Protocol of a cluster randomised trial of BodyKind: a school-based body image programme for adolescents.

BACKGROUND: Poor body image is prevalent among adolescents and associated with several negative outcomes for their physical and psychological health. There is a pressing need to address this growing public health concern, yet there are few evidence-informed universal programmes for older adolescents that address contemporary body image concerns (i.e., social media). BodyKind is a four lesson, school-based, teacher led, universal body image programme that incorporates empirically supported principles of cognitive dissonance, self-compassion, compassion for others and social activism, to support positive body image development. Building on previous pilot trials in the USA, this paper outlines the protocol for a cluster randomised control trial (cRCT) and implementation evaluation of the BodyKind programme which was culturally adapted for the Irish cultural context. METHODS: We aim to recruit 600 students aged 15-17 years in Transition Year (4th year) across 26 second-level schools in Ireland. Using minimisation, schools will be randomly assigned to receive BodyKind (intervention condition, n=300) or classes as usual (waitlist control, n=300). Teachers in intervention groups will receive training and deliver the programme to students over four weeks, at a rate of one lesson per week. Primary outcomes of body appreciation, body dissatisfaction and psychological wellbeing and secondary outcomes of self-compassion, compassion for others, body ideal internalisation, social justice motives and appearance-based social media use will be assessed at pre-, post- and 2 month follow up. Mediation and moderation analyses will be conducted to identify how and for whom the intervention works best. An implementation evaluation will assess the quality of programme implementation across schools and how this may influence intervention outcomes. Waitlist control schools will receive the programme after the 2-month follow up. CONCLUSION: This study will be the first to implement a cRCT and an implementation evaluation to assess the impact of this multicomponent school-based body image programme designed to support healthy body image development. If shown to be effective, BodyKind will have the potential to improve adolescent body image and wellbeing and inform efforts to implement sustainable and scalable programmes in schools. TRIAL REGISTRATION: The trial was retrospectively registered on 10/10/2023 on ClinicalTrials.gov NCT06076993 .

Birth Doula Care in California During COVID-19: The Impacts of Social Distancing on a High-Touch Helping Profession.

Birth doulas were deemed "non-essential" personnel during the COVID-19 pandemic and were generally excluded from attending hospital births in person. This study documents the impacts of pandemic-related contextual factors on birth doula care in the San Francisco Bay Area, examines how doulas adapted their services, and explores implications for policy and practice. We employed a contextually bound qualitative case study methodology driven by social action theory and conducted interviews with 15 birth doulas. The pandemic disrupted physical settings, the social environment, communication modalities, contractual arrangements, and organizational level factors. The historical context also amplified awareness of institutionalized racism in birth settings and highlighted birth doulas' advocacy role. Striking deficits exist in birth doulas' integration into US healthcare systems; this made their services uniquely vulnerable to the pandemic circumstances. Birth doulas' value ought to be more formally recognized within health policy, health insurance, and hospital systems as complementary care to that provided by medical providers to improve access to high-quality perinatal care.

Realizing Yoga's all-access pass: a social justice critique of westernized yoga and inclusive embodiment.

In the 21st century, the ancient mind-body practice of yoga has surged in popularity among western enthusiasts for its numerous health benefits. Particularly, a growing evidence base supports yoga for cultivating positive embodiment and reducing risk for disordered eating. Nevertheless, amidst its rise are concerns about yoga's departure from its spiritual foundations and increasing assimilation into the appearance- and commercial-driven exercise and fitness culture. Consequently, an exclusionary identity has been perpetuated in shaping norms surrounding who can and does practice yoga, which contradicts earlier egalitarian visions of a yoga for all. Therefore, we adopt a social justice lens in offering a focused analysis of the intersection of yoga, embodiment, and inclusion for select marginalized social identities typically underrepresented among yoga practitioners and in yoga scholarship. Data are synthesized from both qualitative and quantitative sources and integrate an understanding of how confined media representations of "the yoga body" and other practical constraints may undermine the perceived access to the practice for members of diverse groups. We conclude with inviting future considerations towards fostering more interdisciplinary community-based research partnerships among the variety of stakeholders invested in advancing the accessibility and inclusion of yoga and positive embodiment for all bodies.

"Mom, quit fat talking-I'm trying to eat (mindfully) here!": Evaluating a sociocultural model of family fat talk, positive body image, and mindful eating in college women.

