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Dissonance-based Interventions for the Prevention of Eating Disorders: Using Persuasion Principles to Promote Health

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Abstract

The limited efficacy of prior eating disorder (ED) prevention programs led to the development of dissonance-based interventions (DBIs) that utilize dissonance-based persuasion principles from social psychology. Although DBIs have been used to change other attitudes and behaviors, only recently have they been applied to ED prevention. This article reviews the theoretical rationale and empirical support for this type of prevention program. Relative to assessment-only controls, DBIs have produced greater reductions in ED risk factors, ED symptoms, future risk for onset of threshold or subthreshold EDs, future risk for obesity onset, and mental health utilization, with some effects persisting through 3-year follow-up. DBIs have also produced significantly stronger effects than alternative interventions for many of these outcomes, though these effects typically fade more quickly. A meta-analysis indicated that the average effects for DBIs were significantly stronger than those for non-DBI ED prevention programs that have been evaluated. DBIs have produced effects when delivered to high-risk samples and unselected samples, as well as in efficacy and effectiveness trials conducted by six independent labs, suggesting that the effects are robust and that DBIs should be considered for the prevention of other problems, such as smoking, substance abuse, HIV, and diabetes care.

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References

  • American Psychological Association Task Force on Psychological Intervention Guidelines (1995). Template for developing guidelines: Interventions for mental disorders and psychological aspects of physical disorders. Washington, DC: American Psychological Association.

    Google Scholar 

  • Aronson, E. (1980). Persuasion via self-justification: Large commitments for small rewards. In L. Festinger (Ed.), Retrospection on social psychology (pp. 3–21). Oxford University Press.

  • Aronson, E., Fried, C., & Stone, J. (1991). Overcoming denial and increasing the intention to use condoms through the induction of hypocrisy. American Journal of Public Health, 81, 1636–1638.

    PubMed  CAS  Google Scholar 

  • Austin, S. B. (2001). Population-based prevention of eating disorders: An application of the Rose prevention model. Preventive Medicine, 32, 268–283.

    Article  PubMed  CAS  Google Scholar 

  • Axsom, D., & Cooper, J. (1981). Reducing weight by reducing dissonance: The role of effort justification in inducing weight loss. In E. Aronson (Ed.), Readings about the social animal (3rd ed., pp. 181–196). San Francisco: Freeman.

    Google Scholar 

  • Barnett, L. A., Far, J. M., Mauss, A. L., & Miller, J. A. (1996). Changing perceptions of peer norms as a drinking reduction program or college students. Journal of Alcohol and Drug Education, 41, 39–62.

    Google Scholar 

  • Bathalon, G. P., Tucker, K. L., Hays, N. P., Vinken, A. G., Greenberg, A. S., McCrory, M. A., et al. (2000). Psychological measures of eating behavior and the accuracy of 3 common dietary assessment methods in healthy postmenopausal women. American Journal of Clinical Nutrition, 71, 739–745.

    PubMed  CAS  Google Scholar 

  • Bearman, S. K., Stice, E., & Chase, A. (2003). Effects of body dissatisfaction on depressive and bulimic symptoms: A longitudinal experiment. Behavior Therapy, 34, 277–293.

    Article  Google Scholar 

  • Becker, C. B., Jilka, K., & Polvere, L. (2002). Cognitive dissonance vs. media psychoeducation: A pilot study of eating disorder prevention in sorority members. Paper presented at the Association for the Advancement of Behavior Therapy, Reno, NV.

  • Becker, C. B., Smith, L., & Ciao, A. C. (2005). Reducing eating disorder risk factors in sorority members: A randomized trial. Behavior Therapy, 36, 245–254.

    Article  Google Scholar 

  • Becker, C. B., Smith, L. M., & Ciao, A. C. (2006). Peer facilitated eating disorders prevention: A randomized effectiveness trial of cognitive dissonance and media advocacy. Journal of Counseling Psychology, 53, 550–555.

