OBJECTIVE:To examine neonatal physicians' perceptions of optimistic versus pessimistic prognostic framing when delivering serious news to parents. DESIGN:Multicentre, double-blind, randomised crossover study. SETTING:Conducted online between February and April 2022 at the University Medical Centre Mainz, Germany. PARTICIPANTS:Neonatal physicians from tertiary perinatal centres in Germany, Austria, Switzerland and Italy. INTERVENTION:Participants viewed two scripted videos of a physician-parent conversation about a very preterm infant with severe intraventricular haemorrhage. Both conveyed identical numerical prognostic estimates but differed in framing: emphasising survival without disability (optimistic) or risk of death and impairment (pessimistic). MAIN OUTCOME MEASURES:Primary outcome was framing preference. Secondary outcomes included Likert scale ratings of parental preparedness, physician professionalism and compassion, prognostic severity and optimism regarding survival and non-impairment, as well as free-text comments on challenges in prognostic communication. RESULTS:Of 115 participants, 99 (86%) preferred the optimistic video (period-corrected preference odds (95% CI): 8.6 (7.4 to 9.7)). Optimistic framing was associated with higher ratings of parental preparedness and more favourable evaluations of the consulting physician, including professionalism and compassion, but had no effect on perceived prognostic severity, or optimism about survival or non-impairment. Communication was frequently described as an interpersonal challenge, involving the difficulty of maintaining trust, empathy and hope while communicating under prognostic uncertainty. CONCLUSIONS:Neonatal physicians strongly preferred optimistic framing. Framing effects were primarily affective rather than cognitive and highlight implicit and complex framing biases in neonatal communication. TRIAL REGISTRATION NUMBER:German Clinical Trials Register (DRKS), www.drks.de/DRKS00024466.

Emotions represent potential triggers for binge eating, and binge eating can serve as a dysfunctional emotion regulation strategy. Therefore, we investigated emotion-related treatments in patients with binge eating in a systematic review. Change in binge eating were the primary outcome; eating disorder pathology and emotion-related outcomes were secondary outcomes. A meta-analysis was computed regarding pre-changes and post-changes in binge eating frequency within groups, and potential influencing factors were investigated, namely, BMI, eating disorder diagnosis, treatment type, aspects of BE outcome, age, and sex. Thirty-eight articles were included and 31 within the meta-analysis. Data quality was rated as moderate. The sample size varied strongly with a high proportion of women. Only five studies examined adolescents. Binge eating disorder (n = 18) and dialectical behavioral treatment (n = 16) were most frequently examined. Results show significant reductions in binge eating after treatment. Additionally, the systematic review indicates the superiority of emotion-related treatments compared with waitlist control groups and comparability with active control groups in terms of improvements in binge eating, eating disorder pathology, and emotion regulation. The effects appear to be stable at follow-up analyses from 1 to 12 months. Potential influencing factors did not affect the efficacy of emotion-related treatments. Overall, though meta-analytic results have to be interpreted with caution, emotion-related treatments hold promise in treating binge eating, and emotion regulation might represent a potential mechanism of change.

Interest in mindfulness-based programs for students in school settings is growing. Few such programs exist for secondary schools in Germany and none is specifically tailored for integration into the full-year 5th grade school curriculum. Moreover, qualitative surveys of student acceptance are lacking. Therefore, this study assessed the efficacy and acceptance of a school-based mindfulness training (“8SAM”) tailored for preadolescents in the 5th grade. In this feasibility study, the mindfulness training was implemented by trained classroom teachers in a German gymnasium (a type of secondary school) as part of the regular school curriculum for an entire school year. In total, 95 preadolescents aged 10–12 years participated. Following a mixed-methods approach, both quantitative and qualitative instruments were employed. Self-report measures based on the German version of the Child and Adolescent Mindfulness Measure (CAMM) were longitudinally assessed at baseline (t0), mid-intervention (t1), and post-intervention (t2). Acceptance of the training was surveyed using quantitative and qualitative self-reports. A one-way repeated measures ANOVA revealed a significant main effect of time (F(1.66, 151.41) = 14.23, p < 0.001, η_p^2 = 0.14), with mindfulness increasing at t1 and t2. Acceptance was more ambiguous: 52.43

