A guide for self-help guides: best practice implementation.

Guided self-help is an evidence-based intervention used globally. Self-help is a fundamental part of the stepped care model of mental health services that enables the efficient use of limited resources. Despite its importance, there is little information defining the role of the guide and the key competences required. In this context, the guide is defined as the person who facilitates and supports the use self-help materials. This article sets out the role of the guide in guided self-help. It considers practical issues such as the importance of engagement to motivate clients for early change, personalising the intervention, structuring sessions, how best to use routine outcome monitoring and supervision requirements. Key competences are proposed, including generic competences to build the relationship as well as specific competences such as being able to clearly convey the role of the guide to clients. Guides should be prepared for "self-help drift", a concept akin to therapist drift in more traditional therapies. Knowing how to identify mental health problems, use supervision and manage risk and comorbidity are all key requirements for guides. The paper concludes by calling for increased recognition and value of the role of the guide within mental health services.

Targeting the link between social media and eating disorder risk: A randomized controlled pilot study.

OBJECTIVE: Evaluate the feasibility, acceptability, and preliminary efficacy of a self-criticism intervention addressing the link between appearance-motivated social media use and eating disorder risk. Another condition, designed to help users curate their social media feed to reduce negative impacts on wellbeing, was also trialed as an active and credible comparison. METHOD: University students aged 17-25 (N = 170) were screened and randomized (n = 130) to the self-criticism intervention, social media curation, or waitlist control group. The intervention comprised self-guided cognitive behavior therapy delivered in four modules over 1 week. Primary outcomes were feasibility and acceptability. Secondary outcomes were appearance motivations for social media use, appearance comparison, self-criticism, body image flexibility, and disordered eating (at baseline, one-week postrandomization, and two-weeks postrandomization). TRIAL REGISTRATION: ACTRN12621000353897. RESULTS: Participants completed an average of 82% of the intervention modules and 77% of the homework exercises within the week allocated. The intervention was well-accepted; participants reported a range of positive aspects, alongside suggested modifications to the intervention and study design to improve acceptability. Group by time interactions suggested groups changed at a different rate on three secondary outcomes; between-groups effect sizes suggested this was due to greater improvements in the self-criticism group than waitlist control. DISCUSSION: This was the first study to evaluate an intervention for the link between appearance-related social media use and eating disorder risk for young adults. Positive findings relating to feasibility, acceptability, and preliminary efficacy suggest a larger randomized controlled trial, with modifications to the intervention and study design, is warranted. PUBLIC SIGNIFICANCE: Appearance-related social media use has been linked to poorer body image and disordered eating, necessitating treatments that can disrupt this relationship. The self-criticism intervention evaluated in this study shows promise as a strategy to address this need. It is the first intervention focused on appearance-related social media use to be designed for and tested in young adults, who are at heightened risk of developing an eating disorder.

Social media, body image, and the question of causation: Meta-analyses of experimental and longitudinal evidence.

This article presents four meta-analyses that can inform causality in the relationship between social media and body image; 24 experimental samples comparing the effect of appearance-ideal social media images to non-appearance-related conditions (n = 3816); 21 experimental samples examining the effect of contextual features (e.g., comments and captions) accompanying appearance-ideal social media images (n = 3482); 14 experimental samples investigating the effect of appearance-ideal images versus other appearance images on social media (n = 2641); and 10 longitudinal samples on social media use and body image (n = 5177). Social media appearance-ideal images had a moderate negative effect on body image (Hedges' g = -0.61, p < .01), were more damaging in higher- than lower-risk contexts (Hedges' g = -0.12, p < .01), and were moderately more impactful than other social media appearance images (Hedges' g = -0.68, p = .05). These effects were smaller but significant with outliers removed. Social media use had a very small, negative correlation with body image longitudinally (Fisher's Z = -0.08, p < .001). No significant moderators emerged. Clinicians should consider approaches to managing social media use, particularly exposure to appearance-ideal imagery, in case conceptualisation and psychoeducation for clients at risk of, or experiencing, body image disturbance.