    Article  Google Scholar 

  • Burton, E., & Stice, E. (2006). Evaluation of a healthy-weight treatment program for bulimia nervosa: A preliminary randomized trial. Behaviour Research & Therapy, 44, 1727–1738.

    Article  Google Scholar 

  • Burton, E. M., Stice, E., Bearman, S. K., & Rohde, P. (2007). An experimental test of the affect-regulation model of bulimic symptoms and substance use: A randomized trial. International Journal of Eating Disorders, 40, 27–36.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.

    Google Scholar 

  • Cooper, J. (1980). Reducing fears and increasing assertiveness: The role of dissonance reduction. Journal of Experimental Social Psychology, 16, 199–213.

    Article  Google Scholar 

  • Cooper, J., & Axsom, D. (1982). Effort justification in psychotherapy. In G. Weary & H. Mirels (Eds.), Integrations of clinical and social psychology (pp. 98–121). New York: Oxford.

    Google Scholar 

  • Dickerson, C., Thibodeau, R., Aronson, E., & Miller, D. (1992). Using cognitive dissonance to encourage water conservation. Journal of Applied Social Psychology, 22, 841–854.

    Article  Google Scholar 

  • Fairburn, C. G. (1997). Eating disorders. In D.M. Clark, & C.G. Fairburn (Eds.), Science and practice of cognitive behaviour therapy (pp. 209–241). Oxford: Oxford University Press.

    Google Scholar 

  • Fairburn, C. G., Shafran, R., & Cooper, Z. (1999). A cognitive behavioural theory of anorexia nervosa. Behaviour Research and Therapy, 37, 1–13.

    Article  PubMed  CAS  Google Scholar 

  • Festinger, L. (1957). A theory of cognitive dissonance. Palo AHo, CA: Stanford University Press.

    Google Scholar 

  • Field, A. E., Camargo, C. A., Taylor, C. B., Berkey, C. S., & Colditz, G. A. (1999). Relation of peer and media influences to the development of purging behaviors among preadolescent and adolescent girls. Archives of Pediatric Adolescent Medicine, 153, 1184–1189.

    CAS  Google Scholar 

  • Fingeret, M. C., Warren, C. S., Cepeda-Benito, A., & Gleaves, D. H. (2006). Eating disorder prevention research: A meta-analysis. Eating Disorders: The Journal of Treatment and Prevention, 14, 191–213.

    Google Scholar 

  • Green, M., Scott, N., Diyankova, I., Gasser, C., & Pederson, E. (2005). Eating disorder prevention: An experimental comparison of high level dissonance, low level dissonance, and no-treatment control. Eating Disorders, 13, 157–170.

    Article  PubMed  Google Scholar 

  • Groesz, L. M., & Stice, E. (2007). An experimental test of the effects of dieting on bulimic symptoms: The impact of eating episode frequency. Behaviour Research and Therapy, 45, 49–62.

    Article  PubMed  Google Scholar 

  • Heatherton, T. F., & Polivy, J. (1992). Chronic dieting and eating disorders: A spiral model. In J.H. Crowther, D.L. Tennenbaum, S.E. Hobfold, & M.A. Parris (Eds.), The etiology of bulimia nervosa: The individual and familial context (pp. 133–155). Washington, DC: Hemisphere.

    Google Scholar 

  • Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando, FL: Academic.

    Google Scholar 

  • Hoagwood, K., Hibbs, E., Brent, D., & Jensen, P. (1995). Introduction to the special section: Efficacy and effectiveness in studies of child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63, 683–687.

    Article  PubMed  CAS  Google Scholar 

  • Horowitz, J. L., & Garber, J. (2006). The prevention of depressive symptoms in children and adolescents: A meta-analytic review. Journal of Consulting and Clinical Psychology, 74, 401–415.

    Article  PubMed  Google Scholar 

  • Jerome, L. W. (1991). Primary intervention for bulimia: The evaluation of a media presentation for an adolescent population. Unpublished dissertation, Kent, OH: Kent State University.

