Improvements In Psychosocial Functioning Research Articles

Anhedonia predicts poor psychosocial functioning: Results from a large cohort of patients treated for major depressive disorder by general practitioners

BackgroundAnhedonia is a core symptom of major depression and a key prognostic factor that is often poorly explored in clinical trials of major depressive disorder (MDD). Beyond symptomatic remission, psychosocial functioning also reveals difficulty in achieving remission in patients with MDD. The main objective of this study was to explore the interrelationships between social functioning and anhedonia on a longitudinal basis. MethodsIn total, 1570 outpatients treated for MDD with agomelatine were included. Severity of depression and levels of anhedonia and of psychosocial functioning were assessed at inclusion and at 10–14 weeks, with specific standardized scales (MADRS, QFS, SHAPS, CGI). Multivariate regression and mediation analyses were performed. ResultsUsing multivariate regression, we showed that improvement of anhedonia was the strongest predictor of improvement in psychosocial functioning (odds ratio=7.3 [4.3–12.1] P<0.0001). In addition, mediation tests confirmed that the association between improvement of depressive symptoms and improvement of social functioning was significantly underpinned by the improvement of anhedonia over time. Finally, we explored the determinants of the dissociation of the response, i.e., the persistence of psychosocial dysfunctioning despite a symptomatic response to antidepressant treatment, which remains a widespread situation in clinical practice. We showed that this dissociation was strongly predicted by persistence of anhedonia. ConclusionOur results suggest that anhedonia is one of the strongest predictors of psychosocial functioning, along with symptomatic remission, and should be carefully assessed by health professionals, in order to optimize pharmacological as well as non-pharmacological management of depression.

Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients.

The goal of this study was to evaluate the relationship between early change in psychosocial function independent of depression severity and longer-term symptomatic remission. Participants of Combining Medications to Enhance Depression Outcomes trial were randomly selected for model selection (n = 334) and validation (n = 331). Changes in psychosocial function (Work and Social Adjustment Scale, WSAS) from baseline to week 6 were assessed and two data-driven sub-groups of WSAS change were identified in the randomly selected model selection half. Results of analyses to predict symptomatic remission at 3 and 7 months were validated for these sub-groups in the second half (validation sample). From baseline to week 6, psychosocial function improved significantly even after adjusting for depression severity at each visit and select baseline variables (age, gender, race, ethnicity, education, income, employment, depression onset before age 18, anxious features, and suicidal ideation), treatment-arm, and WSAS score. The WSAS change patterns identified two (early improvement and gradual change) subgroups. After adjusting for baseline variables and remission status at week 6, participants with early improvement in the second half (validation sample) had greater remission rates than those with gradual change at both 3 (3.3 times) and 7 months (2.3 times) following acute treatment initiation. In conclusion, early improvement in psychosocial function provides a clinically meaningful prediction of longer-term symptomatic remission, independent of depression symptom severity.

Continuation treatment with escitalopram reduces body dysmorphic disorder relapse

In what is believed to be the first relapse prevention study in body dysmorphic disorder (BDD), researchers found that 6 months of continuation treatment with escitalopram resulted in fewer relapses and an increased time to relapse when compared with placebo. However, patients receiving escitalopram in the study's continuation phase did not see significant improvement in psychosocial functioning or quality of life when compared with placebo patients, the researchers reported.

New models of care in IBD in changing times.

New models of care in IBD in changing times.

Meditation Awareness Training for Individuals with Fibromyalgia Syndrome: an Interpretative Phenomenological Analysis of Participants’ Experiences

