How evaluative pairings improve body dissatisfaction in adult women: evidence from a randomized-controlled online study

Abstract

Background: Many young women are dissatisfied with their bodies. This study investigated the effect on current body dissatisfaction levels of a newly developed evaluative conditioning procedure that paired self-similar and self-dissimilar images of bodies with positive and neutral affective images, respectively. We hypothesized that learning the contingency that self-similar bodies predict positive affectivity is one process that could aid in explaining how these procedures function.

Methods: Adult women without disordered eating pathology participated in an online experiment with random assignment to an intervention or a control condition. All participants initially rated body images in self-similarity and were subsequently asked to categorize positive and neutral images by valence as quickly and accurately as possible. In the intervention condition, self-similar bodies systematically preceded positive images, and self-dissimilar images preceded neutral images, creating a similar body → positive contingency. Pairings in the control condition were unsystematic such that no contingency was present. We measured categorization latencies and accuracies to infer contingency learning as well as current body dissatisfaction immediately before and after exposure to the pairings. All participants further completed measures of trait body image concerns and disordered eating psychopathology at baseline, which we examined as moderators of an expected relation between condition assignment, contingency learning, and body dissatisfaction improvements.

Results: We analyzed data from N = 173 women fulfilling the inclusion criteria. Moderated mediation analyses showed that assignment to the intervention (vs. control) condition predicted increased similar body → positive contingency learning, which in turn predicted improved body dissatisfaction post-intervention, but only among women with higher pre-existing trait body image concerns or disordered eating levels.

Conclusions: The findings point toward the relevancy of further exploring the utility of pairing procedures. Similar body → positive contingency learning predicted improved body dissatisfaction in individuals with normatively high body image concerns, which suggests pairing procedures could help inform future research on reducing body dissatisfaction.

Keywords: Body image; Contingency learning; Eating disorders; Evaluative conditioning; Pairing procedures; Psychotherapy.

Fig. 1

Trial sequence illustration of the pairing procedure. Each trial started with the display of a fixation, followed by a similar or dissimilar body image, then followed by the presentation of a positive or neutral target image. Participants were asked to categorize the target images upon presentation using their keyboard c and m keys. Trials were presented in random order

Fig. 2

Relative frequencies of correct responses during similar body → positive contingency learning. Similar bodies predicted the occurrence of positive images in the intervention condition; there was no contingency between type of body and affective image in the control condition

Fig. 3

The moderated mediation model with group as predictor X (coded 1 0, for intervention and control conditions, respectively), similar body → positive contingency learning as mediator M, BISS post-intervention scores as criterion Y (with baseline scores as covariate), and BSQ body image scores as moderator W of the effect of contingency learning on BISS changes. The boot-strapped model confirmed that a positive effect of the intervention on contingency learning improved body dissatisfaction, but only among individuals with higher body image concerns

Fig. 4

Johnson–Neyman Significance Regions for the Conditional Effects of Contingency Learning on State Body Dissatisfaction at Different Values of the Body Shape Questionnaire (BSQ). The effect is significant at BSQ values above the dotted, vertical line. LL = lower level, UL = upper level, CI = confidence interval

Fig. 5

Johnson–Neyman Significance Regions for the Conditional Effects of Contingency Learning on State Body Dissatisfaction at Different Values of the Eating Disorder Examination-Questionnaire short version (EDE-Q8). The effect is significant at EDE-Q8 values above the dotted, vertical line. LL = lower level, UL = upper level, CI = confidence interval