Study of Patients With Body Image Issues Treated With 2 Different Behavioral Interventions (BDD)

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2011 by Westwood Institute for Anxiety Disorders, Inc
Sponsor:
Information provided by:
Westwood Institute for Anxiety Disorders, Inc
ClinicalTrials.gov Identifier:
NCT01316627
First received: March 7, 2011
Last updated: March 14, 2011
Last verified: March 2011
  Purpose

Body Dysmorphic Disorder (BDD) is a disabling condition that until recently has been largely ignored. Sufferers of BDD worry excessively and unreasonably about some flaw in their appearance that may be minimal or even nonexistent. These internalized body image distortions prompt sufferers to constantly check the perceived defects in mirrors, seek reassurance of their images from others, obtain unnecessary cosmetic and/or dermatological procedures, and even conduct self-surgeries. These obsessive concerns and compulsive behaviors cause significant emotional distress and often significantly interfere with global functioning. Currently, cognitive-behavioral therapy (CBT) in conjunction with psychopharmacology is the preferred treatment for BDD. In addition, two relatively new exposure techniques ("mirror retraining method" and "crooked mirror externalization therapy") that utilize mirrors to exaggerate the patient's imagined defect appear to increase the benefits of CBT. However, the treatment efficacies of these relatively novel methods have not been rigorously tested or methodologically compared. Although six out of seven patients treated with crooked mirror externalization therapy at the Westwood Institute for Anxiety Disorders, Inc. demonstrated significant gains, the small sample size does not allow for any significant generalizations. Thus, the goals of this project are: 1) to determine the efficacy of exposure therapy that utilizes mirrors in the treatment of BDD, and 2) to evaluate the level of effectiveness of the mirror retraining method versus the crooked mirror externalization therapy. To accomplish these goals, each subject taking part in the study will do the following. They will go through an in-depth interview with the study physician, Dr. Kagan, and complete several clinical assessment questionnaires to confirm that they have BDD according to the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV). They will be assessed by the study independent evaluator and complete several paper-and-pencil tests to determine the severity of the BDD and if they have any cognitive difficulties. The subject will participate in 3 weeks of CBT with either the mirror retraining method or the crooked mirror externalization therapy. After the CBT, we will repeat the clinical assessment questionnaires and neurocognitive testing. From the difference between the before and after scores on all these tests, we will determine if there has been any change in the subject's BDD symptoms, and if so, the level of effectiveness between the mirror retraining method and the crooked mirror externalization therapy.


Condition Intervention Phase
Body Dysmorphic Disorders
Behavioral: Crooked Mirror Externalization Therapy
Behavioral: Mirror Retraining Method
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Single Blind (Subject)
Primary Purpose: Treatment
Official Title: Crooked Mirror Externalization Therapy for Body Dysmorphic Disorder

Resource links provided by NLM:


Further study details as provided by Westwood Institute for Anxiety Disorders, Inc:

Primary Outcome Measures:
  • Measure of change in the presence and severity of BDD before and after treatment [ Time Frame: Day 1 and at 1 month ] [ Designated as safety issue: No ]
    Body Dysmorphic Disorder Modification of the Y-BOCS (BDD-YBOCS); Phillips et al. 1997: A 12-item questionnaire designed to assess for the presence and severity of BDD symptoms.


Secondary Outcome Measures:
  • Measure of change in the presence and type of BDD symptoms before and after treatment [ Time Frame: Day 1 and at 1 month ] [ Designated as safety issue: No ]
    Body Dysmorphic Disorder Examination - Self Report (BDDE-SR); Rosen & Reiter 1996; Rosen & Ramirez 1998: A self-report questionnaire that assesses for preoccupation with and negative evaluation of appearance, self-consciousness, embarrassment, excessive importance given to appearance in self-evaluation, avoidance of activities, body camouflaging, and body checking.


Estimated Enrollment: 20
Study Start Date: April 2007
Estimated Primary Completion Date: December 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Crooked Mirror Externalization Therapy
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).
Behavioral: Crooked Mirror Externalization Therapy
After subjects complete the pre-treatment assessments, the study therapist will meet with participants to design their treatment program. Treatment will be conducted every day for 15 days, Monday through Friday, for 90-minute sessions. In addition, as a part of therapy, subjects will complete homework assignments daily. Intensive CBT for BDD is done in the form of Exposure and Response Prevention (ERP) with either the mirror retraining method or the crooked mirror externalization therapy. This involves prolonged and repeated exposures to images of the perceived defects, and prevention of ritualistic behavior (e.g., camouflaging with cosmetics, skin-picking, etc.).
Other Name: Intensive Cognitive-Behavioral Therapy
Active Comparator: Mirror Retraining Method
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).
Behavioral: Mirror Retraining Method
After subjects complete the pre-treatment assessments, the study therapist will meet with participants to design their treatment program. Treatment will be conducted every day for 15 days, Monday through Friday, for 90-minute sessions. In addition, as a part of therapy, subjects will complete homework assignments daily. Intensive CBT for BDD is done in the form of Exposure and Response Prevention (ERP) with either the mirror retraining method or the crooked mirror externalization therapy. This involves prolonged and repeated exposures to images of the perceived defects, and prevention of ritualistic behavior (e.g., camouflaging with cosmetics, skin-picking, etc.).
Other Name: Intensive Cognitive-Behavioral Therapy

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age 18-60
  • Meets DSM-IV criteria for BDD
  • Baseline 12-item BDD-YBOCS score >15
  • Baseline 33-item BDDE score > 99
  • Baseline 3-item BDDDM score > 9
  • IQ > 90
  • English-speaking
  • No changes in psychotropic medication during or 12 weeks prior to study

Exclusion Criteria:

  • No medical contraindications
  • No co-morbid psychiatric contraindications (psychosis, bipolar disorder, Tourette's or other tic disorder, panic disorder, PTSD, ADHD, anorexia nervosa, bulimia)
  • Current suicidality
  • Primary diagnosis of OCD, depression, or substance abuse
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01316627

Contacts
Contact: Eda Gorbis, PhD, LMFT 310-443-0031 edagorbis@yahoo.com

Locations
United States, California
Westwood Institute for Anxiety Disorders, Inc. Recruiting
Los Angeles, California, United States, 90024
Contact: Eda Gorbis, PhD, LMFT    310-443-0031    edagorbis@yahoo.com   
Sub-Investigator: Jenny C Yip, PsyD         
Principal Investigator: Eda Gorbis, PhD, LMFT         
Sponsors and Collaborators
Westwood Institute for Anxiety Disorders, Inc
Investigators
Principal Investigator: Eda Gorbis, PhD, LMFT UCLA - DEPARTMENT OF PSYCHIATRY/BIOBEHAVIORAL SCIENCES
  More Information

No publications provided

Responsible Party: Eda Gorbis, PhD, UCLA PSYCHIATRY/BIOBEHAVIORAL SCIENCES
ClinicalTrials.gov Identifier: NCT01316627     History of Changes
Other Study ID Numbers: IRB#G06-05-061-04
Study First Received: March 7, 2011
Last Updated: March 14, 2011
Health Authority: United States: Institutional Review Board

Keywords provided by Westwood Institute for Anxiety Disorders, Inc:
Body Dysmorphic Disorder (BDD)
Cognitive Behavior Therapy (CBT)
Obsessive Compulsive Disorder (OCD)
Mirror Retraining
Crooked Mirror Externalization Therapy

Additional relevant MeSH terms:
Disease
Body Dysmorphic Disorders
Pathologic Processes
Somatoform Disorders
Mental Disorders

ClinicalTrials.gov processed this record on September 18, 2014