Comparison of a Gratitude-Based and a Cognitive Restructuring Intervention for
Body Dissatisfaction and Eating Behavior in College Women
Wendy L. Wolfe, Kaitlyn Patterson, & Hannah Towhey
Introduction
Gratitude interventions have been used effectively in the treatment of
depression, PTSD, and for improving psychological wellness (Nelson,
2009). Recently, researchers have investigated the efficacy of
gratitude interventions for decreasing body dissatisfaction among a
sample of self-selected male and female adults from the United
Kingdom (Geraghty, Wood, & Hyland, 2010). Results demonstrated
that the gratitude intervention (Grat) worked equally well to decrease
body dissatisfaction as a cognitive restructuring intervention (CR) and
that both performed significantly better than no intervention. Moreover,
fewer participants dropped out of the Grat condition, indicating that
such an intervention may be associated with greater adherence than
the more established CR interventions used for improving body
satisfaction. We have extended this investigation by comparing Grat,
CR, and control conditions on both body dissatisfaction and eating
behaviors in a college female population. Through this investigation,
we hope to replicate the findings of Geraghty et al. (2010) in a nonself-selection sample.
Method
Participants
Participants were 107 female undergraduate students, who received
course credit for their participation (61.5% Caucasian, M age= 20.44).
Materials and Procedures
Our study was conducted in two phases. In the first phase, participants
completed the following measures in Survey Monkey: Body Shape
Questionnaire (BSQ), Eating Attitudes Test (EAT), Positive and
Negative Affect Scale (PANAS), Body Esteem Scale (B-ES), Center
for Epidemiologic Studies Depression Scale (CES-D), Body
Appreciation Scale (BAS), and the Binge Eating Scale (BES). Other
distractor measures and measures of potential mediators were
interspersed with the above measures.
All participants who completed the first survey were invited to
complete a second (intervention) phase of the study. Participants
were randomly assigned to the Grat (N=35), CR (N=28), or control
(N=45) conditions and were emailed the appropriate intervention
workbook. All participants received basic educational information about
body image. Grat participants received a workbook with instructions to
create a gratitude list (a list enumerating the things for which they felt
grateful) on a daily basis for 14 days. CR participants received a
workbook with automatic thought records (ATR’s) and instructions for
completing the ATR’s on a daily basis for 14 days. CR participants were
encouraged to complete the ATR’s in reference to negative thoughts
about the body, or in reference to general negative thoughts if negative
body–related thoughts had not occurred that day. After reviewing their
workbooks, but prior to beginning the intervention, participants rated
how effective they anticipated the intervention would be (expectancy).
During the intervention phase, participants in the Grat and CR
conditions were sent a daily email to assess perceived difficulty and
time spent on the previous day’s worksheet. Participants turned in their
workbook pages at the end of each week. At the end of the 14 days,
participants completed the following measures in Survey Monkey: BSQ,
BAS, B-ES, EAT, BES, CES-D, and PANAS, and were debriefed.
Figure 1. Body dissatisfaction as measured by the BSQ
between the pre-intervention and the post-intervention.
Figure 2. Body satisfaction as measured by the B-ES (Weight Concern
Scale) between the pre-intervention and the post-intervention.
Results
Results indicated no pre-intervention differences across conditions on any
dependent variable and no differences between the Grat and CR conditions
on expectancy, difficulty, or time spent on the intervention. Responses to
body dissatisfaction, eating, and mood measures after the two-week
intervention period were compared to participants’ earlier responses.
Researchers performed repeated-measures general linear model analyses
and found that the Grat intervention performed better than the other
conditions at decreasing levels of body dissatisfaction on the B-ES, weight
concern subscale [F(2, 104)=8.54, p<.01] and the BSQ [F(2, 105)=5.05,
p<.01]. Moreover, the Grat intervention performed better on the EAT
[F(2,105)= 4.4, p<.05]. The Grat intervention also performed better at
decreasing negative mood on the PANAS [F(2, 105)=5.02, p<.01] and the
CES-D [F(2, 104)=6.45, p<.01]. Additionally, the Grat intervention increased
positive mood on the PANAS [F(2, 105)=3.56, p<.05]. Significantly more
Grat participants (80%) than CR participants (67%) completed the two week
intervention (p<.05). To compare the efficacy of the interventions in a subclinical sample, data from participants with a high degree of body
dissatisfaction (1 standard deviation above the published mean of the BSQ
and the B-ES) were analyzed separately (N = 47). The gratitude
intervention performed better than the other conditions at decreasing body
dissatisfaction on the weight concern scale of the B-ES [F(2,44)=6.42,
p<.01] and the results from the other body dissatisfaction measures, while
not statistically significant, trended in the same direction.
For further information, contact: Wendy Wolfe, [email protected]
Figure 3. Change in eating disorder symptoms as measured by the
EAT between the pre-intervention and the post-intervention.
Figure 4. Change in depressive symptoms as measured by the
CES-D between the pre-intervention and the post-intervention.
Conclusion
Our results illustrate a significant difference in how CR interventions
and Grat interventions affect change on the BSQ, B-ES, EAT,
PANAS, and CES-D measures in a non-clinical population. Not only
did the gratitude intervention perform better on these measures, but
the cognitive restructuring intervention tended to have the opposite
effect. Our results suggest that in a nonclinical population, gratitude
interventions should be considered to decrease body dissatisfaction,
dysfunctional eating behaviors, depression, and negative mood.
Key References
Geraghty, A.W., Wood, A. M., Hyland, M.E. (2010). Attrition from self-directed interventions: investigating the
relationship between psychological predictors, intervention content and dropout from a body dissatisfaction
intervention. Social Science and Medicine, 71, 31-37.
Nelson, C. (2009). Appreciating gratitude: can gratitude be used as a psychological intervention to improve
individual well-being. Counseling Psychology Reviews, 24(3&4), 38-50.
Poster presented at the 49th Annual Convention of ABCT (November, 2015)