Dissonance-based Intervention Research Articles

A pilot randomized trial of the body advocacy movement: a novel, dissonance-based intervention designed to target fear of weight gain and anti-fat bias in young adults

ABSTRACT The Body Advocacy Movement (BAM) is a novel, cognitive-dissonance-based intervention designed to target fatphobia and anti-fat bias as mechanisms to drive reductions in eating disorder (ED) risk. Previous dissonance-based programs (i.e. the Body Project; BP) have successfully targeted thin-ideal internalization as an intervention mechanism. As burgeoning research indicates that fatphobia and anti-fat bias may play a central role in the maintenance of ED pathology, a focused intervention designed to target these constructs could bolster prevention efforts. The aims of this pilot study include confirming acceptability and feasibility of BAM and developing preliminary estimates of its effects on intervention targets, along with benchmarking these effects against the BP intervention. BAM was found to be accepted by participants and feasible to facilitate in a peer-led model. Preliminary results from 50 participants (BAM: N = 26; BP: N = 24) reveal small-to-moderate pre-to-post intervention effects on fatphobia, anti-fat bias, thin-ideal internalization, and eating pathology, which dissipated at 8-week follow-up. The BAM intervention has the potential to supplement the existing suite of ED prevention programs by specifically targeting anti-fat bias, though additional testing in larger and more diverse samples is necessary to clarify its impact on both hypothesized risk mechanisms and ED outcomes.

Employing Dissonance-Based Interventions to Promote Health Equity Utilizing a Community-Based Participatory Research Approach and Social Network Analysis

The purpose of this paper is to examine and advocate for the consideration of relevant approaches that can be utilized to increase the effectiveness of cognitive dissonance-based interventions (DBIs) designed to promote health equity. Although DBIs informed by different paradigms have been reported to be effective in creating behavior change, particularly among at-risk populations, their long-term impacts on behavior change have apparently been difficult to sustain. We argue that a community-based participatory research (CBPR) approach could considerably improve the effectiveness and long-term impacts of DBIs by harnessing community strengths, increasing stakeholder participation, and facilitating collaborations and partnerships in the planning, implementation, and evaluation of such interventions. Then, we argue that the benefits of employing a CBPR approach in DBIs can be further enhanced when combined with an approach that intentionally utilizes Social Network Analysis (SNA). SNA applies powerful techniques to recognize the type of connections that hold a specific network together and identify that network’s key and influential stakeholders. We conclude by providing recommendations for the use of CBPR and SNA in DBIs and demonstrating the benefits of our recommendations, especially in the context of promoting health equity.

A Brief Online Cognitive Dissonance-Based Intervention to Reduce Consideration of Cosmetic Surgery and Improve Body Image Among Chinese Women

Across many cultures, women are evaluated based on their appearance, with narrow societal beauty ideals as the standard against which they are judged and, eventually, judge themselves. Women who internalize the beauty ideal are more likely to consider cosmetic surgery. Dissonance-based interventions targeting thin-ideal internalization are effective at preventing eating disorders and associated risk factors. In this study, we evaluated an online dissonance-based intervention targeting beauty-ideal internalization to reduce favorable attitudes toward cosmetic surgery among Chinese women. Chinese women who were dissatisfied with their appearance and who were considering cosmetic surgery were randomized to the intervention ( n = 127, Mage = 35.49) or to the educational brochure control condition ( n = 98, Mage = 32.97). Beauty-ideal internalization, favorable attitudes toward cosmetic surgery, facial appearance concerns, body satisfaction, and body appreciation were assessed at pretest, posttest, and 4-week follow-up. Intention-to-treat analyses showed that the intervention reduced beauty-ideal internalization and favorable attitudes toward cosmetic surgery at posttest, with small-to-medium effect sizes; however, effects were not sustained at follow-up. No effects were found for facial appearance concerns, body satisfaction, and body appreciation. This study provides preliminary evidence for the short-term efficacy of the dissonance-based intervention for reducing beauty-ideal internalization and favorable attitudes toward cosmetic surgery, and points to valuable directions for improvement. Additional online materials for this article are available on PWQ's website at http://journals.sagepub.com/doi/suppl/10.1177/03616843231183946 .