A growing evidence base confirms sociocultural theory's predictions regarding the influence of direct exposure to family factors (e.g., parental commentary) in promoting disordered eating behavior as mediated by negative body image. Nevertheless, this model has not been specifically applied to investigating indirect or vicarious exposure to family communications (e.g., negative body talk) in estimating mindful eating behavior via positive body image intervening variables. Therefore, to address this gap the present study provided a preliminary evaluation of the indirect effects of overhearing family fat talk through both body appreciation and functional body appreciation in predicting mindful eating among undergraduate females. Participants included 333 women attending a large southeastern public university who completed measures of mindful eating, family fat talk, body appreciation, and functional body appreciation via an online survey platform. Results indicated that family fat talk was inversely associated with mindful eating, body appreciation, and functional body appreciation. Whereas engaging in mindful eating positively corresponded with both positive body image indices. A regression model controlling for BMI also revealed that an orientation towards appreciating what the body can do (and not a general appreciation of the body) helped explain the inverse association between family fat talk and mindful eating. Our initial findings tentatively suggest that focusing on the self-objectifying and self-denigrating body-related commentary of family members may disrupt attention to one's own appreciation of the (internal) workings of the body thereby undermining the mindful eating process. Implications for further expanding the translation of sociocultural theory in the context of positive body image and mindful eating are considered.

An integrative affect regulation process model of internalized weight bias and intuitive eating in college women.

The present study extended the weight stigma and well-being process model (Tylka et al., 2014) by examining three affect regulation pathways that may help simultaneously explain the predicted inverse association between internalized weight bias and intuitive eating. A weight-diverse sample of 333 college women completed an online survey assessing internalized weight stigma, intuitive eating, body shame, body image flexibility, and self-compassion. Self-reported height and weight were used to calculate body mass index (BMI). Non-parametric bootstrap resampling procedures were computed to ascertain the presence of the indirect effects of internalized weight bias on intuitive eating via the three hypothesized mediators controlling for BMI in a combined model. Results demonstrated that body image flexibility significantly and self-compassion marginally contributed unique variance in accounting for this relationship. Our preliminary cross-sectional findings contribute to a nascent body of scholarship seeking to provide a theoretically-driven understanding of how negative and positive forms of experiencing and relating to the body may co-occur within individuals. Results also point to potential target variables to consider incorporating in later-stage efforts to promote more adaptive ways of eating amidst internalized weight stigma.

Explaining the prospective paths from body appreciation to intuitive eating facets: Does body image flexibility serve as a mediator?

Initial evidence suggests that body appreciation prospectively predicts intuitive eating. However, the limited number of longitudinal studies focused solely on girls and women, with a lack of evaluation among men. Furthermore, the underlying mechanisms explaining this relationship remain poorly understood. The present study examined whether body appreciation prospectively predicted intuitive eating facets among women and men in Germany. We also tested whether adaptive affect regulation skills (i.e., body image flexibility) mediated these relationships. We analyzed data from 1436 women and 704 men across three time points: Baseline (T1), 6-month (T2), and 12-month (T3) follow-up, using latent variable path models to assess direct and indirect effects. Among women, T1 body appreciation directly predicted T3 body-food choice congruence. Additionally, body appreciation indirectly predicted unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on hunger and satiety cues at T3 via its effect on T2 body image flexibility. Among men, T1 body appreciation indirectly predicted T3 eating for physical rather than emotional reasons via T2 body image flexibility. Our findings suggest that body image flexibility plays a pivotal role in explaining why individuals who appreciate their bodies are more likely to eat intuitively.

An Executive Functioning Composite Does Not Moderate the Relationship Between Combat Exposure and Posttraumatic Stress Disorder Symptom Clusters.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing. As combat experiences are likely to significantly modify self-, other-, and society-oriented cognitions and heighten risk for PTSD, examination of related cognitive processes may yield new treatment strategies. The cognitive model of PTSD suggests that persistent threat perceptions contribute to symptom worsening. Thus, cognitive processes of shifting perspectives or generating novel interpretations may be particularly relevant to lessen PTSD symptoms. This cross-sectional study examined executive functioning as a moderator to the relationship between combat exposure and PTSD symptom clusters among post-9/11 Veterans. METHOD: Data from 168 Veterans were drawn from a larger study examining post-deployment mental health and cognitive function. An executive functioning composite derived from Wisconsin Card Sorting Test Perseveration Errors, WAIS-III Similarities, Trail Making Test B, and Stroop Color-Word Inhibition scores was computed. Path analysis was used to test the moderation model. RESULTS: After accounting for age, sex, and estimated premorbid functioning, results indicated that combat exposure was associated with all symptom clusters on the PTSD Checklist-Military. Executive functioning was not significantly associated with the PTSD symptom clusters and did not moderate the relationship between combat exposure and any of the PTSD symptom clusters. CONCLUSIONS: Combat exposure is an important dimension of risk related to PTSD in Veterans that warrants regular screening. Moderation by executive functioning was not observed despite theoretical support. Future work could test methodological and sampling reasons for this finding to determine if theoretical adjustment is necessary.

