Randomized trial of a brief depression prevention program: an elusive search for a psychosocial placebo control condition

This trial compared a brief group cognitive-behavioral (CBT) depression prevention program to a waitlist control condition and four placebo or alternative interventions. High-risk adolescents with elevated depressive symptoms (N=225, M age=18, 70% female) were randomized to CBT, supportive-expressive group intervention, bibliotherapy, expressive writing, journaling, or waitlist conditions and completed assessments at baseline, termination, and 1- and 6-month follow-up. All five active interventions showed significantly greater reductions in depressive symptoms at termination than waitlist controls; effects for CBT and bibliotherapy persisted into follow-up. CBT, supportive-expressive, and bibliotherapy participants also showed significantly greater decreases in depressive symptoms than expressive writing and journaling participants at certain follow-up points. Findings suggest there may be multiple ways to reduce depressive symptoms in high-risk adolescents, although expectancies, demand characteristics, and attention may have contributed to the observed effects.     

Dysfunctional body investment versus body dissatisfaction: Relations with well-being and controlled motivations for obesity treatment

In this study, we investigated the associations between body image and psychological well-being, exploring the mediating role of controlled regulation for entering obesity treatment. In addition, we analyzed whether investment body image was more strongly associated with controlled regulation (and subsequent well-being) compared to evaluative body image. These analyses were performed controlling for baseline BMI effects. Participants were 139 overweight women (age: 38.0 ± 6.7 year; BMI: 32.0 ± 4.1 kg/m²) entering treatment. Evaluative and investment body image, controlled regulation, and psychological well-being were assessed. Body image investment was positively associated with controlled regulation; evaluative body image was not. Controlled regulation was negatively associated with self-esteem and psychological functioning. Controlled regulation partially mediated the effects of body image investment on self-esteem, but did not mediate its effects on psychological functioning. Results suggest that dysfunctional body image investment might undermine well-being within overweight women, partly by increasing controlled regulation for entering obesity treatment. Discussion focuses on the importance of enhancing body image and autonomy during treatment to improve well-being and weight outcomes.     

My Disaster Recovery: a pilot randomized controlled trial of an Internet intervention

Abstract

This pilot study tested the efficacy of the My Disaster Recovery (MDR) website to decrease negative affect and increase coping self-efficacy. Fifty-six survivors of Hurricane Ike were recruited from a larger study being conducted at the University of Texas Medical Branch at the first anniversary of the storm. Restricted randomization was used to assign participants to the MDR website, an information-only website, or a usual care condition. Group×time interactions indicated that MDR reduced participant worry more than the other conditions. A similar trend was also identified for depression. Both websites were accessed a small to moderate amount and participants reported mixed satisfaction for both websites. Although the effect sizes for worry and depression were in the moderate to large range, small sample size and timing of the intervention qualify the findings. These preliminary findings encourage further evaluation of MDR with a larger, demographically diverse sample and indicate that the MDR website might be helpful in reducing worry and depression.     

My Disaster Recovery: a pilot randomized controlled trial of an Internet intervention

This pilot study tested the efficacy of the My Disaster Recovery (MDR) website to decrease negative affect and increase coping self-efficacy. Fifty-six survivors of Hurricane Ike were recruited from a larger study being conducted at the University of Texas Medical Branch at the first anniversary of the storm. Restricted randomization was used to assign participants to the MDR website, an information-only website, or a usual care condition. Group×time interactions indicated that MDR reduced participant worry more than the other conditions. A similar trend was also identified for depression. Both websites were accessed a small to moderate amount and participants reported mixed satisfaction for both websites. Although the effect sizes for worry and depression were in the moderate to large range, small sample size and timing of the intervention qualify the findings. These preliminary findings encourage further evaluation of MDR with a larger, demographically diverse sample and indicate that the MDR website might be helpful in reducing worry and depression.     

Impacts of exposure to images of ideal bodies on male body dissatisfaction: a review

Research suggests that young men's body dissatisfaction increases when they see images of attractive muscular men. This article provides the first extensive review of experimental studies exposing men to advertisements or commercials featuring idealized male bodies. Impacts on body dissatisfaction were evaluated by calculating and analyzing effect sizes from 15 studies. The effect sizes indicate that exposure to images of idealized male bodies has a small but statistically significant negative impact on men's body dissatisfaction. Three studies suggest that young men who are dissatisfied with their bodies are at increased risk for negative self-evaluations when exposed to idealized images. Two studies suggest that men who are satisfied with their bodies may be protected against negative impacts from seeing such images.     

