Neziroglu BDD Presentation Part 5

  1. Acceptance and Commitment Therapy
  • ACT- a form of cognitive-behavioral therapy based on Functional Contextualism (Hayes, 1999), and Relational Frame Theory (Hayes, Barnes-Holmes, & Roche, 2001).
  • Functional Contextualism examines a behavior in its context and examines the function.

 

  1. Different from Cognitive Therapy
  • ACT is different in that it does not attempt to use any strategies to alter thoughts or feelings.
  • No disputation
  • No generating rational alternatives
  1. Cognitive Defusion
  • I am depressed”.
  • Person has fused with the label “depressed” and now identifies with the label.
  • A defusion exercise targeting this particular thought could be asking the individual to say, “I am having the experience of being depressed.”
  • In ACT, the therapist attempts to help the individual change the way they view, react to, and interact with thoughts and feelings.
  • Most of the time, an individual with BDD has repeatedly responded to intrusive thoughts in maladaptive ways, ACT teaches that one can respond differently without changing the form or content of the intrusive thought.
  1. Mindfulness
  • Hayes et al (2006) describe this as, “on-going non-judgmental contact with psychological and environmental events as they occur.”
  • Mindfulness exercises are used to introduce this skill and aide the person in practicing acceptance of thoughts and feelings.60. Self as a Context
  • Define context vs. content
  • We are not our thoughts
  • This process allows the person to see that the self can experience many events but is never defined by these events.This allows for more cognitive defusion and acceptance.

 

  1. Values Clarification
  • Values
  • “chosen qualities of purposeful action that can never be obtained as an object but can be initiated moment by moment” (Hayes et al, 2006)
  • values will serve as guides by which to live by and will lead the individual to committed action.

 

  1. Committed Action
  • ACT asks the individual to create more flexible and more abundant patterns of behavior in the service of chosen values.
  • The goal is to live according to one’s values rather than live in the service of reducing anxiety leading to a more meaningful existence.

 

  1. Why ACT?
  • Increase willingness to experience unwanted thoughts or images
  • Reduce belief in overvalued ideas
  • Increase motivation to engage in treatment

 

  1. Directions For The Future…
  • There is a need for more controlled treatment outcome studies for individuals with BDD
  • In specific, research should focus on what is most effective in treatment (e.g., number of participants, duration, frequency of therapy sessions)
  • Group vs. Individual Therapy
  • Whether CT or ERP alone yields greater gains in treatment
  • The role of overvalued ideation (OVI) and insight
  • OVI is higher in individuals with BDD, more likely to believe their defects in bodily appearance are realistic (McKay, 1997)
  • There is little research on treatments (medication, CT or ERP) for patients with higher OVI and poor insight as opposed to individuals with lower OVI
  • More research is needed to learn whether OVI severity affects treatment outcome when BDD patients are treated with medication as well as CT/ERP (would the addition of another component result in treatment gains?)
  • Another area of research which holds promise for the treatment of BDD is the role and extent to which cerebral networks play in somatosensory deficits
  • Teaching BDD patients to shift from detail-oriented to a global/ holistic approach may be effective in the reduction of BDD symptoms (obsessions and compulsions)

 

  1. Conclusions
  • BDD is similar to OCD but some treatment strategies differ.
  • Engagement in treatment is crucial but difficult
  • Engagement needs to focus on functional impairment
  • Medications are often used along with CBT
  • Some perceptual differences exist between individuals with BDD and controls.