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He IR, Gaillard A, Rossell S. Addressing body dysmorphic disorder through mindfulness: A new therapeutic frontier. Aust N Z J Psychiatry 2025; 59:405-412. [PMID: 40145934 DOI: 10.1177/00048674251328557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2025]
Abstract
Body dysmorphic disorder presents in up to 2% of the general population, yet less than half seek psychological support. Some treatment barriers include poor illness insight, low body dysmorphic disorder awareness among mental health professionals and a lack of accessibility to body dysmorphic disorder-specific treatments. Currently available treatments for body dysmorphic disorder, including psychopharmacology and psychotherapy, show modest results in improving body dysmorphic disorder symptoms. With the reduced quality of life and increased risks of suicide among individuals with body dysmorphic disorder, there is a need for new and easily accessible therapeutic approaches specific to body dysmorphic disorder. Emerging research has suggested that mindfulness-based interventions show promise as an addition to available body dysmorphic disorder treatments. Clinical evidence of mindfulness-based interventions demonstrates efficacy in improving symptoms in eating disorders, social anxiety disorder and obsessive-compulsive disorder, conditions that have similar clinical presentations as body dysmorphic disorder. Mindfulness strategies, such as increasing interoceptive awareness, non-judgement and non-reactivity, are also suggested to reduce body image disturbances, anxiety and repetitive thoughts, and cognitive rigidity, clinical characteristics of body dysmorphic disorder. This perspective piece aims to provide evidences for integrating mindfulness into treatment protocols to support mental health professionals better address the challenges faced by individuals with body dysmorphic disorder.
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Affiliation(s)
- Iris R He
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Alexandra Gaillard
- Department of Health Sciences and Biostatistics, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Susan Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
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Bürkle JJ, Schmidt S, Fendel JC. Mindfulness- and acceptance-based programmes for obsessive-compulsive disorder: A systematic review and meta-analysis. J Anxiety Disord 2025; 110:102977. [PMID: 39862744 DOI: 10.1016/j.janxdis.2025.102977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 10/28/2024] [Accepted: 01/15/2025] [Indexed: 01/27/2025]
Abstract
Mindfulness- and acceptance-based programmes (MABPs) in the treatment of obsessive-compulsive disorder (OCD) are increasingly gaining research interest, yet a comprehensive systematic review and meta-analysis is missing. To fill this gap, we analysed 46 trials involving 2221 patients. Two independent reviewers screened records, extracted data, assessed risk of bias, and rated overall quality of evidence. MABPs were associated with large reductions in OCD-severity in between-group analysis in randomised controlled trials (k = 33; g = -.87; CI = -1.13,-.60) and within-group pre-post analysis in all MABPs (k = 49; g = -1.72; CI = -2.00,-1.44). Depressive symptoms decreased between- and within-group with a small to moderate effect, with maintained reductions at follow-up for both OCD and depression. Moderate to large pre-post improvements were also observed in anxiety, obsessive beliefs, and quality of life. MABPs did not differ from cognitive behavioural therapy and exposure and response prevention (k = 9; g=.02; CI = -.23,.26) but were superior to medication (k = 5; g = -.77; CI = -1.44,-.11) and waitlist (k = 16; g = -1.66; CI = -2.1,-1.24). Symptom reductions were observed across world regions, but to varying degrees. When combined, increases in mindfulness and psychological flexibility predicted reductions in OCD symptoms. Outcomes were not moderated by treatment duration, samples', and therapists' characteristics. MABPs can reduce OCD-severity, but further high-quality trials with long-term follow-ups are needed to confirm results.
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Affiliation(s)
- Johannes J Bürkle
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Stefan Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Johannes C Fendel
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Peres RS, Cortez PA. Psychosocial Impact of the COVID-19 Pandemic in Brazilian Post-Peak Period: Differences Between Individuals with and Without Pre-Existing Psychiatric Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 22:27. [PMID: 39857480 PMCID: PMC11765194 DOI: 10.3390/ijerph22010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 12/08/2024] [Accepted: 12/26/2024] [Indexed: 01/27/2025]
Abstract
(1) Background: Validated instruments to measure mental health variables related to sanitary crises can provide data for prevention or intervention plans. The objectives of this study were: (1) to evidence the psychometric factorial internal structure of the Battery for Assessing Mental Health-Pandemic Version (BASM-P) in the sample; (2) to investigate the psychosocial impact of the COVID-19 pandemic in Brazilian post-peak period among individuals with and without pre-existing psychiatric conditions using the BASM-P; and (3) to analyze relationships between the mental health variables measured by the BASM-P in both groups. (2) Methods: This is an internet-based quantitative, cross-sectional study with a non-probabilistic convenience sample. The participants (n = 209) were divided into a non-psychiatric group (n = 168) and a psychiatric group (n = 41). The instruments were the BASM-P and a sociodemographic questionnaire. Data were collected throughout the second semester of 2022 and analyzed with JASP software. (3) Results: The BASM-P demonstrated robust psychometric factorial internal structure. Significant differences were observed between the two groups across all variables. In the non-psychiatric group, obsessive thoughts presented strong connections to fear, distress, and grief from job loss. (4) Conclusions: This study highlights the central role of obsessive thoughts in shaping the psychosocial impact of the COVID-19 pandemic in the Brazilian post-peak period.
