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Body Project

Blueprints Program Rating: Model

A four-session group intervention to prevent the onset of eating disorders such as anorexia, bulimia and binge eating among female high school and college students with body image concerns.

Program Outcomes

  • Mental Health - Other
  • Physical Health and Well-Being

Program Type

  • Counseling and Social Work
  • School - Individual Strategies

Program Setting

  • Mental Health/Treatment Center
  • School

Continuum of Intervention

  • Selective Prevention (Elevated Risk)

Age

  • Late Adolescence (15-18) - High School
  • Early Adulthood (19-22)

Gender

  • Female only

Race/Ethnicity

  • All Race/Ethnicity

Endorsements

  • Blueprints: Model

Program Information Contact

Paul Rohde, Ph.D.
Oregon Research Institute
1776 Millrace Drive
Eugene, OR 97403-2536
(541) 484-1108
paulr@ori.org

Program Developer/Owner

  • Eric Stice
  • Oregon Research Institute

Brief Description of the Program

Body Project is a prevention program designed for high school and college-age girls using four weekly one-hour group sessions. Groups consist of 5-10 young women. Through a series of verbal, written and behavioral exercises, the program attempts to create dissonance in participants by engaging them in a critique of the thin ideal. Participants are also engaged in body acceptance exercises and role-plays to counter thin-ideal statements and resist peer pressure. Facilitators (group leaders with Master's-level training in a clinical mental health discipline or supervised college peer educators), use activities that are counter-attitudinal to the thin ideal and use motivational enhancement, skill acquisition, social support and group cohesion to create dissonance within the participants. The Body Project is not sufficient as a stand-alone treatment for individuals meeting current criteria for an eating disorder, so attempts should be made to exclude such individuals.

See: Full Description

Outcomes

In the first study using female high school and college students (Stice et al., 2006), the dissonance intervention relative to assessment-only or expressive writing controls produced significantly greater improvement in:

  • thin-ideal internalization at posttest, 6-month, 1-year and 2-year follow-up
  • body dissatisfaction at posttest, 6-month, 2-year and 3-year follow-up
  • dieting at posttest, 6-month and 1-year follow-up
  • negative affect at posttest, 6-month, 2-year and 3-year follow-up
  • bulimic symptoms at posttest, 6-month, 1-year and 2-year follow-up
  • risk of obesity onset over the 1-year follow-up
  • psychosocial impairment at 2-year and 3-year follow-up
  • risk for eating pathology onset over the 3-year follow-up

In the second study (Stice et al., 2003), significant differences between dissonance intervention participants and waitlist control participants were found for reductions in:

  • negative affect
  • bulimic symptoms

In the third study (Stice et al., 2001), significant differences between dissonance intervention participants and healthy weight placebo control participants were found for reductions in:

  • thin-ideal internalization

In the fourth study (Stice et al., 2009, 2011), positive effects were found for:

  • eating disorder symptoms at posttest, 6-month follow-up, 1-year and 3-year follow-up
  • thin-ideal internalization at posttest
  • body dissatisfaction at posttest, 6-month follow-up, 1-year and 3-year follow-up
  • dieting at posttest and 1-year follow-up

In the fifth study with college students (Stice et al., 2013, 2015), the following outcomes were significantly improved from baseline to 1-year follow-up and 2- and 3-year follow-ups:

  • negative affect
  • eating disorder symptoms

Regarding program effects on risk/protective factors, the following were significantly improved for the intervention participants compared to the control participants from baseline to 1-year follow-up and 2- and 3-year follow-ups:

  • thin-ideal internalization
  • body dissatisfaction
  • dieting
  • psychosocial functioning

Race/Ethnicity/Gender Details

The samples across all the studies were entirely female, with the following racial make-up in Stice et al. (2006, 2007, 2008): 58% White, 19% Latino, 10% Asian, 6% Black and 7% other race/ethnicity; and the following racial make-up in Stice et al. (2003): 63% White, 16% Hispanic, 13% Asian, 2% African American, and 6% other race/ethnicity. Stice et al. (2009, 2011) had a primarily White sample and the college student sample in Stice et al. (2013, 2015) had the following racial make-up: 58% European American, 17% Asian, 13% Hispanic, 7% African American, 4% American Indian/Alaska Native, and 1% Native Hawaiian/Pacific Islander.

