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，与替代干预和仅评估对照相比，基于失调的选择性预防方案可以减少对身体形象担忧的高风险年轻女性追求不切实际的理想身材，减少饮食失调的风险因素（如身体不满、负面影响）、饮食失调症状、功能障碍和未来饮食失调的发作，一些效果持续3年(Becker et al., 2005; Mitchell et al., 2007；斯蒂斯等人，2000,2006,2008b, 2011c)。一项有效性试验发现，当高中临床医生招募学生并实施该计划时，相对于教育宣传册控制，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，2009b）。与大学临床医生一起进行的一项增强失调版本的有效性试验（初步研究）正在产生更大的效果。这些试验证实了这种干预措施的有效性，但也表明，很难在高中和大学里找到并招募到有时间和专业知识来实施这种预防计划的临床医生。解决这一传播障碍的一种方法是在同伴领导项目中培训大学生，以招募学生并实施该项目，因为同伴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）。使用同行领导可以显著扩大该计划的覆盖面和可持续性。在一项试点试验中，与教育宣传册对照相比，同伴主导的强化失调组在理想瘦型内在化、身体不满意、节食、负面影响和饮食失调症状方面显著降低（M d = 0.76），产生的效果与临床医生主导的组相似。在我们的大学有效性试验中，与临床医生领导的小组相比，效果更好

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.