Pretty hurts. A scoping review of interventions targeting digitally manipulated images

This scoping review synthesizes 59 empirical studies examining interventions addressing psychological and behavioral responses to exposure to idealized or digitally altered images across media contexts. Following PRISMA-ScR guidelines, the literature was mapped according to intervention types, mediating and moderating mechanisms, and outcome measures. Seven primary intervention categories were identified: disclaimers and warning labels, media literacy and psychoeducation, bodypositive and self-compassionate messages, Instagram vs reality paired images, retouch-free and authenticity labels, diversity and brand campaigns, and comments and user-generated content. Disclaimer-based strategies dominate the field and are most often associated with limited or mixed outcomes, including occasional increases in appearance-related concerns. In contrast, body-positive, self-compassionate messages, paired images showing unedited reality, and authenticity-focused interventions are more frequently linked to positive body-related and affective outcomes. Media literacy and psychoeducational approaches tend to show modest and short-term effects, while legally mandated disclosures primarily increase awareness of image manipulation without consistent evidence of broader attitudinal change. Diversity campaigns and user-generated comments show variable effects depending on content valence and tone. Across studies, perceived authenticity and realism commonly emerge as mediators, with appearance comparison and thin-ideal internalization as recurring moderators. Overall, the review highlights dominant research patterns and gaps, pointing to a growing emphasis on emotionally engaging and authenticity-oriented approaches over traditional warning-based strategies. • Systematic review of 59 studies on digital image intervention effectiveness. • Disclaimer labels were largely ineffective across body image outcomes. • Authenticity- and body-positive cues consistently improved body satisfaction. • Media literacy showed short-term benefits but limited long-term impact. • Emotionally engaging, culturally adapted interventions show greatest promise.