1
|
Caponnetto P, Caramazza M, Caci G, Signorelli MS, Petralia A, Quattropani MC. Body dysmorphic disorder and psychotherapeutic interventions: a systematic literature review. Health Psychol Res 2024; 12:117649. [PMID: 38883698 PMCID: PMC11176052 DOI: 10.52965/001c.117649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 05/09/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Body dysmorphism disorder (BDD) is a disabling mental disorder characterized by an anxious preoccupation with a perceived defect in physical appearance. Objective This systematic review arose with the main objective of identifying the most effective psychotherapeutic intervention in the treatment of BDD. Methods From February to October 2022, we conducted a systematic review aimed at identifying the psychotherapeutic intervention for BDD, the search for these concepts was on PubMed. There were no language limitations, only time limitations, we delved into studies published in the databases between 2015 and 2022. Results We identified a total of 393 unique records. Of these, 43 full-text articles were evaluated for eligibility, and seven of these met the inclusion criteria and were included in the final systematic review. Conclusions Cognitive-behavioral therapy has been shown to be effective compared with other therapies, especially when combined with drug therapy. The results confirm that BDD-NET (INTERNET-based CBT) led to significant improvement of symptoms in patients with body dysmorphism. In conclusion, we can say that cognitive-behavioral therapy, whether in direct or online form, appears to be the most effective treatment for this disorder.
Collapse
Affiliation(s)
- Pasquale Caponnetto
- Department of Educational Sciences, Section of Psychology, University of Catania, 95123 Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, 95121 Catania, Italy
| | - Manila Caramazza
- Department of Educational Sciences, Section of Psychology, University of Catania, 95123 Catania, Italy
| | - Grazia Caci
- Department of General Surgery and Medical-Surgical Specialities, University of Catania, Catania, Italy.Infectious Disease Department at University Hospital AOU Policlinico "G. Rodolico- San Marco" of Catania, Italy
| | - Maria S Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Antonino Petralia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Maria C Quattropani
- Department of Educational Sciences, Section of Psychology, University of Catania, 95123 Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, 95121 Catania, Italy
| |
Collapse
|
2
|
Linde J, Luoma JB, Rück C, Ramnerö J, Lundgren T. Acceptance and Compassion-Based Therapy Targeting Shame in Body Dysmorphic Disorder: A Multiple Baseline Study. Behav Modif 2022; 47:693-718. [PMID: 36373413 PMCID: PMC10150257 DOI: 10.1177/01454455221129989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Shame is considered central in body dysmorphic disorder (BDD) and empirical accounts highlight the link between shame and BDD symptoms as well as common negative psychosocial effects of the disorder, yet there is a lack of interventions addressing shame in this context. In the past decade, Acceptance and commitment therapy (ACT) and interventions that foster self-compassion have shown promise for reducing the negative effects of shame in a range of clinical problems. The aim of the present study was to develop and evaluate an acceptance and compassion-based treatment specifically targeting shame in BDD. Using a randomized nonconcurrent multiple baseline design, the 12-session intervention, ACT with Compassion (ACTwC), was examined in a psychiatric outpatient sample of five adults diagnosed with BDD. The daily ratings showed marked reductions in BDD-behaviors and self-criticism at posttreatment for four of five participants, while three participants demonstrated decreases in body shame compared to baseline. Improvements were maintained at 6-months follow-up. The intervention also led to reliable long-term improvements in general shame, overall BDD-symptoms, depressive symptoms, and quality of life for four of five participants. All treatment responders showed significant gains in psychological flexibility and self-compassion. Participants reported high credibility and satisfaction with the treatment. These preliminary results suggest that ACTwC may be a promising approach to treating shame in BDD, worthy of further investigation.
