A randomized trial exploring mindfulness and gratitude exercises as eHealth-based micro-interventions for improving body satisfaction

Protecting young women's body image from appearance-based social media exposure: A comparative study of self-compassion writing and mindful breathing interventions

OBJECTIVE

This study compared the effectiveness of self-compassion writing and mindful breathing in protecting body image after exposure to appearance-focused social media. It focused on individuals with high self-objectification and explored the underlying mechanisms and emotional benefits of these interventions.

METHODS

A randomized controlled trial was conducted with 107 young females (17-25 years) assigned to self-compassion writing (n = 37), mindful breathing (n = 36), or control (n = 34) groups. Body dissatisfaction was induced using idealized body imagery, after which participants completed their respective interventions. State body image was measured at baseline, post-induction, and post-intervention. At the end of the study, a semi-structured interview was conducted, and the data were analyzed using Neff's self-compassion framework.

RESULTS

A two-way ANOVA revealed a significant interaction effect between group and time point F (3.98, 207.15) = 8.45, p < 0.001, partial η2 = 0.140. Self-compassion writing through enhanced self-kindness improved state body image beyond baseline levels. Trait self-objectification moderated the efficacy of the intervention (∆R2 = 0.04, F (2,100) = 3.48, p = 0.035). Mediation analysis revealed that both interventions improved emotional state through body image enhancement (mediation effect size = 0.21).

CONCLUSIONS

Self-compassion writing demonstrated superior efficacy over mindful breathing, primarily through fostering self-kindness. Body image emerged as a critical mediator of emotion improvement, highlighting the value of mindfulness-based interventions in promoting body positivity and emotional resilience following appearance-based social media exposure.

Evaluation of curricular mindfulness micro-interventions to support college student resilience: a pilot study

Objective: This study addressed two research questions: (1) What is the feasibility of embedding curricular resilience micro-interventions across campus at a small university? (2) How do students and faculty describe their experiences of participating in resilience micro-interventions? Participants: 12 faculty, 267 students. Methods: Mixed-methods, quasi-experimental design. Faculty were randomly assigned to either implement curricular micro-interventions (the experimental group) or not (the control group). Student participants completed three surveys: pre-, mid-, and post-test. Six experimental group faculty completed a post-study focus group. Results: Qualitative data indicated micro-interventions are feasible to implement (RQ1), and students responded well and perceived a positive impact on their lives (RQ2). Conclusions: Resilience micro-interventions are feasible to implement in the classroom and show promise for supporting student resilience and well-being. Future research directions include studying their long-term impact, scalability, and effectiveness in diverse educational contexts.

Rapid, Tailored Dietary and Health Education Through A Social Media Chatbot Microintervention: Development and Usability Study With Practical Recommendations

BACKGROUND

There is an urgent need to innovate methods of health education, which can often be resource- and time-intensive. Microinterventions have shown promise as a platform for rapid, tailored resource dissemination yet have been underexplored as a method of standardized health or dietary education; social media chatbots display unique potential as a modality for accessible, efficient, and affordable educational microinterventions.

OBJECTIVE

This study aims to provide public health professionals with practical recommendations on the use of social media chatbots for health education by (1) documenting the development of a novel social media chatbot intervention aimed at improving dietary attitudes and self-efficacy among South Asian American young adults and (2) describing the applied experiences of implementing the chatbot, along with user experience and engagement data.

METHODS

In 2023, the "Roti" chatbot was developed on Facebook and Instagram to administer a 4-lesson tailored dietary health curriculum, informed by formative research and the Theory of Planned Behavior, to 18- to 29-year-old South Asian American participants (recruited through social media from across the United States). Each lesson (10-15 minutes) consisted of 40-50 prescripted interactive texts with the chatbot (including multiple-choice and open-response questions). A preintervention survey determined which lesson(s) were suggested to participants based on their unique needs, followed by a postintervention survey informed by the Theory of Planned Behavior to assess changes in attitudes, self-efficacy, and user experiences (User Experience Questionnaire). This study uses a cross-sectional design to examine postintervention user experiences, engagement, challenges encountered, and solutions developed during the chatbot implementation.

RESULTS

Data from 168 participants of the intervention (n=92, 54.8% Facebook; n=76, 45.2% Instagram) were analyzed (mean age 24.5, SD 3.1 years; n=129, 76.8% female). Participants completed an average of 2.6 lessons (13.9 minutes per lesson) and answered an average of 75% of questions asked by the chatbot. Most reported a positive chatbot experience (User Experience Questionnaire: 1.34; 81/116, 69.8% positive), with pragmatic quality (ease of use) being higher than hedonic quality (how interesting it felt; 88/116, 75.9% vs 64/116, 55.2% positive evaluation); younger participants reported greater hedonic quality (P=.04). On a scale out of 10 (highest agreement), participants reported that the chatbot was relevant (8.53), that they learned something new (8.24), and that the chatbot was helpful (8.28). Qualitative data revealed an appreciation for the cheerful, interactive messaging of the chatbot and outlined areas of improvement for the length, timing, and scope of text content. Quick replies, checkpoints, online forums, and self-administered troubleshooting were some solutions developed to meet the challenges experienced.

CONCLUSIONS

The implementation of a standardized, tailored health education curriculum through an interactive social media chatbot displayed strong feasibility. Lessons learned from challenges encountered and user input provide a tangible roadmap for future exploration of such chatbots for accessible, engaging health interventions.

The co-design and acceptability of a genital body image educational video for people with a penis

Within body image research, genital body image has not received significant attention. This project aimed to explore how positive genital body image could be fostered among people with a penis by co-designing and developing an educational resource. Participants were 22 people in Australia who identified as having a penis and were involved in three phases of co-design focus groups. Thematic and content analyses were used to generate themes across the data with each phase informing the next, culminating in a prototype resource being shown to participants in the final phase. Amongst the predominantly cisgender men sample, there was consensus that a brief, animated, educational video could have potential in promoting a positive genital body image in people with a penis. For video content, participants were not supportive of challenging societal messaging around penis size that "bigger is better". Instead, participants supported the inclusion of information about the range of penile functions, promoting acceptance of penile size/appearance and that fulfilling intimate relationships were possible irrespective of penis size. The feedback was positive overall for the final prototype video. To our knowledge, we describe the first co-designed educational resource for people with a penis and contribute to the understanding of this understudied topic.

