Abstract
This study evaluated a targeted intervention designed to alleviate body image and eating problems in adolescent girls that was delivered over the internet so as to increase access to the program. The program consisted of six, 90-minute weekly small group, synchronous on-line sessions and was facilitated by a therapist and manual. Participants were 73 girls (mean age=14.4 years, SD=1.48) who self-identified as having body image or eating problems and were randomly assigned to an intervention group (n=36) (assessed at baseline, post-intervention and at 2- and 6-months follow-up) or a delayed treatment control group (n=37) (assessed at baseline and 6–7 weeks later). Clinically significant improvements in body dissatisfaction, disordered eating, and depression were observed at post-intervention and maintained at follow-up. Internet delivery was enthusiastically endorsed. The program offers a promising approach to improve body image and eating problems that also addresses geographic access problems.
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References
Abascal, L., Brown, J. B., Winzelberg, A. J., Dev, P., & Taylor, C. B. (2004). Combining universal and targeted prevention for school-based eating disorder programs. International Journal of Eating Disorders, 35, 1–5.
Australian Psychological Society. (2005, October 1). Aussie teens turn to Internet for e-motional healing. Retrieved October 29, 2005, from http://www.psychology.org.au/news/media_releases/ 10.1_127.asp
Banasiak, S. J., Wertheim, E. H., Koerner, J., & Voudouris, N. J. (2001). Test-retest reliability and internal consistency of a variety of measures of dietary restraint and body concerns in a sample of adolescent girls. International Journal of Eating Disorders, 29, 85–89.
Beck, A. T., & Beck, R. W. (1972). Screening depressed patients in family practice: A rapid technique. Postgraduate Medicine, 52, 81–85.
Beck, A. T., Rial, W. Y., & Rickels, K. (1974). Short form of Depression Inventory: Cross-validation. Psychological Reports, 34, 1184–1186.
Benedikt, R., Wertheim, E. H., & Love, A. (1998). Eating attitudes and weight-loss attempts in female adolescents and their mothers. Journal of Youth and Adolescence, 27, 43–57.
Bunnell, D. W., Cooper, P. J., Hertz, S., & Shenker, I. R. (1992). Body shape concerns among adolescents. International Journal of Eating Disorders, 11, 79–83.
Calogero, R. M., Davis, W. N., & Thompson, J. (2004). The Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ-3): Reliability and normative comparisons of eating disordered patients. Body Image, 1, 193–198.
Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA) 2001, Australia
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
Committee on Prevention of Mental Disorders. (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington, DC: National Academy Press.
Dallal, G. E. (n.d.). Randomization plan generator. Retrieved August 8, 2003, from http://www.randomization.com.
Evans, C., & Dolan, B. (1993). Body shape questionnaire: Derivation of shortened “alternate forms”. International Journal of Eating Disorders, 13, 315–321.
Farrell, C., Shafran, R., & Lee, M. (2006). Empirically evaluated treatments for body image disturbance: A review. European Eating Disorders Review, 14, 289–300.
Faul, F., & Erdfelder, E. (1992). GPower: A priori, post-hoc, and compromise power analysis for MS-DOS [computer program]. Bonn, Germany: Bonn University, Department of Psychology.
Franko, D. L., Mintz, L. B., Villapiano, M., Green, T. C., Mainelli, D. et al. (2005). Food, Mood and Attitude: Reducing risk for eating disorders in college women. Health Psychology, 24, 567–578.
Garner, D. M., Olmsted, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2, 15–34.
Gollings, E. K., & Paxton, S. J. (2006). Comparison of internet and face-to-face delivery of a group body image and disordered eating intervention for women: A pilot study. Eating Disorders: The Journal of Treatment and Prevention, 14, 1–15.
Himes, J. H., Hannan, P., Wall, M., & Neumark-Sztainer, D. (2005). Factors associated with errors in self-reports of stature, weight, and body mass index in Minnesota adolescents. Annals of Epidemiology, 15, 272–278.
Hollis, S., & Campbell, F. (1999). What is meant by intention to treat? Survey of published randomized controlled trials. British Medical Journal, 319, 670–674.
Kaiser Family Foundation Survey. (2001). Generation Rx.com: How young people use the Internet for health information. Retrieved October 10, 2005, from http://www.kff.org/entmedia/ upload/Toblines.pdf
Kaminski, P. L., & McNamara, K. (1996). A treatment for college women at risk for bulimia: A controlled evaluation. Journal of Counseling and Development, 74, 288–294.
Killen, J. D., Taylor, C. B., Hayward, C., Haydel, K. F., Wilson, D. M., Hammer, L., Kraemer, H., Blair-Greiner, A., & Strachowski, D. (1996). Weight concerns influence the development of eating disorders: A 4-year prospective study. Journal of Consulting and Clinical Psychology, 64, 936–940.
Leibert, T., Archer, J., Munson, J., & York, G. (2006). An exploratory study of client perceptions of internet counseling and the therapuetic alliance. Journal of Mental Health Counseling, 28, 69–83.