Counter-attitudinal intervention decreased positive attitudes and behavioral tendencies towards video games

Based on Festinger's theory of cognitive dissonance, this study aimed to explore whether arousing cognitive dissonance among game players can alter their attitudes and behavioral tendencies towards their favorite games. Sixty-six college students (Study 1) and 108 primary school students (Study 2) were randomly divided into a game-related dissonance group and a snack-related dissonance group to perform a short-term counter-attitudinal self-persuasion intervention task. The results suggested that college and primary school students in the game-related dissonance group experienced a significantly higher decrease in positive attitudes towards games and behavioral tendencies to continue playing games than those in the snack-related dissonance group. The participants' attitudinal change toward the games played a mediating role in the effects of the counter-attitudinal intervention on their changes in the behavioral tendency to continue playing the games. In addition, there was a significantly higher game-related dissonance-based intervention effect in the sample of college students than in the sample of primary students. The findings expanded the application of cognitive dissonance in the gaming field and provided implications for educational computer systems to change the attitudes and behaviors of students with excessive gaming behaviors.

Treatment Approaches to Eating Disorders Among LGBTQIA+ Population: A Narrative Review

IntroductionHistorically, eating disorders (ED) have been regarded as the diseases of heterosexual, affluent white women. Instead, research shows that the population most at risk of ED is lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/aromantic/agender (LGBTQIA+). Indeed, in addition to many of the same sociocultural influences on body dissatisfaction faced by their peers, LGBTQIA+ individuals experience unique body- and gender-related concerns as well as high levels of stress due to interpersonal prejudice and discrimination.ObjectivesThis narrative review presents an overview of current research on treatment approaches to ED among LGBTQIA+ individuals.MethodsWe conducted a PubMed search for studies published after 1990 using terms that aimed to represent the primary concepts of “eating disorder” and “LGBTQIA+” and “therapy.” Next, we inductively created relevant macro-themes by synthesizing the data from the included articles.ResultsOf 123 PubMed studies, we included 12 studies and identified three relevant macro-themes. The first macro-theme, “ordinary treatments,” focused on efficacy studies of conventional ED therapies applied to this category of patients. In particular, the first study proved the efficacy of the dissonance-based intervention, engaging participants to induce cognitive dissonance concerning the thin-ideal standard of beauty; the second study showed that sexual minorities patients accessing day hospital treatment reported greater overall ED and comorbid symptoms but started treatment with higher scores and improved at a faster rate compared to heterosexual patients; the third study provided evidence that transgender/nonbinary individuals and cisgender individuals showed similar improvement in ED symptoms during higher levels of care treatment, but the first group had less improvement in depression and no improvement in suicidality during ED treatment. The second macro-theme, “relational approach,” investigated newer treatment paradigms involving family and school support, both revealing positive implications for eating and weight-related behaviors. The third macro-theme, “gender-affirming therapy,” focused on medical and surgical treatment toward gender transition, which has been shown to correlate with improvements in body image, ED psychopathology, and psychological functioning.ConclusionsMembers of the LGBTQIA+ community are at greater risk for ED; to our knowledge, there is no targeted treatment that considers the entirety of their experience. These findings denote the need to focus future research efforts on effective treatment strategies specific to sexual and gender identity groups.Disclosure of InterestNone Declared

An Examination of a Cognitive Dissonance Body Image and Health Intervention for the College Classroom

Creating a positive college environment regarding body image concerns is warranted given their strong association with eating disorders (EDs) and the alarming rates of EDs on college campuses. There is also a growing need to universally diversify ED prevention programs and enhance selective prevention recruitment initiatives. This study included 132 undergraduate students in a universal and mixed-gendered setting (i.e., classrooms). Participants in the intervention condition received a single session of an adapted cognitive dissonance-based intervention aimed at reducing ED risk factors. The control condition included participants who received a general classroom lecture. Women and men in the two conditions were compared at pre-intervention, post-intervention, and 1-month follow-up timepoints on appearance-ideal internalization (thin-ideal and muscular-ideal), body image satisfaction, and behavioral intention to enroll in a selective ED prevention program, known as The Body Project (BP). Using mixed-effects modeling, results showed that women in the intervention condition significantly lowered muscular-ideal internalization scores at follow-up when compared to the control condition. There were no significant differences across all other variables, which suggests that the single session universal intervention was not effective in reducing body image dissatisfaction or triaging participants into The BP. Implications include further exploration of muscular-ideal internalization in ED development for women and the examination of other underlying dimensions of body image, such as internalized weight stigma and body functionality. Mixed-gendered settings might also benefit from cultivating conversations regarding the social injustices of beauty standards. These adjustments may help enhance the levels of cognitive dissonance experienced by participants.

