Body image satisfaction: A gratitude pilot intervention for at-risk adolescents in Singapore

Samantha S. NgREACH (West)National University Hospital, SingaporeContact: samantha_sy_ng@nuhs.edu.sg

Dr. Albert K. LiauPsychological Studies National Institute of EducationNanyang Technological University, SingaporeContact: albert.liau@nie.edu.sg

What is body image satisfaction?

Body image and adolescence

Implications of poor body image

Straits Times, October 13, 2013

Traditional interventions targeting poor body image

Applying positive psychology to BIS

Development of the BIS-gratitude intervention

Purpose of the study

1. Examine the effectiveness of the BIS-gratitude intervention in an Asian context on the following outcomes:

• General well-being• Body image

2. Examine factors that mediate the impact of the BIS-gratitude intervention

MethodPretest-Posttest Experimental Design

Experimental Group (22 participants)- Wrote about 3 things they

appreciated about their bodies

Control Group (22 participants)- Wrote about their past week

44 participants (18 male, 26 female)Mean age = 12.95

Measures

Well-being:• PA: Positive Affect; NA: Negative Affect

• 20-item PANAS (Watson et al., 1988)

• Gratitude• 5 gratitude-related items (grateful, glad, appreciative,

thankful & understood; Emmons & McCullough, 2003; Froh et al., 2008)

• OLS: Overall Life Satisfacton • 6-item Brief Multidimensional Students’ Life Satisfaction

scale (Froh et al., 2008)

Measures

Body image:• BA: Body Appreciation

• 13-item Body Appreciation Scale (Avalos, Tylka, & Wood-Barcalow, 2005)

Procedure of the Study

T1 T2 T3

Pretest data collection

Session 2 Posttest 2 data collection

Session 1 Posttest 1 data collection

Gratitude conditionThere are many things in our lives, both large and small, that we might be grateful about. Think about your health and the different parts of your body, such as your eyes, arms and legs. Write down three parts of your body you are thankful for, and why you are thankful for each of them. You can write in any language you want. Don't worry about spelling or grammar.

Control conditionThink about your past week. These might include what happened in your family, what your schedule was like, what you liked and did not like, what you thought about, and what your classes were like. On this paper, write what you can think of. You can write in any language you want. Don't worry about spelling or grammar.

Results

ResultsPreliminary Analyses

• There were no significant differences in all the outcomes between the experimental and control group

• Gender was not associated with condition• In general, no gender differences in the

outcomes except for T1 PA

ResultsData Analyses Plan

2 X 3 MANOVA for repeated measures• (condition by time)• Time by group interaction effect

2 X 3 ANOVAs for each outcomes• Time by group interaction effect• Parameter estimates group effects @ T1,T2,T3

Post hoc analyses• Within groups• Changes from T1 to T2, & T1 to T3

ResultsData Analyses Plan

2 X 3 MANOVA for repeated measures• Significant time main effect• Significant time by group interaction effect

2 X 3 ANOVAs for each outcomes• Significant time effects for NA & BA• Significant time by group interaction effects for PA, LS

& Gratitude

Post hoc analyses• Please see graphs

There was a significant difference between groups at T2 (t=2.12, p=.04, d=.64)Post hoc analyses indicated a significant decrease from T1 to T2 for the control group, and no changes for the experimental group.

ResultsIntervention Effects

There was a significant difference between groups at T2 (t=3.06, p=.004, d=.92)Post hoc analyses indicated a significant increase from T1 to T2 & Tt to T3 for the experimental group, & no changes for the control group.

ResultsIntervention Effects

There was a significant difference between groups at T2 (t=2.56, p=.01, d=.77)Post hoc analyses indicated a significant increase from T1 to T2 & Tt to T3 for the experimental group, & no changes for the control group.

ResultsIntervention Effects

There was a significant difference between groups at T2 (t=2.17, p=.04, d=.65)Post hoc analyses indicated no significant changes for the experimental and control groups.

ResultsIntervention Effects

ResultsIntervention Effects

There was a significant difference between groups at T3(t=-3.45, p=.001, d=1.04)Post hoc analyses indicated a significant increase from T1 to T3 for the control group; no changes for the experimental group.

ResultsMediating Effects

• To help us understand better the processes of change in the study from the pretest to the posttest (T1 to T2), change scores in the main outcomes from the pretest to the posttest were calculated.

ResultsMediating Effects

Intervention

Changes in Gratitude

Changes in Body Appreciation

Changes in Outcome

Results Mediating Effects

• Product-of-coefficients approach of testing indirect effects

• SPSS Macro Indirect (Preacher & Hayes, 2014)

• Allows testing of multiple mediators• Analyses focused on change scores from

T1 to T2

ResultsMediating Effects

Intervention

Changes in Gratitude

Changes in Body Appreciation

Changes in LS

Changes in BA mediated the effects of the intervention on changes in LS (bootstrap mean=.17, SE=.09, 95% CI=.03,.40)

ResultsMediating Effects

Intervention

Changes in Gratitude

Changes in Body Appreciation

Changes in PA

Changes in Gratitude & BA mediated effects of the intervention on changes in PA (bootstrap mean=1.92,SE=1.25,95%CI=.20,5.26; bootstrap mean=1.34,SE=.81,95%CI=.19,3.55, respectively)

DiscussionThe BIS-Gratitude intervention was able to improve adolescents’ body appreciation more than a control condition

Significant results are similar to that of longer programmes

DiscussionBIS-gratitude intervention was able to improve adolescents’ life satisfaction more than a control condition.

Results are generally consistent with previous research findings that showed improvements in positive feelings, gratitude, and life satisfaction at post-intervention(Chan, 2010; 2013; Froh et al., 2008; Senf & Liau, 2012).

DiscussionSignificant findings at post-intervention were not sustained at 1-week follow-up.

Programme durationLack of maintenance effects in many CBT interventions without booster sessions.

DiscussionHowever, there was a significant difference in negative affect.

Consistent with other research in Asian contexts where positive psychology interventions influence negative affect not positive affect (Liau, Neihart, Teo, Lo, 2014)

DiscussionBody appreciation and Gratitude mediated the effects of the intervention on positive affect.Body appreciation mediated the effects of the intervention on life satisfaction.

The mediation results are consistent with Broaden-and-Build Theory that positive emotions elicited through a BIS-gratitude exercise can lead to improved well-being.

Acknowledgments• Conference travel was funded by the Ministry of Health,

Singapore, and the National Institute of Education, NTU• Thank you to all who were involved in the study, i.e. CARE

Singapore, and the schools, teachers, and students involved.• Thank you for listening!• samantha_sy_ng@nuhs.edu.sg• albert.liau@nie.edu.sg

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ResultsMediation Effects• Change in Gratitude was related to changes in PA (Positive

Affect)

• Change in BA (Body Appreciation) was related to changes in PA and LS (Life Satisfaction)

Significant difference between groups at T2 (t=3.46, p=.001, d=1.04)Post hoc analyses indicated a significant increase in the experimental group, and a significant decrease in the control group from T1 to T2.

• Body Preference (BP): • chi-square test for independence conducted to test for changes

in the proportions of participants who desired to gain weight, remain the same size, or lose weight.

ResultsIntervention Effects

DiscussionThere was a significant difference in positive affect.However, this is due to a reduction in the control group, and not an increase of the experimental group.

The participants are in Grade 7 which is a transition to the first year of secondary school. Hence, there are new academic & social demands.

Discussion

BIS-gratitude intervention did not have an effect on the proportion of participants who desired to remain the same size (body preference).

Possibly an objective need for to either lose weight or gain weight.