Making it relevant: A codesign and cultural acceptability study of Be Real's BodyKind Ireland body image programme for older adolescents.

Body image is an established public health concern and there is a pressing need for evidence-informed universal programmes for older adolescents. To ensure high standard, quality programmes, there have been calls to adapt existing programmes to different contexts in ways that ensure materials are relevant, but still aligned with their theoretical foundations. This study outlines the cultural adaptation of the BodyKind programme in Ireland, which was initially developed in the USA, to address an unmet need to provide an inclusive, strengths-focused, school-based body image intervention for older adolescents. After receiving BodyKind, codesign workshops were conducted with 12 adolescents aged 15-16 years, who provided feedback and designed content (examples/scenarios) to increase the programme's relevance for adolescents. Feedback on cultural appropriateness of programme materials were obtained via interviews with six female post-primary teachers and one mental health clinician. Qualitative data were analysed using thematic analysis. BodyKind was perceived as highly acceptable by stakeholders who offered suggestions for programme refinement. Themes included 1.) Programme acceptability, 2.) Implementation considerations, 3.) Programme refinement. This study used multi-stakeholder feedback to engage in cultural adaptation of BodyKind prior to further evaluation, thereby informing efforts to implement sustainable and scalable programmes in schools.

Exploring the reciprocal associations between body appreciation, body image flexibility, and body acceptance by others in the context of the COVID-19 pandemic in Germany: Results from cross-lagged panel analyses among women and men.

The COVID-19 pandemic provided a context associated with negative consequences for body image and eating behavior. However, little is known about what factors helped to mitigate these consequences and build a positive body image. Previous research pointed to the significance of body image flexibility and perceived body acceptance by others in predicting body appreciation. However, as most of the studies have been cross-sectional, causal relationships are poorly understood. This longitudinal study tested the reciprocal association between body appreciation, body image flexibility, and perceived body acceptance by others during the COVID-19 pandemic in Germany. We analyzed data from a large community sample consisting of 1436 women and 704 men who were invited to complete the study measures (BAS-2, BI-AAQ-5, BAOS-2) at three time points, each approximately six months apart. Latent cross-lagged panel analyses revealed that greater T1 body appreciation predicted an increase in T2 body image flexibility among both genders, while for women, we additionally observed reciprocal effects between T2 and T3. Among both genders, we further found that greater body appreciation predicted increased perceived body acceptance by others over both measurement intervals (but not vice versa). Our findings are discussed in light of pandemical constraints during the studies' assessments.

Fashion versus fitspo: The effect of viewing images of contemporary Barbie® dolls in passive versus active poses on college women's body image and affect.

The modern millennial- and Gen Z-targeted Barbiecore feminist movement has emerged in tandem with Barbie®'s reinvention to inspire inclusion and active play. Stimulated by these media trends, the present study using a pre-post experimental design evaluated whether exposure to images depicting contemporary passively-posed Barbie Fashionista® (BF) dolls versus images of actively-posed Barbie Made to Move® (M2M) "fitspiration" dolls versus images of Lego Friends® (LF) scenes would differentially affect aspects of state body image and affect in a sample of 106 racially-diverse young adult college women (MAge = 19.2, SD = 1.39). ANCOVA models assessed the effects of condition on post state measures while controlling for baseline state measures. Results indicated that participants exposed to the BF images reported significantly lower body appreciation relative to those who viewed the LF play sets. A similar trend emerged for participants shown the newer M2M doll images. Additionally, viewing images of the actively-posed M2M dolls was associated with marginally higher appearance comparison scores versus the LF control. These initial findings have implications for considering the relevance of expanded digital strategies for marketing more realistically appearing and functioning Barbie® dolls in affecting the body image experiences and potential purchasing choices of young adult female consumers.

Caring for myself while I'm growing somebody else: Mindful self-care buffers between pregnancy body disconnection and distress.

