Behavioral Interventions for Body Dysmorphic Disorder

(BDD Trial)

Overseen By Eda Gorbis, PhD, LMFT

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: Westwood Institute for Anxiety Disorders, Inc

Disqualifiers: Psychosis, Bipolar, Tourette's, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 18

Duration: 3 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two different mirror-based therapies for treating Body Dysmorphic Disorder (BDD), a condition where individuals worry excessively about perceived flaws in their appearance. Participants will receive cognitive-behavioral therapy (CBT) combined with either the "mirror retraining method" or the "crooked mirror externalization therapy" to determine which is more effective. Both therapies use mirrors to help change how participants view their perceived flaws. This trial is suitable for those diagnosed with BDD who struggle with obsessive concerns about their appearance. As a Phase 2 trial, the research measures the treatment's effectiveness in an initial, smaller group, offering participants a chance to contribute to developing effective therapies for BDD.

Will I have to stop taking my current medications?

The trial requires that you do not change your psychotropic medications during the study or for 12 weeks before joining. If you are on such medications, you must have been stable on them for at least 12 weeks prior to participating.

What prior data suggests that these behavioral interventions are safe for treating Body Dysmorphic Disorder?

Research shows that both crooked mirror therapy and mirror retraining can help treat Body Dysmorphic Disorder (BDD). In crooked mirror therapy, patients view distorted images of themselves in curved mirrors, helping them gradually get used to exaggerated versions of their perceived flaws. Although the results are promising, studies have involved only a small number of participants.

Mirror retraining, by contrast, helps patients change their self-perception. It uses regular and magnifying mirrors to encourage patients to describe their appearance in more neutral terms. This method has helped some individuals view their looks more objectively.

Specific safety data for these therapies is limited. However, since they are based on cognitive-behavioral techniques already used for BDD, they are likely well-tolerated. More research is needed to fully understand their safety. These therapies focus on changing perception rather than using medication, which generally means a lower risk of side effects. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Crooked Mirror Externalization Therapy and the Mirror Retraining Method for Body Dysmorphic Disorder (BDD) because they offer unique approaches that differ from typical cognitive-behavioral therapy (CBT) and medication. Crooked Mirror Therapy uses distorted mirrors to exaggerate perceived defects, helping patients get used to and rethink their internalized body image. This externalization process can lead to a shift in how patients view their perceived flaws, which is a novel approach compared to standard treatments. Meanwhile, the Mirror Retraining Method uses ordinary and magnifying mirrors to help patients see their appearance in a more balanced way, challenging their habit of focusing solely on perceived flaws. This method aims to change negative self-evaluations into objective views, offering a fresh perspective in treating BDD.

What evidence suggests that this trial's treatments could be effective for Body Dysmorphic Disorder?

Research has shown that cognitive-behavioral therapy (CBT) can help reduce symptoms of Body Dysmorphic Disorder (BDD). In this trial, participants will join one of two treatment arms. One arm uses the mirror retraining method, which teaches patients to view their appearance more objectively, rather than focusing on perceived flaws. This approach has been linked to significant improvements in BDD symptoms. The other arm employs crooked mirror externalization therapy, which also uses CBT principles. It involves fun house mirrors to exaggerate perceived defects, helping patients adjust to their distorted self-image. Early research suggests this method succeeds, with most patients showing significant improvement. Both approaches aim to change how individuals see themselves and reduce distress about their body image. ^{1 2 3 5 6}

Who Is on the Research Team?

Eda Gorbis, PhD, LMFT

Principal Investigator

UCLA - DEPARTMENT OF PSYCHIATRY/BIOBEHAVIORAL SCIENCES

Are You a Good Fit for This Trial?

This trial is for adults aged 18-60 with Body Dysmorphic Disorder (BDD), as defined by the DSM-IV, who are English-speaking and have not changed their psychotropic medication recently. They must score above certain thresholds on BDD-specific assessments. People with primary OCD, depression, substance abuse issues or other psychiatric conditions like psychosis or bipolar disorder cannot join.

Inclusion Criteria

Meets DSM-IV criteria for BDD

IQ > 90

Baseline 3-item BDDDM score > 9

Exclusion Criteria

I do not have any severe psychiatric conditions.

I have been diagnosed with OCD, depression, or substance abuse.

