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The current study aims to explore the efficacy of a text message based safety behavior fading intervention compared to a relaxing video intervention for appearance concerns.
Description: Appearance-related safety behavior fading intervention procedures will follow methodology previously used in the Cougle Lab. The safety behavior fading intervention is designed to target a decrease or elimination of appearance-related safety behaviors. Individuals randomly assigned to the safety behavior fading condition will receive instructions to decrease or eliminate their endorsed appearance-related safety behaviors. In addition, they will receive daily reminders via text message to decrease these behaviors, along with a safety behavior monitoring checklist in which the participant indicates the extent to which they decreased and/or eliminated each safety behavior over the previous day. The daily reminder will include the following language: "Hi! This is a friendly reminder to avoid using your checklist behaviors. Please tap the link below to access today's checklist: [link to checklist]." Text messages will be delivered using EZtexting a text messaging platform used for research and marketing. Note that no identifying information will be included in this platform. Each participants phone number will be accompanied with a anonymized ID code. Individuals randomly assigned to the relaxing video condition will receive a total of 4 videos over the course of a month (1 video per week, 15 minutes each) wherein participants will be invited to close their eyes and focus their attention on the present moment while listening to relaxing piano music and songbirds.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Safety Behavior Fading | Experimental | Individuals randomly assigned to the safety behavior fading condition will receive instructions to decrease or eliminate their endorsed appearance-related safety behaviors. In addition, they will receive daily reminders via text message to decrease these behaviors, along with a safety behavior monitoring checklist in which the participant indicates the extent to which they engaged in each safety behavior over the previous day. |
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| Relaxing Video | Active Comparator | Individuals randomly assigned to the relaxing video condition will receive a total of 4 videos over the course of a month (1 video per week, 15 minutes each) wherein participants will be invited to close their eyes and focus their attention on the present moment while listening to relaxing piano music and songbirds. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Safety Behavior Fading for Appearance Concerns | Behavioral | Participants are asked to reduce or eliminate safety behaviors via text message reminders and checklists to monitor progress. |
| Measure | Description | Time Frame |
|---|---|---|
| The Social Appearance Anxiety Scale (SAAS; Hart et al., 2008) | Self-report scale that measures appearance anxiety symptoms. Scores range from 16 to 80 with higher scores indicating higher levels of appearance concerns. | Day 0, Day 28, Day 56 |
| Social Phobia Inventory (SPIN; Connor et al., 2000) | Self-report scale that measures social anxiety symptoms. Scores range from 0 to 68 with higher scores indicating higher levels of social anxiety. | Day 0, Day 28, Day 56 |
| Credibility and Expectancy Questionnaire (Devilly & Borkovec, 2000). | Self-report scale for measuring treatment expectancy and rationale credibility for use in clinical outcome studies. Three items are rated on a 0-10 scale and one item is rated on a 0-100 scale with higher scores meaning greater expectancy and credibility. | Day 0 |
| Eating Disorder Inventory (EDI; Garner et al., 1983). | Self-report scale for measuring drive for thinness, bulimia, and body dissatisfaction for use in clinical outcome studies. Each item is rated on a 0-5 scale with a total score range of 0-125 with higher scores indicating greater drive for thinness, bulimia, and body dissatisfaction. | Day 0, Day 28, Day 56 |
| Appearance Behaviors Checklist past-week version (author constructed) | Self-report scale used to measure frequency of engaging in appearance-related safety behaviors. This scale will be used as a manipulation check. Each item is rated on a 0 to 10 scale. Total scores range from 0 to 130 with higher scores indicating greater engagement in appearance-related safety behaviors | Day 0, Day 28, Day 56 |
| Measure | Description | Time Frame |
|---|---|---|
| Distress Intolerance Index (McHugh & Otto, 2012) | Self-report scale for measuring tolerance to distress for use in clinical outcome studies. Each item is rated on a 0-4 scale with a total score range of 0-40 with higher scores indicating greater intolerance of distress. | Day 0, Day 28, Day 56 |
| Frost Multidimensional Perfectionism Scale-Concerns over mistakes subscale (Frost et al., 1990) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jesse Cougle, Doctor of Philosophy | Florida State University | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Florida State University | Tallahassee | Florida | 32304 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42080861 | Derived | Patel TA, Cougle JR. Who benefits from a digital intervention for appearance concerns? A randomized controlled trial of a large mixed-gender sample. J Consult Clin Psychol. 2026 Apr;94(4):216-227. doi: 10.1037/ccp0001007. |
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| ID | Term |
|---|---|
| D057215 | Body Dysmorphic Disorders |
| D000072861 | Phobia, Social |
| D001068 | Feeding and Eating Disorders |
| ID | Term |
|---|---|
| D013001 | Somatoform Disorders |
| D001523 | Mental Disorders |
| D010698 | Phobic Disorders |
| D001008 | Anxiety Disorders |
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Participants are randomized to one of two conditions
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| Relaxing Video | Behavioral | Participants are asked to view weekly videos lasting 15 minutes each to engage in relaxation exercises. |
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Self-report scale for measuring concerns for making mistakes for use in clinical outcome studies. Each item is rated on a 0-4 scale with a total score range of 0-36 with higher scores indicating greater concerns for making mistakes. |
| Day 0, Day 28, Day 56 |
| Center for Epidemiologic Studies Depression Scale-10 (CESD; Andreson, 1994) | Self-report measure of depression symptom severity. Each item is rated on a 0 to 3 scale. Total scores range from 0 to 30 with higher scores indicating greater depression severity. | Day 0, Day 28, Day 56 |
| D012817 |
| Signs and Symptoms, Digestive |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |