There are many young women in the United States who suffer from eating disorders and never get treated. Eating disorders not only detriment your physical health but your mental health as well and can even become a fatal illness if not treated. That is why it is crucial to advance research into discovering the most beneficial treatment to prevent eating disorders. Dissonance-based prevention programs have been developed to treat and prevent many health problems and have recently been advanced to treat eating disorders such as anorexia and bulimia (Stice, Shaw, Becker, & Rohde, 2008). In this experiment the researcher will use the cognitive dissonance-based prevention program in order to reduce the biggest risk factor for eating disorders which is the thin-ideal internalization. The thin-ideal internalization is when someone is pressured into meeting society’s beauty ideal (Stice, Rizvi, & Telch, 2000). The researcher will have two independent variables that will consist of the amount of sessions participants attend to and the setting in which the dissonance-based prevention program will take place in. The researcher will gather sixty female participants with self-identified body image concerns and randomly assign the young women to the number of sessions they will attend. The program will consist of verbal and written exercises that will help participants reduce the thin-ideal. The experiment will yield a significant difference in that participants who attend six sessions will have less eating disorder symptoms than participants who attend four sessions or two sessions and participants who attend four sessions will have less eating disorder symptoms than those participants who attend two sessions. The greatest difference between eating disorder symptoms will be between school setting and laboratory setting at six sessions. It is important to note that these advances can be crucial into treating and preventing eating disorders and hopefully treating other health problems later on.
Introduction
Many people in the United States suffer from eating disorders, especially young women. Nearly ten percent of young women experience eating disorders and never get treated (Lewinsohn, Striegel-Moore, & Seeley, 2000). Eating disorders such as bulimia nervosa and anorexia nervosa pose a high risk for negative effects on physical and mental health throughout an adolescent’s life. Eating disorders can increase risk of anxiety disorder, emergence of obesity, depression, substance abuse, and more health-related problems (Johnson, Cohen, Kasen, & Brook, 2002). The importance to treat this disorder is crucial to many young women. The prevention program using cognitive dissonance is able to reduce the risk factors for eating disorders and aid in the reduction of eating disorder symptoms (Stice, Mazotti, Weibel, & Agras, 2000).
Eating disorders which include bulimia nervosa and anorexia nervosa have symptoms of binge eating and purging. An individual will eat food even though the individual is full and purge. Purging is distinguished by self-induced vomiting, excessive use of dietary pills and misuse of laxatives (Treasure, Claudino, & Zucher, 2010). It is also characterized as the individual feeling very guilty and embarrassed for eating, especially in front of other people. Anorexia nervosa includes symptoms of very low food intake and excessive exercise. Also, someone with anorexia nervosa will be extremely under-weight and try to lose more weight. These eating disorders can lead to other health problems such as cardiovascular problems, depressive disorders, chronic fatigue and pain, infectious diseases, difficulty sleeping, neurological symptoms, and suicide attempts during early adulthood (Johnson et al., 2002).
The cognitive dissonance prevention program will be designed to help young women at risk of having an eating disorder and its effects. The cognitive dissonance theory expresses that the retention of inconsistent thoughts or actions creates psychological tension that motivates people to change their cognitions to produce greater consistency (Festinger & Carlsmith, 1959). Previous experiments have found that when individuals take a counter attitudinal stance (individuals are pushed to act in a way that is contrary to an original attitude) it creates a tension that leads individuals to change their attitudes to reduce the inconsistency between the original and the new thought or attitude (Leippe & Eisenstadt, 1994). Also, evidence suggests that a person may change their future attitude or behavior to reduce cognitive dissonance, especially if it challenges the beliefs a person possesses (Leippe & Eisenstadt, 1994). This theory has been used to help with eating disorder prevention and other health related problems.
Previous research done by Stice and Associates in 2001 looked into two types of intervention: healthy weight intervention & dissonance-based intervention. Stice and Associates gathered eighty-seven young women with self-identified body image concerns and randomized the participants to the two interventions. The results show a greater reduction in thin-ideal internalization and body dissatisfaction for the dissonance-based intervention than in the healthy weight intervention (Stice, Rizvi, & Telch, 2000). Another experiment done in 2001by Stice and Associates looked into the cognitive dissonance prevention program being given at a high school setting. Their findings show that the effects of the cognitive dissonance prevention program were significant at different term follow ups. But, it is important to note that clinical experience in this experiment could’ve significantly changed the outcomes and made the results more persistent in the long term (Stice, Rhode, Shaw, & Gau, 2001)
One of the most established risk factors that lead to the eating disorders is the thin-internalization. Thin-internalization is characterized by the pressure individuals come across by society’s thin ideal standards. It highly contributes to body-dissatisfaction, negative affect, bulimic symptoms, and other eating disorder symptoms (Stice et al., 2000). The cognitive dissonance prevention program’s goal is to target this risk factor in order to prevent and reduce eating disorder symptoms. The cognitive dissonance prevention program will have participants who have internalized the thin ideal argue against this idea by participating in an intervention that includes written, verbal, and behavioral exercises. Theoretically, the discomfort experienced by the participants will be resolved by reducing agreement thoughts of society’s thin ideal (Stice et al., 2008).