Risk and Protective Factors

Risk Factors
  • Individual: Body Image Concerns*

*Risk/Protective Factor was significantly impacted by the program.

See also: Body Project Logic Model (PDF)

Training and Technical Assistance

Two training options are provided (1-day for mental health professionals; 2-day for peer educators), in addition to hourly consultation.

1 Full-Day Training: Clinician or University/High School Staff Body Project Training
 
   Cost: $1250 (plus trainer travel expenses) at customer's site - up to 16 participants

2 Full-Day Training: Combined Peer Leader and Train-the-Trainer Clinician Body Project Training
 
   Cost: $2500 (plus trainer travel expenses) at customer's site - up to 16 student participants and 6 clinician participants

Recommended Post-Training Supervision:
    Cost: $125 per hour

Developed using a community participatory research methodology, the 2-day training model has been repeatedly used during naturalistic clinical implementation of the Body Project and other prevention programs (i.e., has been extensively field tested). In this training, individuals are trained as Body Project facilitators while supervisors can be simultaneously trained in a “train-the-trainer” approach. Everyone is strongly encouraged to read the intervention script before the training, which includes an introduction describing the conceptual rationale for the intervention and delivery tips. A master trainer first walks everyone through the manual, reviewing the theoretical basis of the intervention, structure of the manual, and general rationale behind all major activities. Next, trainees lead an abbreviated version of the first half of the sessions, with the trainer observing and the remaining participants serving as mock participants. Trainees are encouraged to initially read directly from the script, but can closely paraphrase the material once they become familiar with it. The master trainer then supervises the trainees (and models how to provide supervision for the trainers-in-training, if applicable). Facilitators switch roles to lead the first half of sessions. This process is repeated, so that by the end of training everyone has experienced/observed all of the sessions and had an opportunity to lead these sessions at least once, with supervisory feedback. Trainees are encouraged to complete some of the home exercises between the two days of training to experience that component of the program.

In these workshops trainees gain experience in general group leadership skills (e.g., summarizing, transitions, non-verbal behaviors), how to respond to talkative and quiet participants, how to respond to participants reluctant to discuss costs of the thin ideal, how best to present the material (i.e., interacting with the group while writing on a whiteboard), and challenges of sticking to a scripted intervention while addressing ongoing group dynamics. Trainees also learn procedures to maximize homework completion, attendance, and retention, and how to arrange make-up sessions. Finally, trainees learn how to address group members who either develop or first reveal that they have an eating disorder or other mental health condition during groups.

Brief Evaluation Methodology

All five studies had a similar recruitment and randomized controlled design. The first study (Stice et al., 2006, 2007, 2008) sought to determine the effectiveness of the dissonance intervention compared to three other conditions: healthy weight intervention, expressive-writing control intervention, and assessment-only control intervention. Participants were recruited for this study from high schools and one university using mailings, flyers and leaflets that invited female participants between the ages of 14 and 19 with body image concerns to participate in the study to help them accept their bodies. The only exclusion criterion was meeting the diagnosis for an eating disorder. A total of 481 participants were randomly assigned to one of four conditions: dissonance intervention (n=115), healthy weight intervention (n=117), expressive-writing control intervention (n=123), or assessment-only control intervention (n=126). Data were collected at pretest, posttest, and at 6-month, 1-year, 2-year, and 3-year follow-ups after posttest. The mediation analysis also reported on data collected weekly from baseline to posttest.