OBJECTIVES:To investigate the psychosocial impact of the COVID-19 pandemic on children with chronic health conditions (CHC) and their legal guardians (LG) living in Germany. DESIGN:Qualitative interview study based on the transcripts of semistructured individual telephone interviews. METHODS:Data were collected from October to December 2021 and the time frame of reference was January-June 2021 with two interviewers. Discussed aspects were, for example, socioeconomic information, daily life, thoughts and feelings of both children and LG, as well as family communication, unmet needs and possible advantages. Data were analysed using qualitative content analysis. The category system and subsequent coding schemes with anchor examples were based on interviews and the interview guide. It was tested for integrity and feasibility with one interview and finalised. To ensure classification reliability within all 11 interviews, 1 specifically trained rater (who did not participate in the interviewing to separate data collection and analysis) coded all transcripts. PARTICIPANTS:11 LG of children with CHC participating in the ikidS (ich komme in die Schule) study. RESULTS:The three aspects that were mentioned most often in the interviews were a psychological impact on children, a psychological impact on LG and an impact on the daily routines of LG. The majority of children and LG were burdened, had changed their activities and spent more time together, while having more conflicts. Children did not worry about becoming infected with COVID-19, but were worried about the health of their relatives. It was further reported that children had become more autonomous. LG additionally reported unmet needs such as opportunities for childcare or psychotherapy. CONCLUSIONS:While the changes brought about by the COVID-19 pandemic and their impact were often seen as negative, the LG in our study also perceived some opportunities for personal development both in their children and themselves, underlining that future research on the impact of the COVID-19 pandemic should focus not only on negative consequences but also on opportunities and positive change. Qualitative methods can be used on an exploratory basis to inform quantitative studies, as they are able to delve deeper into the area being examined and provide greater insight into which aspects interviewees focus on.

AimChildren with special health care needs (SHCN) perform more poorly at school compared to their classmates. Specific causal pathways have not yet been extensively studied. Therefore, we investigated teacher-rated global attention, an important prerequisite for educational attainment, in children with SHCN.MethodsData of a population-based prospective cohort study, which recruited preschool children from the Mainz-Bingen area, Germany, were analysed. Children with SHCN were identified by the Children with Special Health Care Needs screening tool. In 2016, global attention was reported by teachers at the end of first grade (mean age: 7.3 years) on a 5-point rating scale ranging from -2 through +2. Associations between SHCN consequences and teacher-rated attention were estimated by linear mixed models, adjusted for confounding variables.ResultsWe included 1921 children (51% males); of these, 14% had SHCN. Compared to their classmates, children with SHCN had poorer teacher-rated attention scores (adjusted mean difference: -0.35, 95% CI: -0.52 to -0.17). The effect was strongest among children with treatment or counselling for mental health problems or functional limitations. The effect remained after excluding children with attention deficit hyperactivity disorder from the analysis.ConclusionChildren with SHCN showed more teacher-rated attention problems, which could explain their lower educational attainment.

