Background and study aims Many teenagers feel unhappy with their bodies, which can lead to problems like eating disorders, low self-esteem, and depression. Social media plays an important role in shaping how young people see themselves, often promoting unrealistic beauty standards. This study aims to test the effectiveness of a school-based programme called IMPACTREEL, which teaches adolescents how to critically understand social media and improve their relationship with their body using strategies from third-wave psychological therapies. The goal is to help teenagers feel better about their bodies and reduce the risks of developing mental health problems. Who can participate? The study is open to first year high-school adolescents who attend selected secondary schools in the province of Alicante (Spain). Participation is voluntary, and both the students and their parents/legal guardians must give consent to take part. Young people showing severe symptoms of eating disorders will not be included, as they may need clinical treatment. What does the study involve? Participants will be randomly assigned by classroom to one of two groups: The intervention group will receive the IMPACTREEL programme, which consists of seven weekly sessions, each lasting 55 minutes, delivered at school by trained facilitators. The control group will not receive the programme during the study but will be offered it later. Both groups will be asked to complete a series of questionnaires about body image, social media use, emotional well-being, and quality of life before the programme, after it ends, and again 6 months and 12 months later. These questionnaires are confidential and anonymous. What are the possible benefits and risks of participating? Participants in the intervention group may learn new skills to help them manage how they feel about their body and how they use social media. These strategies may also help reduce stress and improve emotional well-being. There are no known risks of taking part in this study. Completing the questionnaires or discussing body image may make some students feel uncomfortable, but they are free to stop participating at any time. No clinical diagnosis or treatment is involved in this study. Where is the study run from? The study is being run by psychologists and researchers from the Universidad Miguel Hernández de Elche (Spain), in collaboration with local secondary schools in the province of Alicante. When is the study starting and how long is it expected to run for? The study started in 2024 and is expected to continue until 2028, including follow-up assessments and data analysis. Who is funding the study? The study is funded by a FPU (Formación del Profesorado Universitario) grant from the Spanish Ministry of Universities, which supports doctoral training and research. Who is the main contact? Main contact: Sheila Fernández García Email: sheila.fernandezg@umh.es Affiliation: Universidad Miguel Hernández de Elche
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
DOUBLE
Enrollment
184
The IMPACTREEL programme is a school-based intervention designed to promote positive body image in adolescents. It combines social media literacy education with third-wave strategies, including mindfulness, self-compassion, and psychological flexibility. The intervention consists of 7 weekly group sessions lasting 55 minutes each, delivered by trained psychologists facilitators during school hours. The content targets appearance ideal internalisation, critical thinking about social media, and healthier body image attitudes.
Universidad Miguel Hernández de Elche
Elche, Alicante, Spain
Change in body esteem
Body esteem will be assessed using one validated questionnaire: the Body Esteem Scale for Adolescents and Adults (BESAA). This tool assesses self-perception and satisfaction with one's own body appearance, weight, and attribution by others. Body self-esteem measures a person's satisfaction or dissatisfaction with his or her own body. The positive appearance and negative appearance subscales assess overall satisfaction or dissatisfaction with physical appearance, including various visual aspects without focusing on a specific ideal. An example item is: "I like the way I look in pictures". The third subscale, weight, focuses on the person's satisfaction with his or her own weight, as in the item: "I am satisfied with my weight". The higher the score, the higher the body esteem. The range of scores is from 18 to 90.
Time frame: Baseline, post-intervention (week 9), 6-month follow-up, and 12-month follow-up
Change in self-compassion
Self-compassion will be measured using the Self-Compassion Scale - Youth Version (SCS-Y), which assesses adolescents' ability to treat themselves with kindness and understanding during difficult experiences, particularly those related to body image. This instrument measures the degree to which young people respond to their own mistakes and difficulties with kindness, understanding and a balanced perspective. It assesses the ability to treat oneself with understanding in the face of mistakes, measures the ability to recognize imperfections are part of the human experience and the tendency to become angry with oneself when one's own expectations are not met. The higher the score, the higher the self-compassion. The range of scores is from 17 to 85.
Time frame: Baseline, post-intervention (week 9), 6-month follow-up, and 12-month follow-up
Change in perceived pressure and comparison on social media
This outcome will be assessed using the Sociocultural Attitudes Towards Appearance Questionnaire -3, Media, Spanish (SATAQ-3-M-S), which evaluates perceived pressure to conform to beauty ideals and the tendency to compare one's appearance with that of celebrities and influencers seen on social media. This variable measures the influence of social media on body satisfaction. It measures exposure to content about beauty and body ideals on social media; assesses perceived social pressure to conform to certain appearance standards; and internalization of general beauty ideals related to the body on social media (e.g., being athletic or thin). A higher score indicates greater perceived pressure on body image from social media. The score range is from 17 to 85.