Digital body image interventions for adult women: A meta-analytic review

Although many women experience body dissatisfaction, treatment options that prevent the onset of more serious conditions are limited in accessibility. As such, digital interventions may be an appropriate alternative resource to address restricted treatment options. This study provides statistical syntheses of the evidence for digital body image interventions for non-clinical adult women. A systematic literature search identified 19 studies (N = 2424) that tested the effect of a digital body image intervention compared to a control condition. Study results were synthesised using random effects models, and small to medium statistically significant effect sizes indicated that digital interventions were beneficial in increasing overall global satisfaction (g = 0.43) and reducing cognitive body dissatisfaction (g = 0.36). These meta-analytic findings provide evidence for the efficacy of digital body image interventions for non-clinical adult women. Intervention type was not found to be a statistically significant moderator, which may suggest that a range of intervention types can produce similar reductions in body dissatisfaction. Overall, digital body image interventions may be a feasible option to alleviate body dissatisfaction, particularly for women who may be unable to access conventional treatment.

Perspectives of Children and Adolescents on Engaging With a Web-Based Mental Health Program: Focus Group Study

Background

Despite accessibility and clinical benefits, open access trials of self-guided digital health interventions (DHIs) for young people have been plagued by high drop-out rates, with some DHIs recording completion rates of less than 3%.

Objective

The aim of this study was to explore how young people motivate themselves to complete an unpleasant task and to explore perceived motivators and demotivators for engaging with a DHI.

Methods

In this qualitative research study, 30 children and adolescents aged between 7 and 17 years were recruited to participate in 7 focus groups conducted over a 3-month period. Focus group activities and discussions explored sources of motivation to complete tasks and engage in a hypothetical 6-week DHI for anxiety.

Results

Children (aged 7-11 years) reported greater reliance on external motivators such as following parent instruction to complete unpleasant tasks, while adolescents (aged 12-17 years) reported greater internal motivation such as self-discipline. Program factors, such as engaging content, were the most commonly mentioned motivators for engaging with a DHI across both age groups. After that, internal sources of motivation were most commonly mentioned, such as perceived future benefits. External factors were the most commonly mentioned demotivators across all ages, with time commitment being the most frequently mentioned.

Conclusions

The study's findings have implications for enhancing adherence in future DHIs targeted to children and adolescents. Recommendations include the need for supportive parental involvement for children, while adolescents would likely benefit from mechanisms that promote autonomy, establish a supportive environment, and align with personal interests and values. Belief that a DHI will provide short-term benefits is important to both children and adolescents, as well as having confidence that future benefits will be realized.

Testing the efficacy of a brief online writing intervention on body image and distress in female cancer survivors

OBJECTIVE

This study tested the feasibility and efficacy of two iterations of a low-intensity online writing intervention, Expand Your Horizon (EYH), in improving body image and distress in a cancer population.

METHODS

In study 1 (3-session version of EYH), adult female cancer survivors (N = 201) were randomised to EYH, where they described their body functionality, or a creative writing control. Outcomes assessed at baseline and one-week follow-up included body appreciation, body dissatisfaction, and distress. In study 2 (1 session version of EYH), adult female cancer survivors (N = 65) were randomised to EYH or a neutral writing control. Outcomes (assessed at baseline, immediately post-intervention and one-week follow-up) included body appreciation, body functionality appreciation, body dissatisfaction and distress.

RESULTS

Study 1 experienced severe attrition; only 14 participants (7 %) completed the intervention and follow-up. Study 2 had higher retention, with 74 % completing the study. In study 2, while no significant differences emerged between EYH or control, both groups significantly improved immediately post-intervention across all outcomes. No differences were found at follow-up.

CONCLUSIONS

A single-session online writing intervention for cancer survivors appears to be more feasible than multi-session, however the efficacy of EYH for this population remains to be established.

Effects of app-based relaxation techniques on perceived momentary relaxation: Observational data analysis in people with cancer

OBJECTIVE

To examine the effects of six relaxation techniques on perceived momentary relaxation and a possible association of relaxation effects with time and practice experience in people with cancer.

METHODS

We used data from participants with cancer in a larger study practicing app-based relaxation techniques over 10 weeks, assessed momentary relaxation before and after every third relaxation practice, and analyzed momentary relaxation changes with a linear mixed-effects model.

RESULTS

The sample included 611 before-after observations from 91 participants (70 females (76.9%)) with a mean age of 55.43 years (SD 10.88). We found moderate evidence for variations in momentary relaxation changes across different techniques (P = .026), with short meditation, mindfulness meditation, guided imagery, and progressive muscle relaxation more frequently observed and leading to more relaxation than body scan and walking meditation. Furthermore, we found moderate evidence for increasing momentary relaxation changes over time (P = .046), but no evidence for an association between momentary relaxation and the number of previous observations (proxy for practice experience; P = .47).

CONCLUSION

We compared six app-based relaxation techniques in a real-life setting of people with cancer. The observed variations in perceived momentary relaxation appear to correspond with the popularity of the techniques used: The most popular relaxation techniques were the most effective and the least popular were the least effective. The effects increased over time, likely caused by dropout of individuals who gained no immediate benefit. Our findings open an interesting avenue for future research to better understand which relaxation techniques work best for whom in which situations.

TRIAL REGISTRATION

DRKS00027546; https://drks.de/search/en/trial/DRKS00027546.

Predictors, mediators, and moderators of response to digital interventions for eating disorders: A systematic review

OBJECTIVE

Digital interventions show promise as an effective prevention or self-management option for eating disorders (EDs). However, it remains unclear how, for whom, and through what mechanisms they work in this population, as a synthesis of outcome predictors, moderators, and mediators is lacking. This systematic review synthesized empirical research investigating predictors, mediators, and moderators of response to digital interventions for EDs.

METHOD

Six databases were searched (PROSPERO CRD42022295565) for studies that assessed predictors, moderators, or mediators of response (i.e., uptake, drop-out, engagement, and symptom level change) to a digital prevention or treatment program for EDs. Variables were grouped into several overarching categories (demographic, symptom severity, psychological, etc.) and were synthesized qualitatively across samples without a formally diagnosed ED (typically prevention-focused) and samples with a formally diagnosed ED (typically treatment-focused).

RESULTS

Eighty-six studies were included. For studies recruiting samples without a formal diagnosis (n = 70 studies), most predictors explored were statistically unrelated to outcome, although participant age, baseline symptom severity, confidence to change, motivation, and program engagement showed preliminary evidence of prognostic potential. No robust moderators or mediators were identified. Few studies recruiting samples with a formal diagnosis emerged (n = 16), of which no reliable predictors, moderators, or mediators were identified.