Importance:In the neonatal intensive care unit, there is a lack of understanding about how best to communicate the prognosis of a serious complication to parents. Objective:To examine parental preferences and the effects of optimistic vs pessimistic message framing when providing prognostic information about a serious complication. Design, Setting, and Participants:This crossover randomized clinical trial was conducted at a single German university medical center between June and October 2021. Eligible participants were parents of surviving preterm infants with a birth weight under 1500 g. Data were analyzed between October 2021 and August 2022. Interventions:Alternating exposure to 2 scripted video vignettes showing a standardized conversation between a neonatologist and parents, portrayed by professional actors, about the prognosis of a hypothetical very preterm infant with severe intraventricular hemorrhage. The video vignettes differed in the framing of identical numerical outcome estimates as either probability of survival and probability of nonimpairment (optimistic framing) or a risk of death and impaired survival (pessimistic framing). Main Outcomes and Measures:The primary outcome was preference odds (ratio of preference for optimistic vs pessimistic framing). Secondary outcomes included state anxiety, perceptions of communication, and recall of numerical estimates. Results:Of 220 enrolled parents (142 [64.5%] mothers; mean [SD] age: mothers, 39.1 [5.6] years; fathers, 42.7 [6.9] years), 196 (89.1%) preferred optimistic and 24 (10.1%) preferred pessimistic framing (preference odds, 11.0; 95% CI, 6.28-19.10; P < .001). Preference for optimistic framing was more pronounced when presented second than when presented first (preference odds, 5.41; 95% CI, 1.77-16.48; P = .003). State anxiety scores were similar in both groups at baseline (mean difference, -0.34; -1.18 to 0.49; P = .42) and increased equally after the first video (mean difference, -0.55; 95% CI, -1.79 to 0.69; P = .39). After the second video, state anxiety scores decreased when optimistic framing followed pessimistic framing but remained unchanged when pessimistic framing followed optimistic framing (mean difference, 2.15; 95% CI, 0.91 to 3.39; P < .001). With optimistic framing, participants recalled numerical estimates more accurately for survival (odds ratio, 4.00; 95% CI, 1.64-9.79; P = .002) but not for impairment (odds ratio, 1.50; 95% CI, 0.85-2.63; P = .16). Conclusions and Relevance:When given prognostic information about a serious complication, parents of very preterm infants may prefer optimistic framing. Optimistic framing may lead to more realistic expectations for survival, but not for impairment. Trial Registration:German Clinical Trials Register (DRKS): DRKS00024466.

Einleitung Spezialisierte Wohngruppen für Menschen mit Essstörungen sind ein Behandlungsangebot für chronisch kranke Patient:innen und können die Lücke zwischen stationärer und ambulanter Behandlung schließen. Bisherige Studien konzentrierten sich auf die US-amerikanische Struktur und sind nur begrenzt auf europäische Essstörungswohngruppen übertragbar.

Einleitung Risikofaktoren der Binge Eating-Störung (BES) und relevanten Übergewichts/Adipositas überschneiden sich. Viele Betroffene mit einer BES begeben sich zuerst in Behandlungen, die vornehmlich das Ziel einer Gewichtsrehabilitation anstreben. Diese Personengruppe, insbesondere Adoleszente, wurde in Deutschland bisher kaum untersucht.

IntroductionBinge eating (BE) behaviour is highly prevalent in adolescents, and can result in serious metabolic derangements and overweight in the long term. Weakened functioning of the behavioural inhibition system is one potential pathway leading to BE. Food cue exposure focusing on expectancy violation (CEEV) is a short intervention for BE that has proven effective in adults but has never been tested in adolescents. Thus, the current randomised pilot trial evaluates the feasibility of CEEVfor adolescents and its efficacy in reducing eating in the absence of hunger (EAH) of binge food items.Methods and analysisThe trial will includeN=76 female adolescents aged between 13 and 20 years with a diagnosis of bulimia nervosa, binge eating disorder (BED) or their subthreshold forms based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Participants will be randomly assigned to two sessions of CEEVor behavioural analysis (BA), a classical cognitive–behavioural therapy-based intervention. The primary endpoint is the change in EAH measured according to ad libitum consumption of personally preferred binge food in a bogus taste test at post-test based on the intention-to-treat population. Key secondary endpoints are changes in EAH of standardised binge food at post-test, in EAH at 3-month follow-up (FU) and in food craving after induction of food cue reactivity at post-test and FU. To identify further valid outcome parameters, we will assess effects of CEEVcompared with BA on global ED psychopathology, BE frequency within the last 28 days, body weight, response inhibition and emotion regulation abilities. Treatment groups will be compared using analysis of covariance with intervention as fixed factor and body mass index at baseline as covariate.Ethics and disseminationThis clinical trial has been approved by the Ethics Review Committee of the Medical Association of Rhineland-Palatinate and the Medical Faculty of the Ruhr-University Bochum. The collected data will be disseminated locally and internationally through publications in relevant peer-reviewed journals and will be presented at scientific and clinical conferences. Participants data will only be published in an anonymised form.Trial registration numberDRKS00024009.