Efficacy of a multivitamin adherence program based on cognitive dissonance for bariatric patients: A randomized controlled trial.

Micronutrient deficiencies are common among bariatric patients; this study aimed to determine whether a cognitive dissonance-based virtual program improved adherence to multivitamin use in bariatric patients from northern Mexico. A randomized controlled trial of the supplementation strategy was conducted over three months. The participants were randomized to an intervention or waitlisted control group and received two psycho-educative and four cognitive dissonance virtual sessions. Multiple linear regression was used to determine standardized estimates of associations between the intervention and dependent variables. Two path analyses were evaluated considering baseline and post-test measurements. Intervention was associated with higher concentrations of Hb (β=0.758, p<0.001), vitamin D (β=0.577, p<0.001), iron (β=0.523, p<0.001), folate (β=0.494, p<0.01), calcium (β=0.452, p<0.01), higher adherence (β=0.467, p<0.001), and level of knowledge (β=0.298, p<0.05. The dissonance-based intervention potentiated the level of supplementation adherence. A higher level of adherence was reflected in micronutrient concentrations, thus providing confirmation of intervention. Thus, support is found for a multidisciplinary clinical practice that enhances nutrition status after bariatric surgery for obesity.

Physical activity in women attending a dissonance-based intervention after Roux-en-Y Gastric Bypass: A 2-year follow-up of a randomized controlled trial.

The majority of Roux-en-Y gastric bypass (RYGB) patients are not sufficiently physically active post-surgery, yet little support from the Swedish healthcare system is offered. We investigated if a dissonance-based group intervention, aiming to increase health-related quality of life after surgery, had any effect on patients' physical activity two years post-RYGB. Women undergoing RYGB surgery were recruited from five Swedish hospitals and randomized to intervention or control group (standard post-surgery care). The dissonance-based intervention was conducted three months post-RYGB and consisted of four group sessions, each with a specific topic, of which one addressed physical activity. ActiGraph GT3X+ accelerometers were used to measure physical activity at pre-RYGB, one- and two-years post-surgery. At pre-RYGB, 259 women were recruited and randomized (intervention n = 156 and control n = 103). Participants had a mean age of 44.7 years (SD 10.3) and pre-RYGB body mass index of 40.8 (SD 4.5) kg/m2. At two-years follow-up, 99 participants (63.5%) in intervention group and 68 (66.0%) in control group had valid accelerometer-measurements. Pre- to post-surgery increases were seen in all physical activity outcomes, but no statistically significant differences between the groups were observed at the two-years follow-up, and intervention effects were poor (d = 0.02-0.35). To our knowledge, this is the first dissonance-based intervention targeting women undergoing RYGB surgery. At two-years follow-up, we did not observe any differences in physical activity levels between the intervention group and control group. Trial registration number: ISRCTN16417174.

Effects of internet-delivered eating disorder prevention on reward-based eating drive: A randomized controlled trial

ObjectiveThis study is a secondary analysis testing the effects of an internet eating disorder prevention program on reward-based eating drive in a high-risk sample of college-aged women. MethodWe analyzed data from 278 women who were randomized to internet dissonance-based intervention (DBI-I), internet cognitive-behavioral treatment (CBTI), or no intervention (NI). Both active conditions consisted of self-guided activities completed over the course of four weeks. Linear mixed effects modeling was used to test the effect of internet intervention on reward-based eating drive. ResultsDBI-I was associated with greater reductions in reward-based eating over time than NI. No other Condition × Time effects were found. DiscussionThe results provide preliminary support for DBI-I as a strategy for reducing reward-based eating drive in a high-risk population relative to no intervention.