Collapse
Affiliation(s)
- Johanna Linde
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jason B. Luoma
- Portland Psychotherapy Clinic, Research, & Training Center, OR, USA
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Ramnerö
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
3
|
Greenberg JL, Jacobson NC, Hoeppner SS, Bernstein EE, Snorrason I, Schwartzberg A, Steketee G, Phillips KA, Wilhelm S. Early response to cognitive behavioral therapy for body dysmorphic disorder as a predictor of outcomes. J Psychiatr Res 2022; 152:7-13. [PMID: 35700586 PMCID: PMC9447469 DOI: 10.1016/j.jpsychires.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/14/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
Individuals with body dysmorphic disorder (BDD) suffer from distressing or impairing preoccupations with perceived imperfections in their appearance. This often-chronic condition is associated with significant functional impairment and elevated rates of psychiatric comorbidity and morbidity, including depression, substance use disorders, and suicidality. Cognitive behavioral therapy (CBT) for BDD has been shown to be efficacious. However, this intervention is long (up to 24 weeks) relative to many manualized approaches for other related conditions, there is a significant shortage of clinicians trained in CBT for BDD, and some patients drop out of treatment and/or do not respond. Thus, there is great interest in understanding and predicting who is most likely to respond, to better allocate clinical resources. This secondary data analysis of participants enrolled in prior uncontrolled and controlled studies of CBT for BDD explored whether early response to CBT, operationalized as percentage change in symptom severity within the first four weeks and the first 12 weeks of this 24-week treatment, predicts clinical outcomes for patients with BDD (n = 90). The findings indicated that minimal early symptom change was not indicative of eventual non-response. This suggests that patients and clinicians should not be discouraged by limited early improvement but should instead continue with a full course of treatment before reevaluating progress and alternative interventions. Overall, the results support the view that treatment success is more likely if a longer CBT protocol is followed. More work is needed to understand mechanisms of change and thus match optimal interventions to patient characteristics.
Collapse
Affiliation(s)
- Jennifer L. Greenberg
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA,Corresponding author. (J.L. Greenberg)
| | - Nicholas C. Jacobson
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA,Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, USA
| | - Susanne S. Hoeppner
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | - Emily E. Bernstein
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | - Ivar Snorrason
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Anna Schwartzberg
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Gail Steketee
- Boston University School of Social Work, 264 Bay State Rd, Boston, MA, 02215, USA.
| | - Katharine A. Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA,New York-Presbyterian Hospital and Weill Cornell Medical College, 315 East 62nd Street, New York, 10065, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| |
Collapse
|
4
|
Pickard JA, Lumby C, Deane FP. True beauty lies within: therapist interview of a client who received acceptance and commitment therapy for body dysmorphic disorder. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1948304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Judy A. Pickard
- School of Psychology, University of Wollongong, NSW, Wollongong, Australia
| | - Carrie Lumby
- School of Psychology, University of Wollongong, NSW, Wollongong, Australia
| | - Frank P. Deane
- School of Psychology, University of Wollongong, NSW, Wollongong, Australia
| |
Collapse
|
5
|
Angelakis I, Pseftogianni F. Association between obsessive-compulsive and related disorders and experiential avoidance: A systematic review and meta-analysis. J Psychiatr Res 2021; 138:228-239. [PMID: 33866051 DOI: 10.1016/j.jpsychires.2021.03.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022]
Abstract
The associations between the distinct types of obsessive-compulsive and related disorders and experiential avoidance have received mixed evidence. We, thus, undertook this meta-analysis to i) re-examine the association between obsessive-compulsive disorder and experiential avoidance, ii) extend this association to hoarding disorder, trichotillomania, and body dysmorphic disorder, and iii) identify potential variables affecting these associations. Five databases, including Medline, Embase, PsychINFO, Web of Science and CINAHL, were searched until March 15th, 2021. Meta-analyses based on random-effect models were performed. Heterogeneity and publication bias tests were applied using the I2 statistic and the Egger's test. Meta-regression analyses were performed to identify potential moderators affecting the strength of these associations. Thirty-six unique studies based on n = 11,859 participants were identified. The association between obsessive-compulsive disorder and experiential avoidance was moderate (SMD = 0.75, 95% CI = 0.57-0.92), whereas the associations between individual obsessive-compulsive symptoms, including obsessions, responsibility for harm, ordering, checking, washing and neutralizing, and experiential avoidance ranged from low to strong (SMD ranged between 0.41 and 1.06, 95% CI = 0.25 to 1.40). The associations between hoarding disorder (SMD = 0.93, 95% CI = 0.46-1.40), trichotillomania (SMD = 0.56, 95% CI = 0.48-0.63), body dysmorphic disorder (SMD = 1.55, 95% CI = 0.72-2.37) and experiential avoidance were moderate to strong. Meta-regression analyses demonstrated that studies using the AAQ/AAQ-II scales for measuring experiential avoidance, and/or self-report scales for assessing OCRDs contributed smaller effect sizes. These findings suggest that reducing experiential avoidance may be a viable way of complementing exposure strategies in alleviating obsessive-compulsive and related symptoms.
