Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: Acute effectiveness of these delivery modalities.
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OBJECTIVE: Because independent trials have provided evidence for the efficacy and effectiveness of the dissonance-based Body Project eating disorder prevention program, the present trial tested whether clinicians produce the largest intervention effects, or whether delivery can be task-shifted to less expensive undergraduate peer educators or to Internet delivery without effect size attenuation, focusing on acute effects. METHOD: = 22.2 years, SD = 7.1) recruited at colleges in 2 states were randomized to clinician-led Body Project groups, peer-led Body Project groups, the Internet-based eBody Project, or an educational video control condition. RESULTS: Participants in all 3 variants of the Body Project intervention showed significantly greater reductions in eating disorder risk factors and symptoms than did educational video controls. Participants in clinician-led and peer-led Body Project groups showed significantly greater reductions in risk factors than did eBody Project participants, but effects for the 2 types of groups were similar. Eating disorder onset over 7-month follow-up was significantly lower for peer-led Body Project group participants versus eBody Project participants (2.2% vs. 8.4%) but did not differ significantly between other conditions. CONCLUSIONS: The evidence that all 3 dissonance-based prevention programs outperformed an educational video condition, that both group-based interventions outperformed the Internet-based intervention in risk factor reductions, and that the peer-led groups showed lower eating disorder onset over follow-up than did the Internet-based intervention is novel. These acute-effects data suggest that both group-based interventions produce superior eating disorder prevention effects than does the Internet-based intervention and that delivery can be task-shifted to peer leaders. (PsycINFO Database Record
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With the exception of the study by Vollert et al. which did not report outcomes, all trials of indicated Internet-based eating disorder prevention programs reported eating disorder risk reduction following the intervention.
“With the exception of the study by Vollert et al. [28] who focussed on the impact of recruitment strategies and did not report outcomes, all trials reported eating disorder risk reduction following the intervention [25–27, 29].”
All studies of indicated Internet-based eating disorder prevention programs used face-to-face assessments and two used external rewards (i.e., monetary compensation) which may prove difficult to implement in real-world settings.
“In addition, all studies used face-to-face assessments and two used external rewards (i.e., monetary compensation) [27, 29] which may prove difficult to implement in real-world settings.”
Other trials of online programs employed either face-to-face or telephone diagnostic interviews or an online validated structured self-report measure to exclude participants with an eating disorder.
“Other trials of online programs employed either face-to-face or telephone diagnostic interviews [25, 28] or an online validated structured self-report measure [29] to exclude participants with an eating disorder.”
Findings on the relationship between symptom severity and program engagement are mixed.
“other findings with regard to the relationship between symptom severity and program engagement are mixed [26, 29]”
Other studies of indicated prevention programs have broadened their criteria to include individuals with lower levels of weight concerns (e.g., WCS > 47) or body dissatisfaction only without any additional behavioural criteria.
“other studies of indicated prevention programs have broadened their criteria to include individuals with lower levels of weight concerns (e.g., WCS > 47; [25, 26]) or body dissatisfaction only without any additional behavioural criteria [29].”
Based on the current and previous research, it is likely that indicated Internet-based intervention outcome studies require large numbers of potential participants to be screened to achieve samples that meet certain eligibility criteria (i.e., 1500-4500 participants).
“Nevertheless, based on the current and previous research, it is likely that indicated Internet-based intervention outcome studies require large numbers of potential participants to be screened to achieve samples that meet certain eligibility criteria (i.e., 1500–4500 participants) [25, 28, 29].”
The proportion of interested individuals excluded due to severe eating disorder pathology in this study (51%) is markedly higher than in other indicated prevention trials (less than 15%).
“The majority of interested individuals (51%) were excluded due to their severe eating disorder pathology, in marked contrast to less than 15% in other indicated prevention trials [25, 27, 29].”
The online screening approach used in the current study is not without its limitations.
“although also employed in other indicated eating disorder prevention trials [25, 26, 29] the online screening approach used in the current study is not without its limitations.”
Attrition rates in the current trial were higher compared to indicated trials of StudentBodies and The Body Project, where assessment completion ranged from 63 to 91% at post-intervention.
“Thus, attrition rates was higher compared to indicated trials of StudentBodies and The Body Project, where assessment completion ranged from 63 to 91% at post-intervention [25–27, 29].”
In other studies with higher completion rates, participants were often provided with incentives for completing study assessments.
“in other studies with higher completion rates, participants were often provided with incentives for completing study assessments [27, 29]”
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- Authors
- Stice, E., Rohde, P., Shaw, H., & Gau, J. M.
- Affiliations
- Oregon Research Institute (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2017-09
- Volume
- 85
- Issue
- 9
- Pages
- 883-895
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC5578897
- OpenAlex
- W2607264478
- Cited by
- 103
- References
- 53
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 11 · 2023: 8 · 2022: 18 · 2021: 16 · 2020: 9 · 2019: 11 · 2018: 9 · 2017: 3 · 2016: 1
- FWCI
- 10.83
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH097720)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Keywords
- eating disorder prevention, dissonance-based intervention, Body Project, peer-led intervention, online intervention, task shifting, eating disorder risk factors, eating disorder onset, university students, group intervention
- MeSH terms
- Adolescent, Adult, Feeding and Eating Disorders, Body Image, Cognitive Dissonance, Female, Humans, Patient Education as Topic, Peer Group, Psychotherapy, Outcome Assessment, Health Care, Internet, Young Adult
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