A controlled trial of an internet-based intervention program for cannabis users

In the last decade, several programs for the treatment of cannabis-related disorders were developed. Until now, no information is available on the efficacy of Internet-based counseling approaches for this target group. This article describes the evaluation of "quit the shit," a web-based intervention developed to help young people to quit or reduce their cannabis use significantly. Cannabis users seeking web-based treatment were included in a two-arm controlled trial conducted on a website for drug-related information and prevention. After the baseline assessment, members of the treatment condition were randomized to a 50-day intervention program. Other trial participants were put on a waiting list. A post-test was conducted 3 months after randomization. Of all 1,292 subjects included in the trial, a total of 206 participants took part at the post-test. Per-protocol- and intention-to-treat analyses were conducted. Members of the treatment condition showed a significantly stronger reduction in cannabis use (primary outcome) than the control group. In the per-protocol analyses, moderate-to-strong effects were found for the reduction of the frequency and the reduction of the quantity of consumed cannabis. Small-to-moderate effects were observed on the secondary outcomes (use-related self-efficacy, anxiety, depression, and life satisfaction). Despite limitations concerning the interpretation of the results, the intervention seems to offer an effective treatment option for persons with cannabis-related problems.     

Thinking meta-theoretically about the role of internalization in the development of body dissatisfaction and body change behaviors

Internalization of societal standards of physical attractiveness (i.e., internalization of the thin ideal for women and internalization of the mesomorphic ideal for men) is a widely studied and robust risk factor for body dissatisfaction and maladaptive body change behaviors. Substantial empirical research supports internalization as both a mediator and a moderator of the relation between societal influences and body dissatisfaction. In this paper, a primer on mediation and moderation is followed by a review of literature and discussion of the extent to which internalization can theoretically fulfill the roles of both mediation and moderation. The literature review revealed a stark contrast in research design (experimental versus non-experimental design) when alternate conceptualizations of internalization are adopted. A meta-theoretical, moderated mediation model is presented. This model integrates previous research and can inform future empirical and clinical endeavors.     

Cue exposure and response prevention with alcoholics: a controlled trial

Ten severely alcohol-dependent subjects were divided into two groups, one of which received only 6 sessions of in-vivo cue exposure and response prevention and the other of which received 6 sessions of imaginal cue exposure, followed by 6 sessions of in-vivo cue exposure and response prevention. The in-vivo cue exposure produced significant decrements on behavioural and subjective measures for both experimental groups on Desire to Drink and Difficulty to Resist Alcohol. Imaginal cue exposure produced trivial changes on these measures. The implications for both theory and practice are discussed.     

Mediators of the relationship between media literacy and body dissatisfaction in early adolescent girls: Implications for prevention

This study examined in young adolescent girls the fit of a theoretical model of the contribution of media literacy to body dissatisfaction via the mediating influences of internalisation of media ideals and appearance comparisons. Female Grade 7 students (N = 469) completed self-report assessments of media literacy, internalisation, appearance comparisons, body dissatisfaction, and media exposure. Strong, significant inverse associations between media literacy and body dissatisfaction, internalisation, and appearance comparisons were observed. Path analysis revealed that a slightly modified revision of the model provided a good fit to the data. Specifically, body dissatisfaction was influenced directly by appearance comparisons, internalisation, and body mass index, and indirectly by media literacy and media exposure. Indirect pathways were mediated by appearance comparisons and internalisation. Thus, a relationship between media literacy and eating disorder risk factors was observed. Findings may explain positive outcomes of media literacy interventions in eating disorder prevention.     

Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy.

