Atkinson Melissa J, Parnell Jade, Diedrichs Phillippa C
Department of Psychology, University of Bath, Bath, UK.
Centre for Appearance Research, University of the West of England, Bristol, UK.
Int J Eat Disord. 2024 Feb;57(2):327-340. doi: 10.1002/eat.24100. Epub 2023 Nov 25.
Increasing effectiveness and sustainability of universal school-based eating disorder prevention is needed. This study adapted two existing selective prevention programmes for universal delivery, investigating feasibility, acceptability, and preliminary effects when delivered by trained teachers to classes of mixed-gender adolescents.
A three-arm controlled pilot study with Year 9 students (N = 288; M = 13.61 SD = .50). Three schools in south Wales and south-west England were allocated to mindfulness-based intervention (MBI), dissonance-based intervention (DBI), or classes-as-usual (CAU) control. Self-reported eating disorder risk factors were collected at baseline, 6-week post-intervention, and 2-month follow-up. Focus groups were conducted post-intervention.
Delivery and evaluation were feasible, allowing for flexibility in scheduling, with good retention. Student and teacher ratings indicated moderate acceptability of both interventions, with recommendations for refinement. Mixed model analyses, controlling for baseline, showed significant effects of condition across post-intervention and follow-up for body esteem (DBI > CAU; Cohen's d = .34) and positive affect (MBI > CAU, d = .58). For girls only, both MBI and DBI improved body satisfaction and internalization, and the MBI additionally resulted in improved weight and shape concerns, negative affect, and life disengagement (d's = .39-1.12), across post-intervention and follow-up.
Selective eating disorder prevention programmes based on cognitive dissonance and mindfulness can be delivered universally in schools, by teachers, allowing for appropriate flexibility necessary for real world implementation. Moderate acceptability indicates areas for improving content and delivery; positive effects on key outcomes are encouraging. These findings provide support for further robust evaluation.
Existing universal eating disorder prevention is limited by small effects and reliance on highly trained facilitators. This study is the first to adapt mindfulness- and dissonance-based interventions for delivery by teachers, to adolescents of all genders in a classroom setting. Delivery was largely feasible and acceptable, and both interventions showed significant effects across key risk factors for eating disorders, with larger effect sizes than found previously. This underpins further robust evaluation.
提高学校普遍开展的饮食失调预防工作的有效性和可持续性。本研究对两个现有的选择性预防项目进行调整以用于普遍推广，调查由经过培训的教师向混合性别的青少年班级授课时的可行性、可接受性和初步效果。
一项针对9年级学生（N = 288；M = 13.61；SD = 0.50）的三臂对照试点研究。威尔士南部和英格兰西南部的三所学校被分配到基于正念的干预组（MBI）、基于认知失调的干预组（DBI）或常规课程对照组（CAU）。在基线、干预后6周和2个月随访时收集自我报告的饮食失调风险因素。干预后进行焦点小组讨论。
实施和评估是可行的，在时间安排上具有灵活性，且保留率良好。学生和教师的评分表明两种干预措施都具有中等可接受性，并提出了改进建议。控制基线的混合模型分析显示，在干预后和随访期间，干预措施对身体自尊（DBI > CAU；科恩d值 = 0.34）和积极情绪（MBI > CAU，d值 = 0.58）有显著影响。仅对女孩而言，MBI和DBI在干预后和随访期间均改善了身体满意度和内化程度，并且MBI还改善了对体重和体型的关注、消极情绪和生活脱离感（d值 = 0.39 - 1.12）。
基于认知失调和正念的选择性饮食失调预防项目可以由教师在学校普遍开展，为实际实施提供必要的适当灵活性。中等可接受性表明在内容和实施方面有改进的空间；对关键结果的积极影响令人鼓舞。这些发现为进一步的严格评估提供了支持。
现有的普遍饮食失调预防工作受到效果不佳和依赖训练有素的促进者的限制。本研究首次将基于正念和认知失调的干预措施调整为由教师在课堂环境中向所有性别的青少年授课。实施在很大程度上是可行的且可接受的，两种干预措施在饮食失调的关键风险因素方面均显示出显著效果，效应量比之前发现的更大。这为进一步的严格评估奠定了基础。