Collapse
Affiliation(s)
- Ioannis Angelakis
- University of South Wales, School of Psychology, Pontypridd, Wales, UK.
| | | |
Collapse
|
6
|
de Almeida Sampaio TP, Jorge RC, Martins DS, Gandarela LM, Hayes-Skelton S, Bernik MA, Lotufo-Neto F. Efficacy of an acceptance-based group behavioral therapy for generalized anxiety disorder. Depress Anxiety 2020; 37:1179-1193. [PMID: 32333486 DOI: 10.1002/da.23021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) shows the weakest treatment response among anxiety disorders. This study aimed at examining whether an acceptance-based group behavioral therapy (ABBT) for patients in a Brazilian anxiety disorders program, combining mindfulness and exposure strategies, can improve clinical outcome when compared with a standard nondirective supportive group therapy (NDST). METHODS Ninety-two individuals diagnosed with GAD were randomized to receive 10 sessions of either ABBT or NDST. Assessments at pretreatment, midtreatment, posttreatment, and 3-month follow-up comprised the following outcome measures: Hamilton Anxiety Rating Scale (HAM-A), Penn State Worry Questionnaire (PSWQ), Depression Anxiety and Stress Scale (DASS), and the Clinical Global Impressions (CGI). The World Health Organization Quality of Life (WHOQOL) was administered at pretreatment and posttreatment. RESULTS The mixed-effects regression models for DASS-stress, Hamilton Anxiety Interview, and CGI showed a significant effect for Time and the Time × Treatment effect, but not for the Treatment main effect. Similarly, there was a significant Time × Treatment effect for the PSWQ, but not main effects of Time or Treatment. Altogether, these data indicate that symptoms decreased in both conditions across treatment and follow-up, and that the rate of change was more rapid for those participants in the ABBT condition. We found no differences between groups from pretreatment to posttreatment in DASS-anxiety or any secondary outcome measure, but for the physical health domain of WHOQOL, which was faster in ABBT. CONCLUSIONS Both groups showed good clinical outcomes, but in general, participants of the ABBT group improved faster than those in the NDST group.
Collapse
Affiliation(s)
- Thiago Pacheco de Almeida Sampaio
- Department of Clinical Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Renê Cabral Jorge
- Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Daniel Santos Martins
- Department of Clinical Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Lucas Marques Gandarela
- Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Sarah Hayes-Skelton
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts
| | - Márcio Antonini Bernik
- Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Francisco Lotufo-Neto
- Department of Clinical Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
7
|
Schaumberg K, Reilly EE, Gorrell S, Levinson CA, Farrell NR, Brown TA, Smith KM, Schaefer LM, Essayli JH, Haynos AF, Anderson LM. Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clin Psychol Rev 2020; 83:101952. [PMID: 33221621 DOI: 10.1016/j.cpr.2020.101952] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.
