognitive-behavioral (CB) intervention is rare. One hundred and eighty Chinese college students who were identified as being at risk for depression were randomly assigned to three groups: 1) a brief group cognitive–behavioral (CB) intervention, 2) a supportive group (SG) intervention, and 3) a wait-list control condition. The Zung Self-Rating Depression Scale (SDS), the Zung Self-Rating Anxiety Scale (SAS), and the Chinese College Student Adjustment Scale (CCSAS) were administered at pre-test, post-test, and six-month follow-up. Analysis of variance (ANOVA) conducted among the three groups revealed that the CB group demonstrated significantly less increase in measures of primary symptoms of anxiety and depression than the wait-list controls at post-test and six-month follow-up. The prevention effect of the SG group was significant only at the six-month follow-up. CB participants also showed significantly greater improvements in social adjustment than did SG participants and controls at the post-test and six-month follow-up.     

Adapted motivational interviewing for women with binge eating disorder: a randomized controlled trial

In this randomized controlled trial, 108 women with binge-eating disorder (BED) recruited from the community were assigned to either an adapted motivational interviewing (AMI) group (1 individual AMI session + self-help handbook) or control group (handbook only). They were phoned 4, 8, and 16 weeks following the initial session to assess binge eating and associated symptoms (depression, self-esteem, quality of life). Postintervention, the AMI group participants were more confident than those in the control group in their ability to change binge eating. Although both groups reported improved binge eating, mood, self-esteem, and general quality of life 16 weeks following the intervention, the AMI group improved to a greater extent. A greater proportion of women in the AMI group abstained from binge eating (27.8% vs. 11.1%) and no longer met the binge frequency criterion of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) for BED (87.0% vs. 57.4%). AMI may constitute a brief, effective intervention for BED and associated symptoms.     

Effectiveness of an Internet Dissonance-Based Eating Disorder Prevention Intervention Among Body-Dissatisfied Young Chinese Women

Body image disturbances are widespread in highly populated, rapidly developing Asian nations such as China, but there are severe shortages of practitioners qualified to treat these issues. In such contexts, validated online interventions offer a potentially viable approach for addressing the lack of treatment resources. In this study, we evaluated effects of the eBody Project, an online, dissonance-based eating disorder prevention program, on functioning among body-dissatisfied young Chinese women. Participating women were randomly assigned to the 6-week eBody Project intervention (n = 191) versus an education brochure control condition (n = 181). Self-report assessments of eating disorder risk factors (body dissatisfaction, thin ideal internalization, depressive symptoms, restrained eating), self-esteem, body appreciation, and disordered eating were completed at baseline, posttreatment, and a 6-month follow-up. There were no intervention differences on outcomes before treatment but eBody Project women experienced significantly larger improvements on all outcomes following treatment and/or at follow-up compared to controls; corresponding effect sizes were small to medium. Results indicated the eBody Project program is a promising intervention for young women at risk for eating disorders in China and provide foundations for broad implementation in low- and middle-income countries where resources for in-person therapy and supervision are limited or unavailable altogether.     

A randomized motivational enhancement prevention group reduces drinking and alcohol consequences in first-year college women.

Alcohol consumption among college students has become an increasing problem that requires attention from college administrators, staff, and researchers. Despite the physiological differences between men and women, college women are drinking at increasingly risky rates, placing them at increased risk for negative consequences. The current study tested a group motivational enhancement approach to the prevention of heavy drinking among 1st-year college women. Using a randomized design, the authors assigned participants either to a group that received a single-session motivational enhancement intervention to reduce risky drinking that focused partly on women's specific reasons for drinking (n = 126) or to an assessment-only control group (n = 94). Results indicated that, relative to the control group participants, intervention participants drank fewer drinks per week, drank fewer drinks at peak consumption events, and had fewer alcohol-related consequences over a 10-week follow-up. Further, the intervention, which targeted women's reasons for drinking, was more effective in reducing consumption for participants with high social and enhancement motivations for drinking.     

