Author: Hau, Soek
Title: Use of expressive writing intervention to increase body image satisfaction in Hong Kong elite athletes : a randomised controlled feasibility study
Advisors: Leung, Sau Fong (SN)
Degree: DHSc
Year: 2022
Subject: Athletes -- Psychology
Writing -- Psychological aspects
Clinical health psychology
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xvii, 222 pages : color illustrations
Language: English
Abstract: Background: Elite athletes have long been battling with issues concerning body image disturbance and disordered eating symptoms. While different treatments and interventions are implemented to help athletes alleviate body image distress, many of them have failed to be successful or effective. Expressive writing intervention as an alternative potential therapeutic intervention which focuses on written emotional disclosure, could be used to offer a less threatening remedy for athletes to release these inner thoughts and feelings about the aforementioned struggles.
Aims: The present study aimed to examine the feasibility, acceptability and preliminary efficacy of expressive writing intervention for elite athletes to improve body image dissatisfaction and to reduce disordered eating behaviors, to enhance self-esteem and to alleviate sport competition anxiety. The first objective of this study was to evaluate the feasibility and acceptability of implementing expressive writing intervention among elite athletes. The second objective was to explore the preliminary efficacy of expressive writing intervention among elite athletes to improve body image dissatisfaction and to reduce disordered eating behaviors, to enhance self-esteem and to alleviate sport competition anxiety after 2 weeks of intervention and at 1-month follow-up.
Methods: This study is an intervention study with a two group, repeated measures design.
Eighty eight elite athletes were recruited through convenience sampling and snowball sampling. Participants were randomly assigned to two groups. The experimental group contained 48 participants receiving the expressive writing intervention and the control group had 40 participants with no intervention. The experimental group was required to write about "their deepest thoughts and feelings about their body image and eating concerns" in person at baseline. They were further encouraged to complete the same expressive writing task at least two times online within the following two weeks.
Outcome measures: The Body Shape Questionnaire (BSQ) was to evaluate body dissatisfaction. SCOFF questionnaire and the Eating Concern subscale of the Eating Disorder Examination Questionnaire (EDE-Q) were used to examine disordered eating behaviors. Participants' self-esteem was assessed by the Rosenberg Self-Esteem Scale (RSE) and athletes' sport competition anxiety was evaluated by the Sport Competition Anxiety Test (SCAT). These questionnaires were administered at baseline, after 2-week intervention period and at 1-month follow-up to both experimental group and control group participants. Data on experimental group’s acceptability, perceptions and feedback of the expressive writing task were solicited through the Manipulation Check Scale (MCS) at the end of each writing intervention session. Demographic information was collected and data on refusal rate, dropout rate and completion rate were also calculated. Statistical analyses on complete case and intention-to-treat were conducted through multivariate analysis of variance (MANOVA), univariate tests (ANOVAs) and generalized estimating equations (GEE).
Results: There were 45 males and 43 females initially joining the study, age ranged from 15 to 38 years old (M =22.25, SD =5.67) with a majority of them came from Hong Kong (93.2%). Most athletes were training full-time (83%) and their years of involvement in respective sports were averaged to be 11.98 years. Feasibility of the study revealed a refusal rate of 16.19%. Out of the 88 athletes who agreed to participate, 38 eventually dropped out contributing to a 43.18% dropout rate. The experimental group reported an average points ranged from 2.87 to 4.98 out of 7 among the five separate items of the MCS. The expressive writing intervention was generally acceptable as athletes reported revealing a high degree of their true thoughts and emotions through the writing task. Complete case analysis revealed no statistically significant intervention effects between time and groups. The only significant result was that athletes from the experimental group who practiced expressive writing 3 times had a reduction in eating concern at 2-week posttest. Due to a high dropout rate of 43.18%, three single imputation methods were used so as to conduct intention-to-treat (ITT) analysis, namely, last observation carried forward (LOCF) method, multiple linear regression method, and expectation-maximization (EM) method. No intervention effects of expressive writing were observed with the LOCF imputed dataset. Analysis with the Regression imputed dataset showed that there was a significant decrease in body dissatisfaction from baseline to 2-week posttest for both groups. The EM imputed dataset showed that the experimental group athletes reported a significant decrease in sport competition anxiety from baseline to 2-week posttest and this improvement was higher than that of the control group. Other baseline exploratory analyses were conducted to enhance a better understanding on the issue of body image and its related variables among elite athletes.
Conclusion: The seemingly ineffective results for the use of expressive writing intervention in this study could possibly due to the sudden emergence of the COVID-19 global pandemic. Yet, feedbacks from the completers were generally favorable and the findings did yield some interesting and insightful outcomes under this unique circumstance. For the implementation of similar intervention program in the future, it was suggested that at least three writing sessions were needed in order to generate meaningful results. This study helped to offer a more comprehensive understanding of the body dissatisfaction within the sport environment in relation to other influencing factors of disordered eating behaviors, self-esteem and sport competition anxiety.
Rights: All rights reserved
Access: restricted access

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