Independent Variable 1
The first independent variable will be the amount of dissonance-based intervention sessions the participants attend to. The three levels of this variable will be two sessions, four sessions, and six sessions. The dissonance-based intervention program exercises will be the same for the three levels. The participants will be randomly assigned by alphabetical order to the amount of sessions they attend to. This variable is manipulated to demonstrate if there is an effect on the amount of sessions young women go to receive the treatment and the eating disorder symptoms.
Independent Variable 2
The second independent variable will be the setting of the prevention program. It will have two levels, a high-school setting and a laboratory setting. This variable is manipulated to demonstrate if there is an effect between the setting of the intervention program and the eating disorder symptoms. The importance of the setting is characterized by how the participants will interact in either setting. It’s possible that participants feel ashamed when participating in a high-school setting rather than a laboratory setting where the atmosphere is more professional, and participants feel the need to be honest.
Dependent Variable
The dependent variable will be the eating disorder symptoms. The eating disorder symptoms include binge eating and purging which are characterized by self-induced vomiting or excessive use of dietary pills and misuse of laxatives after eating (Treasure, Claudino, & Zucher, 2010). The study will look at whether the symptoms for eating disorders decreased after the prevention program treatment was given in the different levels.
Recent research studies such as the Stice and Associates study have looked into different variables such as the type of intervention used to help women with eating disorders (Stice et al., 2000). This study, on the other hand will have one dissonance-based prevention program and different variables such as the amount of sessions the participants attend to and the setting of where they receive the dissonance-based prevention program.
The participant attending six sessions will have less eating disorders symptoms than a participant who attends four sessions or two sessions. Participants attending four sessions will have less eating disorder symptoms than participants attending two sessions. The participants attending the dissonance-based prevention program at a laboratory setting will have less eating disorders symptoms than participants who attend the dissonance-based intervention program at a high-school setting. The greatest difference in eating disorder symptoms between school setting and laboratory setting is in six sessions.
Method
Participants
The participants in this study are all young women whose ages range from 16 to 18 years old (M = 17). The young women who participate in this study will be self-identified with body image concerns and will voluntarily apply to become part of the study. Members (N = 60) will be randomly assigned to the number of sessions they will attend to. The research does not focus on the ethnicity of the young women, only their age. The reason why the research only includes young women is because the researcher only wants to focus on women participants due to their prevailing risk of having an eating disorder. The recruitment of participants will be by posting ads online as well as emails and news-paper advertisements. Also, there will be announcements made by randomly assigned schools were women can decide whether they want to participate in the study. The compensation for participating in this study will be the treatment itself and $25 for their time
Materials
Informed consent and assent forms will be used to provide the participant with information regarding the study, the risks and benefits of participating in the study, and the counseling information as well as the researcher’s contact information. Other materials will include pencils and papers to do the written part of the exercises. Also, laboratory space will be required to conduct part of the study and a high school setting. The two independent variables in this study are the settings in which the study will take place in and the number of sessions the participants will attend to.
Eating Disorder Diagnostic Scale. The Eating Disorder Diagnostic Scale (Stice et al., 2000) will be used as a self-report scale to diagnose eating disorders such as binge eating, bulimia nervosa, and anorexia nervosa. The Eating Disorder Diagnostic Scale will be given after the experiment to determine the measurements of eating disorder symptoms of the participants at the end of the study. The questionnaire will include a series of questions regarding concerns about weight, eating, and shape.
The environment in which this study will take place in will be calm with only the participants and treatment provider in the room. It is important that the participants feel unafraid when participating in the study’s exercises, so they can fully engage in the study.
Design and Procedure
The research design of this study is an experimental research that includes the setting of the study and number of sessions as the independent variables. The participants will be randomly assigned to different amount of sessions given in the study. The participants will be given informed consent and will decide whether or not they want to participate in the study. For the participants younger than 18 years of age, it will be required to obtain an assent as well as the informed consent from a legal guardian. Once the researcher has sixty participants, the researcher will randomly assign the participants to the number of sessions they attend to receive the cognitive dissonance treatment. The participants will be randomly assigned to receive the treatment in a laboratory setting or at a high school setting. Once the participants are in their randomly assigned setting, the treatment provider (researcher) will give the treatment, which consists of multiple exercises in the course of a month. The participants will be given date in which they will have to go to the high school / laboratory and participate in the exercises. Finally, when the treatment has ended a debriefing will take place with each participant to make sure they fully understood the study and check their well- being.