A Pilot Study of Acceptance and Commitment Therapy as a Workshop Intervention for Body Dissatisfaction and Disordered Eating Attitudes

Body image dissatisfaction is a source of significant distress among non-eating-disordered women, but because it is subclinical it is generally not treated. It remains stable throughout adulthood, and has proven resistant to many prevention interventions. This study presents a pilot test of a practical alternative: a 1-day Acceptance and Commitment Therapy (ACT) workshop targeting body dissatisfaction and disordered eating attitudes. Women with body dissatisfaction (N = 73) were randomly assigned to the workshop or to a wait list. Participants in both conditions also completed appetite awareness self-monitoring of hunger and satiety. After a brief 2-week follow-up, wait-list participants were also offered the workshop. Eating attitudes, body anxiety, and preoccupation with eating, weight, and shape improved in both arms of the study following the workshop. Participants in the ACT group showed significant reductions in body-related anxiety and significant increases in acceptance when compared to the wait-list control condition. ACT presented as a brief workshop intervention may be applicable for a broad range of women experiencing disordered eating attitudes and distress related to eating and body image; however, larger studies with longer follow-ups are needed.     

Effect of Client Sense of Humor and Paradoxical Interventions on Test Anxiety

This study investigated the effectiveness of paradoxical and non-paradoxical interventions with clients [henceforth known as participants] possessing a high or low sense of humor. Fifty-three test-anxious participants were divided into a low sense of humor group and a high sense of humor group and were assigned to a paradoxical intervention condition, a nonparadoxical intervention condition, or a no-treatment control group. Participants in all groups improved over time but, contrary to the hypothesis, low sense of humor participants improved significantly more with a paradoxical intervention than high sense of humor participants with a paradoxical intervention. There were no differences in improvement due to treatment condition for the high sense of humor group. Low sense of humor participants perceived the counselor as more able to help than did high sense of humor participants. The paradoxical intervention was seen as more surprising than the nonparadoxical intervention. Implications for the use of paradoxical interventions are discussed.     

Effects of Participant’s Choice of Different Digital Interventions on Outcomes for Binge-Spectrum Eating Disorders: A Pilot Doubly Randomized Preference Trial

It is unclear whether offering individuals a choice between different digital intervention programs affects treatment outcomes. To generate initial insights, we conducted a pilot doubly randomized preference trial to test whether offering individuals with binge-spectrum eating disorder a choice between two digital interventions is causally linked with superior outcomes than random assignment to these interventions. Participants with recurrent binge eating were randomized to either a choice (n = 77) or no-choice (n = 78) group. Those in the choice group could choose one of the two digital programs, while those in the no-choice group were assigned a program at random. The two digital interventions (a broad and a focused program) took 4 weeks to complete, were based on cognitive-behavioral principles and have demonstrated comparable efficacy, but differ in scope, content, and targeted change mechanisms. Most participants (79%) allocated to the choice condition chose the broad program. While both groups experienced improvements in primary (Eating Disorder Examination Questionnaire global scores and number of binge eating episodes over the past month) and secondary outcomes (dietary restraint, body image concerns, etc.), no significant between-group differences were observed. The two groups did not differ on dropout rates, nor on most indices of intervention engagement. Findings provide preliminary insights towards the role of client preferences in digital mental health interventions for eating disorders. Client preferences may not determine outcomes when digital interventions are based on similar underlying principles, although larger trials are needed to confirm this.     

555例危险行为高危青少年的心理干预：来自个体辅导和团体辅导的效果对照

对有较高风险发展为危险行为青少年的高危群体实施有针对性的心理干预是非常有价值的。本研究对青少年危险行为高危人群进行结构化的个体与团体心理干预,评估两种干预的即时效果和六个月的预后情况。采用《青少年健康相关危险行为问卷》等量表对16所中职院校的学生进行筛查,共555名学生参加本研究,被随机分为个体、团体和对照组并分别进行干预。结果发现：干预后,个体心理干预组被试的危险行为水平、心理健康以及抑郁和焦虑情绪均获得显著改善,并且6个月的预后效果依然明显,而接受团体辅导干预组仅在抑郁指标上有所改善,在危险行为评分、焦虑和心理健康水平上均没有明显的改善。研究认为,对危险行为易感青少年的心理干预应以经过良好设计的个体心理干预为主、团体干预为辅的方式进行。     

