How should we adapt cognitive dissonance-based body image interventions for Autistic individuals?

Evidence spanning two decades demonstrates that the Body Project, a cognitive dissonance-based prevention, effectively reduces body dissatisfaction, eating disorder (ED) symptoms and future ED onset in young women (Becker & Stice, 2017). The intervention utilises cognitive dissonance theory (Festinger, 1975), wherein undertaking activities counter to a strongly-held initial attitude can change that attitude over time. The Body Project supports participants in challenging unrealistic appearance ideals/pressures, ultimately driving positive body image change.

However, no research thus far has investigated whether this is an effective or accessible approach to ED prevention for autistic people. Importantly, the Body Project is predicated on neurotypical body image norms and was not designed with autistic experiences in mind. Moreover, challenging internalised sociocultural appearance ideas may be less relevant to autistic people as many are accustomed to feeling distinct from others and questioning monolithic norms, so may already hold less rigid body ideals.

Understanding the Body Project in the context of autism is vital given the high prevalence of autism amongst people with EDs (Westwood & Tchanturia, 2017; Huke et al., 2013). Since body dissatisfaction is a causal risk factor for ED pathogenesis, tailoring interventions to address body image in autism is crucial to reduce ED risks.

The extant literature shows that autistic people often face body dissatisfaction but may experience embodiment differently due to sensory, cognitive, emotional, and perceptual differences (Asada et al., 2017; Demartini et al., 2021; Healy et al., 2021; Krumm et al., 2017; Mansour et al., 2016). Alongside this, Brede et al. (2020) and Healy et al. (2021) report that autistic individuals’ attention to unrealistic appearance ideals may be part of ‘camouflaging’ (masking) with neurotypical peers rather than a deep-rooted internalisation. Others highlight that autistic traits can even instil positive body image experiences (Longhurst et al., 2023; Jones et al., 2009). Overall, existing evidence argues for the importance of identifying autism-specific approaches to improving body image for autistic individuals.

Research question

To explore how we should adapt existing cognitive dissonance-based body image interventions for autistic individuals, the following research questions will be addressed:

1. How do autistic individuals experience body image?
2. What are autistic people’s views and perceptions of current cognitive dissonance-based body image interventions?
3. How could these interventions be adapted to be more accessible and/or beneficial for autistic individuals?

Exploring these questions provides valuable insight into a) whether cognitive dissonance approaches are suitable for autistic people at all and b) if so, how they can be tailored based on the perspectives of autistic people with lived experience of body image/eating distress.

Methodology

Participants

We will recruit 8 participants who identify as women and who:

• are 18-30
• have a clinical diagnosis of autism or self-identify as autistic
• have either a) past personal experience of eating/body image distress, or b) have been a participant or trainer in The Body Project.

For ethical reasons people with a current eating or body image disorder cannot participate. Participants will provide informed consent prior to interviewing and will receive a detailed debrief afterwards (supervisor will obtain ethical approval).

Method

This qualitative research will consist of individual semi-structured interviews (approx. 1 hour) conducted via Teams and recorded with participants’ permission for transcription. To facilitate autistic communication styles, interviews will be online and participants may optionally keep their cameras off and/or type in the chatbox rather than speaking. This is established good practice in providing accessible interview options. The semi-structured interviews format will ensure that participants have the freedom to explore any points they feel are relevant to the research question. Participants will be recruited from an existing database of autistic people and via posts on Durham University-focused social media.

Analysis

Transcripts of the interviews will be interpreted using Thematic Analysis (Braun & Clarke, 2006), through which I will develop key themes to establish findings relevant to each research question. Reflexive analysis will be used to critically reflect upon my positionality in relation to data interpretation.

Results

I will document the main findings in a report that will contribute to a research article to be submitted for publication. The report will be shared with relevant research charities (e.g., Autistica/BEAT) and with the international Body Project research teams. A summary of the findings will also be shared with participants.

Potential limitations of this research include its focus on individuals identifying as women, and those with previous experience of eating/body image distress, meaning we cannot extrapolate to people of other genders or without such lived experiences. However, the participant criterion and qualitative approach will provide rich data that centres autistic people’s lived experiences of body image in understanding on this topic.

Plan of work & time schedule

I will meet twice weekly with my supervisor, and more if needed.

Week 1-2: Conduct interviews (transcribing throughout)

Week 3: Complete all interview transcriptions

Week 4-5: Analysis

Week 6: Write-up