OBJECTIVE: Compare the efficacy of a multicomponent social support intervention to standard-of-care counseling on medication adherence among HIV-infected patients initiating antiretroviral therapy. DESIGN: Randomized controlled trial. Generalized estimating equations tested for differences in the percentage of participants achieving 90% adherence. MAIN OUTCOME MEASURES: Pill-taking, electronically monitored over 6 consecutive months; plasma viral load (VL), assessed at 3 and 6 months following initiation of therapy. RESULTS: Of 226 participants who were randomized and began the trial, 87 (38%) were lost to the study by 6 months. The proportion of adherent participants declined steadily over time, with no time by group interaction. Sustained adherence was associated with increased odds of achieving an undetectable VL (OR=1.78; 95% CI=1.01, 3.13). In intention-to-treat analyses, a larger proportion of the intervention group than the control group was adherent (40.15% vs. 27.59%, p=.02) and achieved an undetectable VL p=.04). However, the majority of participants who remained on study experienced some reduction in VL (>or=1-log drop or undetectable), regardless of experimental condition. CONCLUSION: The multicomponent social support intervention significantly improved medication adherence over standard-of-care counseling; evidence for improved virologic outcomes was inconsistent. Early discontinuation of care and treatment may be a greater threat to the health of HIV patients than imperfect medication-taking.     

No body is perfect: the significance of habitual negative thinking about appearance for body dissatisfaction, eating disorder propensity, self-esteem and snacking

Thinking negatively about one's appearance may be a major source of unhappiness. It was investigated whether the habitual quality of negative body image thinking constitutes an additional vulnerability factor, i.e. when such thinking is repetitive and automatic. The cognitive content of negative body image thinking ('what') was distinguished from the habitual occurrence of such thinking ('how'). The mental habit component uniquely predicted explicit as well as implicit body dissatisfaction (the latter measured by an implicit association test) over and above cognitive content. Mental habit also accounted for eating disturbance propensity, low self-esteem and restrained snacking behaviour over and above cognitive content, even when controlled for body dissatisfaction. The habitual component of negative thinking about appearance thus seems a significant body image construct, has discriminant validity against body dissatisfaction, and constitutes a vulnerability factor for feelings of low self-worth and eating disturbance propensity. Implications for intervention strategies, such as mindfulness-based approaches, are discussed.     

Media exposure, mood, and body image dissatisfaction: an experimental test of person versus product priming

In the current study, 138 college females were randomly assigned to four media exposure conditions based on the presence or absence of an attractive person (fashion model) and the presence or absence of an appearance-related product. Outcome measures consisted of visual analogue ratings of multiple body image and mood variables. The results revealed a significant main effect for person, indicating that the presence of a model increased levels of body dissatisfaction and negative mood. No product effect emerged and there was no significant interaction between person and product. These findings suggest that the appearance priming effect of media exposure on body dissatisfaction and mood is specific to a person stimulus, with no additional effect promoted by a generic appearance-relevant stimulus.     

A longitudinal study of body dissatisfaction and pubertal timing in an ethnically diverse adolescent sample

In a 7-year study, adolescents’ body dissatisfaction (N = 1370) was examined across four high school years as a function of pubertal development (perceived timing relative to peers and self-reported physical changes measured during Grades 6–10) in the context of the high school transition. Boys and girls who, during early high school, perceived themselves to be late relative to peers were at risk for body dissatisfaction across the high school years. Boys who were late in pubertal development reported more body dissatisfaction in early high school than on-time boys, but then decreased over time. African-American girls reported less body dissatisfaction across the high school years relative to other girls. Asian girls reported more dissatisfaction in early high school than African-American, Latina, and Multiethnic girls, and increased over time. Results highlight the importance of considering late development within context as a risk factor in body dissatisfaction research.     

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.     

Internet use among Chinese college students: implications for sex education and HIV prevention.

The Internet has gained great popularity among Chinese college students, but studies on Internet use behaviors and their relationship with sexual risk perception and behaviors have been limited. A survey was conducted among 1,845 college students in an eastern province of China, in order to assess the pattern of Internet use among Chinese college students, to examine the relationship of Internet use and HIV knowledge and susceptibility, and to explore the relationship of online risk behaviors with sexual status, sexual intention, and sexual perceptions. Data suggest that many students used the Internet frequently and often spent long hours online. Differences between genders and across grades were observed in the patterns of students' Internet use. Male students reported much higher rates of visiting pornographic websites or engaging in other online risk behaviors. Students' HIV knowledge or susceptibility did not differ by the extent of Internet use, but online risks were positively associated with their sexual status, sexual intention, and sexual perceptions. Students who were sexually active, planned to have sex, or possessed permissive attitudes toward pre-marital sex were more likely to report online risk behaviors such as visiting pornographic sites, cyberbullying, or distributing erotic materials via the Internet. The data underscore the importance to provide students with appropriate guidance on their Internet use, especially for reducing online risks and utilizing Internet as a source for sex education and HIV prevention.     