Exploring gender differences in body image,eating pathology,and sexual harassment

This study examines the relationship between body image (weight/shape concerns), eating pathology, and sexual harassment among men and women (N = 2446). Hierarchical regressions controlling for depression revealed main effects of gender such that women reported greater weight/shape concerns, eating pathology, dietary restraint, eating concerns, and binge eating compared to men. Main effects for sexual harassment indicated that as harassment increased, participants reported increased weight/shape concerns, eating pathology, dietary restraint, eating concerns, binge eating, and compensatory behaviors. There were small but significant interactions between gender and harassment for eating pathology total score (which included each of the domains listed above), weight/shape concerns, dietary restraint, and eating concerns such that the relationship between increased harassment and increased pathology was stronger for women compared to men. The largest interaction was found for compensatory behaviors, such that while women and men's scores both increased as harassment increased, the relationship was stronger for men.     

Ethnic identity,thin-ideal internalization,and eating pathology in ethnically diverse college women

Although much research suggests that ethnic identity is positively correlated with psychological health for ethnic minority women, research examining ethnic identity's relationships to thin-ideal internalization, weight concerns, and eating concerns is sparse. Consequently, this study examined these relationships in European American, African American, Latina, and Asian American college women (N = 816). As expected, univariate analyses of variance indicated that European American women scored lowest on ethnic identity and highest on eating and weight concerns, whereas African American women scored lowest on thin-ideal internalization. Hierarchical regression analyses indicated that ethnic identity was negatively associated with eating and weight concerns, while body mass index and thin-ideal internalization were positively associated. Ethnic identity moderated the relationship between thin-ideal internalization and eating concerns such that the relationship was stronger for participants with lower ethnic identity. These results suggest ethnic identity may be a direct or interactive protective factor against eating concerns in ethnically diverse college women.     

Body image in eating disorders: the influence of exposure to virtual-reality environments

The aim of this article was to study the effect of virtual-reality exposure to situations that are emotionally significant for patients with eating disorders (ED) on the stability of body-image distortion and body-image dissatisfaction. A total of 85 ED patients and 108 non-ED students were randomly exposed to four experimental virtual environments: a kitchen with low-calorie food, a kitchen with high-calorie food, a restaurant with low-calorie food, and a restaurant with high-calorie food. In the interval between the presentation of each situation, body-image distortion and body-image dissatisfaction were assessed. Several 2?x?2?x?2 repeated measures analyses of variance (high-calorie vs. low-calorie food?x?presence vs. absence of people?x ED group vs. control group) showed that ED participants had significantly higher levels of body-image distortion and body dissatisfaction after eating high-calorie food than after eating low-calorie food, while control participants reported a similar body image in all situations. The results suggest that body-image distortion and body-image dissatisfaction show both trait and state features. On the one hand, ED patients show a general predisposition to overestimate their body size and to feel more dissatisfied with their body image than controls. On the other hand, these body-image disturbances fluctuate when participants are exposed to virtual situations that are emotionally relevant for them.     

Increasing help-seeking for eating pathology among collegiate athletes: An examination of a novel,customized intervention

Athletes experience elevated risk for eating pathology (EP), but evidence lower levels of help seeking for EP than the general population. Indeed, athletes experience general (e.g., stigma) and athlete-specific (e.g., “push past physical and mental pain” attitude) barriers to help-seeking. Although general mental health help-seeking interventions have improved help seeking outcomes in athlete samples, no study has developed an intervention to increase EP help-seeking among athletes. The current study examined the effects of a 75-min mental health literacy and stigma reduction intervention among 107 collegiate athletes (54.2% female) randomly assigned to an intervention or control group. All athletes completed measures of help-seeking stigma, attitudes, intentions, and behavior at baseline, post-intervention, and six-week follow-up.At post-intervention, the intervention group demonstrated significant improvements in attitudes and intentions towards seeking help for EP and general mental health, relative to the control group. No significant differences in stigma were found between the groups. At six-week follow-up, the intervention group demonstrated higher rates of help-seeking and/or referring a friend for help than the control group. However, sustained improvements in help-seeking attitudes and intentions were not present in the intervention group compared to the control group, apart from EP help-seeking attitudes. Findings support the effectiveness of a customized intervention to improve EP help-seeking variables among athletes.     