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Affiliation(s)
| | - Pedro Afonso Cortez
- Instituto de Psicologia, Universidade Federal de Uberlândia, Avenida Pará, 1720-Bloco 2C, Campus Umuarama, Uberlândia 38405-240, MG, Brazil;
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De la Peña-Arteaga V, Cano M, Porta-Casteràs D, Vicent-Gil M, Miquel-Giner N, Martínez-Zalacaín I, Mar-Barrutia L, López-Solà M, Andrews-Hanna JR, Soriano-Mas C, Alonso P, Serra-Blasco M, López-Solà C, Cardoner N. Mindfulness-based cognitive therapy neurobiology in treatment-resistant obsessive-compulsive disorder: A domain-related resting-state networks approach. Eur Neuropsychopharmacol 2024; 82:72-81. [PMID: 38503084 DOI: 10.1016/j.euroneuro.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/21/2024]
Abstract
Mindfulness-based cognitive therapy (MBCT) stands out as a promising augmentation psychological therapy for patients with obsessive-compulsive disorder (OCD). To identify potential predictive and response biomarkers, this study examines the relationship between clinical domains and resting-state network connectivity in OCD patients undergoing a 3-month MBCT programme. Twelve OCD patients underwent two resting-state functional magnetic resonance imaging sessions at baseline and after the MBCT programme. We assessed four clinical domains: positive affect, negative affect, anxiety sensitivity, and rumination. Independent component analysis characterised resting-state networks (RSNs), and multiple regression analyses evaluated brain-clinical associations. At baseline, distinct network connectivity patterns were found for each clinical domain: parietal-subcortical, lateral prefrontal, medial prefrontal, and frontal-occipital. Predictive and response biomarkers revealed significant brain-clinical associations within two main RSNs: the ventral default mode network (vDMN) and the frontostriatal network (FSN). Key brain nodes -the precuneus and the frontopolar cortex- were identified within these networks. MBCT may modulate vDMN and FSN connectivity in OCD patients, possibly reducing symptoms across clinical domains. Each clinical domain had a unique baseline brain connectivity pattern, suggesting potential symptom-based biomarkers. Using these RSNs as predictors could enable personalised treatments and the identification of patients who would benefit most from MBCT.
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Affiliation(s)
| | - Marta Cano
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain; Network Centre for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Daniel Porta-Casteràs
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain; Mental Health Department, Unitat de Neurociència Traslacional, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Sabadell, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Muriel Vicent-Gil
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain; Network Centre for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Neus Miquel-Giner
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Sabadell, Spain; Department of Mental Health, Parc Sanitari Sant Joan de Déu, Cornellà de Llobregat, Spain
| | - Ignacio Martínez-Zalacaín
- Department of Radiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Lorea Mar-Barrutia
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Marina López-Solà
- Department of Medicine, School of Medicine and Health Sciences, Universitat de Barcelona - UB, Barcelona, Spain
| | - Jessica R Andrews-Hanna
- Department of Psychology - Cognitive Science, University of Arizona, Tucson, United States of America
| | - Carles Soriano-Mas
- Network Centre for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona - UB, Barcelona, Spain
| | - Pino Alonso
- Network Centre for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona - UB, L'Hospitalet de Llobregat, Spain
| | - Maria Serra-Blasco
- Network Centre for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; ICOnnecta't e-Health Program of the Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Spain; Psycho-oncology and Digital Health Group, Health Services Research in Cancer, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet del Llobregat, Spain.
| | - Clara López-Solà
- Network Centre for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Mental Health Department, Unitat de Neurociència Traslacional, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Sabadell, Spain; Health Clinical Psychology Section, Department of Psychiatry & Clinical Psychology, Institut Clínic de Neurociències (ICN), Hospital Clínic, Barcelona, Spain.
| | - Narcís Cardoner
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain; Network Centre for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Bevione F, Martini M, Toppino F, Longo P, Abbate-Daga G, Brustolin A, Panero M. Cognitive Impulsivity in Anorexia Nervosa in Correlation with Eating and Obsessive Symptoms: A Comparison with Healthy Controls. Nutrients 2024; 16:1156. [PMID: 38674849 PMCID: PMC11054498 DOI: 10.3390/nu16081156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Impulsivity in eating disorders (ED) has been historically focused on bingeing-purging symptoms, evidencing lower levels in restricting subtypes. In the recent literature, obsessive-compulsive disorder (OCD) has been described as characterized by high cognitive impulsivity. This specific impulsivity factor has been rarely studied in anorexia nervosa (AN). In this study, 53 inpatients with anorexia nervosa and 59 healthy controls completed the following questionnaires: the Barratt Impulsiveness Scale (BIS-11), the Obsessive-Compulsive Inventory (OCI), the Eating Disorders Inventory-2 (EDI-2), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). AN individuals showed significantly increased levels of cognitive instability but no difference in global score and other subscales of impulsivity compared to the healthy controls. Among AN individuals, cognitive instability emerged as being associated with the global score and obsession subscale of the OCI. It was also significantly associated with interoceptive awareness and impulse regulation. Cognitive instability was the main predictor of obsessive thoughts and behaviors in AN. Our study supports the hypothesis of AN as being characterized by high cognitive instability and adds the result that the cognitive domain of impulsivity may be associated with the presence of obsessive symptoms, specifically obsessive thoughts.