Here I sit, making men in my own image: how learning disorder labels affect teacher student’s expectancies

Teacher’s evaluation of students is sometimes negatively affected by diagnostic labels. We explored such negative effects caused by the labels “dyscalculia”, “dyslexia”, and “ADHD” in teacher students. In Experiment 1, we varied the presence of the dyscalculia and dyslexia label in vignettes between participants. The dyslexia but not the dyscalculia label had a negative effect on participant’s academic expectations. In our preregistered Experiment 2, the presence of the ADHD label in vignettes was manipulated within participants. To understand the cognitive mechanisms driving label effects, we explored participants’ attributions regarding the students’ problems. Furthermore, a short dissonance-based intervention for counteracting negative label effects was implemented. Unexpectedly, we found both negative and positive label effects. The label led to more positive performance expectations and to more negative ratings of problem stability and problem control. The dissonance-based intervention led to more positive evaluations regardless of whether the ADHD label was mentioned or not. Overall, our findings suggest that learning-disorder labels affect teachers’ expectations in different ways.

Dissonance-based eating disorder prevention improves intuitive eating: a randomized controlled trial for Brazilian women with body dissatisfaction.

Investigate the efficacy of a dissonance-based (DB) intervention (i.e., the Body Project), during which some examples of intuitive eating were provided by peer leaders, in improving intuitive eating and targeting risk and protective factors for eating disorders (ED) among Brazilian women with body dissatisfaction. Participants were randomized to a four-session DB intervention (n = 38) or assessment-only control (AOC) (n = 36), and completed validated measures assessing intuitive eating, body appreciation, self-esteem, body-ideal internalization, body dissatisfaction, negative affect, and disordered eating pre-intervention, post-intervention, and at 4- and 24-week follow-ups. The DB condition demonstrated significantly greater increases in intuitive eating, body appreciation and self-esteem scores compared to AOC from pre-intervention to post-intervention (between-condition Cohen's d = 0.73-0.98), 4-week (between-condition Cohen's d = 1.25-1.87) and 24-week follow-up (between-condition Cohen's d = 0.82-1.38). Also, the DB condition showed significantly greater decreases in body-ideal internalization, body dissatisfaction and disordered eating scores from pre-intervention to post-intervention (between-condition Cohen's d = 0.76-1.04), 4-week (between-condition Cohen's d = 1.27-1.71) and 24-week follow-up (between-condition Cohen's d = 1.04-1.19). Regarding negative affect, DB condition showed significantly greater reduction only at 24-week follow-up (between-condition Cohen's d = 0.60). Results reinforce the efficacy of DB interventions in reducing ED risk factors for young women and support the preliminary efficacy of these programs in improving intuitive eating, body appreciation, and self-esteem. Level I, randomized controlled trial. ReBEC (Brazilian Registry of Clinical Trials; available at http://www.ensaiosclinicos.gov.br/ ) number of registration: RBR-2f57cs. Date of registration: June 1, 2020.

Self-compassion and dissonance-based interventions for body image distress in young adult women

Self-compassion interventions have been suggested as a potentially more acceptable way to address body image distress compared to interventions that emphasize challenging (often firmly entrenched) thin-ideals. In the current randomized controlled trial, young adult women endorsing body image concerns were randomized to a self-compassion (SC) intervention consisting of one in-person session plus one week of self-guided practice (n = 50), a similarly-structured dissonance-based (DB) intervention (n = 50), or a waitlist (WL) control (n = 51). Both brief interventions were acceptable and were more effective than WL. The two interventions did not differ significantly from each other in reducing the global measure of body dissatisfaction, improving body appreciation, or reducing appearance-contingent self-worth. The DB intervention alone decreased thin-ideal internalization, but only among participants with initially high scores. More participants initially expressed a preference for the SC rationale, and at post-test SC participants reported a higher likelihood of recommending the intervention they had received to others. Change in self-compassion emerged as a possible mechanism of action within both interventions, suggesting it may be useful to integrate aspects of both approaches to enhance acceptability and provide the greatest benefits.