Pregnancy embodiment describes the way a pregnant individual inhabits their body, including disconnection and connection, likely influencing both distress and well-being. Emerging work indicates that acceptance of pregnancy-related bodily change may support well-being, particularly when co-occurring with self-care behaviors. Yet, specific associations of pregnant embodiment and intentional, individualized self-care practices (mindful self-care; MSC) with well-being and distress remain unexamined. The present study tested independent and interactive associations between MSC and positive embodiment (body agency), and negative embodiment (body estrangement), respectively, with maternal distress and well-being in a sample of US pregnant women (N = 179; Mage = 31.3 years, aged 21-43; 85.6 % White, 4.9 % Hispanic/Latinx). Challenge and threat/harm appraisals of the COVID-19 pandemic were included in the model to represent responses to the unique sociohistorical context. Measurement-corrected path analytic models explained a substantial proportion of variation in well-being and a smaller proportion in prenatal distress. Among those with higher MSC, the association between body estrangement and prenatal distress was weaker. Results support mindful self-care as protective for pregnancy distress in the setting of body disconnection. Future individualized health promotion might consider how high-stress contexts influence application of self-care practices and impact distress and well-being during pregnancy.

"I'll never sacrifice my well-being again:" The journey from negative to positive body image among women who perceive their body to deviate from societal norms.

We conducted one-on-one interviews with 25 Canadian cisgender women who self-identified as having (a) a condition or characteristic causing their body to deviate from societal norms and (b) overcome a negative body image to develop a positive body image. Using coding reliability thematic analyses, we identified 12 themes (italicised) involving processes and experiences associated with shifts in body image. Women had moments that sparked and confirmed the importance of building positive body image (Enough is Enough). They experienced accepting Social Connections and Community and Accessed Critical Knowledge conducive to body positivity. They engaged in Joyful Movement, Adaptive Appearance Investment, and Joyful and Intuitive Eating. They identified how Changing Societal Norms, Becoming Older and Wiser, COVID-19 Pandemic, having Illnesses and Medical Conditions, Pregnancy and Motherhood, and Spirituality, Religion, and Nature affected their body image, values, and valued action. As women engaged in these processes and experiences, shifts occurred in their perceptions of their embodied selves in the world, represented by four "Bigger Lessons:" I Am More Than My Looks, I Am More Than My Body, I am More Than My Self, and I am Inherently Worthy of Love, Respect, and Joy. These findings can inform body image programmes and clinical interventions.

Pilot feasibility and acceptability trial of BE REAL's BodyKind: A universal school-based body image intervention for adolescents.

Body dissatisfaction is prevalent among adolescents and a primary risk factor for eating disorders, yet there are few body image interventions for older adolescents that support development of positive body image. Therefore, we assessed the feasibility, acceptability and preliminary effectiveness of BodyKind, a four-lesson, mixed gender, teacher-led, school-based curriculum for older adolescents, that combines principles of self-compassion, compassion for others, cognitive dissonance, and social activism to address contemporary adolescent body image concerns (i.e., appearance bias, comparisons on social media) and strengthen positive body image development. The sample contained 147 adolescents, predominantly racial/ethnic minorities (>95%), 54.8% male, 41.5% female and 4.1% gender-minority students aged 15-18 years (M=16.24, SD=.96) from a low-income, inner-city high school in the Midwestern US. Two teachers received training and delivered the curriculum to students. This single arm, mixed methods trial assessed student and teacher acceptability, teacher fidelity and student intervention outcomes. Despite reasonable teacher fidelity, recruitment/attendance rates, post-intervention data loss (35% attrition) limited evaluations of program effectiveness and study feasibility. Important learnings regarding study feasibility will inform optimisation for future school-based trials. Findings demonstrate high acceptability of BodyKind among teachers and adolescents in a lower socioeconomic school setting, and further randomized controlled effectiveness trials are required.

Evaluating race/ethnicity in moderating baseline cardiometabolic risk and body composition changes in North Carolina first-year college women.