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Affiliation(s)
| | | | | | | | - Giovanni Abbate-Daga
- Eating Disorders Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, via Cherasco 15, 10126 Turin, Italy; (F.B.); (M.M.); (F.T.); (P.L.); (A.B.); (M.P.)
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Lazarov A, Liberman N, Dar R. The Seeking Proxies for Internal States (SPIS) Model of OCD - A Comprehensive Review of Current Findings and Implications for Future Directions. Curr Neuropharmacol 2024; 22:1807-1825. [PMID: 37881091 PMCID: PMC11284725 DOI: 10.2174/1570159x21666230920165403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/17/2023] [Accepted: 05/19/2023] [Indexed: 10/27/2023] Open
Abstract
The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) explains symptoms of OCD as stemming from attenuated access to internal states, which is compensated for by using proxies, which are indices of these states that are more discernible or less ambiguous. Internal states in the SPIS model are subjective states that are not accessible to others, encompassing physiological states, motivations, preferences, memories, and emotions. Compensatory proxies in OCD include fixed rules and rituals as well as seeking and relying on external information. In the present review, we outline the SPIS model and describe its basic tenets. We then use the SPIS conceptualization to explain two pivotal OCD-related phenomena - obsessive doubt and compulsive rituals. Next, we provide a detailed overview of current empirical evidence supporting the SPIS in several domains, including physiological states, emotions, sense of understanding, decision-making, and sense of agency. We conclude by discussing possible neural correlates of the difficulty in accessing internal states, focusing on the anterior insular cortex (AIC) and highlighting potential clinical implications of the model to the treatment of OCD.
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Affiliation(s)
- Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nira Liberman
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Reuven Dar
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
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Öztürk Y, Özyurt G, Turan S, Tufan AE, Akay AP. Emotion dysregulation and social communication problems but not ToM properties may predict obsessive-compulsive disorder symptom severity. Nord J Psychiatry 2023; 77:778-787. [PMID: 37665655 DOI: 10.1080/08039488.2023.2251953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/06/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Studies have shown that theory of mind, emotion regulation and pragmatic abilities are negatively affected in people with obsessive-compulsive disorder (OCD). We aimed to investigate theory of mind (ToM) abilities, social responsiveness, pragmatic language, and emotion regulation skills in children with OCD and to compare them to healthy controls. METHODS This study was designed as a single-center, cross-sectional, case-control study. ToM abilities were evaluated via "Reading the Mind in the Eyes Test" (RMET), "Faces Test", "Faux-Pas Test", "Comprehension Test" and "Unexpected Outcomes Test". Social responsiveness, pragmatic language and emotion regulation were evaluated by Social Responsiveness Scale (SRS), Children's Communication Checklist- Second Edition (CCC-2), Difficulties in Emotion Regulation Scale (DERS) and Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Within the study period, we enrolled 85 adolescents (42 with OCD and 43 controls). RESULTS The OCD group performed significantly lower than healthy controls in the Faux Pass and Comprehension tests (p = 0.003 for both). We found a statistically significant difference between groups in terms of the goal, strategy, non-acceptance subscales of the DERS (p < 0.001, p = 0.006, p = 0.008, respectively) as well as the total DERS score (p < 0.001). CY-BOCS total scores correlated significantly and negatively with Comprehension, Faux Pas and Unexpected Outcomes tests, and positively with CCC total, SRS total and DERS total scores. In regression analysis the DERS, SRS and CCC tests emerged as significant predictors of CY-BOCS total score. CONCLUSION Addressing ToM, pragmatic, and ER difficulties when planning the treatment of young people with OCD may contribute to positive outcomes.
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Affiliation(s)
- Yusuf Öztürk
- Department of Child and Adolescent Psychiatry, Bolu Abant Izzet Baysal University Medical Faculty, Bolu, Turkey
| | - Gonca Özyurt
- Department of Child and Adolescent Psychiatry, Izmir Katip Çelebi University Medical Faculty, İzmir, Turkey
| | - Serkan Turan
- Department of Child and Adolescent Psychiatry, Uludağ University Medical Faculty, Bursa, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Bolu Abant Izzet Baysal University Medical Faculty, Bolu, Turkey
| | - Aynur Pekcanlar Akay
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University Medical Faculty, Izmir, Turkey
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