Current suicidality

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Further Evaluation

Comprehensive psychiatric evaluation and physical assessment to confirm a primary diagnosis of BDD

1 week

1 visit (in-person)

Treatment

Participants undergo 3 weeks of CBT with either the mirror retraining method or the crooked mirror externalization therapy

3 weeks

15 visits (in-person)

Follow-up

Participants are monitored for changes in BDD symptoms and effectiveness of the treatment

4 weeks

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Crooked Mirror Externalization Therapy
• Mirror Retraining Method

Trial Overview The study compares two behavioral interventions for BDD: Mirror Retraining Method and Crooked Mirror Externalization Therapy. Participants will undergo three weeks of cognitive-behavioral therapy paired with one of these mirror-based techniques to see which is more effective at reducing BDD symptoms.

How Is the Trial Designed?

Group I: Crooked Mirror Externalization Therapy Experimental Treatment 1 Intervention

Of recent, the "crooked mirror" externalization therapy, developed by Dr. Eda Gorbis, has been put to use with much success (Gorbis 2004). This method involves the use of crooked or "fun house" mirrors made from highly reflective surfaces that can be bent in different directions, which distort and exaggerate the patient's perceived defects (Gorbis 2005). In turn, this process externalizes or reverses the patient's internalized distorted body image, and allows the patient to habituate to the reflection of the imagined defect that is even more distorted than the internalized image (Rosen et al. 1995).

Group II: Mirror Retraining Method Active Control 1 Intervention

In treating BDD, the cognitive-behavioral technique, "mirror retraining," uses ordinary and/or magnifying mirrors to amplify the supposed defect, which teaches patients to see their appearance in a more holistic way. Since BDD patients tend to only focus on their perceived flaws when looking in the mirror, and tend to think about their flaws in negative terms, in mirror retraining, patients learn how to change their negative evaluations of their appearance into more objective and nonjudgmental descriptions. Generally, this method is designed to intentionally exaggerate anxiety regarding appearance concerns through exposures with mirrors. However, using exclusively ordinary and/or magnifying mirrors does not address the internal distorted image that many patients with BDD experience (Rosen et al. 1995, Osman et al. 2004, Veale 2004).

Who Is Running the Clinical Trial?

Westwood Institute for Anxiety Disorders, Inc

Lead Sponsor

Trials

1

Recruited

20+

Published Research Related to This Trial

Individuals with body dysmorphic disorder (BDD) experience unique visual processing abnormalities that set it apart from other mental health disorders, indicating a need for tailored treatment approaches.

Current treatments like cognitive behavioral therapy (CBT) could be enhanced by incorporating perceptual mirror retraining and visual training programs to address these specific visual abnormalities, potentially improving treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment Modifications and Suggestions to Address Visual Abnormalities in Body Dysmorphic Disorder. Beilharz, F., Rossell, SL.[2020]

Citations

1. w.hope4ocd.com w.hope4ocd.com/downloads/gorbis_crooked0703.pdf

Crooked Mirrors: Externalization of Self Image in BDD A set of distortion mirrors made out of highly reflecting (anodized) aluminum surfaces bent in different directions is inexpensive and is easily concealed.

2. ctv.veeva.com ctv.veeva.com/study/study-of-patients-with-body-image-issues-treated-with-2-different-behavioral-interventions

Study of Patients With Body Image Issues Treated With 2 ... This method involves the use of crooked or "fun house" mirrors made from highly reflective surfaces that can be bent in different directions, ...

3. withpower.com withpower.com/trial/phase-3-body-dysmorphic-disorders-3-2007-3b18a

Behavioral Interventions for Body Dysmorphic Disorder What data supports the effectiveness of the treatment Crooked Mirror Externalization Therapy, Mirror Retraining Method for Body Dysmorphic Disorder?

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5566091/

Recent advances in understanding and managing body ... While these outcomes are encouraging, 46%–60% of BDD trial participants do not respond sufficiently to CBT, and remission rates are low.

5. semanticscholar.org semanticscholar.org/paper/Crooked-Mirrors-%3A-Externalization-of-Self-Image-in-Gorbis/ec848291f2ae0a9901420d2f5ab8fb3f10bac480

Crooked Mirrors : Externalization of Self Image in BDD Crooked Mirrors : Externalization of Self Image in BDD. @inproceedings ... Long Term Effects of Psychotherapy (Cognitive Behavioral Therapy Models) on Body ...

6. biomedres.us biomedres.us/fulltexts/BJSTR.MS.ID.000367.php

Long Term Effects of Psychotherapy (Cognitive Behavioral ... Gorbis [25] has reported success exposing patients to distorted images of themselves (i.e., using a curved mirror) while having them resist ...