Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention

Examining the factor structure, sex invariance, and psychometric properties of the Body Image Acceptance and Action Questionnaire and the Functionality Appreciation Scale

Body image flexibility and functionality appreciation are two facets of positive body image gaining significant research attention. The measures that assess these constructs- the Body Image Acceptance and Action Questionnaire (BI-AAQ) and Functionality Appreciation Scale (FAS), respectively-have produced a unidimensional structure with adequate psychometric properties. However, the cross-sex invariance of the BI-AAQ has yet to be established, and replicating the FAS' one-factor structure is needed. We examined the factor structure, cross-sex invariance, and psychometric properties of the BI-AAQ and FAS. Data were analyzed from 383 men and 631 women who completed questionnaires (participants were not restricted to a specific country). An unacceptable model fit for the BI-AAQ was found for men and women, indicating that the unidimensional structure was not replicated. The unidimensional structure of the FAS and an abbreviated 5-item BI-AAQ was replicated, and tests of measurement invariance between men and women were upheld. Evidence of internal consistency, convergent validity, and incremental validity for the abbreviated BI-AAQ and FAS was found. Overall, the abbreviated BI-AAQ and the FAS appear to be psychometrically sound measures of positive body image. Findings suggest that sex comparisons on the abbreviated BI-AAQ and FAS are permissible.

Can Acceptance, Mindfulness, and Self-Compassion Be Learned by Smartphone Apps? A Systematic and Meta-Analytic Review of Randomized Controlled Trials

The potential health benefits of acceptance, mindfulness, and self-compassion are well-documented. However, interventions that teach these principles typically rely on face-to-face delivery, which can limit their dissemination. Delivering these interventions through smartphone apps could help overcome this. This meta-analysis examined whether principles of acceptance, mindfulness, and self-compassion can be learned through smartphone apps. Twenty-seven randomized controlled trials were included. Smartphone apps that included acceptance and/or mindfulness components resulted in significantly higher levels of acceptance/mindfulness than comparison conditions (k = 33; g = 0.29; 95% CI = 0.17, 0.41). These effects were moderated by the type of comparison and whether reminders to engage were offered. Smartphone apps also resulted in significantly lower levels of psychological distress than comparisons (k = 22; g = -0.32; 95% CI = -0.48, -0.16). Meta-regression revealed a negative relationship between the effect sizes for mindfulness/acceptance and the effect sizes for distress. Smartphone apps produced significantly greater increases in self-compassion than comparisons (k = 9; g = 0.31; 95% CI = 0.07, 0.56), although the quality of RCTs in this analysis was poor. Findings suggest that principles of acceptance, mindfulness, and self-compassion may be learned through cheap, easily accessible, and low-intensity interventions delivered via smartphone apps. However, the quality of available evidence is poor, as low risk of bias was noted in few trials (18%) and the observed effects were likely explained by a digital placebo.

Self-compassion as a moderator of the relationships between shape and weight overvaluation and eating disorder psychopathology, psychosocial impairment, and psychological distress

Shape and weight overvaluation is a core component of body image theorized to drive many of the symptoms of eating disorders (ED) and associated distress and impairment. Identifying variables that protect against the negative effects of shape and weight overvaluation is needed for informing primary intervention targets. Self-compassion may be a protective factor given its role as an adaptive affect regulation strategy. We thus examined whether self-compassion would attenuate the relationships between shape and weight overvaluation and ED psychopathology, psychosocial impairment, and psychological distress. Cross-sectional data were analyzed from 992 (619 women and 373 men) participants. Multiple regression analyses revealed that self-compassion moderated the relationship between shape and weight overvaluation and each dependent variable. Specifically, among men and women with lower levels of self-compassion, overvaluation of shape and weight was strongly associated with each of the criterion variables; however, these relationships were either absent or weaker among those with higher levels of self-compassion. Present findings suggest that it may be beneficial for ED prevention and early intervention programs to explicitly incorporate components of compassion-focused interventions to improve mental health outcomes among the general public.

Prevention of eating disorders: 2019 in review

This article reviews 11 prevention-related publications in Eating Disorders: The Journal of Treatment & Prevention during 2019. Two models from the 2018 review continue to frame this analysis: (1) the Mental Health Intervention Spectrum from health promotion → types of prevention → case identification and referral → treatment; and (2) parsing phases of prevention into rationale, theory, and methodology → clarification of risk factors → implications for specific preventive interventions → design innovation and feasibility (pilot) research → efficacy and effectiveness research → program dissemination. These articles illustrate how the theoretical complexity and rigorous methodological demands of prevention science are manifest in the eating disorder field. A subset of articles also demonstrates the importance of working with researchers and community stakeholders to improve our understanding of how ethnicity, class, and gender intersect with planning for improvements in all phases of prevention. Other subsets show the need to expand the list of relevant risk factors, and how the traditional schema of masculinity creates both maladaptive biases in case identification and obstacles to an effective and compassionate understanding of EDs. Finally, implications of the absence of efficacy, effectiveness, and dissemination studies are discussed.

Cognitive-behavioral roots of body image therapy and prevention

The existing array of evidence-based body image prevention and intervention approaches has evolved over time. However, the majority originated directly or indirectly from a cognitive-behavioral conceptualisation of body image pioneered by Thomas F. Cash. In this way, it is difficult to overstate the impact Tom Cash has had on body image intervention research and practice. His ground-breaking work, building on the work of Schilder and Fisher, was the first to provide a comprehensive model of body image that reflected the broad range of influences and consequences of body image. His differentiation of the components of body image as a construct and between body image traits and states allowed us to identify and influence targets for intervention. Moreover, the intervention strategies that Tom Cash employed are still used today and laid the foundations for contemporary intervention programs. There is a gap of more than 15 years between the first and last of us receiving our PhDs, yet Cash's work has been an important influence on us all. We are extremely grateful for the theoretical and practical tools that he has given to our field. In this paper, we will outline how Cash's work has informed contemporary body image intervention and prevention. We will describe Cash's theory and intervention tools before discussing how this work paved the way for subsequent research and practice.

A systematic review and meta-analysis of dropout rates from dialectical behaviour therapy in randomized controlled trials

Dropout is an important factor that may compromise the validity of findings from randomized controlled trials (RCTs) of dialectical behaviour therapy (DBT). We conducted a targeted meta-analytic review of dropout from RCTs of DBT, with the aims of (1) calculating average rates of dropout from DBT; (2) investigating factors that moderate dropout; (3) examining whether dropout rates from DBT differ to control interventions; (4) synthesising reasons for dropout. Forty RCTs of DBT met full inclusion criteria. The weighted mean dropout rate was 28.0% (95% CI = 23.6, 32.9). Dropout rates were not related to target disorder, dropout definition, delivery format, therapist experience, and therapist adherence. Unexpectedly, dropout rates were significantly higher in trials that offered telephone coaching and utilized a therapist consultation team. DBT dropout rates did not significantly differ to dropout rates from control interventions. Few trials reported reasons for dropout, and there was little consistency in the reported reasons. Findings suggest that over one in four patients drop out from DBT in RCTs. This review highlights the urgency for future trials to explicitly report detail pertaining to patient dropout, as this may assist in the development of strategies designed to prevent future dropouts in RCTs of DBT.