Culturally Adapted Cognitive Behavioral Therapy for Body Dysmorphic Disorder: Case Examples

A systematic review of visual processing and associated treatments in body dysmorphic disorder

OBJECTIVE

Recent advances in body dysmorphic disorder (BDD) have explored abnormal visual processing, yet it is unclear how this relates to treatment. The aim of this study was to summarize our current understanding of visual processing in BDD and review associated treatments.

METHOD

The literature was collected through PsycInfo and PubMed. Visual processing articles were included if written in English after 1970, had a specific BDD group compared to healthy controls and were not case studies. Due to the lack of research regarding treatments associated with visual processing, case studies were included.

RESULTS

A number of visual processing abnormalities are present in BDD, including face recognition, emotion identification, aesthetics, object recognition and gestalt processing. Differences to healthy controls include a dominance of detailed local processing over global processing and associated changes in brain activation in visual regions. Perceptual mirror retraining and some forms of self-exposure have demonstrated improved treatment outcomes, but have not been examined in isolation from broader treatments.

CONCLUSION

Despite these abnormalities in perception, particularly concerning face and emotion recognition, few BDD treatments attempt to specifically remediate this. The development of a novel visual training programme which addresses these widespread abnormalities may provide an effective treatment modality.

Treatment Modifications and Suggestions to Address Visual Abnormalities in Body Dysmorphic Disorder

Recent psychophysical and neurocognitive findings implicate abnormal visual processing for a range of stimuli in body dysmorphic disorder (BDD); such abnormalities differentiate BDD from other mental health disorders. Current treatments most commonly involve cognitive behavior therapy with or without accompanying antidepressant medications. These are moderately successful yet appear to overlook the core phenomenological aspect of abnormal perception in BDD. The following text summarizes the current literature of perceptual abnormalities within BDD and how these findings may be applied and incorporated into treatment options. Possible modifications of cognitive behavioral therapy (CBT) based on the widespread visual abnormalities within BDD include making perceptual mirror retraining a compulsory component of therapy and implementing self-exposure tasks within exposure and response prevention. Alternative options such as a visual training program to remediate visual abnormalities across a range of visual stimuli are also explored, which may be included as an adjunctive treatment alongside CBT.

Die körperdysmorphe Störung

Charakteristisch für die körperdysmorphe Störung (KDS) ist eine übermäßige Beschäftigung mit einem wahrgenommenen Makel oder Defekt im körperlichen Aussehen (z. B. Hautunreinheiten, Falten, Asymmetrien im Gesichtsbereich), die mit einer signifikanten Beeinträchtigung im sozialen und/oder beruflichen Leben einhergeht. Menschen, die an einer KDS leiden, zeigen ritualisierte Verhaltensweisen (z. B. überprüfen sie ihr Äußeres immer wieder in Spiegeln) und leiden zudem häufig unter Angst vor negativer Bewertung sowie Vorstellungen, dass andere Personen negativ über ihr Aussehen sprechen. Aktuelle Studien zur Prävalenz der KDS in der Allgemeinbevölkerung weisen auf eine Punkt-Prävalenz von ca. 2 % hin (Geschlechterverhältnis: ca. 60 % Frauen versus 40 % Männer). Bei der psychotherapeutischen Behandlung der KDS haben sich kognitiv-behaviorale Psychotherapieansätze bewährt. Dennoch liegen derzeit zu wenig randomisiert-kontrollierte Psychotherapiestudien vor, um evidenzbasierte Handlungsempfehlungen zur Psychotherapie geben zu können.

Preliminary study on the effectiveness of short group cognitive behavioral therapy (GCBT) on Indonesian older adults

This research aims to develop evidence based affordable psychological therapy for Indonesian older adults. An affordable psychological therapy is important as there is virtually no managed care or health insurance that covers psychological therapy in Indonesia. Multicomponent group cognitive behavior therapy (GCBGT) was chosen as a starting point due to its extensive evidence, short sessions, and success for a wide range of psychological problems. The group format was chosen to address both the economic and the cultural context of Indonesia. Then, the developed treatment is tested to common psychological problems in older adults' population (anxiety, chronic pain, depression, and insomnia). The treatment consists of 8 sessions with twice a week meetings for 2.5 hours. There are similarities and differences among the techniques used in the treatment for the different psychological problems. The final participants are 38 older adults that are divided into the treatment groups; 8 participants joined the anxiety treatment, 10 participants for the chronic pain treatment, 10 participants for depression treatment, and lastly, 10 participants joined the insomnia treatment. The research design is pre-test post-test with within group analysis. We used principal outcome measure that is specific for each treatment group, as well as additional outcome measures. Overall, the result shows statistical significance change with large effect size for the principal outcome measure. In addition, the result for the additional measures varies from slight improvement with small effect size to statistically significant improvement with large effect size. The result indicates that short multicomponent GCBT is effective in alleviating various common psychological problems in Indonesian older adults. Therefore, multicomponent GCBT may be a good starting point to develop an effective and affordable psychological therapy for Indonesian older adults. Lastly, this result adds to the accumulating body of evidence on the effectiveness of multicomponent GCBT outside western context.