Fibromyalgia syndrome (FMS) is a complex and poorly understood psychosomatic pain disorder. The illness has been the subject of controversy, both in terms of the alleged lack of interest and capability of the medical community to understand and support patients with FMS, and the burden that such individuals place upon economic and healthcare resources. Due to the lack of convincing data for the effectiveness of extant pharmacological and non-pharmacological FMS treatments, a recent direction in FMS research has been the empirical investigation of mindfulness and other meditation-based approaches. The present qualitative study explored whether following participation in a mindfulness-based intervention, patients with FMS report experiencing changes in (i) how they experience and relate to their illness and (ii) their attitudes towards societal participation, work and unemployment. Ten individuals with FMS were randomly selected from the intervention arm of a randomised controlled trial (RCT) evaluating the effectiveness of a mindfulness-based intervention known as Meditation Awareness Training (MAT) for the treatment of FMS. Transcripts of semi-structured interviews were analysed using Interpretative Phenomenological Analysis, a robust and rigorous qualitative methodology for analysing subjective experiences. Five super-ordinate themes emerged from the dataset: (i) reservations about participating, (ii) improvements in psychosomatic well-being, (iii) spiritual growth, (iv) awareness of impermanence and (v) increased sense of citizenship. MAT was experienced as both an acceptable and accessible intervention by individuals with FMS, and participants reported experiencing improvements in psychosocial functioning as well as an increased sense of societal responsibility. MAT appears to have utility for treating FMS and for changing the attitudes of some individuals with FMS towards community engagement and societal contribution.

Guided Internet-Based Self-Help Intervention for Social Anxiety Disorder With Videoconferenced Therapist Support

We describe the development of a novel, Internet-based, self-help intervention for social anxiety disorder (SAD) in adults, and report data on the preliminary efficacy of the program when administered with minimal therapist support delivered via a common videoconferencing platform. Participants (n=13) completed the intervention, which consists of 8 weekly modules and a brief weekly videoconferenced check-in with a therapist. The intervention program is derived from an acceptance-based CBT program that utilizes traditional behavioral interventions (e.g., exposure) within the context of a model emphasizing mindful awareness and psychological acceptance of distressing subjective experiences. Assessments revealed that participants experienced a significant reduction in SAD symptoms and improvements in psychosocial functioning, and that treatment gains were maintained over a 3-month follow-up period. The effect sizes for the main outcome measures were large to very large (d=0.90 to 1.47), and comparable to other Internet-based treatment programs as well as in-person trials for SAD (e.g., Feske & Chambless, 1995; Tulbure, 2011). Participants also rated the treatment program as highly acceptable. This pilot study provides preliminary evidence that an Internet-based intervention grounded in basic behavioral and acceptance-based principles is effective for the treatment of SAD, and that videoconferenced therapist support may be useful in enhancing treatment compliance. Implications and future directions are discussed.

Randomized trial on the effectiveness of long- and short-term psychotherapy on psychosocial functioning and quality of life during a 5-year follow-up

Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term therapy in treating mood and anxiety disorder, when measured by improvements in psychosocial functioning and life quality. In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP), and followed up for 5 years from the start of treatment. The outcome measures comprised 4 questionnaires on psychosocial functioning, assessing global social functioning (Social Adjustment Scale (SAS-SR), sense of coherence (Sense of Coherence Scale (SOC)), perceived competence (Self-Performance Survey), dispositional optimism (Life Orientation Test (LOT)), and 1 questionnaire assessing quality of life (Life Situation Survey (LSS)). Short-term therapies improved psychosocial functioning and quality of life more than LPP during the first year. The only exceptions were LOT and perceived competence, which did not differ between SPP and LPP. Later in the follow-up, SOC and perceived competence showed significantly more improvement in LPP than in the short-term therapy groups. No direct differences between SFT and SPP were noted. Short-term therapy has consistently more short-term effects on psychosocial functioning and quality of life than LPP, whereas LPP has some additional long-term benefits on psychosocial functioning.

Are There Distinctive Outcomes from Self-Exclusion? An Exploratory Study Comparing Gamblers Who Have Self-Excluded, Received Counselling, or Both

Research has not determined whether typical improvements in psychosocial functioning following self-exclusion are due to the intervention. This study aimed to explore distinctive outcomes from self-exclusion by assessing outcomes between 1) self-excluders who had and had not received gambling counselling and 2) self-excluders compared to non-self-excluders who had received gambling counselling. A longitudinal design administered three assessments on gambling behaviour, problem gambling severity, gambling urge, alcoholism, general health, and harmful consequences. Of the 86 participants at Time 1 with similar baseline scores, 59.3 % completed all assessments. By Time 2, all groups (self-excluded only, self-excluded plus counselling, counselling only) had vastly improved on most outcome measures. Improvements were sustained at Time 3. Outcomes did not differ for self-exclusion combined with counselling. Compared to non-excluders, more self-excluders abstained from most problematic gambling form and fewer had harmful consequences. Findings suggest self-exclusion may have similar short-term outcomes to counselling alone and may reduce harm in the short-term.