Effects of an indicated cognitive-behavioral depression prevention program are similar for Asian American, Latino, and European American adolescents

The authors tested whether a brief indicated cognitive-behavioral depression prevention program produced similar effects for Asian American, Latino, and European American adolescents (M age = 17.3, SD = 1.6) with elevated depressive symptoms using data from two randomized trials. The first trial involved 37 Asian-American/Pacific Islanders, 32 Latinos, and 98 European Americans and the second trial involved 61 Latinos and 72 European Americans. Reductions in depressive symptoms from pre- to post-intervention and from pre to 6-month follow-up for intervention participants versus assessment-only controls did not differ significantly for the various ethnic groups in either trial, despite sufficient power to detect clinically meaningful differences. These findings suggest that this indicated depression prevention intervention is similarly efficacious for Asian American, Latino and European American adolescents.     

Body dissatisfaction and body change behaviors in Chile: the role of sociocultural factors

With interest in body image and body change behaviors growing around the world, there has been surprisingly little research conducted in Latin America on these issues. In order to gain some understanding of them in this context, this study investigated body image and body change behaviors, and the sociocultural factors that may influence them, among 337 Chilean adolescents aged 12–18 years. Participants completed a questionnaire that assessed BMI, body dissatisfaction, strategies to lose weight and strategies to increase muscle bulk. In addition, perceived pressure from family, peers, and the media to change body shape was evaluated. Results were partially consistent with those reported in Western nations. Girls were found to report greater body dissatisfaction than boys, but no difference was found between males and females in perceived pressure from adults in the family or from older siblings/cousins to lose weight. However, girls experienced higher levels of perceived pressure to lose weight from the media than boys, and boys reported greater perceived pressure from peers to lose weight than girls, and more pressure than girls from all sources to increase muscle bulk. These findings are discussed in relation to research conducted in other contexts, and it is concluded that findings from other locations may not be applied universally.     

Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder

This randomized controlled trial compared the effectiveness of metacognitive therapy (MCT) and intolerance-of-uncertainty therapy (IUT) for generalized anxiety disorder (GAD) in an outpatient context. Patients with GAD (N = 126) consecutively referred to an outpatient treatment center for anxiety disorder were randomly allocated to MCT, IUT, or a delayed treatment (DT) condition. Patients were treated individually for up to 14 sessions. Assessments were conducted before treatment (pretreatment), after the last treatment session (posttreatment), and six months after treatment had ended (follow-up). At posttreatment and follow-up assessments, substantial improvements were observed in both treatment conditions across all outcome variables. Both MCT and IUT, but not DT, produced significant reductions in GAD-specific symptoms with large effect sizes (ranging between 0.94 and 2.39) and high proportions of clinically significant change (ranging between 77% and 95%) on various outcome measures, and the vast majority of the patients (i.e., 91% in the MCT group, and 80% in the IUT group) no longer fulfilled the diagnostic criteria for GAD. Results further indicate that MCT produced better results than IUT. This was evident on most outcome measures, and also reflected in effect sizes and degree of clinical response and recovery.     

A randomized trial of skin cancer prevention in aquatics settings: the Pool Cool program.

Skin cancer is increasing, and prevention programs are essential. This study evaluated the impact of a skin cancer prevention program on sun-protection habits and swimming pool environments. The intervention included staff training; sun-safety lessons; interactive activities; providing sunscreen, shade, and signage; and promoting sun-safe environments. A randomized trial at 28 swimming pools in Hawaii and Massachusetts tested the efficacy of this program (Pool Cool) compared with an attention-matched injury-prevention control program. Results showed significant positive changes in children's use of sunscreen and shade, overall sun-protection habits, and number of sunburns and improvements in parents' hat use, sun-protection habits, and reported sun-protection policies and environments. Observations corroborated the positive findings. Pool Cool had significant positive effects at swimming pools in diverse audiences.