Time frame: Baseline, post-intervention, 6-month follow-up, 12-month follow-up
Change in internalisation of appearance ideals (SATAQ-4)
Internalisation of cultural beauty standards will also be measured using the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4), which assesses pressure and awareness of appearance norms from media and peers. This instrument measures the degree of acceptance of cultural standards of beauty and physical appearance. It assesses the perceived pressure from family, friends, and the media to conform to ideals of thinness, and measures the degree to which the person accepts and pursues the ideal of thinness and the importance of having an athletic and muscular body. A higher score indicates greater internalization of the slim and muscular ideal. The score range is from 22 to 110.
Time frame: Baseline, post-intervention (week 9), 6-month follow-up, and 12-month follow-up
Change in social media literacy
Social media literacy will be assessed using a 9 item from three validated measures. Items 1-7 were adapted from Tamplin et al. (2018), based on the Critical Thinking about Media Messages Questionnaire (Scull et al., 2010), reworded to reference social media. Item 8 ("I think that physical appearance can only be achieved with filters or editing") was taken from the Fake subscale of the Critical Processing of Beauty Images Scale (Petrie et al., 2019). Item 9 ("People (in real life) look like social media models/influencers") was adapted from the Realism subscale of the Media Attitudes Questionnaire Participants rated the frequency of each behaviour on a 6-point Likert scale (1 = never to 6 = always). The higher the score, the greater the social media literacy. The score ranged from 9 to 54.
Time frame: Baseline, post-intervention, 6-month follow-up, 12-month follow-up
Change in social media engagement
Social media use will be measured using the Social Media Engagement Scale for Adolescents (SMES-A), which evaluates the frequency, habits, and engagement levels of adolescents with social media platforms. This instrument assesses the degree of emotional and behavioural involvement of adolescents with social media, as well as their dependence on it for personal satisfaction and social connection. The items reflect different aspects of social media use, from the habit of constantly checking it to the social reinforcement of using it and the preference for being on social media rather than interacting face to face. The higher the score, the greater the engagement with social media. The score ranged from 15 to 75.
Time frame: Baseline, post-intervention, 6-month follow-up, 12-month follow-up
Change in eating disorder
Eating disorder risk will be assessed using the Eating Attitudes Test-26 (EAT-26), a screening tool to detect attitudes and behaviours associated with eating disorders. The EAT-26 is a questionnaire used to identify eating behaviours and attitudes that may be associated with a risk of developing eating disorders, such as anorexia nervosa (AN) and bulimia nervosa (BN). The higher the score, the greater the symptoms of eating disorders. The cut-off point for considering a person at risk is 20 points or more.
Time frame: Baseline, post-intervention, 6-month follow-up, 12-month follow-up
Change in depressive symptoms
Depression will be measured using the depression subscale of the Revised Child Anxiety and Depression Scale (RCADS), which assesses symptoms of low mood and emotional distress in young people. The subscale measures depressive symptoms in children and adolescents using 10 items that explore various manifestations of sadness, lack of interest, sleep problems, low energy, and feelings of worthlessness. Each item has response options that reflect the frequency of symptoms. The higher the score, the greater the depressive symptoms. The score range varies from 0 to 30 points.
Time frame: Baseline, post-intervention, 6-month follow-up, 12-month follow-up
Change in life satisfaction
Life satisfaction will be measured using the Satisfaction With Life Scale (SWLS), a five-item measure assessing overall perceived well-being and satisfaction with life. A comprehensive measure of personal satisfaction, designed to assess individuals' subjective judgement of their well-being and fulfilment of personal goals. It consists of five items, in which students rate key aspects of their lives, such as achievements, circumstances and overall satisfaction. The higher the score, the greater the satisfaction with life. The score range varies from 5 to 25 points.
Time frame: Baseline, post-intervention, 6-month follow-up, 12-month follow-up
Change in body image perception
Body image perception will be assessed using the Childress Contour Drawing Rating Scale, a validated figure rating scale that evaluates perceived and ideal body size. Participants select images that represent how they see themselves and how they would like to look, allowing for the assessment of body dissatisfaction. To analyse this instrument, the difference in absolute value between the actual body number they consider themselves to have and the ideal body number they would prefer to have is taken into account. If there is no difference, the person is considered to be satisfied with their body. If there is a difference of one or more points between these two items, there will be body dissatisfaction. The greater the difference in score, the greater the body dissatisfaction.
Time frame: Baseline, post-intervention (week 9), 6-month follow-up, and 12-month follow-up.
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