Randomized controlled trial of brief interventions to reduce college students' drinking and risky sex

The present study tested the proposition that an intervention to reduce alcohol use among college students will also reduce their risky sexual behavior. In a randomized controlled trial, 154 heavy-drinking, predominantly White, heterosexual college students at behavioral risk for infection with HIV and other sexually transmitted diseases were assigned to receive no intervention or a two-session, in-person, motivational interviewing-based intervention focused on (a) reducing alcohol risk behavior, (b) reducing HIV risk behavior, or (c) reducing both alcohol and HIV risk behavior. Three-month retrospective assessments of alcohol use and sexual behavior were conducted at intake and at 3-, 6-, 9-, 12-, and 15-month follow-up appointments. During follow-up, participants who received the single-focus alcohol risk-reduction intervention drank less frequently and consumed fewer drinks per drinking day as compared with no-intervention control participants, but did not differ from control participants in their frequency of intercourse without a condom or number of sexual partners. Participants who received the single-focus HIV risk-reduction intervention evidenced fewer unprotected sex events during follow-up, as compared with control participants. The number of sexual partners reported during follow-up did not differ by condition. Effects of the interventions did not vary significantly over time and were not moderated by participant gender. Results suggest that intervening to reduce alcohol use may not reduce risky sexual behavior among nonminority college students, but that a brief motivational intervention targeting HIV risk behavior may have utility for reducing the frequency of unprotected sex in this population.     

Gender typing,importance of multiple roles,and mental health consequences for women

The present study examined the interactive influence of gender role typing and multiple role involvement with regard to specific mental health concerns among middle-class Caucasian women. As with previous research, depression and anxiety proved to be a function of gender role typing (feminine-typed and undifferentiated women displayed greater depression and anxiety relative to masculine-typed or androgynous women) with no differences attributable to multiple role involvement. For substance abuse, however, an interaction effect was obtained. Gender-typed (both masculine and feminine) women striving to excel across multiple roles engaged in greater substance abuse than women not gender typed (androgynous and undifferentiated); indeed, the latter displayed low risk comparable to women not similarly striving at multiple roles regardless of gender typing. A similar interaction previously has been reported with regard to disordered eating. These findings suggest that the lack of gender typing for women may enable them to cope more effectively with the conflicting demands of multiple roles and thereby reduce certain health risk behaviors (e.g., disordered eating and substance abuse), but that other mental health concerns (e.g., depression and anxiety) may not be similarly affected.     

Can the onset of type 2 diabetes be delayed by a group-based lifestyle intervention? A randomised control trial

This study was a randomised control trial with a waiting control group. It was designed to evaluate the effectiveness of a 6-month, group-based diabetes prevention programme, The Healthy Living Course and assess whether participation in the programme led to changes in modifiable risk factors for type 2 diabetes among an already at-risk pre-diabetic population. Individuals designated at risk for diabetes by their general practitioners (GPs) were screened using an Oral Glucose Tolerance Test. Volunteers (N = 307) with pre-diabetes were assigned to an intervention or wait-control group in the ratio of approximately 2 : 1. The sample was pre-tested on biochemical, anthropometric and self-report behavioural, cognitive and mood variables and post-tested either at the end of the educational/support-based lifestyle programme or the end of the wait period. The intervention group significantly improved their diabetes knowledge, motivation to change, positive affect, healthy eating and activity levels and showed significantly greater reductions in weight, body mass index, waist circumference, diastolic blood pressure and fasting plasma glucose in comparison with controls. The intervention group also changed their diagnostic status from pre-diabetes to non-diabetes at a greater rate than the wait group (43% vs. 26%) who received standard care from their GPs.