DISCUSSION

It remains unclear how, for whom, and under what circumstances digital programs targeting EDs work. We offer several recommendations for future research with the aim of advancing understanding of client characteristics and intervention elements that signal success from this intervention modality.

PUBLIC SIGNIFICANCE

Digital interventions have shown potential as an effective, scalable, and accessible intervention option for EDs. However, responsiveness varies, so advancing understanding of predictors, mediators, and moderators of outcome to digital interventions for EDs is needed. Such knowledge is important for enabling safe and efficient treatment matching, and for informing future development of effective digital interventions.

"They Don't Come With a Handbook": Exploring Design Opportunities for Supporting Parent-Child Interaction around Emotions in the Family Context

Parenting practices have a profound effect on children's well-being and are a core target of several psychological interventions for child mental health. However, there is only limited understanding in HCI so far about how to design socio-technical systems that could support positive shifts in parent-child social practices in situ. This paper focuses on parental socialisation of emotion as an exemplar context in which to explore this question. We present a two-step study, combining theory-driven identification of plausible design directions with co-design workshops with 22 parents of children aged 6-10 years. Our data suggest the potential for technology-enabled systems that aim to facilitate positive changes in parent-child social practices in situ, and highlight a number of plausible design directions to explore in future work.

Perceptions and effectiveness of episodic future thinking as digital micro-interventions based on mobile health technology

Objective

Delay discounting denotes the tendency for humans to favor short-term immediate benefits over long-term future benefits. Episodic future thinking (EFT) is an intervention that addresses this tendency by having a person mentally "pre-experience" a future event to increase the perceived value of future benefits. This study explores the feasibility of using mobile health (mHealth) technology to deliver EFT micro-interventions. Micro-interventions are small, focused interventions aiming to achieve goals while matching users' often limited willingness or capacity to engage with interventions. We aim to explore whether EFT delivered as digital micro-interventions can reduce delay discounting, the users' perceptions, and if there are differences between regular EFT and goal-oriented EFT (gEFT), a variant where goals are embedded into future events.

Method

A randomized study was conducted with 208 participants allocated to either gEFT, EFT, or a control group for a 21-day study.

Results

Results indicate intervention groups when combined achieved a significant reduction of Δ log k = - .80 in delay discounting (p = .017 ) compared to the control. When split into gEFT and EFT separately only the reduction of Δ log k = .96 in EFT delay discounting was significant (p = .045 ). We further explore and discuss thematic user perceptions.

Conclusions

Overall, user perceptions indicate gEFT may be slightly better for use in micro-interventions. However, perceptions also indicate that audio-based EFT micro-interventions were not always preferable to users, with findings suggesting that future EFT micro-interventions should be delivered using different forms of multimedia based on user preference and context and supported by other micro-interventions to maintain interest.

A short-form drama series created for the digital media environment: A randomised controlled trial exploring effects on girls' body satisfaction, acceptance of appearance diversity, and appearance-related internalised racism

'Edutainment' micro-interventions are a scalable public health strategy that can challenge media-related body image pressures and race- and weight- based stigma. This study evaluated the impact of viewing a brief, theoretically-informed, short-form drama episode on Black and non-Black adolescent girls' body image, acceptance of diversity of appearance (assessed by acceptance of an individual in a larger body and a Black individual), and appearance-related internalised racism (among Black girls only). The fictional drama depicted characters of diverse body sizes and race/ethnicities, with each episode focusing on a risk or protective factor for body image concerns among adolescent girls (e.g., appearance-related teasing and conversations). Participants (N = 686; 50.4 % Black, 49.6 % non-Black) aged 13-18 (Mage = 15.72 years) were randomly allocated to view either the first episode of this series (focused on social media's unrealistic appearance ideals and strategies to resist pressures) or a non-body-image-related control video. Findings revealed no significant differences in body satisfaction between conditions but significant improvements in the acceptance of appearance diversity among all girls who viewed the body image episode. Black girls who viewed this episode experienced significant improvements to appearance-related internalised racism. Edutainment micro-interventions constitute a promising avenue for promoting acceptance of appearance diversity and reducing appearance-related internalised racism.

Testing a Low-Intensity Single-Session Self-Compassion Intervention for State Body Shame in Adult Women: A Dismantling Randomized Controlled Trial

State body shame is a risk factor for eating disorders, and self-compassion is emerging as a potentially effective treatment option in such cases. This study tested the efficacy of a brief (15-minute) self-compassion intervention in reducing state body shame. Using dismantling trial methodology, participants were randomly allocated to an active compassion condition (n = 23), an inactive control compassion condition (n = 23), or an educational control condition (n = 23). Measures of state body image and state shame were collected pre-intervention, immediately after the intervention, and a day after the intervention. Subjective units of state body shame (SUBS) were intensively measured during each invention. Self-compassion interventions were equally efficacious at protecting against deterioration of state body shame and were effective at reducing state shame compared to the educational control condition, with medium effect sizes (respectively - np2 = .07 and np2 = .08). Reductions in state shame were retained at follow-up. None of the interventions had an effect on body image (np2 = .04). Findings demonstrate the clinical promise of brief self-compassion interventions, particularly as evidenced-based "homework" exercises.

Delivering a media literacy intervention for body dissatisfaction using an app-based intervention: A feasibility and pilot trial

Body dissatisfaction rates continue to remain high, and the consequences remain dire, especially among young women. Traditional media literacy interventions have found success in addressing body image-related constructs, though they are limited in their reach and are often quickly outdated. This study was designed to examine the feasibility and acceptability of delivering a media literacy intervention via ecological momentary intervention. This pilot study tested a media literacy intervention delivered via a smartphone app designed to disrupt the connection between media use and body dissatisfaction. Thirty-seven undergraduate women (Mage = 21.17; SD = 2.20) received a 15-day media literacy intervention through a smartphone application. The primary outcomes were completion rates, retention rates, percentage of data points lost to technological errors, and participant feedback. The secondary outcome was change in body dissatisfaction. The retention and percentage of data points lost to technological errors, alongside participants' ratings, indicated that this intervention is feasible and acceptable. Several targets were identified to increase participant acceptance and potential efficacy of the intervention. Trait body dissatisfaction decreased, though not significantly, following the intervention. State body image satisfaction improved significantly from the first day to the last day of engagement with the app. Overall, the intervention was deemed feasible and acceptable, opening the door for future research in which the intervention and its delivery system are improved, and its efficacy is reexamined. Future digital media literacy interventions should focus on building a user-centered app, further reducing participant burden, and testing efficacy in large and diverse samples.

