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

20 Participants Needed

Trial Summary

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

Research shows that cognitive-behavioral therapy (CBT), which includes techniques like modifying intrusive thoughts and exposure to avoided situations, significantly reduces symptoms of body dysmorphic disorder (BDD). In one study, 82% of participants no longer met the criteria for BDD after treatment, and improvements were maintained at follow-up. ^{1 2 3 4 5}

Is mirror exposure therapy safe for humans?

Mirror exposure therapy, used to improve body image and satisfaction, has been shown to be beneficial for individuals with body dissatisfaction and eating disorders. However, some adverse events have been reported during clinical trials, indicating that while generally safe, there may be some risks involved. ^{6 7 8 9 10}

How does Crooked Mirror Externalization Therapy differ from other treatments for body dysmorphic disorder?

Crooked Mirror Externalization Therapy, which includes the Mirror Retraining Method, is unique because it specifically addresses the visual perception abnormalities in body dysmorphic disorder (BDD) by incorporating perceptual mirror retraining and self-exposure tasks. This approach targets the core issue of abnormal perception in BDD, which is often overlooked by standard cognitive-behavioral therapy (CBT) treatments. ^{1 4 5 7 11}

What is the purpose of this trial?

This trial uses special mirror exercises to help people who worry excessively about their looks. The treatment helps them see their appearance more realistically and reduces their anxiety.

Research Team

Eda Gorbis, PhD, LMFT

Principal Investigator

UCLA - DEPARTMENT OF PSYCHIATRY/BIOBEHAVIORAL SCIENCES

Eligibility Criteria

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

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)

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral body image therapy for body dysmorphic disorder. [2019]

2. England pubmed.ncbi.nlm.nih.gov

Modular cognitive-behavioral therapy for body dysmorphic disorder. [2021]

3. Germany pubmed.ncbi.nlm.nih.gov

[Body dysmorphic disorder. Epidemiology, clinical symptoms, classification and differential treatment indications: an overview]. [2018]

4. England pubmed.ncbi.nlm.nih.gov

Cognitive-Behavioral Therapy for Body Dysmorphic Disorder by Proxy. [2018]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral treatment of body dysmorphic disorder: a case report. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Modular cognitive-behavioral therapy for body dysmorphic disorder: a randomized controlled trial. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

A review of cognitive behavioral and pharmacological treatment of body dysmorphic disorder. [2018]

9. England pubmed.ncbi.nlm.nih.gov

Adjunctive mirror exposure for eating disorders: a randomized controlled pilot study. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Mirror exposure therapy for body image disturbances and eating disorders: A review. [2019]

11. United States pubmed.ncbi.nlm.nih.gov

Treatment Modifications and Suggestions to Address Visual Abnormalities in Body Dysmorphic Disorder. [2020]