“I didn’t want to say something and them to go outside and tell everyone”: The acceptability of a dissonance-based body image intervention among adolescent girls in the UK

Cognitive dissonance-based interventions (CDIs) have been well established as effective programs for the prevention of eating disorders. However, limited research has qualitatively explored adolescent girls experience of such interventions. The present study examined the acceptability of a cognitive dissonance-based body image intervention among adolescent girls in UK secondary schools. Adolescent girls aged 14–18 years (N = 99; Mage = 14.87, SD = 0.97) who opted to participate in the intervention were invited to provide intervention feedback via open-ended questions and small focus groups. The findings suggest that the intervention was largely acceptable among adolescent girls. Peers played an important role. Despite initial concerns about sharing within the group, the groups provided a sense of belonging and participants no longer felt alone in their experience of body dissatisfaction. Participants discussed a transition from negative to positive body image following the intervention. Although acceptability was generally high, the data provides some interesting insights into potential considerations and modifications which may be advantageous in future CDIs. These include enhancing authenticity through reduced reliance on the script, inclusion of more personal content from the peer-leaders, and more interactive activities and physical movement.

Dissonance-based eating disorder prevention delivered in-person after an online training: A randomized controlled trial for Brazilian men with body dissatisfaction.

Few prevention programs have been developed and empirically evaluated to address eating disorder (ED) and muscle dysmorphia (MD) symptoms in men. Furthermore, new strategies for the broad implementation of available programs are needed. We investigated the acceptability and efficacy of a dissonance-based (DB) intervention for Brazilian undergraduate men with body dissatisfaction to target risk and protective factors for ED and MD symptoms (the Body Project: More Than Muscles) after an online training for facilitators. Participants were randomized to a two-session DB-intervention (n = 89) or assessment-only control (AOC) (n = 91), and completed validated measures assessing ED and MD risk and protective factors pre-intervention, post-intervention, and at 4- and 24-week follow-up post-intervention. Acceptability ratings were highly favorable. Regarding efficacy, the DB condition demonstrated significantly greater decreases in ED and MD risk factors compared to AOC from pre-intervention to 4-week (p-values <.05, between-condition Cohen's d = 0.35-1.10) and 24-week follow-up (p-values <.05, between-condition Cohen's d = 0.33-0.78). Results at post-intervention were not significant, with the exception that body appreciation showed significantly greater improvements in the DB condition (post-intervention: p < .01, between-condition Cohen's d = 0.40; 4-week: p < .001, between-condition Cohen's d = 0.80; and 24-week follow-up: p < .001, between-condition Cohen's d = 0.58). Results support the acceptability and efficacy of a DB-intervention delivered in-person after an online training for facilitators up to 24-week follow-up in Brazilian men.

Theory and Practice of Eating Disorder Prevention Program: A Dissonance-Based Intervention

Theory and Practice of Eating Disorder Prevention Program: A Dissonance-Based Intervention

Implicit and Explicit Anti‐Fat Attitude Change Following Brief Cognitive Dissonance Intervention for Weight Stigma

Research has demonstrated that explicit anti-fat attitudes decrease immediately following a brief cognitive dissonance-based intervention targeting weight stigma. The current study explores changes in explicit and implicit anti-fat attitudes immediately following a cognitive dissonance-based weight stigma intervention and 1 week after. College students (N = 156) were randomly assigned to a control or dissonance weight stigma intervention. Weight stigma attitudes were assessed at three time points, and participants completed a measure of values at baseline. Participants in the dissonance condition were told that they had anti-fat attitudes that were inconsistent with their values, whereas participants in the control group were told that their attitudes aligned with their values. All participants reviewed feedback at a follow-up visit before completing explicit and implicit weight stigma assessments a final time. Individuals in the dissonance condition reported statistically significant decreases in explicit attitudes from Visit 1 to Visit 3. In contrast, there was not a significant condition by time interaction on implicit attitudes. This study provides support for cognitive dissonance-based interventions to reduce explicit, but not implicit, anti-fat attitudes following repeated exposure to dissonance induction.

Food waste: Disapproving, but still doing. An evidence-based intervention to reduce waste at household

This action-research project conducted in partnership with French local public authorities aims at designing an intervention procedure to reduce food waste in households. To broach the complex problem of food waste reduction as a behavioral gap, we compared three interventions: a classical information-based intervention, an awareness-based intervention using a kitchen diary to make people aware of their own waste, and a dissonance-based intervention using principles of cognitive dissonance. Behavioral changes were estimated by weighing food waste and analyzing them (compositional analyses) one week before and after the interventions, and also five weeks later in order to comprehend middle-term effects. Results showed that dissonance-based intervention was the most efficient in actually reducing food waste, but only within a middle-term perspective. This delay could be necessary given the behavioral complexity of the global act of “reducing food waste”, known as the result of multiple and interacting activities taking place at different times and in different contexts.

