Neziroglu BDD Presentation Part 3

Jun 10, 2015 | Author: Bio Behavioral Institute

. Understanding Issues that may Interfere with Treatment

         Overvalued ideation

         Personality disorders

         Extent of avoidance behaviors


         Severity of Depression

         Lack of support system

         Family with psychiatric disorders

         Readiness for change

         Social anxiety

         Family criticism


26. Predictors of Treatment Outcome in BDD

·        Overvalued Ideation

·        OVIS is highly predictive of treatment outcomes for OCD and BDD

·        Personality Disorders

·        Extent of avoidance behaviors

·        Comorbidity

·        Severity of Depression

·        Lack of Support System

·        Family with Psychiatric depression

·        Readiness for change

·        Khemlani-Patel, S., Neziroglu, F., & Mancusi, L. M. (2011). Cognitive-behavioral therapy for body dysmorphic disorder: A comparative investigation. International Journal Of Cognitive Therapy, 4(4), 363-380. doi:10.1521/ijct.2011.4.4.363


27. BDD and Overvalued Ideation (OVI)

·        Characteristics of Overvalued Ideas:

·        Non-delusional conviction (The belief is not impossible nor alien).

·        Non-obsessional preoccupation. (The belief is experienced as natural rather than intrusive).

·        Nonphobic fear (The belief arouses uneasiness and apprehension rather than terror).

·        BDD should be classified with other disorders characterized by overvalued ideas.

·        High overvalued ideas need to be addressed prior to exposure.

·        The higher the OVI the poorer the prognosis.

·        Our values are derived from our beliefs.

·        Neziroglu, F., Stevens, K.P., McKay, D., Yaryura-Tobias, J.A. (2001).


28. Important Treatments Aspects in BDD

·        Engaging patient in therapy

·        Motivational interviewing

·        Assessing overvalued ideation

·        Assessing severity of depression

·        Evaluating core and specific beliefs and values

·        Hypothesis testing

·        Rabinowitz, D., Neziroglu, F., & Roberts, M. (2007). Clinical application of a behavioral model for the treatment of body dysmorphic disorder. Cognitive And Behavioral Practice, 14(2), 231-237. doi:10.1016/j.cbpra.2006.03.001


29. CBT For BDD: How is it Different than CBT for OCD?

·        Body Image Component

·        Higher levels of Depression

·        Higher levels of Overvalued Ideation

·        More personality disorders

·        More difficult to engage in treatment

·        Takes longer

·        Neziroglu, F., McKay, D., Yaryura-Tobias, J. A., Stevens, K. P., & Todaro, J. (1999). The Overvalued Ideas Scale: development, reliability and validity in obsessive–compulsive disorder. Behaviour research and therapy, 37(9), 881-902.


30. Appropriate Treatments for BDD

·        Exposure and Response Prevention

·        Cognitive Therapy

·        Psychopharmacological Treatment

·        Support Groups

·        Family Involvement


31. Assessment, Engagement, Treatment

1.      Assessment

2.      Engage the patient in treatment plan

3.      Treat

4.      Often have to switch between the three modules in BDD for several sessions


32. Strategies to Engage the Patient

·        Psychoeducation

·        Family Intervention

·        Targeting Quality of Life Issues

·        Stressing Impairment Due to Symptoms

·        Providing Alternative Treatment Approaches

·        Telephone contact or e-mail instead of in office visits

·        Alternate treatment settings (e.g. car, office, patient’s home)


33. Conceptualization of BDD

·        Do not describe BDD as an imagined defect

·        Discuss BDD as a preoccupation and discuss the distress experienced as a result of BDD

·        Discuss the difference between the way the patient feels about their appearance and what others say about their appearance

·        Validate the patient’s experiences and feelings associated with the BDD (e.g. feelings of disgust)

·        Careful with term “acceptance” or “coping” which can be interpreted as resigning oneself to be ugly 


34. Case Study

·        Bill, a 28 year old single male diagnosed with Body

·        Dysmorphic Disorder

·        Main Concern: hair loss

·        Problem Solving Attempts: Bill has made multiple visits

·        to various doctors for his hair loss problem, he has spent

·        hundreds of dollars on hair products, such as thickening

·        shampoos and hair growth treatments

·        Impairments: Bill refuses to leave the house without a hat. He no longer goes to get haircuts, but trims his own hair in the privacy of his bathroom.

·        Dysfunctional Beliefs/Cognitive Distortions: He believes that

·        his hair loss makes him less worthy than other men, thus he

·        will never find a girlfriend or get married, never get a high

·        paying job, and never be accepted by his family like his siblings

·        because no one will ever be able to look past his imperfection


35. Initial Stages: Cognitive Strategies

·        Address Readiness for Change

·        Target Depression and/or Suicidal Ideation

·        Motivational Interviewing to Patients who are Reluctant to Continue Treatment

·        Stress the degree of dysfunction and suffering

o       The therapist will discuss with Bill the ways in which his preoccupations are impacting his daily life and personal relationships with friends and family


36. Cognitive Strategies: Targeting BDD Symptoms

·        Target Cognitive Distortions or Faulty Beliefs (Beck/ Ellis Modalities work well)

         The therapist will identify Bill’s irrational beliefs related to his preoccupation with his hair. For example, ‘Looking good will protect me from being treated badly’

·        Hypothesis Testing/Collaborative Empiricism

                     Take patient’s photograph and collect ratings of attractiveness. The therapist may have Bill look at a photo of himself and rate his attractiveness on a scale from 1-10


37. Faulty Beliefs- Cognitive Distortions Examples

·        I need to be perfect

·        I need to be noticed

·        If I feel that my body part is unattractive, it means that it looks unattractive

·        If my body part is not beautiful, then it must be ugly

·        If I looked better, my whole life would be better

·        Happiness comes from looking good


38. Four Ways To Challenge Beliefs For BDD

·        What is the evidence that supports or contradicts this belief?

·        Are there any other ways to interpret this situation?

·        Realistically, what is the worst thing that could happen in this situation and how would it honestly affect my life?

·        Even if the negative belief is warranted, what can I realistically do to help remedy the situation?

·        Geremia, G. M., & Neziroglu, F. (2001). Cognitive therapy in the treatment of body dysmorphic disorder. Clinical Psychology & Psychotherapy, 8(4), 243-251. doi:10.1002/cpp.284


39. Cognitive Therapy: Targeting Values on Appearance

·        Targeting value of appearance may be an important component of preventing relapse

·        Methods to Target Values and Attitudes



         Pie-Chart of Important Values


40. Behavioral Component of BDD

·        Mirror checking/ avoiding

·        Excessive grooming

·        Excessive usage of skin or hair products

·        Reassurance seeking

·        Camouflaging

·        Skin picking

·        Repeated checking of body part

·        Do It Yourself Surgery


41. Behavioral Activation

·        Make detailed contextual functional analysis of what your patient is avoiding or process of ruminating

·        Gradually structure day and timetable activities from avoidance hierarchy and act according to valued directions rather than a feeling

·        Focus on process of cognitive avoidance/ ruminate

·        Review homework and agree on agenda

·        Therapist is empathic coach

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