Perceptual Training Techniques for Body Dysmorphic Disorder

Overseen By Research Analyst

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Centre for Addiction and Mental Health

Must not be taking: Psychotropic medications

Disqualifiers: Bipolar, Psychotic, Neurological, Pregnancy, others

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

Compensation: Varies

Number of Visits: 2

Duration: 1 week

146 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores new techniques to help people with body dysmorphic disorder (BDD) manage their self-perception. It focuses on the face or head area, using methods like attention modulation (also known as attentional retraining) and naturalistic viewing to study changes in perception. The goal is to understand how these techniques can improve insight and reduce delusional thinking in BDD. Suitable participants have concerns about their appearance related to their face or head, are not currently on medication, and have not recently undergone cognitive-behavioral therapy. As an unphased trial, this study offers a unique opportunity to contribute to groundbreaking research that could lead to new ways of managing BDD.

Will I have to stop taking my current medications?

Yes, participants must be medication-free for at least 8 weeks before joining the trial, except for certain short-term medications for insomnia or anxiety, which have specific usage limits.

What prior data suggests that these perceptual training techniques are safe for individuals with body dysmorphic disorder?

Research shows that certain training techniques, such as focusing exercises, may help treat body dysmorphic disorder (BDD). For instance, a study with 40 individuals with BDD found that a specific type of training improved their symptoms, suggesting these techniques might be easy to manage.

People with similar conditions, like social anxiety, have also benefited from these focusing exercises, indicating they could be safe for BDD as well.

Another method, involving visual exercises, was tested in a small study. This study implemented a 10-week program and found it manageable, indicating it might not cause major side effects.

A different technique, called naturalistic viewing, is still under investigation, and direct safety data is not yet available. However, because it involves simply observing, it is likely to be safe.

Overall, while direct safety data is limited, these techniques aim to change how people see and focus on things without invasive procedures, suggesting they might be safe options for those with BDD. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these perceptual training techniques for Body Dysmorphic Disorder (BDD) because they offer a fresh approach compared to current treatments, which often rely on medication and cognitive behavioral therapy. The techniques—attentional modulation, perceptual modulation, and naturalistic viewing—are unique as they aim to directly alter how individuals perceive their own bodies. This could lead to more immediate and lasting changes in body image perception, potentially improving symptoms faster than traditional methods. By focusing on changing perception rather than just managing symptoms, these techniques might offer more personalized and effective solutions for those struggling with BDD.

What evidence suggests that this trial's treatments could be effective for body dysmorphic disorder?

This trial will compare different perceptual training techniques for Body Dysmorphic Disorder (BDD). Research has shown that certain training techniques can improve BDD symptoms by altering visual perception and attention. Participants may receive attentional modulation, which changes how the brain connects visual parts and affects eye movement when viewing faces. Another group will receive perceptual modulation, which has shown promise in helping individuals with BDD view their appearance more positively. Additionally, some participants will engage in naturalistic viewing, involving real-world images, which may reinforce changes made during training. Together, these methods aim to adjust how the brain processes visual information, potentially reducing BDD symptoms. ^{6 7 8 9 10}

Who Is on the Research Team?

Jamie D Feusner, M.D.

Principal Investigator

Centre for Addiction and Mental Health

Are You a Good Fit for This Trial?

This trial is for individuals aged 18-40 with Body Dysmorphic Disorder (BDD) or subclinical BDD, focused on facial concerns. Participants must meet specific criteria on the Dysmorphic Concern Questionnaire and be medication-free for at least 8 weeks. Healthy controls with low scores on the same questionnaire can also join. Exclusions include other major mental disorders, current psychotherapy, neurological issues, pregnancy, certain medical conditions affecting brain function, and visual acuity worse than 20/35.

Inclusion Criteria

I am 18-40, have intense concern about my face or head's appearance, and haven't taken medication for it in 8+ weeks.

I am 18-40, worried about my face or head appearance, and haven't taken any related medication for 8 weeks.

Exclusion Criteria

Healthy Controls: Participants with any current Axis I disorder, lifetime bipolar disorder or psychotic disorder, or psychiatric medication

I have body dysmorphic disorder but no bipolar, psychotic disorders, or current CBT.

All participants: Participants with neurological disorders, pregnancy, current major medical disorders affecting cerebral metabolism, current risk of suicide with a plan and intent, ferromagnetic metal implantations or devices, and visual acuity worse than 20/35 for each eye

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Participants undergo baseline assessments including fMRI, eye-tracking, and emotional valence measurements

1 week

1 visit (in-person)

Treatment

Participants receive visual modulation techniques to assess changes in perceptual functioning and brain activity

1 week

Multiple sessions (in-person)

Follow-up

Participants are monitored for changes in perceptual functioning and brain activity post-treatment

1-2 weeks

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• attentional modulation
• naturalistic viewing
• perceptual modulation

Trial Overview The study examines how people with BDD process visual information about appearance and tests if attentional and perceptual modulation techniques can alter this processing. It aims to understand the brain's role in these distortions and develop new treatment approaches based on retraining perception.

