Cognitive dissonance prevents eating disorders

In 1957, Psychologist Leon Festinger published his theory of cognitive dissonance. Cognitive dissonance occurs when there is a discrepancy between one’s beliefs and one’s actions. This produces an uncomfortable tension that motivates people to restore consistency by changing their actions and attitudes. Recently though, cognitive dissonance has been developed as an effective prevention for eating disorders.

An eating disorder is defined as any “persistent eating behavior.” According to “best,” the three most commonly diagnosed eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder. In the United States, an estimated 30 million people will struggle with an eating disorder at some point in their life-time. The greatest number of those people begin at college. It is estimated that 10-20% of college-aged females and 4-10% of college-aged males have an eating disorder. Furthermore, it is estimated that 20-25% of college-aged students will have a chronic eating disorder which will persist over their life-time.

Prevention is defined as any systematic attempt to change the circumstances that promote, sustain and intensify problems, such as problems like eating disorders. Eating disorders often arise from social, emotional and physical issues that a person may face. Each of these issues are addressed in any effective eating disorder prevention.

The cognitive dissonance based eating disorder prevention specifically targets adolescents and young women who struggle with their bodies and the appearance ideal as a target for intervention and prevention. In this method of prevention, the participants are encouraged to critique the appearance idea through a series of verbal, written and behavioral exercises. These activities are hypothesized to create cognitive dissonance, which reduces the extent to which a person subscribes to the appearance ideal. The overall goal of this prevention technique is for participants to speak, act and write in ways that are different from their own appearance ideal and increase self esteem. The participants need to be able to develop their own costs of the appearance ideal in order for cognitive dissonance to occur. This method of prevention is also hypothesized to result in improvements in body dissatisfaction, negative affect and eating disorder symptoms.

In 2012, “The Body Project: A Dissonance-Based Eating-Disorder Prevention Intervention,” was published with topics and courses on this cognitive dissonance based prevention. This book offers three different dissonance-based prevention programs. In session 1, the first part of their program criticizes magazine and advertisements’ strategies of beauty. Each participant is encouraged to critique the physical and computer tactics used by the media/advertisements. They are encouraged to critique how they are not actually the real/average body type. This part of the intervention also encourages the participants to select two magazine pictures with what they believe the appearance ideal is, and then criticize the pictures. The second session of “The Body Project” is to have the participants discuss the costs of the appearance ideal. Furthermore, the third session encourages the participants to write a letter to a teenage girl to encourage them, increase their self esteem and encourage them not to follow the appearance ideal. The participants are encouraged to read their letter out loud. Lastly, another technique this method uses is comebacks to the appearance ideal statements that participants can use in their everyday life. For example, if someone would say: “Does this shirt make me look fat?” The participant would say: “I think it’s best if we do not dwell on appearance issues.”   

Becker et al. (2010) research confirms the belief that cognitive dissonance can help prevent eating disorders in an experiment conducted in 2010. Becker had 102 new sorority members split into two groups; dissonance-based intervention or modified healthy weight.

Both groups meet in two 105-minute sessions in which, after each session, a questionnaire was given. In the dissonance-based intervention participants: (a) defined the thin-ideal, (b) discussed the origin of the thin-ideal and how it is perpetuated, (c) brainstormed costs of pursuing the thin-ideal, (d) participated in a verbal challenge activity and (e) were given a mirror homework assignment which included saying nice things to yourself in the mirror. In the second session the participants: (a) reviewed the mirror assignment, (b) engaged in role plays in which peer-facilitators assumed the roles of women invested in the thin-ideal and participants tried to discourage pursuit of the thin-ideal, (c) discussed ways to challenge and avoid common “fat talk” statements, (d) listed ways to resist pressure to pursue the thin-ideal both individually and collectively as sororities, (e) discussed possible barriers to body activism and ways to overcome those barriers, and (f) individually selected a self-affirmation exercise to continue their practice of positive body talk. The modified healthy weight (a) defined the thin-ideal, (b) defined the healthy-ideal and contrasted it with the thin-ideal, (c) discussed the importance of eating nutrient-dense foods in maintaining an intake/output balance, (d) listed the benefits of aspiring to a healthy-ideal, (e) discussed the importance of sleep in maintaining a healthy weight and body, (f) listed reasons to pursue the healthy-ideal, and (g) were given two homework assignments. In the second session (a) reviewed the benefits of pursuing the healthy-ideal, (b) discussed the difference between healthy dietary restriction (e.g., moderate, flexible, aimed at pursuing the healthy-ideal in an obesogenic food culture) and unhealthy dietary restriction (rigid, overly restrictive, extreme, typically aimed at pursuing the thin-ideal), (c) reviewed food and exercise logs, (d) identified healthy changes they could make to improve their diet with respect to nutrient density, along with barriers to such change, and strategies to overcome barriers, (e) discussed specific ways to make meals more nutrient-dense, (f) discussed the benefits of exercise, (g) identified healthy changes they could make to be more active, along with barriers to change, and strategies to overcome barriers, (h) discussed ways that sororities could promote a healthy-ideal for their members, and (i) committed to specific goals to continue their pursuit of the healthy-ideal.    

The results of the study concluded that both dissonance-based and modified healthy weight help prevent eating disorders at the 14-week follow-up. However, dissonance-based intervention produced significantly greater reductions than modified healthy weight in negative affect (measuring negative feelings), thin-ideal internalization, and bulimic pathology.