Project connect online: user and visitor experiences of an Internet-based intervention for women with breast cancer.

This study's purpose was to characterize the experience of patients with breast cancer randomly assigned to the intervention arm of Project Connect Online (PCO), a randomized controlled trial of an Internet-based intervention, and to examine relationships between website use variables and psychosocial outcomes. In the larger PCO trial, patients with breast cancer (n = 88) were randomly assigned to an intervention or a waiting-list control. This report pertains to the 46 women in the intervention arm, a 3-h workshop for creation of personal websites with a blog function to communicate with their interpersonal network and chronicle their breast cancer experience. Participants completed assessments at 1 and 6 months. Visitors to the websites (n = 66) completed an online questionnaire. Reactions to website use were positive, although lack of time was a barrier for some. Women with advanced cancer were more likely to use their websites. Women found the websites useful for telling the story of their experience and expressing emotions. Positive word use was associated with heightened positive mood at 6 months; negative word use was associated with improved depressive symptoms. Visitors were most commonly female friends of participants who valued the websites as a way to connect emotionally with participants and receive information about their health. Specific aspects of patients' blogs predicted improvements in psychosocial functioning. Personal websites can help women with breast cancer construct a narrative of their experience, express emotions, and receive the social support they need, particularly from friends and extended family.

The impact of comorbid depression on recovery from personality disorders and improvements in psychosocial functioning: Results from a randomized controlled trial

Depressive disorders often co-occur with personality disorders. The extent to which depressive disorders influence treatment outcome in personality disorders remains unclear. The aim of this study was to determine the impact of co-morbid depression on recovery from personality disorders and improvements in psychosocial functioning. This study drew data from a randomized-controlled trial in which patients (N = 320) with cluster-c (92%), paranoid, histrionic and/or narcissistic personality disorders received schema-therapy, treatment-as-usual, or clarification-oriented psychotherapy. Recovery from personality disorders at three-year follow-up and improvements in psychosocial functioning over a course of three years was predicted by the diagnostic status of depressive disorders at baseline using mixed model regression analyses. Based on the number of axis-I and axis-II disorders, personality disorder severity and global symptomatic distress and functioning a baseline severity index was computed and included in subsequent analyses to test the specificity of baseline depression in predicting outcomes. Patients with co-occurring depression reported higher baseline severity compared to patients without co-occurring depression. Depression at baseline was associated with lower recovery rates at three-year follow-up (p = 0.01) but this effect disappeared after controlling for baseline severity. Patients with depression at baseline reported higher psychosocial impairments throughout treatment (p < 0.001). Depression at baseline did not moderate treatment effects except for one psychosocial outcome measure. In conclusion, depression is associated with lower recovery rates from personality disorders but this effect disappears when general severity is taken into account. Patients with primarily cluster-c personality disorders and co-occurring depression might benefit from additional depression treatment in terms of improved psychosocial functioning.

Social and psychological functioning of opiate dependent patients in methadone maintenance treatment – longitudinal research report

IntroductionSubstitution treatment is recommended by the WHO as an effective form of curbing and abstaining from opiate use and improvement of psychosocial functioning of drug addicted persons. It was positively demonstrated that this treatment leads to abstinence from illegal drugs and reduction of harm of use. However, despite the long-term application of this form of treatment, and despite various studies on changes occurring under its influence, still little is known about what changes occur in patients participating in substitution treatment. For this reason, the aim of the present research analysis was to determine what changes appeared in cognitive emotion regulation strategies, sense of coherence, intensity of psychopathological symptoms and level of developmental task completion in the patient group. MethodThe longitudinal study procedure was applied. Opiate addicts were studied twice – first when on starting therapy and second after six months of participation. The research was conducted at five substitution treatment centres in Poland. The first research stage included 37 subjects addicted to opiates, and the second 22 persons after 6 months of substitution treatment. ResultsAfter six months of methadone treatment, patients displayed a statistically significant change in sense of coherence. The respondents believed life to be more understandable, predictable and meaningful. A significant increase in the realisation of all developmental tasks was also observed, but not of specific tasks. There were no significant changes in cognitive emotional regulation strategies and intensity of psychopathological symptoms.

Evaluation of a new person-centered integrated care model in psychiatry.