Einleitung Essanfallsbezogene Störungen beginnen in der Adoleszenz, allerdings begeben sich nur wenige junge Betroffene in Behandlung. Eine frühzeitige Behandlung könnte eine Chronifizierung der Essstörung und die Entwicklung von Übergewicht vermeiden. Bisherige kognitiv-behaviorale Therapieansätze erzielen vergleichbare Abstinenzraten wie bei Erwachsenen, wobei die Hälfte der PatientInnen zu Behandlungsende noch Essanfälle oder weitere impulsive Essverhaltensmuster aufweist. Eine modifizierte nahrungsbezogene Cue-Exposure hat sich bei adulten Patientinnen sowie bei Adoleszenten mit Adipositas als effektiv erwiesen. Im Rahmen einer multizentrischen Pilotstudie soll daher die Feasability und Wirksamkeit von Cue-Exposure mit Fokus auf Erwartungsverletzung (CEEV) bei Adoleszenten mit essanfallsbezogenen Störungen untersucht werden.

Einleitung Negative Emotionen stellen potentielle Auslöser für Essanfälle dar. Zudem können Essanfälle als dysfunktionale Emotionsregulationsstrategie dienen. Daher scheinen emotionsbezogene Interventionen bei der Behandlung von Essanfällen sinnvoll. Unsere Arbeitsgruppe untersucht diesbezüglich den aktuellen Forschungsstand im Rahmen eines systematischen Überblicks.

Aufgrund der hohen Prävalenz psychischer Belastungen bei geflüchteten Menschen besteht ein wachsender Bedarf an kultursensitiven Ansätzen zur Prävention sowie zur Diagnostik und Therapie psychischer Erkrankungen. Im Rahmen einer aktuellen Fördermaßnahme des Bundesministerium für Bildung und Forschung (BMBF) zur psychischen Gesundheit von Geflüchteten werden insgesamt 7 Forschungsverbünde mit 31 Teilprojekten gefördert. Sie bündeln Kompetenzen in der kulturspezifischen klinischen Forschung und Versorgungsforschung zu psychischen Erkrankungen. Sie adressieren unterschiedliche Zielgruppen von Geflüchteten, wodurch ein breites Spektrum von spezifischen Versorgungsbedarfen abgedeckt wird. Mit dem Förderschwerpunkt legt das BMBF wichtige Grundlagen für die Verbesserung der gesundheitlichen Versorgung geflüchteter Menschen in Deutschland. Nicht zuletzt entsteht durch die Erprobung und Evaluation niedrigschwelliger, kultursensitiver Ansätze ein bundesweites Netzwerk konkreter Maßnahmen, die einen direkten Beitrag zur Verbesserung der Gesundheitsversorgung geflüchteter Menschen in Deutschland leisten.