Does cognitive dissonance occur in older age? A study of induced compliance in a healthy elderly population.

Does cognitive dissonance change as people age? Although cognitive dissonance has been one of the most widely studied theories in psychology, scant research has investigated the experience of dissonance over the life span and, to our knowledge, no prior research has investigated its effects in healthy older adults. The current study is the 1st empirical test of cognitive dissonance in an elderly population. We found that, consistent with dissonance theory, older adults showed effects of cognitive dissonance as measured by attitude differences in the direction of attitude-discrepant behavior in a classic induced compliance paradigm. Implications for the development of prohealth, dissonance-based interventions are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

One-year follow-up of a dissonance-based intervention on quality of life, wellbeing, and physical activity after Roux-en-Y gastric bypass surgery: a randomized controlled trial

BackgroundHealth-related quality of life (HRQoL) peaks around 1 year after Roux-en-Y gastric bypass (RYGB) surgery, and thereafter, in many patients, slowly deteriorates. ObjectivesThe aim of the present study was to test early effects (study endpoint 2 years) of a dissonance-based group intervention on HRQoL (primary outcome) and wellbeing among women who underwent RYGB: a 1-year follow-up of the WELL-GBP trial. SettingWomen were recruited from 5 different hospitals in Sweden pre-RYGB surgery. Participants were randomized to intervention or a control group (regular care). MethodsThe intervention consisted of 4 group sessions, 2 to 3 months post-surgery, comprising the following 4 different topics: (1) physical activity, (2) eating behavior, (3) social relationships, and (4) intimate relationships. Participants answered questionnaires about HRQoL (SF-36, Short-Form Health Survey), social adjustment, body esteem, eating behavior, and wore an accelerometer for 7 days at pre- and 1 year post-RYGB. ResultsTwo hundred fifty-nine women were recruited and 203 (78%) completed 1-year follow-up measurements. Mean body mass index pre-surgery was 40.8 (standard deviation = 4.5), mean age 44.7 (standard deviation = 10.3) years, and 61 of 120 women in the intervention group received the intervention according to protocol (≥3 group sessions). We observed no difference between the intervention and the control group at 1-year post-RYGB surgery. All scales improved in both groups from pre- to 1 year post-surgery. ConclusionsWe did not observe any 1-year early effects on HRQoL from a dissonance-based group intervention among female RYGB patients. Future studies may investigate long-term effects of the intervention.

A controlled trial of a dissonance-based eating disorders prevention program with Brazilian girls

BackgroundGiven that most young women with eating disorders do not receive treatment, implementing effective prevention programs is a public health priority. The Body Project is a group-based eating disorder prevention program with evidence of both efficacy and effectiveness. This trial evaluated the efficacy of this prevention program with Brazilian girls, as no published study has tested whether this intervention is culturally sensitive and efficacious with Latin-American adolescents.MethodsFemale students were allocated to a dissonance-based intervention (n = 40) or assessment-only (n = 22) condition. The intervention was a dissonance-based program, consisted of four group sessions aimed to reduce thin-ideal internalization. The sessions included verbal, written, and behavioral exercises. The intervention group was evaluated at pretest and posttest; assessment-only controls completed measures at parallel times.ResultsCompared to assessment-only controls, intervention participants showed a significantly greater reduction in body dissatisfaction, sociocultural influence of the media, depressive symptoms, negative affect, as well as significantly greater increases in body appreciation. There were no significant effects for disordered eating attitudes and eating disorder symptoms.ConclusionsThese results suggest that this dissonance-based eating disorder prevention program was culturally sensitive, or at least culturally adaptive, and efficacious with Brazilian female adolescents. Indeed, the average effect size was slightly larger than has been observed in the large efficacy trial of this prevention program and in recent meta-analytic reviews.Trial registrationRBR-7prdf2. Registered 13 August 2018 (retrospectively registered).