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Attrition from self-directed interventions: Investigating the relationship between psychological predictors, intervention content and dropout from a body dissatisfaction intervention
Abstract
The aims of this study were to (a) identify the predictors of attrition from a fully self-directed intervention, and (b) to test whether an intervention to increase gratitude is an effective way to reduce body dissatisfaction. Participants (N=479, from the United Kingdom) aged 18-76 years took part in a self-help study via the Internet and were randomized to receive one of two interventions, gratitude diaries (n=130), or thought monitoring and restructuring (n=118) or a waitlist control (n=231) for a two week body dissatisfaction intervention. The gratitude intervention (n=40) was as effective as monitoring and restructuring (n=22) in reducing body dissatisfaction, and both interventions were significantly more effective than the control condition (n=120). Participants in the gratitude group were more than twice as likely to complete the intervention compared to those in the monitoring and restructuring group. Intervention content, baseline expectancy and internal locus of control significantly predicted attrition. This study shows that a gratitude intervention can be as effective as a technique commonly used in cognitive therapy and is superior in retaining participants. Prediction of attrition is possible from both intervention content and psychological variables.
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“In a study of an online body dissatisfaction intervention, participants who completed a gratitude diary were twice as likely to complete the intervention compared with a thought-monitoring and cognitive-restructuring group [31].”
From Disseminating Self-Help: Positive Psychology Exercises in an Online Trial (2012) · cites this paper as [31]
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Fernandes, D. V., Monteiro, F., Canavarro, M. C., & Moreira, H. (2022) · Mindfulness · doi:10.1007/s12671-022-02016-0 · Cited by 35
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Blom, K., Jernelöv, S., Lindefors, N., & Kaldo, V. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.03.004 · Cited by 33
“This is in line with previous research looking into adherence to CBT (Kaldo et al., 2015b; El Alaoui et al., 2015; Geraghty et al., 2010; Matthews et al., 2013).”
ResultGratitude and Late Adolescents’ School Well-being: The Mediating Role of Materialism
Jiang, H., Sun, P., Liu, Y., & Pan, M. (2015) · Social Indicators Research · doi:10.1007/s11205-015-1007-5 · Cited by 39
Bremer, V., Chow, P. I., Funk, B., Thorndike, F. P., & Ritterband, L. M. (2020) · doi:10.2196/preprints.17738 · Cited by 29
“Furthermore, in a research setting, high dropout rates and, consequently, low exposure to digital content might affect the reported effects of a digital intervention and the validity of the results [11,12].”
BackgroundMacaskill, A. (2012) · The Journal of Positive Psychology · doi:10.1080/17439760.2012.702783 · Cited by 34
Wootten, A. C., Abbott, J.-A. M., Chisholm, K., Austin, D. W., Klein, B., McCabe, M., Murphy, D. G., & Costello, A. J. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.10.001 · Cited by 27
“This compares favourably to other internetbased self-help interventions for non-cancer patients (Geraghty et al., 2010; Klein et al., 2011; Lintvedt et al., 2013), with attrition being as high as 99% in some studies (Geraghty et al., 2010).”
ResultTong, E. M. W., & Oh, V. Y. S. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.628937 · Cited by 20
“Gratitude interventions have also been found to enable disengagement from negative cognitions (22).”
BackgroundO’Hara, L., Ahmed, H., & Elashie, S. (2021) · Body Image · doi:10.1016/j.bodyim.2021.02.006 · Cited by 27
Mofidi, T., El-Alayli, A. G., & Brown, A. A. (2014) · Journal of College Student Retention Research Theory & Practice · doi:10.2190/cs.16.3.b · Cited by 31
“In a study geared at increasing body satisfaction, Geraghty, Wood, and Hyland (2010) found that not only was a gratitude intervention successful, but those participating in the intervention were over twice as likely to stay with the program than participants enrolled in an equally effective…”
BackgroundDoes gratitude promote recovery from substance misuse?
Chen, G. (2016) · Addiction Research & Theory · doi:10.1080/16066359.2016.1212337 · Cited by 25
“Similarly, gratitude is a mental attitude that can be developed and learned through practice and patience (Geraghty et al. 2010).”