Background One of the numerous challenges preterm birth poses for parents and physicians is prognostic disclosure. Prognoses are based on scientific evidence and medical experience. They are subject to individual assessment and will generally remain uncertain with regard to the individual. This can result in differences in prognostic framing and thus affect the recipients’ perception. In neonatology, data on the effects of prognostic framing are scarce. In particular, it is unclear whether parents prefer a more optimistic or a more pessimistic prognostic framing. Objective To explore parents’ preferences concerning prognostic framing and its effects on parent-reported outcomes and experiences. To identify predictors (demographic, psychological) of parents’ communication preferences. Design, setting, participants Unblinded, randomized controlled crossover trial (RCT) at the Division of Neonatology of the University Medical Center Mainz, Germany, including German-speaking parents or guardians of infants born preterm between 2010 and 2019 with a birth weight < 1500 g. Inclusion of up to 204 families is planned, with possible revision according to a blinded sample size reassessment. Intervention Embedded in an online survey and in pre-specified order, participants will watch two video vignettes depicting a more optimistic vs. a more pessimistic framing in prognostic disclosure to parents of a preterm infant. Apart from prognostic framing, all other aspects of physician-parent communication are standardized in both videos. Main outcomes and measures At baseline and after each video, participants complete a two-part online questionnaire (baseline and post-intervention). Primary outcome is the preference for either a more optimistic or a more pessimistic prognostic framing. Secondary outcomes include changes in state-anxiety (STAI-SKD), satisfaction with prognostic framing, evaluation of prognosis, future optimism and hope, preparedness for shared decision-making (each assessed using customized questions), and general impression (customized question), professionalism (adapted from GMC Patient Questionnaire) and compassion (Physician Compassion Questionnaire) of the consulting physician. Discussion This RCT will explore parents’ preferences concerning prognostic framing and its effects on physician-parent communication. Results may contribute to a better understanding of parental needs in prognostic disclosure and will be instrumental for a broad audience of clinicians, scientists, and ethicists. Trial registration German Clinical Trials Register DRKS00024466. Registered on April 16, 2021.

OBJECTIVE:Given the severity of eating disorders, effective and easily implementable prevention programs which reduce incidence rates and in addition have health-economic benefits are essential. The majority of research on prevention programs focuses on questionnaire-based efficacy or the reduction of eating disorder symptoms while neglecting the health-economic perspective. By contrast, the present study focuses on both an efficacy analysis considering diagnostic criteria (DSM-5) and on evaluating the cost-benefit of a universal prevention program for eating disorders ("MaiStep").METHOD:A three-arm randomized controlled trial with baseline, posttreatment and 12-month follow-up was conducted with 1,654 adolescents (M = 13.35, SD = 0.76), comprising two intervention groups (MaiStep delivered by psychologists or teachers, IG-T) and an active control group (ACG). The primary outcome was DSM-5 eating disorder diagnosis measured with the SIAB-S. Furthermore, the costs of the prevention program and the savings in health care costs were calculated.RESULTS:A significant difference in eating disorder diagnosis was found between the IG-T and the ACG for posttreatment (χ2 (1= 7.352, p = .007), Relative Risk (RR) = .53 and 12-month follow-up (χ2 (1= 5.203, p = .023), RR = .61. MaiStep proved to be cost-effective (tcbr  = 6.75), saving about 560,000 € (standardized per 1,000 students = 601,388.19 €).DISCUSSION:Universal prevention can both reduce incidence rates of eating disorders and be cost-beneficial for health care systems. Future research should analyze prevention programs regarding efficacy and cost-benefit to enable comparability and derive guidelines for political decision-makers.TRIAL REGISTRATION NUMBER:MaiStep is registered at the German Clinical Trials Register (DRKS00005050).

OBJECTIVE:Adolescents with anorexia (AN) and bulimia nervosa (BN) often struggle with emotion regulation (ER). These difficulties have predominantly been assessed across emotions, without considering adaptive and maladaptive ER separately. We compared adolescents with AN or BN to healthy adolescents (HCs) regarding the adaptive and maladaptive ER of three emotions. METHOD:A treatment-seeking sample of 197 adolescents (atypical/full-threshold AN: N = 118, atypical/full-threshold BN: N = 32; HC: N = 47) reported emotion-specific ER with the FEEL-KJ questionnaire. Mixed models were calculated for adaptive and maladaptive ER to assess differences between emotions (anxiety, anger, and sadness) and groups (AN, BN, and HC). RESULTS:Main effects of emotion (p < .001) and group (p < .001) were found, but no interaction effects were found (p > .05). Post hoc tests showed lower maladaptive and higher adaptive ER for anxiety than anger or sadness (p < .001). AN and BN reported lower adaptive (p < .001) and higher maladaptive ER than HCs (p < .001). BN showed the highest levels of maladaptive ER (p = .009). DISCUSSION:The differences between AN and BN in adaptive and maladaptive ER should be considered. Furthermore, investigating differences in ER of other emotions in eating disorders might be promising.