Using Chatbot Technology to Improve Brazilian Adolescents' Body Image and Mental Health at Scale: Randomized Controlled Trial

BACKGROUND

Accessible, cost-effective, and scalable mental health interventions are limited, particularly in low- and middle-income countries, where disparities between mental health needs and services are greatest. Microinterventions (ie, brief, stand-alone, or digital approaches) aim to provide immediate reprieve and enhancements in mental health states and offer a novel and scalable framework for embedding evidence-based mental health promotion techniques into digital environments. Body image is a global public health issue that increases young peoples' risk of developing more severe mental and physical health issues. Embedding body image microinterventions into digital environments is one avenue for providing young people with immediate and short-term reprieve and protection from the negative exposure effects associated with social media.

OBJECTIVE

This 2-armed, fully remote, and preregistered randomized controlled trial assessed the impact of a body image chatbot containing microinterventions on Brazilian adolescents' state and trait body image and associated well-being outcomes.

METHODS

Geographically diverse Brazilian adolescents aged 13-18 years (901/1715, 52.54% girls) were randomized into the chatbot or an assessment-only control condition and completed web-based self-assessments at baseline, immediately after the intervention time frame, and at 1-week and 1-month follow-ups. The primary outcomes were mean change in state (at chatbot entry and at the completion of a microintervention technique) and trait body image (before and after the intervention), with the secondary outcomes being mean change in affect (state and trait) and body image self-efficacy between the assessment time points.

RESULTS

Most participants who entered the chatbot (258/327, 78.9%) completed ≥1 microintervention technique, with participants completing an average of 5 techniques over the 72-hour intervention period. Chatbot users experienced small significant improvements in primary (state: P<.001, Cohen d=0.30, 95% CI 0.25-0.34; and trait body image: P=.02, Cohen d range=0.10, 95% CI 0.01-0.18, to 0.26, 95% CI 0.13-0.32) and secondary outcomes across various time points (state: P<.001, Cohen d=0.28, 95% CI 0.22-0.33; trait positive affect: P=.02, Cohen d range=0.15, 95% CI 0.03-0.27, to 0.23, 95% CI 0.08-0.37; negative affect: P=.03, Cohen d range=-0.16, 95% CI -0.30 to -0.02, to -0.18, 95% CI -0.33 to -0.03; and self-efficacy: P=.02, Cohen d range=0.14, 95% CI 0.03-0.25, to 0.19, 95% CI 0.08-0.32) relative to the control condition. Intervention benefits were moderated by baseline levels of concerns but not by gender.

CONCLUSIONS

This is the first large-scale randomized controlled trial assessing a body image chatbot among Brazilian adolescents. Intervention attrition was high (531/858, 61.9%) and reflected the broader digital intervention literature; barriers to engagement were discussed. Meanwhile, the findings support the emerging literature that indicates microinterventions and chatbot technology are acceptable and effective web-based service provisions. This study also offers a blueprint for accessible, cost-effective, and scalable digital approaches that address disparities between health care needs and provisions in low- and middle-income countries.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04825184; http://clinicaltrials.gov/ct2/show/NCT04825184.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-021-12129-1.

Genital body image education in young adolescent girls: A proof of concept pilot study

Our research team previously developed a brief educational video aimed at increasing adolescent girls' knowledge of the variation in cisgender female genital appearance and improving attitudes towards genital appearance. This video was efficacious with 16-18-year-old girls, but their feedback suggested that younger girls may gain greater benefit. Owing to the younger age group and sensitivity of the topic, we undertook a small pilot study, using a mixed methods approach (quantitative followed by qualitative study phase), to explore the understanding of 13-15-year-old girls of their genital anatomy and body image, and their impressions of the video. The sample (N = 6) showed, on average, low-to-moderate levels of genital anatomical knowledge and genital appearance satisfaction. In qualitative interviews, thematic analysis showed girls had received limited genital-related sexual education and had not considered genitals to be part of their concept of body image. However, after watching the video, they reported an appreciation of the diversity in genital appearance and encouraged use of the video in schools to prompt discussions about genital body image. There are broader implications of this research, namely, that the education of girls about the diversity in genital appearance could be important in improving their future gynaecological and sexual well-being.

Can following body positive or appearance neutral Facebook pages improve young women's body image and mood? Testing novel social media micro-interventions

Small changes to social media use could have a large impact across the population. The present study tested novel social media micro-interventions (i.e., brief content delivered in everyday life) in which young women (N = 159) were instructed to either (1) follow a body positive Facebook group, (2) follow an appearance neutral Facebook group, or (3) use Facebook as usual. Relevant content was posted to the Facebook groups three times per day for two weeks. Primary outcomes were trait body image (body dissatisfaction and appreciation) and mood, and secondary outcomes were trait self-objectification, appearance comparison tendency, and body activism. Outcomes were assessed across three timepoints: pre-test (T1), post-test (T2) after the 14-day intervention period, and follow-up (T3) 4-weeks after T2. Participants in both the body positive and appearance neutral conditions reported decreased body dissatisfaction from T1 to T2 (small-medium effects) and participants in the body positive condition reported decreased appearance comparisons from T1 to T2 (medium effect). There were no changes for those variables from T2 to T3. No other significant differences were found. Viewing a small number of body positive or appearance neutral posts on social media may be an effective inexpensive micro-intervention for improving young women's body image.

Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches

BACKGROUND

App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials.

OBJECTIVE

To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding.

METHODS

In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user's personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified.

RESULTS

Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery.

CONCLUSIONS

Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population.