BackgroundCheung, E. O., Addington, E. L., Bassett, S. M., Schuette, S., Shiu, E. W., Cohn, M., Leykin, Y., Saslow, L. R., & Moskowitz, J. T. (2018) · JMIR Research Protocols · doi:10.2196/10494 · Cited by 25
“However, many Web-based interventions tend to suffer from poorer adherence and retention [37,46,47], and these issues can be exacerbated in depressed samples, potentially because of the specific psychological features of depression, including pessimism, low motivation, loss of energy, and impaired…”
BackgroundJournaling for self-care and coping in mothers of troubled children in the community
Kim‐Godwin, Y. S., Kim, S., & Gil, M. (2020) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2020.02.005 · Cited by 28
Geraghty, A. W. A., Stuart, B. L., Terluin, B., Kendrick, T., Little, P. S., & Moore, M. V. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.05.064 · Cited by 24
“Geraghty et al. / Journal of Affective Disorders 184 (2015) 198–204 199”
BackgroundSelf-citationUsing Gratitude to Promote Sport Injury–Related Growth
Salim, J., & Wadey, R. (2019) · Journal of Applied Sport Psychology · doi:10.1080/10413200.2019.1626515 · Cited by 24
None the wiser: Year-long longitudinal study on effects of adversity on wisdom
Dorfman, A., Moscovitch, D. A., Chopik, W. J., & Grossmann, I. (2021) · European Journal of Personality · doi:10.1177/08902070211014057 · Cited by 29
“Attrition between waves was compatible with typical attrition in clinical studies (Geraghty et al., 2010) and longitudinal surveys (Roberts et al., 2006).”
Beatty, L., Binnion, C., Kemp, E., & Koczwara, B. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3663-2 · Cited by 20
“However, one notable limitation of this research in both cancer and non-cancer populations is inconsistent adherence and high attrition [9], with noncompletion typically ranging from 30 to 60% [10, 11].”
BackgroundThe Good Enough Parenting early intervention schema therapy based program: Participant experience
Louis, J. P., Ortiz, V., Barlas, J., Lee, J. S., Lockwood, G., Chong, W. F., Louis, K. M., & Sim, P. (2021) · PLoS ONE · doi:10.1371/journal.pone.0243508 · Cited by 19
“Even where different interventions have been shown to be equally as effective in clinical outcomes in randomized controlled trials (RCTs), how effective they are in uncontrolled settings depends on factors such as disengagement and drop out that arise from patient experience [79].”
BackgroundSchweier, R., Romppel, M., Richter, C., & Grande, G. (2016) · Health Education Research · doi:10.1093/her/cyw019 · Cited by 21
Geraghty, A. W. A., Muñoz, R. F., Yardley, L., McSharry, J., Little, P. S., & Moore, M. V. (2016) · JMIR Mental Health · doi:10.2196/mental.5845 · Cited by 22
“Removing structured human guidance frequently results in low use, high attrition, and reduced effectiveness [5-7], leading some to call for unguided formats to be avoided [8].”
BackgroundSelf-citationThe Power and Practice of Gratitude
Bono, G., Krakauer, M. L., & Froh, J. J. (2015) · Wiley eBooks · doi:10.1002/9781118996874.ch33 · Cited by 19
Wood, A. M., & Johnson, J. (2016) · doi:10.1002/9781118468197.ch1 · Cited by 19
Self-citationInterventions efficaces en psychologie positive: Une revue systématique.
Sitbon, A., Shankland, R., & Martin‐Krumm, C. (2018) · Canadian Psychology/Psychologie canadienne · doi:10.1037/cap0000163 · Cited by 28
“Les interventions pourraient pour ce faire chercher à améliorer le locus de contrôle interne et les attentes en matière d’efficacité (Geraghty et al., 2010).”
BackgroundInfluential
Metadata
- Authors
- Geraghty, A. W. A., Wood, A. M., & Hyland, M. E.
- Affiliations
- University of Southampton (GB)
- University of Manchester (GB)
- University of Plymouth (GB)
- Corresponding author
- Geraghty, Adam W.A.
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2010-07
- Volume
- 71
- Issue
- 1
- Pages
- 30-37
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2150861271
- Cited by
- 241
- References
- 73
- Citations by year
- 2026: 3 · 2025: 13 · 2024: 14 · 2023: 16 · 2022: 24 · 2021: 16 · 2020: 23 · 2019: 12 · 2018: 11 · 2017: 11 · 2016: 28 · 2015: 25 · 2014: 17 · 2013: 8 · 2012: 7
- FWCI
- 9.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Stirling Online Research Repository (University of Stirling) (submittedVersion, public-domain)
- ePrints Soton (University of Southampton) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- attrition, dropout, self-guided intervention, body dissatisfaction, gratitude interventions, cognitive restructuring, online self-help, intervention content, locus of control, expectancy, participant retention, predictors of attrition
- MeSH terms
- Adolescent, Adult, Aged, Body Image, Female, Humans, Internal-External Control, Male, Middle Aged, Patient Dropouts, Personal Satisfaction, Psychotherapy, Self-Help Groups, Treatment Outcome, Internet, Young Adult
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