The present study evaluated a new integrated treatment concept offering inpatient care, acute psychiatric day hospital and outpatient treatment by the same therapeutic team. 178 patients participated in this randomized controlled trial. Data on psychopathology, global and social functioning, patient satisfaction, continuity of care and administrative data was gathered on admission, throughout the course of treatment, upon discharge and at 1-year follow-up. In addition, the physicians in charge rated the therapeutic relationship. The data analysis consists of group-wise comparisons and regression analyses (cross-tabulations and χ(2) test statistics for categorical data and Mann-Whitney U tests for continuous data). Differences between groups over time were analyzed with a series of generalized linear mixed model. The integrated care group showed a significant reduction in psychopathological impairment (20.7%) and an improvement of psychosocial functioning (36.8%). The mean number of days before re-admission was higher in the control group when compared to the integrated care group (156.8 vs. 91.5). There was no difference in the number of re-admissions and days spent in psychiatric institutions. This new approach offers a treatment model, which facilitates continuity of care. Beside it improves psychopathological outcome measures and psychosocial functioning in patients with mental illness.

Efficacy of technology-based interventions for obesity prevention in adolescents: a systematic review.

About one third of adolescents in the USA are overweight and/or obese. Obesity during the adolescent years is associated with many adverse health consequences, including type 2 diabetes, hypertension, hyperlipidemia, and psychosocial problems. Because of substantial advances in technologies and wide acceptance by adolescents, it is now possible to use technology for healthy weight management and prevention of obesity. This systematic review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and aimed to evaluate the existing literature reported on the effectiveness of technology-based intervention (web-based, e-learning, and active video games) in preventing obesity in adolescents. The primary aim of this review was to explore if components of specific interventions were associated with a reduction in body mass index. Research articles obtained from CINAHL, Embase, PubMed, PsycInfo, and the Cochrane database from1990 to 2014 were reviewed. A total of 131 published articles were identified, and 14 met the inclusion criteria of a randomized or nonrandomized clinical study with body mass index as primary outcome and/or secondary outcomes of diet/physical activity and/or psychosocial function, tested lifestyle interventions to prevent obesity, used technology, and studied adolescents (aged 12–18 years). The results indicated that six of 14 studies found body mass index and/or body fat decreased at short-term (less than 12 months) follow-up. Six of eleven studies that examined physical activity or physical activity-related outcomes found an improved physical activity outcome (time playing active video games and increase in physical activity time), while five of seven studies which assessed dietary outcomes indicated improvement in dietary behaviors. Five of seven studies suggested an improvement in psychosocial function (reduced depression, improved self-esteem and efficacy, improvement on Behavior Assessment Scale) in adolescents involved in the technology-based intervention. All effective interventions utilized dietary and physical activity strategies as part of intervention components. Because of the variation in duration of intervention (range 10 weeks to 2 years), it is not clear what length of intervention is most effective. Future research should assess the long-term impact of technology-based interventions and evaluate mediators and moderators for weight change in adolescents.

The course of binge eating from adolescence to young adulthood.

The course of binge eating in adolescence is variable, and little is known about factors maintaining binge eating behaviors. The current study sought to characterize the course of binge eating and identify psychosocial factors associated with its maintenance. A population-based sample reported on binge eating, depression symptoms, self-esteem, and body satisfaction at 5-year intervals spanning early/middle adolescence (Time 1 [T1]), late adolescence/early young adulthood (Time 2 [T2]), and early/middle young adulthood (Time 3 [T3]). Logistic regression examined factors predicting maintenance or cessation of binge eating. A total of 15.8% of participants with binge eating at T1 continued to report binge eating at T2, and 42.0% of participants with binge eating at T2 continued to report binge eating at T3. From T1 to T2, improvements in self-esteem predicted cessation of binge eating. From T2 to T3, cessation of binge eating was predicted by improved body satisfaction, greater decreases in depression symptoms, and greater improvements in self-esteem. Binge eating is relatively stable from late adolescence/early young adulthood to early/middle young adulthood, but less so from middle/late adolescence to late adolescence/early young adulthood. Improvements in psychosocial functioning during this timeframe may improve the outcome of binge eating, although mechanisms responsible for psychosocial changes (e.g., treatment involvement) require further investigation. Self-esteem appears to be a particularly salient factor involved in binge eating cessation and should be targeted in prevention and treatment programs.