The roles of race/ethnicity and geographical region in the context of first-year college weight gain remain largely under-examined. The present study evaluated whether race/ethnicity: (1) at baseline was associated with greater representation in cardiometabolic health risk categories for body mass index, percent body fat, waist circumference, and waist-to-hip ratio in the full sample of 54 Black/African American and 80 White/European American first-year female undergraduates attending a North Carolina state university; and (2) moderated body composition changes between the beginning of the fall and spring semesters among the 83 participants who completed baseline and follow-up visits (N = 39 Black/African Americans). More Black/African Americans than White/European Americans had percent body fat values ≥32% at baseline; a greater proportion of White/European Americans than Black/African Americans had a waist-to-hip ratio >0.80. Among those who completed baseline and follow-up visits, White/European Americans had higher waist-to-hip ratios (unadjusted: p <0.01, adjusted for family income: p < 0.01) and waist circumferences (adjusted for family income: p < 0.05) at both time points. No strong moderating effects of race/ethnicity were detected. Preliminary results suggested that greater consideration of racial/ethnic indicators and potential regional variation in these biometric attributes among first-year college students is warranted.

Feasibility and Acceptability of a Guided Self-Help, Text-Messaging Intervention to Promote Positive Body Image of Emerging Adult Women.

The predominant approach of existing eating disorder prevention programs targets risk factors for development; furthermore, burgeoning evidence suggests that promotion of protective factors against eating disorders (e.g., positive body image) is also a worthy avenue for prevention efforts. The present study considered existing literature gaps in the design of an 8-week guided self-help intervention meant to address the risk for disordered eating through the improvement of positive body image and enhancement of current adaptive functioning. The intervention incorporated elements of weight-inclusive health promotion (e.g., Health at Every Size; HAES) alongside positive psychology and third-wave behavioral interventions [e.g., self-compassion, mindful eating, Acceptance and Commitment Therapy (ACT)] to promote engagement in mindful-self-care. This mixed-methods study evaluated the feasibility and acceptability of the text-messaging based intervention in a diverse sample of cisgender college women (N = 30; 30% Black; 30% bisexual) at risk for disordered eating. Results indicated a high level of engagement and satisfaction with the intervention. Proof of concept was preliminarily supported by the observed significant changes in variables of interest (i.e., body appreciation, positive embodiment, mindful self-care, intuitive eating, self-compassion, disordered eating, and body image dissatisfaction) across the intervention. Overall, results of this study suggest that the use of a guided self-help program based in technology which seeks to reduce risk factors for disordered eating while also supporting adaptive functioning may be indicated for emerging adult women. This article will discuss how the present study provides the groundwork for continued development of innovative and remotely accessible interventions which promote positive body image.

Yoga at Every Size: A Preliminary Evaluation of a Brief Online Size-Inclusive Yoga and Body Gratitude Journaling Intervention to Enhance Positive Embodiment in Higher Weight College Women.

The present pilot randomized controlled trial (RCT) evaluated the feasibility, acceptability, and preliminary efficacy of a 4-week online yoga and body gratitude journaling intervention for strengthening positive embodiment among racially-diverse higher weight college women. Seventy-five participants were initially randomized to either the yoga condition (n = 36) or to a wait-list control (n = 39). Participants completed measures of positive and negative body image, weight bias internalization, self-compassion, drive for leanness, and physical activity acceptance at both baseline and post. Preliminary results among the 42 analyzed completers (mean age = 20.9, SD = 2.4; 30% Black or African American) revealed acceptable feasibility given the low-intensity nature of the intervention reflected in a 36% attrition rate. Self-reported adherence was strong for the yoga component with 81% of participants indicating that they practiced with the videos ≥3-4 times per week as suggested. Although 71% reported completing the body gratitude journal ≥1-2 times per week, daily adherence was minimal. Acceptability was also high among participants randomized to the yoga condition as indicated by 86% expressing at least moderate levels of satisfaction with the overall program. Qualitative feedback from participants further supported the acceptability of the program and pointed to important areas in further refining the protocol in the future. Preliminary efficacy was supported by significant reductions in internal body shame and gains in body appreciation, functional body appreciation, functional body satisfaction, functional body awareness, and behavioral commitment to physical activity engagement among the yoga vs. wait-list control participants. These promising findings once replicated in larger, higher-powered trials may have important implications for extending the reach and accessibility of mind-body wellness practices like yoga to benefit racially-/ethnically-diverse college women of higher weight. This research is further responsive to the growing need for efficacious remotely-delivered, and scalable behavioral health interventions in the ongoing era of the COVID-19 pandemic. However, additional research is warranted to explore ways of enhancing engagement of participants with lower levels of positive embodiment and to further incentivize the journaling component of the intervention.

Body image and internalization of appearance ideals in Black women: An update and call for culturally-sensitive research.