Collapse
Affiliation(s)
| | | | - Sasha Gorrell
- University of California, San Francisco, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | | | - Tiffany A Brown
- University of California, San Diego, United States of America
| | - Kathryn M Smith
- Sanford Health, United States of America; University of Southern California, United States of America
| | | | | | - Ann F Haynos
- University of Minnesota, United States of America
| | | |
Collapse
|
8
|
|
9
|
Lewis CJ, Hodgkinson EL, Allison KP. Corrosive attacks in the UK - Psychosocial perspectives and decontamination strategies. Burns 2019; 46:213-218. [PMID: 31784238 DOI: 10.1016/j.burns.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 10/25/2022]
Abstract
Acid attacks, or vitriolage, are defined as violent assaults involving the deliberate throwing of an acid or similarly corrosive substance with the intention to "maim, disfigure, torture or kill" [1]. The Acid Survivors Trust International suggest a prevalence of 1500 attacks reported worldwide per annum, although this is likely to be an underestimate by 40% [2]. The UK is thought to have one of the highest of rates of recorded corrosive attacks, with an increase from 228 attacks in 2012 to 601 in 2016. Most were reported by the London Metropolitan police force followed by Northumbria, Cambridgeshire, Hertfordshire, Greater Manchester and Humberside [[2]]. The chemical agents involved include acids, alkalis, oxidising and reducing agents, alkylating and chelating agents and solvents. They cause injury by producing a chemical interaction which can lead to extensive tissue destruction and extreme pain. Herein, we present a review on the changing epidemiology of corrosive attacks in the UK and currently employed management strategies.
Collapse
Affiliation(s)
- C J Lewis
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK.
| | - E L Hodgkinson
- Psychology in Healthcare, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - K P Allison
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
10
|
Mohajerin B, Bakhtiyar M, Olesnycky OS, Dolatshahi B, Motabi F. Application of a transdiagnostic treatment for emotional disorders to body dysmorphic disorder: A randomized controlled trial. J Affect Disord 2019; 245:637-644. [PMID: 30445389 DOI: 10.1016/j.jad.2018.11.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/14/2018] [Accepted: 11/03/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a common disorder which is associated with a high rate of comorbidity and functional impairment. Although research shows that cognitive-behavioral therapy can be an efficacious treatment for BDD, there is growing evidence that dysregulated emotion is a core deficit. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a transdiagnostic, emotion focused cognitive-behavioral therapy protocol that has been developed to target emotion regulation processes that play an important role in the development and maintenance of many emotional disorders METHODS: : In the present study, 128 patients meeting criteria for BDD were randomized to either the UP (n = 64) or waitlist/treatment-as-usual (WL/TAU) condition. Diagnoses were determined using semi-structural interviews and patients also completed the Brown Assessment of Beliefs Scale (BABS), the Appearance Anxiety Inventory (AAI), the Difficulties in Emotion Regulation Scale (DERS), the Beck Depression Inventory (BDI) and the Clinical Global Impression (CGI). RESULTS Repeated measure ANOVA indicated that the UP significantly decreased depression, BDD symptoms and body-related anxiety, as well as significantly improving emotional regulation all with large effect sizes compared to the TAU/WL condition. Treatment gains as well as remission of comorbid conditions were maintained at the three-month follow-up. LIMITATIONS Our study limitations include restricted follow-up periods and excluding participants who were actively suicidal. CONCLUSIONS To our knowledge, this is the first examination of the UP for BDD, and results suggest that this disorder shares common mechanisms with other disorders of emotion, and that the UP may be an additional efficacious treatment for this condition.