  • Johnson, J. G., Cohen, P., Kasen, S., & Brook, J. S. (2002). Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood. Archives of General Psychiatry, 59, 545–552.

    Article  PubMed  Google Scholar 

  • Killen, J. D. (1985). Prevention of adolescent tobacco smoking: The social pressure resistance training approach. Journal of Child Psychology and Psychiatry and Allied Disciplines, 26, 7–15.

    Article  CAS  Google Scholar 

  • Killen, J. D., Taylor, C. B., Hammer, L., Litt, I., Wilson, D. M., Rich, T., et al. (1993). An attempt to modify unhealthful eating attitudes and weight regulation practices of young adolescent girls. International Journal of Eating Disorders, 13, 369–384.

    Article  PubMed  CAS  Google Scholar 

  • Killen, J. D., Taylor, C. B., Hayward, C., Haydel, K. F., Wilson, D. M., Hammer, L., et al. (1996). Weight concerns influence the development of eating disorders: A 4-year prospective study. Journal of Consulting and Clinical Psychology, 64, 936–940.

    Article  PubMed  CAS  Google Scholar 

  • Leake, R., Friend, R., & Wadhwa, N. (1999). Improving adjustment of chronic illness through strategic self-presentation: An experimental study on a renal dialysis unit. Health Psychology, 18, 54–62.

    Article  PubMed  CAS  Google Scholar 

  • Leippe, M. R. (1994). Generalization of dissonance reduction: Decreasing prejudice through induced compliance. Journal of Personality and Social Psychology, 67, 395–413.

    Article  Google Scholar 

  • Levine, M. D., Marcus, M. D., & Moulton, P. (1996). Exercise in the treatment of binge eating disorder. International Journal of Eating Disorders, 19, 171–177.

    Article  PubMed  CAS  Google Scholar 

  • Levine, M. P., & Smolak, L. (2006). The prevention of eating problems and eating disorder: Theory, research, and practice. Mahwah, NJ: Erlbaum.

    Google Scholar 

  • Lewinsohn, P. M., Striegel-Moore, R. H., & Seeley, J. R. (2000). Epidemiology and natural course of eating disorders in young women from adolescence to young adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1284–1292.

    Article  PubMed  CAS  Google Scholar 

  • Lichtman, S. W., Pisarska, K., Berman, E. R., Pestone, M., Dowling, H., Offenbacher, E., et al. (1992). Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. New England Journal of Medicine, 327, 1893–1898.

    PubMed  CAS  Google Scholar 

  • Low, K. G., Charanasomboon, S., Lesser, J., Reinhalter, K., Martin, R., Jones, H., et al. (2006). Effectiveness of a computer-based interactive eating disorder prevention program at long-term follow-up. Eating Disorders, 14, 17–30.

    PubMed  Google Scholar 

  • Martin, C. K., Williamson, D. A., Geiselman, P. J., Walden, H., Smeets, M., Morales, S., et al. (2005). Consistency of food intake over four eating sessions in the laboratory. Eating Behaviors, 6, 365–372.

    Article  PubMed  Google Scholar 

  • Matusek, J. A., Wendt, S. J., & Wiseman, C. V. (2004). Dissonance thin-ideal and didactic healthy behavior eating disorder prevention programs: Results from a controlled trial. International Journal of Eating Disorders, 36, 376–388.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • McVey, G. L., Lieberman, M., Voorberg, N., Wardrope, D., Blackmore, E., & Tweed, S. (2003b). Replication of a peer support program designed to prevent disordered eating: Is life skills approach sufficient for all middle school students? Eating Disorders, 11, 187–195.

    Article  PubMed  Google Scholar 

  • Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11, 147–172.