Appreciating the Good Things in Life During the Covid-19 Pandemic: A Randomized Controlled Trial and Evaluation of a Gratitude App

The Covid-19 pandemic has had many negative consequences on the general public mental health. The aim of this study was to test the effectiveness of and satisfaction with an app with gratitude exercises to improve the mental health of people with reduced mental well-being due to the Covid-19 pandemic, as well as potential mechanisms of well-being change and dose-response relationships. A two-armed randomized controlled trial design was used, with two groups receiving the 6-week gratitude intervention app either immediately (intervention group, n = 424) or after 6 weeks (waiting list control group, n = 425). Assessments took place online at baseline (T0), six weeks later (T1) and at 12 weeks (T2), measuring outcomes (i.e., mental well-being, anxiety, depression, stress), and potential explanatory variables (i.e., gratitude, positive reframing, rumination). Linear mixed models analyses showed that when controlled for baseline measures, the intervention group scored better on all outcome measures compared to the control group at T1 (d = .24-.49). These effects were maintained at T2. The control group scored equally well on all outcome measures at T2 after following the intervention. Effects of the intervention on well-being were partially explained by gratitude, positive reframing, and rumination, and finishing a greater number of modules was weakly related to better outcomes. The intervention was generally appealing, with some room for improvement. The results suggest that a mobile gratitude intervention app is a satisfactory and effective way to improve the mental health of the general population during the difficult times of a pandemic.

Social Comparison Orientation and Cyberbullying Perpetration and Victimization: Roles of Envy on Social Networking Sites and Body Satisfaction

Although some studies have explored the psychological and behavioral outcomes of social comparison orientation (SCO), few have explored the associations of SCO with cyberbullying perpetration and victimization. The current study aimed to investigate the associations of SCO with cyberbullying perpetration and victimization, and considered envy on social networking sites (SNS) as a mediator and body satisfaction as a moderator in these relations. To test our expectations, 941 adolescents aged between 10 and 16 years (M = 13.15, SD = 1.18) completed multiple questionnaires, namely the Social Comparison Orientation Scale, the Revised Cyber Bullying Inventory, an envy scale revised for the SNS context, and the Body Areas Satisfaction Scale. Correlation analysis revealed that cyberbullying perpetration and cyberbullying victimization were significantly and positively correlated with SCO and envy on SNS, and significantly and negatively correlated with body satisfaction. The results of structural equation modeling (SEM) revealed that envy on SNS played a mediating role in the associations of SCO with cyberbullying perpetration and victimization. The results of SEM and simple slope test analysis indicated that body satisfaction weakened the direct association of SCO with envy on SNS and further weakened the indirect associations of SCO with cyberbullying perpetration and victimization via envy on SNS. Specifically, individuals with high levels of SCO were more likely to feel envious on SNS, and further tended to bully others and be bullied online when they were dissatisfied with their bodies. In other words, positive body satisfaction protected individuals with high levels of SCO from cyberbullying perpetration and victimization by decreasing their feelings of envy on SNS.

ePSICONUT: An e-Health Programme to Improve Emotional Health and Lifestyle in University Students

The use of information and communication technologies in the health field is known as eHealth. Nowadays, the application of technological and digital tools for maintaining/improving physical and mental health is experiencing an exponential boom. These tools have been perceived as a powerful support for face-to-face therapies and lifestyle changes. Nevertheless, there is not enough scientific research that analyses the impact and consequences of eHealth interventions. More studies are needed to validate its application. Therefore, the aim of this study was to evaluate the impact of eHealth tools in a programme called ePSICONUT. This programme was created to promote healthy lifestyle habits in university students. The sample consisted of 16 university students from the Dominican Republic aged 18−24 years (x¯ = 20.69; s = 1.74). ePSICONUT was developed in 12 weeks and its impact was analyzed by comparing the initial and the final psychological and lifestyle tests results, which were completed online by the participants. Results reported that the professionally supervised use of eHealth tools was associated with better psychological well-being, lees anxiety and depression, and better lifestyle habits (such as diet quality), even in stressful and changing situations such as the COVID-19 pandemic circumstances. However, more studies are needed to validate and promote the use of eHealth-based intervention programmes.

Finding My Way from clinical trial to open access dissemination: comparison of uptake, adherence, and psychosocial outcomes of an online program for cancer-related distress

PURPOSE

Few digital psycho-oncology programs have been adopted into routine practice; how these programs are used after trial completion remains unexplored. To address this, the present study transitioned our evidence-based 6-module CBT-based program, Finding My Way, into open access (OA) after completion of the RCT, and compared uptake, usage, and psychosocial outcomes to the earlier RCT.

METHODS

Recruitment was passive, via promotion through (1) media and social media releases, (2) public lectures, (3) radio interviews and podcasts, and (4) clinician-initiated referral. Measures included number of enrolled users, number of modules completed, and pre- and optional post-measures of distress and quality of life (QOL).

RESULTS

Uptake was lower in OA (n = 120; 63% of RCT). Usage was markedly lower: 1.5 modules were completed on average (vs 3.7 in RCT), and only 13% completed a 'therapeutic dose' of 4 + modules (vs. 50% in RCT). Research attrition was high; n = 13 completed post-measures. OA users were more sociodemographically and clinically diverse than RCT users, had higher baseline distress (OA M_pre = 36.7, SD = 26.5; RCT M_pre = 26.5, SD = 21.7), and reported larger pre-post reductions than their RCT counterparts (OA M_post = 23.9, SD = 20.7; RCT M_post = 21.2, SD = 21.2). Moderate improvements in mental QOL occurred during OA (M_pre = 37.3, SD = 12.6; M_post = 44.5, SD = 12.1), broadly replicating RCT findings.

CONCLUSION

Findings that OA users were more medically and sociodemographically diverse and distressed at baseline than their RCT counterparts, and - despite having lower usage of the program - achieved larger changes from baseline to post-program, will help to shape future intervention design, tailoring, and dissemination.

Exploring the impact of a gratitude-focused meditation on body dissatisfaction: Can a brief auditory gratitude intervention protect young women against exposure to the thin ideal?

This study aimed to determine if a brief gratitude-focused meditation would significantly impact body dissatisfaction, and whether it would serve as a protective factor from exposure to thin idealized images in a sample of undergraduate women. 176 participants (M_age= 19.75) engaged in either a gratitude meditation, mindfulness meditation, or listened to a recording of a history textbook. Women were subsequently exposed to a set of neutral images or thin ideal images. Women reported significant decreases in state body dissatisfaction following all auditory conditions, regardless of auditory content. Decreased levels of body dissatisfaction persisted through exposure to neutral images, but not through exposure to thin ideal images. Results indicated that both the gratitude and mindfulness interventions were effective in eliciting a significant increase in self-reported levels of gratitude and mindfulness compared to controls. The results of the study suggest that auditory micro-interventions can decrease body dissatisfaction in young adult women. However, further investigation into the optimal modality, length, and frequency of micro-interventions aimed at buffering the negative effects of idealized thin image exposure on women is needed.