Results
The results will be analyzed with a 2×3 (settings x amount of treatment sessions) factorial analysis of variance (ANOVA). The ANOVA is expected to yield a significant main effect of the settings on the eating disorder symptoms (F(5,59) = 8.1, p = .04) in that participants who receive the treatment at a laboratory setting (M = 10.67, SD = 0.36) will have less eating disorder symptoms than people who receive the treatment at a school setting (M = 15.67, SD = 0.52; see figure 1).
The ANOVA is expected to yield a significant main effect of the amount of treatment sessions on eating disorder symptoms (F(6, 59) = 7.6, p = 0.4) in that participants who receive six treatment sessions (M = 8, SD = 0.27) will have a have less eating disorder symptoms than participants who receive four treatment sessions (M = 12, SD = 0.4), or two treatment sessions (M = 19.5, SD = 0.65; see figure 2).
The ANOVA is expected to yield a significant interaction between the school setting and the laboratory setting in that the greatest difference in eating disorder symptoms between participants who receive the treatment at school and laboratory will be observed when participants are also receiving six treatment sessions (M = 12, SD = 1.2, M = 4, SD = 0.4 respectively; see figure 3). A summary of overall findings is also provided (see table).
Discussion
For this study our findings suggest that the cognitive dissonance prevention program is more successful when given in numerous sessions. For this study, two, four, and six sessions will be compared and the amount of sessions that reduce eating disorder symptoms the most, will be the six sessions participants attend to. This finding suggests that giving the prevention program in numerous sessions helps participants better engage in the program and fully process the treatment. Also, our findings suggest that when giving the dissonance-based prevention program at different settings, a different out-come is produced. The results suggest that eating disorder symptoms are reduced when the prevention program is given at a laboratory rather than at a high-school setting. There was a magnitude interaction when the participant where receiving the prevention program in two sessions. This interaction between the setting and the amount of sessions might be due to the low impact of the low number of sessions. This suggests that the setting is not very crucial when the participants are receiving the prevention program in only two sessions. However, in the four and six sessions, the setting had an impact on the eating disorder symptoms. The participants given the prevention program at a laboratory setting reduced the eating disorder symptoms more than the participants who received the prevention program at the high-school setting. This finding suggests that participants have a higher level of honesty and are more outspoken in a formal setting such as a laboratory rather than the high-school setting which could make participants more ashamed of sharing among peers. These findings suggest that giving the cognitive dissonance prevention program in a laboratory may yield greater results for reducing eating disorder symptoms as well as having the participants attend more prevention program sessions.
Previous research has shown that cognitive dissonance prevention programs have been very successful in treating numerous health problems, including eating disorders (Stice, Shaw, Becker, & Rohde, 2008). Even though previous research has shown a significant effect of the cognitive dissonance prevention program, it is important to demonstrate how different variables can impact the final outcome of eating disorder symptoms. The Stice and Associates study in 2001 demonstrated that the cognitive dissonance prevention program was more effective in reducing thin-ideal internalization and body dissatisfaction than a healthy weight intervention (Stice et al., 2000). Also, in Mitchell and Associates study in 2007, the results suggested that the dissonance-based intervention program decreased eating disorder symptoms, drive for thinness, and body dissatisfaction more compared to the control group and yoga group (Mitchell, Mazzeo, Rausch, & Cooke, 2007). Therefore, this study supports the cognitive dissonance theory and its application in a prevention program but differs from past research in that this study focuses on different variables that affected the eating disorder symptoms of participants.
There are several limitations that should be considered when interpreting the results from this study. The follow up period was set to a month, but findings may vary if the follow up period becomes longer such as one year or more. Also, the study only included high-school participants, future research should investigate other samples such as older women or even younger women, this might affect the findings significantly. Another limitation in this study was the prevention program treatment givers. Using different treatment givers such as nurses or teachers might yield a difference in the findings. With many studies supporting the use of cognitive dissonance as a prevention program treatment, future research should investigate the use of this treatment on males, females, and transgenders. Also, future research should look into giving the dissonance-based prevention program treatment through different methods such as online activities and exercises or computer administered workshops. Future research can also investigate different settings and how they impact the participants eating disorder symptoms. The cognitive dissonance prevention program could be able to help many more people so future research should focus on applying this prevention program to other health related problems such as diabetes care and compliance to medication regiment.