    Article  Google Scholar 

  • Mitchell, K. S., Mazzeo, S. E., Rausch, S. M., & Cooke, K. L. (2007). Innovative interventions for disordered eating: Evaluating dissonance-based and yoga interventions. International Journal of Eating Disorders, 40, 120–128.

    Article  PubMed  Google Scholar 

  • Neumark-Sztainer, D., Butler, R., & Palti, H. (1995). Eating disturbances among adolescent girls: Evaluation of a school-based primary prevention program. Journal of Nutritional Education, 27, 24–31.

    Google Scholar 

  • Pallak, M., Cook, D., & Sullivan, J. (1980). Commitment and energy conservation. In L. Bickman (Ed.), Applied Social Psychology Annual, Vol. 1 (pp. 235–253). Beverly Hills: Sage.

    Google Scholar 

  • Presnell, K., & Stice, E. (2003). An experimental test of the effect of weight-loss dieting on bulimic pathology: Tipping the scales in a different direction. Journal of Abnormal Psychology, 112, 166–170.

    Article  PubMed  Google Scholar 

  • Richman, R. D. (1997). Preventing eating disorders; Promoting healthy attitudes and behaviors: A school based program. Unpublished doctoral dissertation, Simon Fraser University, Burnaby, British Columbia.

  • Roehrig, M., Thompson, J. K., Brannick, M., & van den Berg, P. (2006). Dissonance-based eating disorder prevention program: A preliminary dismantling investigation. International Journal of Eating Disorders, 39, 1–10.

    Article  PubMed  Google Scholar 

  • Rolls, B. J., Castellanos, V. H., Shide, D. J., Miller, D. L., Pelkman, C. L., Thorwart, M. L., et al. (1997). Sensory properties of a nonabsorbable fat substitute did not affect regulation of energy intake. American Journal of Clinical Nutrition, 65, 1375–1383.

    PubMed  CAS  Google Scholar 

  • Rosenthal, R. (1991). Meta-analytic procedures for social research. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Schumacher, J., & Slep, A. (2004). Attitudes and dating aggression: A cognitive dissonance approach. Prevention Science, 5, 231–243.

    Article  PubMed  Google Scholar 

  • Smolak, L., Levine, M., & Schermer, F. (1998). A controlled evaluation of an elementary school primary prevention program for eating problems. Journal of Psychosomatic Research, 44, 339–353.

    Article  PubMed  CAS  Google Scholar 

  • Stewart, D. A., Carter, J. C., Drinkwater, J., Hainsworth, J., & Fairburn, C. G. (2001). Modification of eating attitudes and behavior in adolescent girls: A controlled study. International Journal of Eating Disorders, 29, 107–118.

    Article  PubMed  CAS  Google Scholar 

  • Stice, E. (1994). A review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14, 633–661.

    Article  Google Scholar 

  • Stice, E. (2001). A prospective test of the dual pathway model of bulimic pathology: Mediating effects of dieting and negative affect. Journal of Abnormal Psychology, 110, 124–135.

    Article  PubMed  CAS  Google Scholar 

  • Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825–848.

    Article  PubMed  Google Scholar 

  • Stice, E., & Presnell, K. (2007). The body project: Promoting body acceptance and preventing eating disorders, facilitators guide, New York: Oxford University Press.

  • Stice, E., & Shaw, H. (2004). Eating disorder prevention programs: A meta-analytic review. Psychological Bulletin, 130, 206–227.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Stice, E., Fisher, M., & Lowe, M. R. (2004). Are dietary restraint scales valid measures of acute dietary restriction? Unobtrusive observational data suggest not. Psychological Assessment, 16, 51–59.

    Article  PubMed  Google Scholar 

  • Stice, E., Killen, J. D., Hayward, C., & Taylor, C. B. (1998). Age of onset for binge eating and purging during adolescence: A four-year survival analysis. Journal of Abnormal Psychology, 107, 671–675.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Stice, E., Mazotti, L., Weibel, D., & Agras, W. S. (2000). Dissonance prevention program decreases thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms: A preliminary experiment. International Journal of Eating Disorders, 27, 206–217.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Stice, E., Rohde, P., & Tepp, R. (2008b). Dissonance-based eating disorder prevention trail: Results from a randomized effectiveness trial (in progress).

