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

描述(由申请人提供)：有效性试验表明，与替代干预和仅评估对照相比，在有身体形象担忧的高危年轻女性中，减少追求不切实际的瘦理想的基于不和谐的选择性预防计划可以降低进食障碍的风险因素(例如，身体不满、负面情绪)、进食障碍症状、功能障碍和未来的进食障碍发作，一些效果持续3年(Becker等人，2005年；Mitchell等人，2007年；Stices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提供该计划时，与教育手册对照相比，它产生的结果减少更多，包括通过3年的随访减少进食障碍症状(Stices等人，2009b)。与大学临床医生一起进行的该计划的增强不和谐版本的有效性试验正在产生更大的影响(普莱姆研究)。这些试验证实了这种干预的有效性，但也揭示了在高中和大学寻找和招募有时间和专业知识的临床医生能够有效地实施这一预防计划可能是困难的。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，以招收学生并提供项目，因为同行领导的干预似乎很有希望，有时产生的效果比临床医生领导的干预版本更大(Botwin等人，1984；Rhee等人，2011年)。使用同行领导可以显著扩大该计划的影响范围和可持续性。在一项试点试验中，与教育手册对照组(MD=0.76)相比，增强不和谐计划的同行领导小组在瘦理想内化、身体不满、节食、负面影响和饮食障碍症状方面产生了显著更大的减少，产生的效果与临床医生领导小组的效果相似。在我们的大学有效性试验(M)中，与临床医生领导的小组的效果相比是有利的 D=.66)和对适应女生联谊会的不和谐程序的同行主导版本的非对照研究(MD=.46；Becker等人，2010；Perez等人，2010)。我们建议对同伴领导的增强不和谐组进行一项大型的多点有效性试验，其中480名有身体形象担忧的女大学生将被随机分为同伴领导组、临床医生领导组或教育视频控制组。目的1：测试完成同伴领导小组的参与者是否在3年的随访中表现出比教育视频对照组和完成临床医生领导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更大的减少。目的2：测试同辈领导的小组与临床医生领导的小组的忠诚度和能力评级是否相似。目的3：测试瘦-理想内化的减少是否中介了干预对其他下游结果的影响，并检查同行和临床医生领导的组的干预效果的调节因素(例如，基线较高的薄-理想内化)。目的4：测试与教育视频控制条件相比，同伴领导的小组与临床医生领导的小组相比，是否会节省更多的成本和增加成本效益。

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.