Collapse
Affiliation(s)
- Banafsheh Mohajerin
- Department of Clinical Psychology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Bakhtiyar
- Department of Clinical Psychology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Olenka S Olesnycky
- Center for Anxiety and Related Disorders, Boston University, Massachusetts, USA
| | - Behrouz Dolatshahi
- Department of Psychology, Iranian Research Center for Substance Abuse and Dependence, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fereshteh Motabi
- Family Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Dehbaneh MA. Effectiveness of acceptance and commitment therapy in improving interpersonal problems, quality of life, and worry in patients with body dysmorphic disorder. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2018. [DOI: 10.29333/ejgm/93468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Givehki R, Afshar H, Goli F, Scheidt CE, Omidi A, Davoudi M. Effect of acceptance and commitment therapy on body image flexibility and body awareness in patients with psychosomatic disorders: a randomized clinical trial. Electron Physician 2018; 10:7008-7016. [PMID: 30128091 PMCID: PMC6092142 DOI: 10.19082/7008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of this research was to examine the effectiveness of the acceptance and commitment therapy (ACT) for body image flexibility and body awareness in these patients. METHODS A randomized clinical trial was conducted at Kashan University of Medical Sciences clinics in Kashan, Iran, from December 1, 2017 to March 30, 2018. A sample of 75 patients with psychosomatic disorders was selected by convenience sampling. The selected patients were randomly divided into three 25-member groups. The experimental group received medicinal treatment combined with the (ACT). The active control group received the usual treatment plus psycho education in general psychology, and the treatment group solely received the medicinal treatment usually used in the treatment centers. The results were obtained using the following scales in the pretest and posttest phases and the two-month follow-up: the demographic questionnaire; Shields' body awareness questionnaire; and Sandoz's body image flexibility questionnaire. The data were analyzed using the descriptive statistics tests (mean and standard deviation) and the repeated measures analysis of variance and chi-square tests in IBM-SPSS version 21. RESULTS There was no significant difference among the three groups in terms of body image flexibility, body awareness, somatic symptoms, and demographic variables. The results of the posttest and follow-up examinations suggested that the ACT group more effectively and significantly improved body image flexibility and body awareness as compared to both of the control groups (p=0.02). CONCLUSIONS The ACT successfully improves body image flexibility and body awareness in patients with psychosomatic disorders. CLINICAL TRIAL REGISTRATION This research was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2017092532057N2. FUNDING Research and Technology Department of Kashan University of Medical Sciences funded the study (Ref: 96053).
Collapse
Affiliation(s)
- Reza Givehki
- MD., Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Afshar
- MD., Psychosomatic Research Center and Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzad Goli
- MD., Head of Danesh-e Tandorosti Institute, Isfahan, Iran
- Professor, Faculty Instructor, Energy Medicine University, California, USA
| | - Carl Eduard Scheidt
- MD., Department of Psychosomatic, Albert Ludwigs University, Freiburg, Germany
| | - Abdollah Omidi
- Ph.D. of Clinical Psychology, Associate Professor, Department of Clinical Psychology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan Iran
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Davoudi
- M.Sc. Student of Clinical Psychology, Department of Clinical Psychology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| |
Collapse
|
13
|
Abstract
Body dysmorphic disorder (BDD) is a disabling illness with a high worldwide prevalence. Patients demonstrate a debilitating preoccupation with one or more perceived defects, often marked by poor insight or delusional convictions. Multiple studies have suggested that selective serotonin reuptake inhibitors and various cognitive behavioral therapy modalities are effective first-line treatments in decreasing BDD severity, relieving depressive symptoms, restoring insight, and increasing quality of life. Selective serotonin reuptake inhibitors have also recently been shown to be effective for relapse prevention. This review provides a comprehensive summary of the current understanding of BDD, including its clinical features, epidemiology, genetics, and current treatment modalities. Additional research is needed to fully elucidate the relationship between BDD and comorbid illnesses such as obsessive–compulsive-related disorders and depression and to develop therapies for refractory patients and those who have contraindications for pharmacological intervention.
Collapse
Affiliation(s)
- Kevin Hong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
| | - Vera Nezgovorova
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
| |
Collapse
|
14
|
Miller ML, Brock RL. The effect of trauma on the severity of obsessive-compulsive spectrum symptoms: A meta-analysis. J Anxiety Disord 2017; 47:29-44. [PMID: 28242410 DOI: 10.1016/j.janxdis.2017.02.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 01/27/2023]
Abstract
It is important to consider trauma-related sequelae in the etiology and maintenance of psychopathology, namely understudied disorders such as those belonging to the Obsessive-Compulsive Spectrum (OCS). This meta-analysis examined the association between past trauma exposure and current severity of OCS disorder symptoms. A systematic literature search was conducted with 24 (N=4557) articles meeting inclusion criteria. A significant overall effect size was obtained (r=0.20), indicating that exposure to past trauma is associated with a higher severity of OCS symptoms, with a stronger association for females (β=0.01, p<.001) but not varying as a function of relationship status. Four types of interpersonal trauma (violence, emotional abuse, sexual abuse, and neglect) were associated with OCS symptom severity (r=0.19 -0.24) and past trauma was significantly associated with more severe compulsions (r=0.17), but not obsessions. Results suggest an important link between multiple types of past trauma exposure and OCS symptoms.