Systematic Review of Digital Interventions for Adolescent and Young Adult Women's Body Image

Background

A growing number of digital interventions have been developed to address a range of mental health issues including body image. Identifying effective interventions for body image is important given the prevalence of body image concerns and their associated negative outcomes among young women. This review aimed to critically evaluate current evidence on the use of digital interventions for adolescent and young adult women's body image.

Methods

A literature search was performed in November 2021 across three databases, PsychINFO, Web of Science and Pubmed to identify studies published with keywords and synonyms of "body image" and "digital interventions" that have been conducted with girls/women aged 10-25 years. Studies were included if they assessed a universal body image intervention delivered through a digital platform (e.g., web-based, mobile phone) and if they reported body image outcomes using validated measures. Two authors independently screened studies extracted data and assessed the quality of studies.

Results

Eight of 15 interventions were effective in improving at least one body image outcome from pre-post intervention; however, effect sizes were mostly small-medium, and few effects were maintained at follow-up. Studies were heterogeneous in terms of delivery format, duration, sample characteristics, quality, and outcomes.

Discussion

Findings suggest that digitally delivered interventions can effectively improve some body image outcomes in young women. Characteristics of effective studies are discussed and suggestions for future work on intervention development in this field are provided.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021281435, identifier CRD42021281435.

Testing a self-compassion micro-intervention before appearance-based social media use: Implications for body image

Using social media applications can lead to increased body dissatisfaction among young women, particularly when they compare themselves to such images. One intervention for combating these harmful effects may be through self-compassion, or the ability to treat oneself as a friend. The goal of this study was to determine whether a self-compassion micro-intervention could prevent increases in body dissatisfaction after comparing themselves to thin ideal images on Instagram. In an online study, 230 women (M = 25.88, SD = 0.70) completed measures of state weight and appearance dissatisfaction before completing a brief self-compassion writing task (experimental condition) or a simple sorting task (control condition). After completing the assigned tasks, participants reported state body dissatisfaction. Next, they were asked to compare themselves to pre-selected thin ideal images of a curated Instagram profile before reporting state body dissatisfaction for a final time. The results demonstrated that the self-compassion intervention led to decreased in weight dissatisfaction and appearance dissatisfaction that were maintained after Instagram use. Those in the control condition showed increased in body image concern after Instagram use. These preliminary findings suggest that a self-compassion micro-intervention may serve as an effective buffer against certain adverse effects of social media on body image.

Comparing self-compassion versus body exposure for adult women with moderate to severe body dissatisfaction: A feasibility and pilot trial

This study assessed the feasibility and effectiveness of two brief online interventions for body shame for women with moderate to severe negative body image, to inform the design of a future randomized controlled trial. The primary feasibility outcomes were recruitment, measure completion rates, retention rates and internet connection failure rates. The secondary pilot outcomes were change on clinical measures and state shame ratings during the interventions. Participants were randomized to either online (40‐min single session) body exposure or self‐compassion interventions. Five validated nomothetic outcome measures (body dissatisfaction, appreciation, eating disorder, external shame and anxiety) were taken at three time points (preintervention, postintervention and 2‐week follow‐up). Subjective units of body shame (SUBS 0–100 scale) were rated every 5 min during the interventions. The target of recruiting 30 participants in 60 days was successfully achieved. The measure completion rate was high (100%), and retention rates (80% to 100%) showed moderate‐to‐high acceptability of the interventions. Online delivery was moderately viable with a 12.5% session disconnection rate. The self‐compassion intervention significantly reduced SUBS ratings during the course of the intervention, but there was no significant improvement or difference between the interventions on nomothetic outcome measures. Findings suggest that a fully powered trial is viable, and sample size calculation and methodological requirements are provided.

Improving body image at scale among Brazilian adolescents: study protocol for the co-creation and randomised trial evaluation of a chatbot intervention

BACKGROUND

Body image concerns are prevalent among Brazilian adolescents and can lead to poor psychological and physical health. Yet, there is a scarcity of culturally-appropriate, evidence-based interventions that have been evaluated and made widely available. Chatbot technology (i.e., software that mimics written or spoken human speech) offers an innovative method to increase the scalability of mental health interventions for adolescents. The present protocol outlines the co-creation and evaluation of a body image chatbot for Brazilian adolescents via a partnership between academics, industry organisations and the United Nations Children's Fund (UNICEF).

METHODS

A two-armed fully remote randomised controlled trial will evaluate the chatbot's effectiveness at improving body image and well-being. Adolescent girls and boys (N = 2800) aged 13-18 years recruited online will be randomly allocated (1:1) into either: 1) a body image chatbot or 2) an assessment-only control condition. Adolescents will engage with the chatbot over a 72-hour period on Facebook Messenger. Primary outcomes will assess the immediate and short-term impact of the chatbot on state- and trait-based body image, respectively. Secondary outcomes will include state- and trait-based affect, trait self-efficacy and treatment adherence.

DISCUSSION

This research is the first to develop an evidence-informed body image chatbot for Brazilian adolescents, with the proposed efficacy trial aiming to provide support for accessible, scalable and cost-effective interventions that address disparities in body image prevalence and readily available resources.

TRIAL REGISTRATION NUMBER

NCT04825184 , registered 30th March 2021.

Exploring the features of an app-based just-in-time intervention for depression

BACKGROUND

Technological advancements make it possible to deliver depression interventions via smartphone applications ("Apps"), including those that deliver content "just-in-time" (e.g., in response to acute negative mood states). This study examined whether an app-based just-in-time intervention (ImproveYourMood+) decreased depressive symptoms, and whether the following features were related to symptom improvement: micro-intervention content, mood monitoring, and just-in-time prompts to use content.

METHODS

Participants (n = 235) from the general population who self-identified as wanting to improve their negative mood were randomised to a waitlist control group (n = 55) or one of three intervention groups: MoodTracker (monitoring-only, n = 58), ImproveYourMood (monitoring and content; n = 62), or ImproveYourMood+ (monitoring, content, and prompts; n = 60). The active intervention phase was 3 weeks. Depressive and anxiety symptoms, and negative automatic thoughts were assessed at baseline, immediately post-intervention, and one month following post-intervention.

RESULTS

Linear mixed modelling revealed greater declines over time in depressive and anxiety symptoms and negative automatic thoughts for the ImproveYourMood group (standardized mean differences [SMDs] ranged from .32 to .40) and improves for the ImproveYourMood+ group for negative automatic thoughts (SMDs ≥ .37) compared to the waitlist control group. No between-group differences were observed between the MoodTracker and control groups (SMDs = .04-.23). User experience appeared to be superior in more comprehensive/multi-modal versions.