The second study (Stice et al., 2003) sought to evaluate the effectiveness of the dissonance intervention against a healthy weight intervention and a waitlist control. Using flyers and announcements in large classes, participants were recruited from three high schools and one university. A total of 148 female students were randomized to one of three conditions resulting in the following distribution after attrition: dissonance intervention (n=48); healthy weight intervention (n=51); or, waitlist control (n=36). Data were collected at baseline, post-intervention, and 1-, 3- and 6-month follow-ups.

The third study (Stice et al., 2001) sought to evaluate the effectiveness of the dissonance intervention against a healthy weight placebo control condition. Using flyers and email messages, participants were recruited from two universities and one community college. A total of 87 female students were randomized to the dissonance intervention (n=48) and the healthy weight placebo control (n=39). Data were collected at baseline, post-intervention (week 3), and at 4-week follow-up (week 7).

The fourth study (Stice et al., 2009 and 2011) evaluated the effectiveness of the four-session version of the intervention delivered by high school nurses, teachers and counselors rather than by the investigators compared to a control condition. A total of 306 students were randomly assigned to the intervention (n=139) or control (n=167) conditions. Assessments were conducted at pretest, immediate posttest, 6-month follow-up, and at 1-, 2-, and 3-year follow-ups.

The fifth study (Stice et al., 2013, 2015) evaluated the effectiveness of the four-session, enhanced version of the intervention delivered by clinicians to female college students compared to a control condition. Participants were recruited from seven Universities in Oregon, Texas and Pennsylvania. A total of 408 students were randomly assigned to the intervention (n=203) or control (n=205) conditions. Assessments were conducted at pretest, immediate posttest, 1-year follow-up, 2-year follow-up, and 3-year follow-up.

Peer Implementation Sites

Marisol Perez
Dept of Psychology
Arizona State University
950 S McAllister Ave, room 230
Tempe, AZ 85287-1104
office: 480-727-2717
marisol.perez00@gmail.com

References

Stice, E., Butryn, M., Rohde, P., Shaw, H., & Marti, C. (2013). An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students. Behaviour Research and Therapy, 51(12), 862-871.

Stice, E., Chase, A., Stormer, S., & Appel, A. (2001). A randomized trial of a dissonance-based eating disorder prevention program. International Journal of Eating Disorders, 29, 247-262.

Stice, E., Marti, C., Spoor, S., Presnell, K., & Shaw, H. (2008). Dissonance and healthy weight eating disorder prevention programs: Long-term effects from a randomized efficacy trial. Journal of Consulting and Clinical Psychology, 76(2), 329-340.

Stice. E, Presnell, K., Gau, J., & Shaw, H. (2007). Testing mediators of intervention effects in randomized controlled trials: An evaluation of two eating disorder prevention programs. Journal of Consulting and Clinical Psychology, 75(1), 20-32.

Stice, E., Rohde, P., Gau, J., & Shaw, H. (2009). An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. Journal of Consulting and Clinical Psychology, 77(5), 825-834.

Stice, E., Rohde, P., Shaw, H., & Gau, J. (2011). An effectiveness trial of a selected dissonance-based eating disorder prevention program for female high school students: Long-term effects. Journal of Consulting and Clinical Psychology, 79(4), 500-508.

Stice, E., Rohde, P., Butryn, M., Shaw, H., & Marti, C. N. (2015). Effectiveness trial of a selective dissonance-based eating disorder prevention program with female college students: Effects at 2- and 3-year follow-up. Behaviour Research and Therapy, 71,20-26.

Stice, E., Shaw, H., Burton, E., & Wade, E. (2006). Dissonance and healthy weight eating disorder prevention programs: A randomized efficacy trial. Journal of Consulting and Clinical Psychology, 74(2), 263-275.

Stice, E., Trost, A., & Chase, A. (2003). Healthy weight control and dissonance-based eating disorder prevention programs: Results from a controlled trial. International Journal of Eating Disorders, 33, 10-21.