Attitudes and dating aggression a cognitive dissonance approach
The limited success of prior ED prevention programs, coupled with clinical experience suggesting that dissonance-induction exercises were effective in eating disorder treatment and the literature showing that dissonance-induction procedures are effective in changing attitudes and behaviors, prompted the development of DBIs as a strategy for reducing an established attitudinal risk factor for body image and eating disturbances; thin-ideal internalization (Stice, Mazotti, Weibel, & Agras, 2000).The goals of the present article are to (1) provide an overview of dissonance theory, (2) review prior applications of DBI that were designed to change a variety of attitudes and behaviors, (3) discuss the formulation and development of DBI for ED prevention, (4) summarize the results from published and unpublished trials that have evaluated DBI for ED prevention, (5) compare the effects sizes produced by DBI versus non-DBI ED prevention strategies, and (6) consider clinical implications of this body of research.It has been argued that dissonance-based persuasion approaches are more effective than psychoeducational appeals because attitudinal change in the former is achieved by challenging a person's self-concept, which is more enduring than change motivated by an external source (providing information) (Aronson, 1980; Dickerson et al., 1992).DBIs have been used to change a variety of problems, including obesity (Axsom & Cooper, 1981), fear of snakes (Cooper, 1980; Cooper & Axsom, 1982), smoking onset (Killen, 1985), substance use (Barnett, Far, Mauss, & Miller, 1996), substance abuse (Ulrich, 1991), dating aggression (Schumacher & Slep, 2004), chronic illnesses (Leake, Friend, & Wadhwa, 1999), safe sexual practices (Stone et al., 1994), water conservation (Dickerson, Thibodeau, Aronson, & Miller, 1992) and energy conservation (Pallak, Cook, & Sullivan, 1980).According to the dual pathway model of bulimia nervosa (Stice, 1994), a reduction in thin-ideal internalization should reduce body dissatisfaction, negative affect, ineffective dieting, and ED symptoms.
Although many types of ED prevention programs have been developed, only 5% of the programs that have been evaluated in controlled trials have produced lasting reductions in current or future ED symptoms (see Stice, Shaw, & Marti, 2007 for a meta-analytic review of prevention trials that reports effect sizes and factors associated with larger effect sizes).Initially, programs were primarily psychoeducational, providing information about eating disorders, putative causes of these disorders, and healthy weight control practices through didactic presentations.Later programs typically focused on reducing risk factors, such as pressure to conform to the thin-ideal, body dissatisfaction, dieting, negative affect, and self-esteem deficits, or increasing protective factors, such as critical use of the mass media and stress management skills.In one early example, Killen (1985) used role plays in which adolescents practiced skills for refusing offers to try cigarettes to reduce the risk for smoking initiation (also referred to as strategic self-presentation).Another clever study provided strong experimental evidence that dissonance-induction procedures are responsible for bringing about attitudinal change.
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Although other programs have been evaluated in multiple trials conducted by the same lab (Jerome, 1991; Low et al., 2006; Mc Vey et al., 2003b; Richman, 1997), it is our understanding that none have produced significant intervention effects for eating pathology in multiple trials and that no other ED prevention programs have been evaluated by independent labs.