EPA-0933 - Psychopathological and functional assessment in psychtic patients in a psychiatric hospital unit

Introduction New psychopharmacology provides a better tolerability profile and drug adherence, which should be accompanied by lower relapse rate, incomings and improvement in psychosocial functioning of patients. Objectives 1. To describe sociodemographic, clinical and psychometric properties of a sample of psychotic patients admitted to the Acute Unit. 2. Assessing the functionality of psychotic patients requiring hospitalization. Methods Sample:patients admitted to the Psychiatric Hospital Unit of the Hospital San Juan de Alicante (August 1 to 31, 2013), with admission diagnosis of psychotic decompensation (F20). Register of sociodemographic and clinical dates, PANSS, CGI and PSP. Statistical analysis using SPSS. Results N=19. 94%=male, 84.2%=single, 68.4%=family support.37%=schizophrenia, 52.7%=brief reactive psychosis, 10.5%=schizophreniform disorder. 9.7% first psychotic episodes. 52.6%=toxic consumption. Mean scores:PSP = 50.89, CGI= 4.42, PANSS=89.89. Significant relationship between the support and PSP(35=not, 53=yes, p Conclusions Although toxics, poor adherence or the long course of the disease are associated with unfavorable scores on scales of function and psychopathology, our results donnot meet it. We attribute the negative results to low sample size and heterogeneity of the group of patients included in the study. Maybe factors such as family support, employment and intellectual level have a greater role. We consider it appropriate to continue the study in the future, standardizing clinical groups and expanding the sample size in order to obtain results with greater statistical significance.

Scientific basis of mind-body interventions.

Mind-body exercise, a form of exercise that combines body movements with mental focus, has a long and winding history around the world. In the two ancient civilizations, India and China, Yoga and Health Qigong/Tai Chi have, respectively, been practiced for thousands of years among healthy individuals or those with a health condition for wellness or therapeutic purpose. In modern times, progressive muscle relaxation, visualization, and Pilates are becoming more and more popular in the western world for health and fitness. Although different types of mind-body exercises have been practiced by people from different cultures and clinical effects have been observed for centuries, these interventions have been criticized by researchers and practitioners to be lacking in scientific support in two aspects. First, many review articles [1, 2] (Ng and Tsang, 2009; Wang and Chan et al.) reveal that most clinical studies on these mind-body interventions are not well controlled and designed. Many do not even have a comparison or control group. These have posed a lot of difficulties on the generalizability of the results. Second, even effects are well documented. The biological or psychosocial mechanisms underlying the effects are largely unknown [3, 4]. My neuropsychiatric rehabilitation research team at The Hong Kong Polytechnic University has been active doing research in providing scientific evidence to Chinese mind-body exercises for the past decade. I am glad to receive many requests for reprints after the research articles are published. Some even requested for access to the video so that they may replicate the studies or apply these mindfulness exercises in their clinical settings. It is an excitement when I was asked by the editorial office to edit a special issue devoted to the scientific basis of mind-body exercises. This special issue in fact is to fill the knowledge gap that may help promote these activities for clinical practice and gradually attain its mainstream status in modern medicine. In this special issue, we are happy to present a total of 7 original research papers to augment the evidence base for mind-body interventions. It is impressive to see that mind-body/mindfulness interventions have been applied to different groups of clients including frail elders, patients with major depressive order, shoulder pain, chronic fatigue, acute respiratory infection, and patients in intensive care unit. Articles submitted to this special issue provide further evidence on the clinical effectiveness in various aspects. H. W. H. Tsang and his team showed that the newly developed adapted mind-body exercise for frail elders improved their thinking operations. EEG data from A. S. Chan et al. and P.-C. Lo and C.-H. Chang showed that Chan-based mind-body intervention helped induce positive mood and calm state mind. J. S. M. Chan et al. reported that Wu Xing Ping Heng Gong reduced total fatigue score among chronic fatigue patents. A. L. Baldwin and colleagues showed that energy healing was as effective as manual manipulation physical therapy in treating patients with shoulder pain problem. A. M. Chiasson et al. realized that patients in intensive care unit found harp music effective in helping them reduce perceived pain. Finally, the mindfulness based stress reduction program by A. Zgierska et al. has been demonstrated to produce improvement in psychosocial functioning among patients with acute respiratory infection. I hope that the results reported in this special issue will further spark further enthusiasm on scientific research for mind-body interventions in the future so that more clients will benefit providing evidence, clinical implications, and inspiration to clinicians, researchers, and patients. Hector Tsang Cecilia L.W. Chan Kevin Chen William Chi-shing Cho Myeong Soo Lee

