About HBS Intervention Research
In addition to its population-level survey research, HBS is comprised of a series of innovative intervention and prevention programs focused primarily on promoting help-seeking among college students with untreated symptoms of disordered eating. This work is motivated by several key factors. On college and university campuses, the prevalence of eating disorders is high: roughly 14% of female and 4% of male students screen positive for clinically significant eating disorders. The traditional college years coincide with age of onset for eating disorders (19-25 years), presenting unique opportunities for early intervention on campus. Unfortunately, this opportunity is largely missed. The treatment gap—the proportion of affected students not receiving treatment—is wide: 80% of students with clinically significant eating disorder symptoms do not receive care. Left untreated, eating disorders typically become more severe and refractory to treatment. For these reasons and more, innovative approaches are urgently needed to narrow the eating disorder treatment gap on college campuses.
In recent years, the HBS team has been involved in the design, implementation, and assessment of numerous intervention and prevention programs. This is an exciting line of research that is constantly evolving and often providing unique opportunities for cross-disciplinary collaboration and mutually-beneficial partnerships with campus practitioners. Several of these on-going projects are described below.
HBS and the Healthy Body Image Program
HBS researchers partner with several health technology companies, including Lantern (see Partnerships). Lantern has developed a tailored suite of online eating disorder prevention and intervention programs called the Healthy Body Image Program (HBI). The HBS-HBI partnership is implemented via a screening algorithm embedded within the online survey (formerly the HBS survey, now the HBS module within the enhanced HMN survey, see Survey Research). Upon completing the survey, students are offered the specific HBI prevention or intervention program that best fits their needs as assessed by validated screening tools within the survey. This screening-linkage initiative was designed to reduce any barriers to program utilization and has been highly effective in increasing HBI uptake.
Using Behavioral Economics and Social Psychology to Promote Help-Seeking
A pilot study, funded by the National Institute of Mental Health (1F31MH105149-01), was conducted on four campuses during the 2015 winter/spring semester. The study tested an intervention using principles from behavioral economics and social psychology to promote help-seeking among undergraduates with untreated symptoms of eating disorders. The intervention was designed as a departure from typical approaches aimed at increasing help-seeking behavior. Mental health service non-utilization is typically attributed to factors such as stigma, information deficits, and financial constraints. Campus interventions often promote service use by attempting to minimize these and other barriers emphasized by theories of health behavior, but have had limited success as evidence by the 80% treatment gap. The present intervention was designed based on findings from HBS survey data which revealed that most students with untreated symptoms actually have low stigma, high knowledge, and minimal financial barriers (i.e., the traditional explanations of non-help-seeking appear insufficient for explaining why students fail to seek help). These students most commonly report not seeking help for reasons such as lack of time, lack of perceived need, ambivalence about the severity of need, belief that the problem will resolve itself without treatment, and a desire to cope on their own. In sum, students do not appear to have deep-rooted beliefs or attitudes preventing help-seeking, rather the decision to seek treatment does not appear to be sufficiently urgent or salient to overcome the inertia of the status quo. These findings form a strong case for a behavioral economic approach to promoting treatment utilization among college students with untreated eating disorder symptoms.
In other health contexts in which individuals appear open to change but lack the urgency to act (e.g., for diet/exercise, use of preventative care), behavioral economic and social psychological interventions have produced positive results by addressing specific cognitive biases, including the default bias (individuals ‘go with the flow’ of preset options) and sign effect (losses (negative outcomes) are substantially more psychologically costly than gains (positive outcomes)). The present study addressed these biases in an effort to increase service use among students with untreated eating disorder symptoms (as identified in an online screen).
In a 12-week study, the study team used a factorial design to test the effects of three intervention components: default option, sign effect, and peer norming. The intervention components were delivered via email messaging. To address the default bias, email messages reframed treatment use as an opt-out (as opposed to opt-in) behavior, thus nudging students to seek help. Students were able to check a box to opt out of receiving treatment linkage. Those who did not opt-out received, without any purposeful action, continued assistance connecting to treatment. For the sign effect, messages emphasized the negative consequences of untreated eating disorders. Students in conditions with peer norming saw how their levels of eating disorder symptoms (individual results from widely-used, validated measures included in the baseline survey) compared with average symptom levels among other undergraduates (with nationally aggregated survey data taken from previous administrations of HBS). The primary outcome was help-seeking (use of counseling/therapy); secondary outcomes included: perceived need, intentions to seek help, barriers to treatment, informal help-seeking (support from nonclinical sources), knowledge of eating disorder services, symptoms, and risks, eating pathology (measured by the SCOFF and Eating Disorder Examination Questionnaire), body image concerns (measured by the Weight Concerns Scale), and impairment (measured by the Clinical Impairment Assessment). Follow-up data were collected at weeks 6 and 12.
For a copy of the aggregate data report from the winter/spring 2015 semester, click HERE.
Participate in HBS Intervention Research
As HBS researchers continue to develop, implement, and assess intervention and prevention programs, there are opportunities for colleges and universities to become involved in innovative and impactful research. If you are a campus administrator interested in enrolling your college or university in HBS intervention research, please contact the research team at firstname.lastname@example.org.