Collapse
|
15
|
Phillipou A, Rossell SL, Wilding HE, Castle DJ. Randomised controlled trials of psychological & pharmacological treatments for body dysmorphic disorder: A systematic review. Psychiatry Res 2016; 245:179-185. [PMID: 27544783 DOI: 10.1016/j.psychres.2016.05.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 05/14/2016] [Accepted: 05/20/2016] [Indexed: 11/25/2022]
Abstract
Treatment for body dysmorphic disorder (BDD) often involves a combination of psychological and pharmacological interventions. However, only a small number of randomised controlled trials (RCTs) have been undertaken examining the efficacy of different therapeutic interventions. The aim of this study was to systematically review the RCTs involving psychological and pharmacological interventions for the treatment of BDD. The literature was searched to June 2015, and studies were included if they were written in English, empirical research papers published in peer-review journals, specifically assessed BDD patients, and involved a RCT assessing BDD symptoms pre- and post-intervention. Nine studies were identified: six involving psychological and three involving pharmacological interventions. Cognitive behaviour therapy, metacognitive therapy and selective serotonin reuptake inhibitors were identified as treatments with potential benefit. The small number of RCTs and the heterogeneity of findings emphasises the need for more high quality RCTs assessing both psychological and pharmacological interventions for BDD.
Collapse
Affiliation(s)
- Andrea Phillipou
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia; Department of Mental Health, The Austin Hospital, Melbourne, VIC, Australia
| | - Susan L Rossell
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia; Brain & Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Helen E Wilding
- Library Service, St Vincent's Hospital, Melbourne, VIC, Australia
| | - David J Castle
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia; Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.
| |
Collapse
|
16
|
Harrison A, Fernández de la Cruz L, Enander J, Radua J, Mataix-Cols D. Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials. Clin Psychol Rev 2016; 48:43-51. [DOI: 10.1016/j.cpr.2016.05.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/15/2016] [Accepted: 05/28/2016] [Indexed: 10/21/2022]
|
17
|
Blashill AJ, Tomassilli J, Biello K, O'Cleirigh C, Safren SA, Mayer KH. Body Dissatisfaction Among Sexual Minority Men: Psychological and Sexual Health Outcomes. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1241-1247. [PMID: 26857379 PMCID: PMC4865402 DOI: 10.1007/s10508-015-0683-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/09/2015] [Accepted: 12/15/2015] [Indexed: 06/05/2023]
Abstract
Body dissatisfaction is common among sexual minority (i.e., gay and bisexual) men; however, few studies have investigated the relationship between body dissatisfaction and psychosexual health variables among this population. The data that do exist are exclusively cross-sectional, casting uncertainty regarding temporal associations. Thus, the aims of the current study were to assess the prospective relationship between body dissatisfaction and psychological and sexual health outcomes. Participants were 131 gay and bisexual men who completed a battery of self-report measures across two time points (baseline and 3-month follow-up), including assessment of body dissatisfaction, depressive symptoms, and sexual health variables (sexual self-efficacy and sexual anxiety). Generalized linear modeling was employed to assess the prospective relationship between body dissatisfaction and outcomes variables, accounting for non-normal distributions. Body dissatisfaction significantly predicted elevated depressive symptoms (B = .21, p = .01), lower sexual self-efficacy (B = -.22, p = .04), and elevated sexual anxiety (B = .05, p = .03). Elevated body dissatisfaction is prospectively associated with negative psychological and sexual health outcomes. Given the high prevalence of body image concerns in sexual minority men, depression and/or HIV/STI prevention programs may benefit from routinely assessing for body dissatisfaction among this population, and addressing those who report concerns.
Collapse
Affiliation(s)
- Aaron J Blashill
- Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA.
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | | | - Katie Biello
- The Fenway Institute, Boston, MA, USA
- Department of Behavioral & Social Sciences, Brown University, Providence, RI, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|