How Is the Trial Designed?

Group I: perceptual modulation Experimental Treatment 1 Intervention

Group II: naturalistic viewing Experimental Treatment 1 Intervention

Group III: attention modulation Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

Centre for Addiction and Mental Health

Lead Sponsor

Trials

388

Recruited

84,200+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

University of Toronto

Collaborator

Trials

739

Recruited

1,125,000+

University of Alabama at Birmingham

Collaborator

Trials

1,677

Recruited

2,458,000+

Published Research Related to This Trial

Individuals with body dysmorphic disorder (BDD) show greater in-the-moment threat interpretation biases and discomfort during social interactions compared to nonpsychiatric controls, as demonstrated through virtual reality (VR) scenarios involving 25 participants in each group.

The study highlights the potential of VR technology to identify and measure these biases in real-time, suggesting it could be a valuable tool for developing more effective treatments for BDD by targeting maladaptive interpretation processes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A virtual reality study of cognitive biases in body dysmorphic disorder. Summers, BJ., Schwartzberg, AC., Wilhelm, S.[2021]

Participants with high body image concern (BIC) showed a significant local processing bias, accurately discriminating inverted body images better than those with low BIC, suggesting a potential risk factor for developing body dysmorphic disorder (BDD).

This local processing bias was more pronounced under conditions of longer stimulus presentation and higher discrimination difficulty, indicating specific parameters that could be targeted in future interventions to help reverse this perceptual abnormality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parameters of visual processing abnormalities in adults with body image concerns. Dhir, S., Ryan, HS., McKay, EL., et al.[2019]

A study involving 37 unmedicated adults with body dysmorphic disorder (BDD) found that a behavioral strategy of modulated viewing, where participants focused on a central point of their face, led to longer visual fixation durations and improved brain connectivity in visual processing areas.

This enhanced connectivity persisted even during naturalistic viewing, suggesting that this technique could help retrain visual perception in individuals with BDD, potentially aiding in the development of effective treatments for their perceptual distortions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neural and behavioral effects of modification of visual attention in body dysmorphic disorder. Wong, WW., Rangaprakash, D., Diaz-Fong, JP., et al.[2022]

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]

Imagery rescripting (ImR) was tested as a brief intervention for body dysmorphic disorder (BDD) in a study involving six individuals, focusing on their aversive memories related to appearance.

Four out of six participants showed significant improvement in their BDD symptoms within the first week after the ImR intervention, suggesting that this technique may be a promising addition to cognitive-behavioral therapy for BDD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Imagery Rescripting for Body Dysmorphic Disorder: A Multiple-Baseline Single-Case Experimental Design. Willson, R., Veale, D., Freeston, M.[2019]

A study involving 74 participants found that higher body image concern (BIC) scores correlated with better accuracy and faster reaction times in recognizing inverted face and body stimuli, suggesting a local visual processing bias that may serve as a marker for body dysmorphic disorder (BDD).

The research demonstrated that this local processing bias can be temporarily reversed by inducing a global processing focus, indicating potential therapeutic strategies for treating individuals with high BIC or BDD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Altering Visual Perception Abnormalities: A Marker for Body Image Concern. Beilharz, FL., Atkins, KJ., Duncum, AJ., et al.[2020]

Individuals with body dysmorphic disorder (BDD) exhibit significantly increased visual attention to perceived flaws in their own faces and in unfamiliar faces, indicating a specific attentional bias associated with the disorder.

In a study involving 60 participants (20 with BDD, 20 with social phobia, and 20 mentally healthy individuals), only those with BDD demonstrated heightened attention to imagined defects, supporting the cognitive-behavioral model of BDD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Selective attention to imagined facial ugliness is specific to body dysmorphic disorder. Grocholewski, A., Kliem, S., Heinrichs, N.[2022]

In a study involving 40 individuals with body dysmorphic disorder (BDD), interpretation bias modification (IBM) training significantly improved benign interpretation biases and reduced threat biases compared to a placebo control, leading to greater reductions in BDD symptoms.

The benefits of IBM were particularly pronounced in individuals with higher pre-treatment BDD symptoms, and these effects were largely maintained one month after treatment, suggesting that IBM may be an effective intervention for managing BDD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Modifying interpretation biases in body dysmorphic disorder: Evaluation of a brief computerized treatment. Summers, BJ., Cougle, JR.[2018]

Citations

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Adjunct Therapy Strategies for the Treatment of BDD ▫ Attentional Training & Task Concentration originally designed for social anxiety. ▫ Control attention regardless of emotional state or surroundings.