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

    Article  PubMed  Google Scholar 

  • Stice, E., Shaw, H., & Marti, C. N. (2007b). A meta-analytic review of eating disorder prevention programs: Encouraging findings. Annual Review of Clinical Psychology, 3, 233–257.

    Article  Google Scholar 

  • Stice, E., Shaw, H., & Marti, C. N. (2006b). A meta-analytic review of obesity prevention programs for children and adolescents: The skinny on interventions that work. Psychological Bulletin, 132, 667–691.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Stone, J., Aronson, E., Craing, A. L., Winslow, M. P., & Fried, C. B. (1994). Inducing hypocrisy as a means of encouraging young adults to use condoms. Personality and Social Psychology Bulletin, 20, 116–128.

    Article  Google Scholar 

  • Sysko, R., Walsh, T. B., Schebendach, J., & Wilson, G. T. (2005). Eating behaviors among women with anorexia nervosa. American Journal of Clinical Nutrition, 82, 296–301.

    PubMed  CAS  Google Scholar 

  • Taylor, C. B., Bryson, S., Luce, K. H., Cunning, D., Celio, A., Abascal, L. B., et al. (2006). Prevention of eating disorders in at-risk college-age women. Archives of General Psychiatry, 63, 881–888.

    Article  PubMed  Google Scholar 

  • Ulrich, J. (1991). A motivational approach to the treatment of alcoholism in the Federal Republic of Germany. Alcoholism Treatment Quarterly, 8, 83–92.

    Google Scholar 

  • Vogeltanz-Holm, N. D., Wonderlich, S. A., Lewis, B. A., Wilsnack, S. C., Harris, T. R., Wilsnack, R. W., et al. (2000). Longitudinal predictors of binge eating, intense dieting, and weight concerns in a national sample of women. Behavior Therapy, 31, 221–235.

    Article  Google Scholar 

  • Wadden, T. A., Foster, G. D., & Letizia, K. A. (1992). Response of obese binge eaters to treatment by behavior therapy combined with very-low-calorie diet. Journal of Consulting and Clinical Psychology, 60, 808–811.

    Article  PubMed  CAS  Google Scholar 

  • Wertheim, E. H., Koerner, J., & Paxton, S. J. (2001). Longitudinal predictors of restrictive eating and bulimic tendencies in three different age groups of adolescent girls. Journal of Youth and Adolescence, 31, 69–81.

    Article  Google Scholar 

  • Wilson, G. T., Becker, C. B., & Heffernan, K. (2003). Eating disorders. In E.J. Mash, & R.A. Barkley (Eds.), Child psychopathology (2nd ed., pp. 687–715). New York: Guilford.

    Google Scholar 

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Authors and Affiliations

  1. University of Texas, Austin, TX, USA

    Eric Stice & Heather Shaw

  2. Trinity University, San Antonio, TX, USA

    Carolyn Black Becker

  3. Oregon Research Institute, 1715 Franklin Blvd., Eugene, OR, 97403, USA

    Eric Stice & Paul Rohde

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  1. Eric Stice
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  2. Heather Shaw
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  3. Carolyn Black Becker
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  4. Paul Rohde
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Correspondence to Eric Stice.

Additional information

This study was supported by research grants (MH/DK061957 and MH70699), a career award (MH01708) from the National Institutes of Health. We are grateful to Nathan Marti for conducting the secondary analysis of the meta-analytic data.

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Stice, E., Shaw, H., Becker, C.B. et al. Dissonance-based Interventions for the Prevention of Eating Disorders: Using Persuasion Principles to Promote Health. Prev Sci 9, 114–128 (2008). https://doi.org/10.1007/s11121-008-0093-x

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