EPA-1650 – Psychoeducation in psychosocial rehabilitation of patients with schizophrenia

Acomprehensive survey was carried out of 142 female patients at the age 18 – 35, which have diagnosis the schizophrenia in period of stabilization state. Depending on the leadingpsychopathologic syndrome the patients were divided into 4 clinical groups, each of those has one of the following syndromes: the apathyabulic syndrome, the wihallucinatory-paranoid syndrome, the depressive-paranoid syndrome, andparanoid one. The integrative model ofpsychoeducational work was proposed, which includes application of variousinformation modules, techniques of cognitive-behavioral therapy, trainingeffects, problem-oriented discussions, and family psychotherapy. The psychoeducation was determined tobe superior over conventional complex treatment intended for reduction ofnegative symptoms, productive symptoms and general psychopathological symptomsof patients with schizophrenia. It is supported by dynamic analysis of theclinical disturbances and psychopathological ones on the PANSS. The improvementof psychosocial functioning and quality of life of the patients withschizophrenia who participated in the psychoeducational activities wasdetermined. It is proved that psychoeducation notonly increases the amount of knowledge intensifies confidence in the fightagainst the disease, but solves the problem of social reintegration of thepatient.

Pragmatic Psychodynamic Psychotherapy—Bridging Contemporary Psychoanalytic Clinical Practice and Evidence-Based Psychodynamic Practice

Pragmatic psychodynamic psychotherapy (PPP; Summers & Barber, 2009) describes the therapeutic principles and approaches found in many forms of manualized psychodynamic psychotherapies, which are being used in research studies with the aim of building an evidence-based psychodynamic practice. This article focuses on one such treatment, Supportive-expressive psychotherapy (SEP; Luborsky 1984), which employs the Core Conflictual Relationship Theme (CCRT) method to formulate core interpersonal problems and treatment goals and identify therapeutic interventions. To illustrate SEP, we describe the 40-session treatment of a patient who met diagnostic criteria for several personality disorders. The case illustrates how complex ego-syntonic character pathology is expressed in CCRT terms and worked through in the transference, gradually becoming ego-dystonic and amenable to modification. In this case, the patient became more aware of his interpersonal wishes and vulnerability. Although his anxiety increased somewhat, he had an improvement in psychosocial functioning.

Influence of Surgical and Minimally Invasive Facial Cosmetic Procedures on Psychosocial Outcomes

Millions of surgical and minimally invasive cosmetic procedures of the face are performed each year, but objective clinical measures that evaluate surgical procedures, such as complication rates, have limited utility when applied to cosmetic procedures. While there may be subjective improvements in appearance, it is important to determine if these interventions have an impact on patients in other realms such as psychosocial functioning. This is particularly important in light of the Patient Protection and Affordable Care Act and its emphasis on patient-centered outcomes and effectiveness. To review the literature investigating the impact of facial cosmetic surgery and minimally invasive procedures on relevant psychological variables to guide clinical practice and set norms for clinical performance. English-language randomized clinical trials and prospective cohort studies that preoperatively and postoperatively assessed psychological variables in at least 10 patients seeking surgical or minimally invasive cosmetic procedures of the face. Only 1 study investigating minimally invasive procedures was identified. Most studies reported modest improvement in psychosocial functioning, which included quality of life, self-esteem, and body image. Unfortunately, the overall quality of evidence is limited owing to an absence of control groups, short follow-up periods, or loss to follow-up. The current literature suggests that a number of psychosocial domains may improve following facial cosmetic surgery, although the quality of this evidence is limited (grade of recommendation 2A). Despite the dramatic rise in nonsurgical cosmetic procedures, there is a paucity of information regarding the impact of chemodenervation and soft-tissue augmentation on psychosocial functioning.

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

ObjectiveEfficacy 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. MethodYoung 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. ResultsDissonance 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. ConclusionsThis 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.