Luce, K. H., Osborne, M. I., Winzelberg, A. J., Das, S., Abascal, L. B., Celio, A. A., Wilfley, D. E., Stevenson, D., Dev, P., & Taylor, C. B. (2005). Application of an algorithm-driven protocol to simultaneously provide universal and targeted prevention programs. International Journal of Eating Disorders, 37, 220–226.
McVey, G. L., Lieberman, M., Voorberg, N., Wardrope, D., & Blackmore, E. (2003a). School-based peer support groups: A new approach to the prevention of disordered eating. Eating Disorders, 11, 169–185.
McVey, G. L., Lieberman, M., Voorberg, N., Wardrope, D., Blackmore, E., & Tweed, S. (2003b). Replication of a peer support program. Eating Disorders, 11, 187–195.
Murphy, D. B., & Mitchell, D. L. (1998). When writing helps to heal: E-mail as therapy. British Journal of Guidance and Counseling, 26, 21–32.
Neumark-Sztainer, D., Levine, M., Paxton, S., Smolak, L., Piran, N., & Wertheim, E. (2006). Prevention of body dissatisfaction and disordered eating: What next? Eating Disorder: Journal of Treatment and Prevention, 14, 265–285.
Neumark-Sztainer, D., Paxton, S. J., Hannan, P. J., Haines, J., & Story, M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health, 39, 244–251.
Neumark-Sztainer, D., Story, M., Hannan, P. J., Perry, C., & Irving, L. M. (2002). Weight-related concerns and behaviors among overweight and non-overweight adolescents: Implications for preventing weight-related disorders. Archives of Pediatrics and Adolescent Medicine, 156, 171–178.
Neumark-Sztainer, D., Wall, M., Guo, J., Story, M., Haines, J., & Eisenberg, M. (2006). Obesity, disordered eating and eating disorders in a longitudinal study of adolescents: How do dieters fare five years later? Journal of the American Dietetic Association, 106, 559–568.
Nicholas, J., Oliver, K., Lee, K., & O’Brien, M. (2004). Help-seeking behavior and the Internet: An investigation among Australian adolescents. Australian e-Journal for the Advancement of Mental Health, 3. Retrieved October 7, 2005, from http://www.ausienet. com/journal.
Openshaw, C., Waller, G., & Sperlinger, D. (2004). Group cognitive behavior therapy for bulimia nervosa: Statistical versus clinical significant of changes in symptoms across treatment. International Journal of Eating Disorders, 36, 363–375.
Paxton, S. J. (2002). Evidence-Based Health Promotion: Resources for Planning. No 6 Body Image. Research Overview. Department of Human Services, Victoria, webpage. http://www.health.vic.gov. au/healthpromotion/quality/body_image.htm
Paxton, S. J., McLean, S., Gollings, E. K., Faulkner, C., & Wertheim, E. H. (2006). How effective are synchronous on-line interventions for body dissatisfaction in adult women and adolescent girls. Paper presentation at Eating Disorders Research Society Conference, Port Douglas, Australia.
Paxton, S. J., Neumark-Sztainer, D., Hannan, P. J., & Eisenberg, M. (2006). Body dissatisfaction prospectively predicts depressive symptoms and low self-esteem in adolescent girls and boys. Journal of Clinical Child and Adolescent Psychology, 35, 539– 549.
Paxton, S. J., Wertheim, E. H., Gibbons, K., Szmukler, G. I., Hillier, L., & Petrovich, J. C. (1991). Body image satisfaction, dieting beliefs and weight loss behaviors in adolescent girls and boys. Journal of Youth and Adolescence, 20, 361–379.
Presnell, K., Bearman, S. K., & Stice, E. (2004). Risk factors for body dissatisfaction in adolescent boys and girls: A prospective study. International Journal of Eating Disorders, 36, 389– 401.
Ragusea, A. S., & VandeCreek, L. (2003). Suggestions for the ethical practice of online psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 40, 94–102.
Reynolds, W. M., & Gould, J. W. (1981). A psychometric investigation of the standard and short form of the Beck Depression Inventory. Journal of Consulting and Clinical Psychology, 49, 306–307.
Ricciardelli, L. A., & McCabe, M. P. (2001). Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys. Behaviour Research and Therapy, 39, 1317–1328.
Rochlen, A. B., Zack, J. S., & Speyer, C. (2004). Online therapy: Review of relevant definitions, debates and current empirical support. Journal of Clinical Psychology, 60, 269–283.
Rosen, J. C., Saltzberg, E., & Srebnik, D. (1989). Cognitive Behavior Therapy for negative body image. Behavior Therapy, 20, 393–404.
Schoemaker, C., van Strien, T., & Van Der Staak, C. (1994). Validation of the eating disorders inventory in a nonclinical population using transformed and untransformed responses. International Journal of Eating Disorders, 15, 387–393.
Skarderud, F. (2003). Shame in cyberspace. Relationships without faces: The E-media and eating disorders. European Eating Disorders Review, 11, 155–169.
Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825–848.
Stice, E., & Bearman, S. K. (2001). Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: A growth curve analysis. Developmental Psychology, 37, 597–607.
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., & Shaw, H. (2004). Eating disorder prevention programs: A meta-analytic review. Psychological Bulletin, 130, 206–227.
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, 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.
Stice, E., & Whitenton, K. (2002). Risk factors for body dissatisfaction in adolescent girls: A longitudinal investigation. Developmental Psychology, 38, 669–678.
Taylor, C. B., Bryson, S., Luce, K. H., Cunning, D., Doyle, A. C., Abascal, L. B., Rockwell, R., Dev, P., & Winzelberg, A. J. (2006). Prevention of eating disorders in at-risk college-age women. Archives of General Psychiatry, 63, 881–888.
Thompson, J. K., Heinberg, L. J., & Tantleff Dunn, S. (1991). The physical appearance comparison scale. Behavior Therapist, 14, 174.
Thompson, J., Van Den Berg, P., Roehrig, M., Guarda, A. S., & Heinberg, L. J. (2004). The Sociocultural Attitudes Towards Appearance scale-3 (SATAQ-3): Development and validation. International Journal of Eating Disorders, 35, 293–304.
van Strien, T., Frijters, J. E. R., Bergers, G. P. A., & Defares, P. B. (1986). The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. International Journal of Eating Disorders, 5, 295– 315.
Varnado-Sullivan, P. J., Zucker, N., Williamson, D. A., Reas, D., Thaw, J., & Netemeyer, R. G. (2001). Development and implementation of the Body Logic Program for adolescents: A two-stage prevention program for eating disorders. Cognitive and Behavioral Practice, 8, 248–259.
Vitousek, K. M., Watson, S., & Wilson, G. T. (1998). Enhancing motivation for change in treatment resistant eating disorders. Clinical Psychology Review, 18, 391–420.
Wardle, J., & Beales, S. (1986). Restraint, body image and food attitudes in children from 12 to 18 years. Appetite, 7, 209–217.
WebCT. (2003). Web course tools: Campus edition (Version 4.1).
Wertheim, E. H., Paxton, S. J., & Blaney, S. (in press). Body image in girls. In L. Smolak & J. K. Thompson (Eds.), Body image, eating disorders and obesity in youth (2nd ed.). Washington, DC: American Psychological Association.
Winzelberg, A. J., Eppstein, D., Eldredge, K. L., Wilfley, D., Dasmahapatra, R., Dev, P., & Taylor, C. B. (2000). Effectiveness of an Internet-based program for reducing risk factors for eating disorders. Journal of Consulting and Clinical Psychology, 68, 346– 350.
Winzelberg, A. J., Luce, K. H., & Abascal, L. B. (2004). Internet-based treatment strategies. In J.K. Thompson (Ed.), Handbook of Eating Disorders and Obesity (pp. 279–296). New Jersey: John Wiley & Sons, Inc.
Zabinski, M. F., Celio, A. A., Jacobs, M., Manwaring, J., & Wilfley, D. E. (2003a). Internet-based prevention of eating disorders. European Eating Disorders Review, 11, 183–197.
Zabinski, M. F., Celio, A. A., Wilfley, D. E., & Taylor, C. (2003b). Prevention of eating disorders and obesity via the Internet. Cognitive Behavior Therapy, 32, 137–150.
Zabinski, M. F., Pung, M. A., Wilfley, D. E., Eppstein, D. L., Winzelberg, A. J., Celio, A., & Taylor, C. B. (2001a). Reducing risk factors for eating disorders: Targeting at-risk women with a computerized psychoeducational program. International Journal of Eating Disorders, 29, 401–408.
Zabinski, M. F., Wilfley, D. E., Pung, M. A., Winzelberg, A. J., Eldredge, K., & Taylor, C. B. (2001b). An interactive internet-based intervention for women at risk of eating disorders: A pilot study. International Journal of Eating Disorders, 30, 129–137.
Zabinski, M. F., Wilfley, D. E., Calfas, K. J., Winzelberg, A. J., & Taylor, C. B. (2004). An interactive psychoeducational intervention for women at risk of developing an eating disorder. Journal of Consulting and Clinical Psychology, 72, 914–919.
Acknowledgements
We appreciate grant support from the Myer Foundation and the Telstra Foundation Community Development Fund provided to Susan Paxton for this project.
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Heinicke, B.E., Paxton, S.J., McLean, S.A. et al. Internet-Delivered Targeted Group Intervention for Body Dissatisfaction and Disordered Eating in Adolescent Girls: A randomized controlled trial. J Abnorm Child Psychol 35, 379–391 (2007). https://doi.org/10.1007/s10802-006-9097-9
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DOI: https://doi.org/10.1007/s10802-006-9097-9
Keywords
- Internet
- Targeted intervention
- Body dissatisfaction
- Disordered eating
- Adolescent girls