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      A Meta-Analytic Review of Stand-Alone Interventions to Improve Body Image

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          Abstract

          Objective

          Numerous stand-alone interventions to improve body image have been developed. The present review used meta-analysis to estimate the effectiveness of such interventions, and to identify the specific change techniques that lead to improvement in body image.

          Methods

          The inclusion criteria were that (a) the intervention was stand-alone (i.e., solely focused on improving body image), (b) a control group was used, (c) participants were randomly assigned to conditions, and (d) at least one pretest and one posttest measure of body image was taken. Effect sizes were meta-analysed and moderator analyses were conducted. A taxonomy of 48 change techniques used in interventions targeted at body image was developed; all interventions were coded using this taxonomy.

          Results

          The literature search identified 62 tests of interventions ( N = 3,846). Interventions produced a small-to-medium improvement in body image ( d + = 0.38), a small-to-medium reduction in beauty ideal internalisation ( d + = -0.37), and a large reduction in social comparison tendencies ( d + = -0.72). However, the effect size for body image was inflated by bias both within and across studies, and was reliable but of small magnitude once corrections for bias were applied. Effect sizes for the other outcomes were no longer reliable once corrections for bias were applied. Several features of the sample, intervention, and methodology moderated intervention effects. Twelve change techniques were associated with improvements in body image, and three techniques were contra-indicated.

          Conclusions

          The findings show that interventions engender only small improvements in body image, and underline the need for large-scale, high-quality trials in this area. The review identifies effective techniques that could be deployed in future interventions.

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          Most cited references48

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          Searching for the structure of coping: a review and critique of category systems for classifying ways of coping.

          From analyzing 100 assessments of coping, the authors critiqued strategies and identified best practices for constructing category systems. From current systems, a list of 400 ways of coping was compiled. For constructing lower order categories, the authors concluded that confirmatory factor analysis should replace the 2 most common strategies (exploratory factor analysis and rational sorting). For higher order categories, they recommend that the 3 most common distinctions (problem- vs. emotion-focused, approach vs. avoidance, and cognitive vs. behavioral) no longer be used. Instead, the authors recommend hierarchical systems of action types (e.g., proximity seeking, accommodation). From analysis of 6 such systems, 13 potential core families of coping were identified. Future steps involve deciding how to organize these families, using their functional homogeneity and distinctiveness, and especially their links to adaptive processes.
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            Factors relevant to the validity of experiments in social settings.

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              Impact of allocation concealment on conclusions drawn from meta-analyses of randomized trials.

              Randomized trials without reported adequate allocation concealment have been shown to overestimate the benefit of experimental interventions. We investigated the robustness of conclusions drawn from meta-analyses to exclusion of such trials. Random sample of 38 reviews from The Cochrane Library 2003, issue 2 and 32 other reviews from PubMed accessed in 2002. Eligible reviews presented a binary effect estimate from a meta-analysis of randomized controlled trials as the first statistically significant result that supported a conclusion in favour of one of the interventions. We assessed the methods sections of the trials in each included meta-analysis for adequacy of allocation concealment. We replicated each meta-analysis using the authors' methods but included only trials that had adequate allocation concealment. Conclusions were defined as not supported if our result was not statistically significant. Thirty-four of the 70 meta-analyses contained a mixture of trials with unclear or inadequate concealment as well as trials with adequate allocation concealment. Four meta-analyses only contained trials with adequate concealment, and 32, only trials with unclear or inadequate concealment. When only trials with adequate concealment were included, 48 of 70 conclusions (69%; 95% confidence interval: 56-79%) lost support. The loss of support mainly reflected loss of power (the total number of patients was reduced by 49%) but also a shift in the point estimate towards a less beneficial effect. Two-thirds of conclusions in favour of one of the interventions were no longer supported if only trials with adequate allocation concealment were included.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                29 September 2015
                2015
                : 10
                : 9
                : e0139177
                Affiliations
                [1 ]Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
                [2 ]Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
                [3 ]Department of Psychology, University of Sheffield, Sheffield, England
                [4 ]School of Psychology, University of Sussex, Brighton, England
                Newcastle University, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Analyzed the data: JMA PS EM. Wrote the paper: JMA PS TLW CM EM. Contributed to the planning of the meta-analysis: JMA PS TLW CM EM. Performed the literature search: JMA. Extracted data for the meta-analysis: JMA CM. Contributed to the design of the taxonomy: JMA PS TLW CM EM. Assisted with interpretation of the results: JMA PS TLW CM EM.

                Article
                PONE-D-15-24840
                10.1371/journal.pone.0139177
                4587797
                26418470
                855fd5aa-9037-4855-b5e2-c2b0fb16e561
                Copyright @ 2015

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                : 8 June 2015
                : 8 September 2015
                Page count
                Figures: 2, Tables: 6, Pages: 32
                Funding
                The contribution of JMA was supported by NWO (The Netherlands Organisation for Scientific Research; www.nwo.nl) grant 404-10-118: Novel strategies to enhance body satisfaction, awarded to CM. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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