IntroductionNo evaluated therapeutic approaches, that can efficiently be established in routine mental healthcare, are currently available for traumatised adolescent refugees in Germany. This study evaluates the efficacy of the Stress-Traumasymptoms-Arousal-Regulation-Treatment (START) programme to reduce trauma-related symptoms and psychological distress in traumatised adolescent refugees based in Germany.Methods and analysisThis randomised, waiting-list-controlled, multicentre trial with a 12-week follow-up will include 174 refugee minors with partial or full post-traumatic stress disorder who are fluent in either Arabic, Dari, English, German or Somali. Eligible refugee minors will be randomised to the START or waiting-list control groups. The manualised 8-week START programme is based on techniques of dialectical behaviour therapy (DBT), fosters adaptive coping with emotional distress and traumatic symptoms and comprises eight therapy modules and a booster session. Study assessments are planned at baseline, post-treatment (ie, after programme participation or waiting time), booster session at week 12 or 12-week waiting time, and at the 12-week follow-up. Primary and coprimary outcomes are changes in psychological distress and traumatic symptoms at post-treatment and will be analysed as response variables in linear mixed regression models. Secondary outcomes are changes in further trauma-related and other psychopathological symptoms, emotion regulation and intermediate effects of the programme at follow-up. We will also assess effects of the programme with ecological momentary assessments and on neuroendocrine stress parameters using hair cortisol.Ethics and disseminationThis study has been approved by the lead ethics committee of Rhineland-Palatinate and the ethics committees of participating sites. The study results will be disseminated through peer-reviewed publications and scientific conferences.Trial registration numberDRKS00020771.

Background Incidents of nonsuicidal self-injury (NSSI) are often accompanied by mental images which could be perceived as distressing and/or soothing; yet existing data is derived from participants with a history of NSSI using retrospective methods. This study investigated mental images related to NSSI (“NSSI-images”), and their relationship to the proposed Nonsuicidal Self-Injury Disorder (NSSID). Methods An e-mail was sent to all female students of the local University providing the link to an online screening and 201 students with a history of repetitive NSSI responded. Nineteen eligible participants meeting criteria of NSSID (mean age = 25; 32% with migrant background) further completed a baseline interview and a ten-day-diary protocol. Results Among the sample of N = 201, 83.6% reported NSSI-images. In the subsample of n = 19 diagnosed with NSSID, the frequencies of NSSI and NSSI-images were correlated; about 80% of the most significant NSSI-images were either of NSSI or of an instrument associated with NSSI (i.e., a razorblade). In the diary, 53% of the sample self-injured. NSSI-images were reported on 94% of NSSI-days, and on days with NSSI and NSSI-images, the images almost always occurred first; the images were overall perceived as twice more distressing than comforting. Images on NSSI-days were characterized by more comfort, intrusiveness and compellingness yet less vividness, and increased subsequent positive and negative affect compared to non-NSSI days. NSSI-days were further marked by increased entrapment beliefs and increased negative yet decreased positive affect at night. These results were non-significant. Limitations Due to non-significant results among a small sample size and a low rate of NSSI among the NSSID-group, results remain preliminary. Conclusions The study provides information on feasibility and methodological challenges such as intervention effects of the diary. NSSI-images may be common among individuals who engage in NSSI; they may capture ambivalent (positive and negative) appraisals of NSSI and thus play a role in NSSI and possibly a disorder such as NSSID. The preoccupation with NSSI (Criterion C of NSSID in DSM-5) may as well be imagery-based. Registration The study was retrospectively registered with the DRKS under the number DRKS00011854.

