Dissonance Eating Disorder Prevention: Clinician-Led, Peer-Led, vs Web-Delivered

描述（由申请人提供）：疗效试验表明，一种基于不和谐的选择性预防计划，减少了对具有身体形象问题的高风险年轻女性不切实际的瘦理想的追求，降低了饮食失调的风险因素（例如，身体不满意、负面影响）、进食障碍症状、功能损害和相对于替代干预和仅评估对照的未来进食障碍发作，其中一些影响持续3年（Becker等人，2005; Mitchell等人，2007; Stice等人，2000年、2006年、2008年b、2011年c）。一项有效性试验发现，当高中临床医生招募学生并提供该计划时，相对于教育手册对照，它产生了更大的结果减少，包括通过3年随访减少饮食失调症状（Stice等人，2009年b）。更大的影响是从一个有效性试验中出现的增强不和谐版本的这个程序与大学临床医生（psychum研究）。这些试验证实了这种干预措施的有效性，但也表明，很难在高中和大学中确定和招募有时间和专业知识的诊所来有效地提供这种预防计划。解决这种传播障碍的一个解决方案是在同侪领导计划中培训大学生，以招募学生并实施该计划，因为同侪领导的干预措施似乎很有希望，有时比临床医生领导的干预措施产生更大的效果（Botvin等人）。，1984; Rhee等人，2011年）。使用同行领导人可以显着扩大这一计划的范围和可持续性。在一项试点试验中，同行领导的增强失调计划组产生显着更大的前后减少瘦理想的内化，身体不满，节食，负面影响，饮食失调症状相对于教育手册控制（M d = .76），产生类似的效果，从临床医生领导的群体。在我们的大学有效性试验中，效果优于临床医生领导的小组（M d = 0.66）和来自适用于女生联谊会的同伴领导版本的不和谐程序的非对照研究（M d = 0.46; Becker等人，2010; Perez等人，2010年）。我们建议进行一项大型的多站点有效性试验，以同伴为主导的增强失调组，其中480名有身体形象问题的女大学生将被随机分配到同伴为主导的组，临床医生为主导的组，或教育视频控制条件。目标1：测试完成同伴领导的小组的参与者在3年的随访中是否比教育视频对照组和完成临床医生领导的小组的参与者在进食障碍风险因素，症状，进食障碍发作和功能障碍方面表现出更大的减少。目标2：测试同行领导的群体与临床医生领导的群体的忠诚度和能力评级是否相似。目标3：测试瘦理想内化的减少是否介导了对其他下游结果的干预效应，并检查干预效应的调节因子（例如，升高的基线瘦-理想内化）。目标4：测试相对于教育视频控制条件，同行领导组与临床医生领导组的成本节约和增量成本效益是否更大。

DESCRIPTION (provided by applicant): Efficacy trials show that a dissonance-based selective prevention program that decreases pursuit of the unrealistic thin-ideal in high-risk young women with body image concerns reduces eating disorder risk factors (e.g., body dissatisfaction, negative affect), eating disorder symptoms, functional impairment, and future eating disorder onset relative to alternative interventions and assessment-only controls, with some effects lasting 3 yrs (Becker et al., 2005; Mitchell et al., 2007; Stice et al., 2000, 2006, 2008b, 2011c). An effectiveness trial found that when high school clinicians recruit students and deliver the program that it produces greater reductions in outcomes relative to educational brochure controls, including reduced eating disorder symptoms through 3-yr follow-up (Stice et al., 2009b). Larger effects are emerging from an effectiveness trial of an enhanced-dissonance version of this program with college clinicians (Prelim Studies). These trials confirm the effectiveness of this intervention, but reveal it can be difficult to identify and recruit clinicias at high schools and colleges with the time and expertise to capably deliver this prevention program. One solution to this dissemination barrier is to train college students in peer leader programs to recruit students and deliver the program, as peer-led interventions appear promising, sometimes producing larger effects than clinician-led versions of the intervention (Botvin et al., 1984; Rhee et al., 2011). Use of peer leaders could markedly extend the reach and sustainability of this program. In a pilot trial, peer-led groups of the enhanced-dissonance program produced significantly greater pre-post reductions in thin-ideal internalization, body dissatisfaction, dieting, negative effect, and eating disorder symptoms relative to educational brochure controls (M d = .76), producing effects similar to those from clinician-led groups. Effects compare favorably to those from clinician- led groups in our college effectiveness trial (M d = .66) and from uncontrolled studies of a peer-led version of the dissonance program adapted for sororities (M d = .46; Becker et al., 2010; Perez et al., 2010). We propose to conduct a large multi-site effectiveness trial of peer-led enhanced-dissonance groups, wherein 480 female college students with body image concerns will be randomized to peer-led groups, clinician-led groups, or an educational video control condition. Aim 1: test whether participants who complete peer-led groups show greater reductions in eating disorder risk factors, symptoms, eating disorder onset, and functional impairment over 3-yr follow-up than educational video controls and reductions similar to those who complete clinician-led groups. Aim 2: test whether fidelity and competence ratings are similar for peer-led vs. clinician-led groups. Aim 3: test whether reductions in thin-ideal internalization mediate the intervention effects on other downstream outcomes and examine moderators of intervention effects (e.g., elevated baseline thin-ideal internalization) for peer- and clinician-led groups. Aim 4: test whether cost savings and incremental cost-effectiveness will be greater for peer-led groups vs. clinician-led groups relative to the educational video control condition.