LIMITATIONS

The study employed a naturalistic design, whereby participants self-selected to utilise the program, did not complete eligibility assessments, and did not receive compensation. The study therefore attained considerable drop-out rate (~50% by the follow-up timepoints), potentially reflecting the usage patterns of real-world mental health apps.

CONCLUSIONS

The findings suggest that micro-interventions can be an effective way to reduce depressive symptoms both in the moment and 1-2 months later. Integration of micro-interventions with full treatment programs is a viable next step in micro-intervention research.

Development of a Positive Body Image Chatbot (KIT) With Young People and Parents/Carers: Qualitative Focus Group Study

BACKGROUND

Body image and eating disorders represent a significant public health concern; however, many affected individuals never access appropriate treatment. Conversational agents or chatbots reflect a unique opportunity to target those affected online by providing psychoeducation and coping skills, thus filling the gap in service provision.

OBJECTIVE

A world-first body image chatbot called "KIT" was designed. The aim of this study was to assess preliminary acceptability and feasibility via the collection of qualitative feedback from young people and parents/carers regarding the content, structure, and design of the chatbot, in accordance with an agile methodology strategy. The chatbot was developed in collaboration with Australia's national eating disorder support organization, the Butterfly Foundation.

METHODS

A conversation decision tree was designed that offered psychoeducational information on body image and eating disorders, as well as evidence-based coping strategies. A version of KIT was built as a research prototype to deliver these conversations. Six focus groups were conducted using online semistructured interviews to seek feedback on the KIT prototype. This included four groups of people seeking help for themselves (n=17; age 13-18 years) and two groups of parents/carers (n=8; age 46-57 years). Participants provided feedback on the cartoon chatbot character design, as well as the content, structure, and design of the chatbot webchat.

RESULTS

Thematic analyses identified the following three main themes from the six focus groups: (1) chatbot character and design, (2) content presentation, and (3) flow. Overall, the participants provided positive feedback regarding KIT, with both young people and parents/carers generally providing similar reflections. The participants approved of KIT's character and engagement. Specific suggestions were made regarding the brevity and tone to increase KIT's interactivity.

CONCLUSIONS

Focus groups provided overall positive qualitative feedback regarding the content, structure, and design of the body image chatbot. Incorporating the feedback of lived experience from both individuals and parents/carers allowed the refinement of KIT in the development phase as per an iterative agile methodology. Further research is required to evaluate KIT's efficacy.

"What can her body do?" Reducing weight stigma by appreciating another person's body functionality

OBJECTIVE

Weight stigma is prevalent across multiple life domains, and negatively affects both psychological and physical health. Yet, research into weight stigma reduction techniques is limited, and rarely results in reduced antipathy toward higher-weight individuals. The current pre-registered study investigated a novel weight stigma reduction intervention. We tested whether a writing exercise focusing on body functionality (i.e., everything the body can do, rather than how it looks) of another person leads to reductions in weight stigma.

METHOD

Participants were 98 women (Mage = 23.17, Range = 16-63) who viewed a photograph of a higher-weight woman, "Anne," and were randomised to complete a writing exercise either describing what "Anne's" body could do (experimental group) or describing her home (active control group). Facets of weight stigma were assessed at pretest and posttest.

RESULTS

At posttest, the experimental group evidenced higher fat acceptance and social closeness to "Anne" compared with the active control group. However, no group differences were found in attribution complexity, responsibility, and likeability of "Anne".

CONCLUSIONS

A brief body functionality intervention effectively reduced some, but not all, facets of weight stigma in women. This study provides evidence that functionality-focused interventions may hold promise as a means to reduce weight stigma.

Examining the efficacy of video-based microinterventions for improving risk and protective factors for disordered eating among young adult women

OBJECTIVE

Brief self-guided activities designed for focused and immediate benefits, termed microinterventions, have the potential to aid reach and engagement in mental health interventions; however further validation is needed. This study evaluated effects of two microinterventions for responding to appearance-ideal media on risk and protective factors for disordered eating.

METHOD

Undergraduate women (N = 202, M_age = 19.90, SD = 2.75) were allocated quasi-randomly to one of three 15-min video-based microinterventions (mindfulness, cognitive dissonance, educational control) in the lab and assessed on state outcomes at baseline and immediate posttest. One week later, trait factors were assessed and participants underwent an appearance-ideal media exposure task.

RESULTS

Both mindfulness and dissonance groups reported significant immediate benefits to state appearance-ideal internalization, perceived sociocultural pressures and related distress, and mood, compared to educational control (Glass's Δ effect sizes = .40-.94), but not state weight or appearance satisfaction. At 1-week follow-up, mindfulness and dissonance groups demonstrated improved trait appearance-ideal internalization (Δ = .40 and .42), weight and shape concerns (Δ = .27 [ns] and .44), and body appreciation (Δ = .39 and .46) compared to the educational control. There were no effects on trait perceived pressures, negative affect, or body image psychological flexibility, and no differential changes in state outcomes from premedia to postmedia exposure.

DISCUSSION

Microinterventions using mindfulness and dissonance techniques show promise for improving some risk and potential protective factors for disordered eating in the immediate and short-term. Further research is required to substantiate their place within the spectrum of eating disorder prevention, early intervention and treatment techniques.

Exploring the gratitude model of body appreciation and intuitive eating among Japanese women

Culture is believed to play a central role in body image and eating problems, and for this reason, it is important to conduct cross-cultural investigations of relevant theoretical models. This study involves a non-Western replication of one of the few existing models of positive body image, the gratitude model of body appreciation, which was originally developed using American women. The model postulates that a grateful attitude is associated with body appreciation and intuitive eating via reduced contingent self-worth and social comparison. The current study aims to examine the applicability of the model to Japanese women. A sample of 648 Japanese women (age range = 15-69, M = 42.1, SD = 15.7) completed online measures of gratitude, contingent self-worth, social comparison, body appreciation, and intuitive eating. In general, all paths in the original model were replicated in the current model. However, two new paths were added to achieve good fit, including a path from basing one's self-worth on others' approval to body appreciation and another path from gratitude directly to intuitive eating. These differential pathways are discussed in the context of Japanese culture that emphasizes appreciation towards foods and self-definition based on social approval. In addition, implications for intervention are described.

