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.

Public Health Relevance

Threshold and sub threshold eating disorders affect 10% of US women and are associated with impairment, distress, comorbidity, medical complications, obesity, and mortality;thus, a pressing public health priority is broad dissemination of empirically supported eating disorder prevention programs. We propose to conduct the first large controlled trial of peer-led dissonance eating disorder prevention groups relative to clinician-led groups and an active educational video control condition over long-term follow-up, which will permit a direct comparison of intervention effects on outcomes, intervention fidelity and competence, and cost-effectiveness for peer- vs. clinician-led groups.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-RPHB-N (03))
Program Officer
Goldstein, Amy B
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Oregon Research Institute
United States
Zip Code
Rohde, Paul; Stice, Eric; Shaw, Heather et al. (2017) Age effects in eating disorder baseline risk factors and prevention intervention effects. Int J Eat Disord 50:1273-1280
Becker, Carolyn B; Stice, Eric (2017) From efficacy to effectiveness to broad implementation: Evolution of the Body Project. J Consult Clin Psychol 85:767-782
Stice, Eric; Rohde, Paul; Shaw, Heather et al. (2017) Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: Acute effectiveness of these delivery modalities. J Consult Clin Psychol 85:883-895
Becker, Carolyn Black; Perez, Marisol; Kilpela, Lisa Smith et al. (2017) Engaging stakeholder communities as body image intervention partners: The Body Project as a case example. Eat Behav 25:62-67
Shaw, Heather; Rohde, Paul; Stice, Eric (2016) Participant feedback from peer-led, clinician-led, and internet-delivered eating disorder prevention interventions. Int J Eat Disord 49:1087-1092
Stice, Eric (2016) Interactive and Mediational Etiologic Models of Eating Disorder Onset: Evidence from Prospective Studies. Annu Rev Clin Psychol 12:359-81
Stice, Eric; Yokum, Sonja; Waters, Allison (2015) Dissonance-Based Eating Disorder Prevention Program Reduces Reward Region Response to Thin Models; How Actions Shape Valuation. PLoS One 10:e0144530
Rohde, Paul; Stice, Eric; Marti, C Nathan (2015) Development and predictive effects of eating disorder risk factors during adolescence: Implications for prevention efforts. Int J Eat Disord 48:187-98
Horney, Audra C; Stice, Eric; Rohde, Paul (2015) An examination of participants who develop an eating disorder despite completing an eating disorder prevention program: implications for improving the yield of prevention efforts. Prev Sci 16:518-26
Linville, Deanna; Cobb, Erin; Lenee-Bluhm, Tracy et al. (2015) Effectiveness of an eating disorder preventative intervention in primary care medical settings. Behav Res Ther 75:32-9

Showing the most recent 10 out of 15 publications