We have experienced a great deal of success in recruiting and retaining participants for the Body Project program, which we believe is due to the empirical support for the program, the engaging content of the intervention, and the quality of the facilitators. However, challenges to successful implementation can arise such as engaging quiet participants, missed sessions and drop-out, and differentiating the thin-ideal from the healthy ideal. This section contains guidelines to conducting an engaging, fun, and effective Body Project group! Common challenges are discussed, followed by suggested techniques previously found to be effective.
Missed Sessions
Given the importance of a group setting for the creation of cognitive dissonance, missing sessions should be avoided whenever possible. Sending e-mail or text reminders before each session can minimize the number of missed sessions. If a participant must miss a session, try to schedule a brief individual 15-minute make-up-session with the individual to cover the key points and exercises before the next scheduled session. Although make-up sessions represent extra work for the facilitators, they are very helpful in minimizing missed sessions and communicating that each session and participant is important.
Completion of Home Exercises
The Body Project home exercises are integral to participants’ adopting an anti-thin-ideal stance and serve to cement the ideas that are taught and practiced in the group. The likelihood that participants will complete home exercises depends on their overall commitment and enjoyment of the group, as well as the extent to which facilitators emphasize the importance of completing these exercises. We have found that compliance is generally quite good, and participants enjoy and feel empowered by the exercises.
To encourage home exercise completion, we suggest that facilitators strive to make the home exercises not feel like “homework” per se, but rather a natural extension of what is learned. Troubleshoot anticipated barriers to home practice completion in the group when making the assignment. Encourage participants to keep their Body Project folders in a visible and accessible place to serve as a reminder and send an e-mail and/or text reminder to promote home exercise completion.
If a participant forgets to complete a home exercise, encourage her to complete it while waiting for the group to begin or while other participants are presenting their home exercises.
To encourage home exercise completion, we suggest that facilitators strive to make the home exercises not feel like “homework” per se, but rather a natural extension of what is learned. Troubleshoot anticipated barriers to home practice completion in the group when making the assignment. Encourage participants to keep their Body Project folders in a visible and accessible place to serve as a reminder and send an e-mail and/or text reminder to promote home exercise completion.
If a participant forgets to complete a home exercise, encourage her to complete it while waiting for the group to begin or while other participants are presenting their home exercises.
Insufficient Amount of Time in Group
The Body Project contains a large amount of material to cover, but extensive experience indicates that it can be comfortably presented as written if the facilitators stick to the scripted material. Because it can be difficult to cover all of the 4-session material in less than a full hour, we developed a second version of the program that covers the all of the material in six 45-minute sessions.
Talkative Group Members
As with any group-based intervention, a particular participant may try to dominate the discussion, either in a way that is relevant to the material or in a way that takes the discussion off-track. When this occurs, it is important to tactfully ask the person to wrap up their thought so that others have the chance to talk. Also, because the intervention focuses on the media and sociocultural forces that contribute to the thin-ideal, the conversation can potentially devolve into a detailed analysis of a particular TV show or celebrity. While some important critiques of the thin-ideal can happen in this context, this can also potentially lead to off-topic discussion. In such a situation, saying something like, “It’s fun to talk about these shows and celebrities, but I’d like to stay focused on …” can get the group discussion back on track.
Another potential challenge is that sometimes there are group members with particularly poignant experiences with body image problems or eating disorders who might have a tendency to dominate discussions. Keeping the discussion focused and on-task sometimes entails curbing a long story. The intervention includes a section (see “Reasons for signing up for the class”) that is intended to allow participants to share a main reason that prompted them to sign up for the class. It is often useful to go around the group for discussion exercises, so that each person has a chance to talk. Ending with the most talkative is one way of ensuring everyone has a chance to speak, which is crucial for positive intervention effects.
Another potential challenge is that sometimes there are group members with particularly poignant experiences with body image problems or eating disorders who might have a tendency to dominate discussions. Keeping the discussion focused and on-task sometimes entails curbing a long story. The intervention includes a section (see “Reasons for signing up for the class”) that is intended to allow participants to share a main reason that prompted them to sign up for the class. It is often useful to go around the group for discussion exercises, so that each person has a chance to talk. Ending with the most talkative is one way of ensuring everyone has a chance to speak, which is crucial for positive intervention effects.
Quiet Group Members
Another issue that can arise when implementing the Body Project is having very quiet participants. Soliciting feedback and ensuring that everyone verbally critiques the thin-ideal is central to the success of this program, thus it is very important to draw out the quieter participants. Going around the group when doing discussion exercises is also a good way to involve quite participants. You can ask for a volunteer to start the discussion, and then go around the room from there. Also, when doing role-plays, make sure that each person has at least two minutes to assume the anti-thin-ideal stance.
Strong Investment in the Thin-Ideal
Some participants start the group with a very strongly investment in the thin-ideal and they sometimes have difficulty adopting a new belief system that counters what they have internalized. It is therefore very important that participants spend a maximum amount of time in the sessions arguing against the thin-ideal to further solidify their new position. As a facilitator, it is beneficial to refrain from lecturing participants about the negative consequences of pursuit of the thin-ideal or attempting to argue them out of pursuing the thin-ideal. Instead, provide participants with as much time as possible to actively engage in these discussions in a Socratic fashion.
Thin-Ideal vs. Healthy Ideal
One way of encouraging participants to adopt an anti-thin-ideal stance is by emphasizing the important distinction between the thin-ideal and the healthy ideal. The thin-ideal is about appearing ultra-slender, at whatever cost. People may be willing to engage in very unhealthy and extreme behaviors, including laxative abuse, cosmetic surgery, substance abuse, or excessive exercise or dieting, to attain this ultra-slender look. In contrast, the healthy-ideal is about striving for a healthy body, which has both fat and muscles, and can be attained by reasonable exercise and a healthy and nutritious diet. Clarifying this distinction is an important means of encouraging participants to adopt an anti-thin-ideal stance, and avoiding any confusion about the goals of the intervention.
Preventing Drop-Out
The best way to prevent drop out and retain participants is to make the group fun and engaging. Although discussion topics should not be trivialized, there is ample room in the sessions for light-heartedness and humor. It is also incumbent on the facilitator to establish rapport with the group and foster group cohesion among participants. In addition, e-mail and text reminders also serve to greatly increase participant retention.
Responding to Participants who Develop Eating Disorders
Eating disorders represent serious health conditions that require trained professional help, and early diagnosis and intervention can improve the chances of recovery. In the event that a participant reports significant eating disorder symptoms during the course of the intervention, facilitators should refer this person to a qualified clinician for treatment. The Body Project is intended as a prevention intervention and should not be used in place of an empirically supported treatment intervention for eating disorders.
Clearly, any individual who meets diagnostic criteria for an eating disorder should be referred to treatment. However, even individuals who do not meet full criteria for an eating disorder may experience significant distress and engage in behaviors that put their health at risk. Therefore, individuals who engage in repeated bingeing or purging or other inappropriate compensatory behaviors or who meet most but not all criteria for an eating disorder should be referred for further assessment and potential treatment. Resources under “Web Links” may be helpful in providing additional information about eating disorders and in locating appropriate referrals.
Clearly, any individual who meets diagnostic criteria for an eating disorder should be referred to treatment. However, even individuals who do not meet full criteria for an eating disorder may experience significant distress and engage in behaviors that put their health at risk. Therefore, individuals who engage in repeated bingeing or purging or other inappropriate compensatory behaviors or who meet most but not all criteria for an eating disorder should be referred for further assessment and potential treatment. Resources under “Web Links” may be helpful in providing additional information about eating disorders and in locating appropriate referrals.