Extant research on body image supports sociocultural theories emphasizing the internalization of societal pressures to attain the thin-ideal, as well as other White or Eurocentric ideals that are predominant in mainstream media. While earlier research suggests that Black women are less likely to report body dissatisfaction and thin-ideal internalization compared to women of other racial backgrounds, recent studies argue that most measures of body image and appearance ideals may not be accurate assessments of body dissatisfaction for this population. In this paper, we summarize the literature over the past two decades on body image and appearance ideals among cisgender Black girls and women and discuss the applications of well-established sociocultural theories of body dissatisfaction. We additionally highlight existing gaps in culturally-sensitive theory and assessment tools and consider the benefits of applying intersectionality-informed research. We lastly propose future directions in research, assessment, and intervention to develop more culturally-sensitive approaches to identifying, assessing, and addressing body dissatisfaction among Black girls and women. This paper encourages researchers to apply culturally-sensitive and intersectionality-informed theory to improve efforts in assessing early warning signs of body dissatisfaction and developing effective interventions for this population.

Universal Design for Measurement: Centering the Experiences of Individuals With Disabilities Within Health Measurement Research.

People with disabilities comprise roughly 25% of the U.S. adult population yet remain underrepresented in mainstream public health and evaluation research. The lack of measures of common constructs that are validated in but not specific to this population may impede their inclusion. This article describes the use of Universal Design for Measurement (UDM), a novel method for developing self-report measurement instruments validated among broad populations to minimize the need for scale adaptation. We applied UDM to the development and content validation of a new body image scale. We assessed content validity by surveying subject matter experts (SMEs) and conducted a Delphi panel study to assess consensus about scale items among community women with (n = 18) and without (n = 15) disabilities. Most scale items were found acceptable by SMEs and community women. The Delphi panel study was useful toward evaluating consensus about scale items among women with and without disabilities. Findings support the use of UDM in developing inclusive and psychometrically sound measurement scales to ultimately facilitate the full inclusion of people with disabilities within health research.

The effects of yoga on functionality appreciation and additional facets of positive body image.

This study investigated the effects of yoga on functionality appreciation, and the potential mechanisms that could explain the impact of yoga on additional facets of positive body image. Young adult women (N = 114; Mage = 22.19) were randomised to a 10-week Hatha yoga programme or waitlist control group. Participants completed measures of functionality appreciation, body appreciation, body compassion, appearance evaluation, self-objectification, and embodiment at Pretest, Midtest, Posttest, and 1-month Follow-Up. Follow-up data could not be analysed due to high levels of attrition. The remaining data showed that, compared to the control group, women in the yoga programme experienced lower self-objectification at Midtest and greater embodiment over time. Further, all participants experienced improvements in body appreciation, body compassion, and appearance evaluation over time, regardless of their assigned group. Lower self-objectification contributed to improvements in body appreciation and body compassion. In addition, greater embodiment contributed to improvements in body appreciation, body compassion, and appearance evaluation. Contrary to our expectations, yoga did not lead to increased functionality appreciation, nor was functionality appreciation a mediator of the impact of yoga on positive body image. Instead, lower self-objectification, and greater embodiment, drove improvements in positive body image.

Euthanasia-related strain and coping strategies in animal shelter employees.

OBJECTIVE: To identify and evaluate coping strategies advocated by experienced animal shelter workers who directly engaged in euthanizing animals. DESIGN: Cross-sectional study. SAMPLE POPULATION: Animal shelters across the United States in which euthanasia was conducted (5 to 100 employees/shelter). PROCEDURES: With the assistance of experts associated with the Humane Society of the United States, the authors identified 88 animal shelters throughout the United States in which animal euthanasia was actively conducted and for which contact information regarding the shelter director was available. Staff at 62 animal shelters agreed to participate in the survey. Survey packets were mailed to the 62 shelter directors, who then distributed them to employees. The survey included questions regarding respondent age, level of education, and role and asked those directly involved in the euthanasia of animals to provide advice on strategies for new euthanasia technicians to deal with the related stress. Employees completed the survey and returned it by mail. Content analysis techniques were used to summarize survey responses. RESULTS: Coping strategies suggested by 242 euthanasia technicians were summarized into 26 distinct coping recommendations in 8 categories: competence or skills strategies, euthanasia behavioral strategies, cognitive or self-talk strategies, emotional regulation strategies, separation strategies, get-help strategies, seek long-term solution strategies, and withdrawal strategies. CONCLUSIONS AND CLINICAL RELEVANCE: Euthanizing animals is a major stressor for many animal shelter workers. Information regarding the coping strategies identified in this study may be useful for training new euthanasia technicians.