The effectiveness of brief animated films as a scalable micro-intervention to improve children's body image: A randomised controlled trial

Creating media to counteract the plethora of media and advertising that perpetuates negative body image is a scalable public health strategy that can be achieved through innovative micro-interventions. This study examined the immediate and short-term (one-week follow-up) impact of viewing brief, evidence-informed animated films on young people's body image, media literacy, and self-efficacy in addressing appearance teasing. The animations were co-created through a partnership among academics, a personal care brand's social mission, and a children's television channel. Participants aged 7-14 (N = 1329, 49 % girls) were randomised into one of three viewing conditions: Appearance Teasing & Bullying, Media & Celebrities, or a non-appearance-related animation. Contrary to predictions, all three animations were comparably effective at eliciting intervention effects. For girls and boys aged 7-10, all three animations immediately improved state body satisfaction (+boys aged 11-14; Cohen's ds = .60-.71) and led to sustained improvements in trait media literacy (+girls aged 11-14; ds = .38-.61), sensitivity to appearance teasing (+boys aged 11-14; ds = .35-.48), and willingness to ignore appearance teasing (7-10 years only; ds = .34-.74) at one-week follow-up. Findings indicate that children's media is an effective medium for developing micro-interventions.

The potential benefits of death reflection for improving women's body image

This study investigated death reflection as a novel strategy to improve body image among women. Young adult women (N = 158; M_age = 21.35) completed a death reflection exercise, a death-related active control exercise (to ensure that effects were due to the manner in which women reflected on their death, rather than due to thoughts about death in general), or a non-death-related active control exercise. Participants completed measures of body image at posttest and 1-week follow-up. The women in the death reflection group, compared to the non-death-related control group, experienced higher body weight satisfaction at posttest. Among women higher in beauty orientation, those in the death reflection group experienced higher body shape satisfaction compared to women in the death-related control group. Effects were medium-to-large in magnitude. No group differences were observed for overall appearance satisfaction, appearance importance, broad conceptualisation of beauty, and endorsement of cultural appearance ideals. These findings provide preliminary support for death reflection as a technique to improve some facets of women's body image. Yet, future research is needed to test whether these effects are replicable and can be extended to other facets of body image.

Genital Self-Image in Adolescent Girls: The Effectiveness of a Brief Educational Video

The study investigated the effectiveness of a very brief video aimed at increasing adolescent girls' knowledge of the variation in normal female genital appearance and improving their attitudes towards their own genitals. The video was developed by the researchers and included information about the anatomical features of cisgender female genitals and their function, as well as emphasizing the diversity in the appearance of these features, particularly the external genitalia or vulvar region. A sample of 343 female adolescents aged 16-18 years were randomly assigned to view the educational video or a control video. The educational video significantly increased the girls' knowledge of female genital anatomy. The educational video also significantly increased genital appearance satisfaction and decreased consideration of undergoing cosmetic genital surgery or labiaplasty in the future. The participants who watched the educational video were also more likely to recommend focusing on the diversity in normal female genital appearance when educating other young people on the topic of female genital anatomy. Our results suggest that a very brief educational video could be a useful tool to assist young girls with their genital self-image.

Digital Micro Interventions for Behavioral and Mental Health Gains: Core Components and Conceptualization of Digital Micro Intervention Care

Although many people access publicly available digital behavioral and mental health interventions, most do not invest as much effort in these interventions as hoped or intended by intervention developers, and ongoing engagement is often low. Thus, the impact of such interventions is minimized by a misalignment between intervention design and user behavior. Digital micro interventions are highly focused interventions delivered in the context of a person’s daily life with little burden on the individual. We propose that these interventions have the potential to disruptively expand the reach of beneficial therapeutics by lowering the bar for entry to an intervention and the effort needed for purposeful engagement. This paper provides a conceptualization of digital micro interventions, their component parts, and principles guiding their use as building blocks of a larger therapeutic process (ie, digital micro intervention care). The model represented provides a structure that could improve the design, delivery, and research on digital micro interventions and ultimately improve behavioral and mental health care and care delivery.

Smartphone Monitoring of Participants' Engagement With Home Practice During Mindfulness-Based Stress Reduction: Observational Study

BACKGROUND

Standardized mindfulness training courses involve significant at-home assignments of meditation practice. Participants' self-reported completion of these assignments has been correlated with treatment outcomes, but self-reported data are often incomplete and potentially biased. In addition, mindfulness teachers typically suggest that participants set aside a regular practice time, preferably in the morning, but the extent to which participants do this has not been empirically examined.

OBJECTIVE

This study aimed to analyze patterns of participant engagement with home practice in a mindfulness-based stress reduction course.

METHODS

We used a novel smartphone app to provide 25 participants with access to their daily practice assignments during the 8-week course. We analyzed data collected through our smartphone app to determine usage and listening patterns and performed analyses of the regularity and frequency of participant behavior.

RESULTS

We found that participants listened to a median of 3 of the 6 practice sessions per week, and they did not typically set aside a regular daily practice time. Across weekdays, participants practiced most frequently in the morning, but there was considerable variation in participants' practice start times. On weekends, the peak practice time was in the evening.

CONCLUSIONS

We suggest that it is feasible to integrate a smartphone-monitoring approach into existing mindfulness interventions. High-frequency smartphone monitoring can provide insights into how and when participants complete their homework, information that is important in supporting treatment engagement.

Body image states in everyday life: Evidence from ecological momentary assessment methodology

This review highlights the contributions of Professor Thomas Cash to the scholarship of body image experiences in daily life, including his influence on subsequent research in this field. Cash's arguments for capturing a broad range of state-based body image experiences have been heeded, with recent studies exploring positive body image constructs as well as the more studied negative body image experiences. Appearance comparisons are the most commonly studied contextual influence on body image, and they seem to have a consistent effect. However, the experiences of body image in sexual contexts, and among adolescents, those who are pregnant, or have other physical characteristics that may increase the salience of appearance warrant further attention. Findings generally support Cash's contention that trait body image relates to likelihood and level of experience of body image in daily life, though the moderating effects of trait aspects on state-based relationships remains unclear. The discussion concludes with consideration of the impact of assessment schedules on obtained results. It is also discussed how accumulated knowledge regarding state-based body image experiences may be leveraged in treatment contexts, particularly in light of clear evidence that repeated assessment of body image in daily life increases self-awareness of one's body image characteristics.