Introduction Teachers and student teachers in Germany are a high-risk population for stress and stress-related mental health problems. This often leads to early retirement in subsequent professional life. Various trials have demonstrated positive effects of stress prevention training on the perceived stress and stress-related symptoms of teachers. Although many studies show positive effects of mindfulness-based stress interventions, there is not yet any mindfulness-based intervention for teachers or student teachers in Germany. The aim of this trial is to evaluate a training that combines mindfulness-based and cognitive interventions into one programme, addressing to the specific burdens of student teachers. Methods and analysis This study protocol presents a prospective block-randomised controlled trial. Assessment will take place at three time points (baseline, post-intervention, 3-month follow-up) for an intervention and waiting control group, and at a fourth assessment point for the waiting control group after receiving the training. The aim is to evaluate the effects of mindfulness-based stress prevention on stress, psychological morbidity, burnout and self-efficacy using validated measures. Participants are student teachers from German teacher training colleges and participation will be voluntary. The targeted total sample size is 96 at 3-month follow-up. The training will comprise three 4-hour sessions conducted every 2 weeks. The control group will participate in the training after the 3-month follow-up. The allotment will be randomised with a stratified allocation ratio by gender. After descriptive statistics have been evaluated, inferential statistical analysis will be conducted using repeated measures analysis of variance with interactions between time and group. Effect sizes will be calculated using partial eta(2) values. Ethics and dissemination Results will be disseminated at conferences, in specialist magazines and through peer-reviewed publications. The trial has been approved by the ethics review board of the local medical association, Mainz, Germany, under the reference number 837.192.16 (10511).

Eating disorders are difficult to treat and often associated with morbidity and mortality. Universal prevention approaches are increasingly focusing on enhancing skills, but few eating disorder programs are available for under-15-year-olds. This study aimed to develop and examine a school-based universal prevention program ('MaiStep') for adolescent boys and girls. A three-arm randomized controlled trial with baseline, post-intervention and 12-month follow-up was conducted with 1654 adolescents (M = 13.35, SD 0.76). 'MaiStep' was delivered by psychologists in the first intervention group (IG1) and teachers in the second intervention group (IG2), and compared to an active control group (ACG). Primary outcomes were eating disorder-related risk factors measured with scales of the Eating Disorder Inventory-2 (e.g. 'drive for thinness', 'interoceptive awareness'), cognitions and affect related to the body (Body Shape Questionnaire, BSQ-8), and behaviors (Body Image Avoidance Questionnaire, BIAQ). The total sample (N1) was divided into a healthy subsample (N2) and a sample fulfilling DSM-5 criteria for a subthreshold eating disorder (N3) measured with the self-report Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-S). Significant improvements in 'interoceptive awareness' (EDI-2) and lower BIAQ scores emerged in N1 at post-intervention and at 12-month follow-up (F(4; 3038) = 3.068, p = .016, eta(2)(part) = 0.004 and F(4; 2900) = 2.993, p = .018, eta(2)(part) = 0.004) and in N2 at post-intervention and at 12-month follow-up (F(4; 2812) = 3.147, p = .014, eta(2)(part) = 0.004 and F(4; 2684) = 3.674, p = .005, eta(2)(part) = 0.005). The healthy subsample N2 additionally showed significantly lower scores on 'drive for thinness' (EDI-2) and on the BSQ-8c at post-intervention (F(2; 1446) = 3.091, p = .046, eta(2)(part) = 0.004 and F(2; 1453) = 3.505, p = .030, eta(2)(part) = 0.005) but not at 12-month follow-up. No significant results emerged for N3. The positive findings of improved 'interoceptive awareness' (EDI-2) and reduced body image avoidance (BIAQ) indicate that broad disseminated universal prevention under the age of 15 is possible.