How to Implement

1Seeking Administrative Approval

If you are seeking institutional permission to deliver The Body Project program in a school or health/counseling center setting, it is important to highlight the empirical support received by this intervention. In general, administrators are most receptive to offering prevention programs such as The Body Project when:

1. it is demonstrated that research supports the beneficial effects of the intervention for participants,
2. implementing this program does not interfere with regular school activities (e.g., classes), and
3. the program reduces rather than increases burden on administrative staff by preventing future cases of eating disorders.

2Effective Recruitment Methods

Recruitment can be a challenge for prevention interventions but is relatively easy for The Body Project. Facilitators are encouraged to use a multi-pronged approach, with at least one form of individual/direct contact, if possible.

We have used a range of recruitment options, including mass mailings, mass email messages, posters, leaflets, announcements on the school PA system, class announcements, ads in the school paper, and announcements on school websites (e.g., Blackboard). Sample recruitment materials are shown in the Documents section of this program. We typically invite all female students at a particular school or college, usually via mass mailings/e-mail messages, to sign up for these body acceptance classes, which also reduces the potential for stigma. This is by far the most effective recruitment approach. It is often useful to send a second mailing/emailing two weeks after the first. The second most effective recruitment approach is hanging recruitment posters around the school. We find that using pictures of ethnic minority girls and young women on these recruitment posters is a good way to attract more ethnically diverse students.

3Screening Prior to Group Participation

Potential group members should be screened for at least a moderate degree of body dissatisfaction, which can be accomplished easily with a simple question. Once a young woman contacts us, we screen for body image concerns using a single question:

If the person can say yes to this question to at least a moderate degree (e.g., concerned with how their body looks? trying to lose weight to be healthy or look better?), we proceed with enrollment.

4Exclusion Criteria

The Body Project will not be sufficient as a stand-alone treatment, particularly for women who already meet diagnostic criteria for anorexia nervosa, so attempts should be made to exclude such individuals, who should be referred to a clinic or therapist for treatment and told that The Body Project is not appropriate for them.

The most straightforward method of screening for anorexia nervosa is to ask any potential participant who appears quite thin to disclose her height and weight. Then use a BMI calculator on the web (CDC BMI calculator) to make sure the young woman is not in the anorexic range (BMI below 17.5). If you are not involved in the screening process and a participant shows up for the first session who appears to be extremely thin, we recommend taking the person aside discretely and saying that the group might not be appropriate for them, but that they are welcome to participate if they are “willing to give the exercises their best effort.” If they are extremely resistant to discussing the costs of pursuing the thin-ideal during the first session, it would be best to inform that person that they are unlikely to benefit from the class and that there may be more appropriate interventions available (referrals should be provided at this point). There are no other inclusion or exclusion criteria for The Body Project groups.

5Group Structure and Delivery

The Body Project is run in a group rather than individual format. This structure serves several purposes, including capitalizing on social cohesion and support among group members, promoting attitudinal change by hearing peers express statements against the thin-ideal, increasing accountability for personal statements against the thin-ideal, and maximizing cost effectiveness. Further, several exercises used in The Body Project to create cognitive dissonance require multiple participants.

Groups consist of one or two facilitators who can be school counselors, psychologists, teachers, nurses, graduate students or peers, and approximately eight participants. Experience suggests that having approximately eight participants is optimal, as this ensures that all members will be able to participate actively while still receiving sufficient personal attention.

The Body Project was designed to consist of 4 one-hour sessions conducted over four weeks. However, we have also created a version consisting of 6 45-minute sessions for settings such as counseling centers where sessions need to be completed in less than an hour or for facilitators who simply want to cover less material per session. Our experience suggests that conducting the sessions spaced one week apart helps foster learning and practicing of the skills discussed in-session, and also allows ample time for participants to complete between-session assignments.

The Body Project sessions are cumulative, with each session building on what was learned and practiced in the previous session. Thus, attending all of the sessions and participating in the in-session and between-session exercises is very important.

It is crucial for facilitators to manage the sessions effectively and make sure that all listed exercises are completed. It is sometimes necessary to tactfully interrupt particularly talkative individuals so that the group leader can move the group onto the next exercise in the manual. Physical features of the group (e.g., sitting in a circle or around a table) help create a space where people are willing to actively participate.

In general, we have found that using humor when possible, appearing relaxed, smiling and laughing when appropriate, and listening carefully to what participants are saying is helpful in engaging participants. When a participant shares personal information or discusses difficulties they have with body image, it is appropriate and desirable to make empathetic statements (“Wow, it sounds like you’re really struggling with this,” “That must have been hurtful when your father made that comment to you about your weight”). Although it is extremely important to stay on track and cover the necessary information for each session, participants want to feel heard and understood.

6Identification of Group Leaders

Experience indicates that a wide variety of trained professionals can successfully deliver The Body Project intervention. The leader’s manual is very detailed and provides scripted material for each session. Nonetheless, careful selection, training, and supervision (when possible) of group leaders is useful in guaranteeing success for as many group members as possible.

It is important for potential group leaders to understand that The Body Project is not intended to be an open-ended discussion or therapy group; its success is dependent on facilitators adhering closely to the manual. It is possible that significant deviations from the manual could render this intervention ineffective or potentially even iatrogenic.

To reduce group facilitator burden, two facilitators typically deliver the intervention together in our research trials. Managing the sessions is more challenging for a single facilitator, though it gets much easier with more experience. We have also favored facilitator teams because if one facilitator gets sick or has a family or clinical emergency, the other can still lead the session when scheduled.

Lastly, we typically prefer to have women rather than men lead the groups, as participants may be more likely to discuss sensitive material and experiences. However, experience indicates that male therapists who are sensitive to the experience of young women in our culture can deliver the intervention effectively.

7Group Leader Training

Facilitator training should include several steps. First, leaders should familiarize themselves with the underlying dissonance theory and background information contained in this volume. We typically recommend that potential facilitators read the published facilitators guide.

Second, we recommend that facilitators watch the training videos contained on this website. These videos provide detailed training and showcase successful implementation of intervention components.

Third, it is crucial to practice each activity in all sessions at least once before attempting to lead a group. We recommend observing an experienced facilitator deliver the intervention live or conducting mock sessions with colleagues or friends.

Facilitators are encouraged to memorize as much of the script as possible. This is generally accomplished by reading the scripted materials aloud several times. Experience indicates that participants quickly lose interest if the group leaders are not familiar with the activities and the flow of the sessions, or if facilitators read the script verbatim.

We strongly recommend that each session be videotaped to maximize accountability, and therefore dissonance induction, among participants; this also provides an excellent opportunity for facilitators to view themselves delivering the intervention, which invariably leads to more effective implementation in the future.

8Quality Assurance

To increase the likelihood of high implementation fidelity and facilitator competence in our research, we use scripted intervention manuals, standardized facilitator training workshops (a video of which is included in this website), videotaped examples of expert clinicians delivering the intervention (also available on this website), and video recordings of sessions to allow detailed supervision. We recommend implementing as many of these quality assurance procedures as possible, at least when facilitators first begin delivering the intervention. In our research, we routinely use detailed checklists (provided in Documents) to rate group sessions for adherence (fidelity) to the intervention script. The quality assurance forms also assess therapeutic competence (i.e., group leader clinical skillfulness) using standardized measures. These adherence and competence ratings form the basis for detailed supervision provided to the facilitator. We recommend that group leaders routinely complete self-ratings of adherence and competence as a method of ensuring high quality delivery of The Body Project intervention.