Cognitive Behavioral Therapy For BDD
Cognitive Behavioral Therapy For BDD
Jamie Feusner (Psychiatrist, Professor, UCLA) gives expert video advice on: How is 'cognitive-behavioral therapy' effective in treating BDD?; Is there evidence cognitive-behavioral therapy works in treating BDD?; What are the goals of cognitive-behavioral therapy in treating BDD? and more...
How is 'cognitive-behavioral therapy' effective in treating BDD?
So cognitive behavior therapy is a type therapy that addresses two things , it has a cognitive component and a behavioral competent. The cognitive component in helps people restructure there thoughts, so if they have thoughts that are not logical or dysfunctional in some way it helps them to be able to identify them and change them in to more rational thought. The behavior component then addresses a lot of the compulsive behaviors in people with BDD do that make their disorder worse ,so it helps them gradually cut down on like the mirror checking, helps them gradually decrease avoidance by going out, and so they can desensitized to the negative they get and likewise become more functional.
Is there evidence cognitive-behavioral therapy works in treating BDD?
There is evidence that cognitive-behavioral therapy can work for treating BDDs. There have been studies of both individual and group therapy. These are controlled studies where they compared them to a controlled type of treatment and they have been found to be effective for BDD.
What are the goals of cognitive-behavioral therapy in treating BDD?
Well the goals really are to be able to improve functionality. I think that some people going into the treatment think, is this going to make me think that I'm attractive? Is this therapy going to help me think that I'm not ugly? And that may happen, but it really is not the primary goal. The primary goal is to get somebody more functional and to think about appearance less in general, and what often follows is they feel better about themselves. In my experience with people they don't always change how they percieve their appearance, but they feel better about themselves overall and they understand that it is less of an important part of one's total being.
What techniques are used to treat BDD?
Within cognitive behavioral therapy, then there's cognitive techniques and behavioral techniques. And the cognitive techniques are about helping a person identify some of the dysfunctional thoughts they have or irrational thoughts and restructuring them, which means changing them to see a little bit more rational viewpoint. And the behavioral component of the treatment can have different parts to it one of them is to do what's called response prevention or ritual prevention and that's decreasing gradually the compulsive behaviors that they do that make the behavior worse so decreasing their mirror checking, spending less time getting ready to leave in the morning things like that. Another technique that we use behaviorally are called behavioral experiments and that's where somebody for example if they have the idea that when I'm around other people they tend to look away from me because they think that I'm ugly. And so you might help somebody setup an experiment where you say well let's test that out if that's really true because it could be that what they're doing is they're not making eye contact or they leaving this situation and they never find out. So the experiment is to go to that party and stay there and observe people and see if it's really true that everybody's turning their eyes away. And then you can maybe disconfirm your previous beliefs.
What are some of the unhealthy thought patterns associated with BDD?
Some of the common unhealthy thought patterns people have are: number one, that they have something different about their appearance. Another major category is that appearance is of utmost importance to everybody in society. And another one is that my value is based on my appearance. Those are kind of general categories of dysfunctional thoughts that most people have.
How can cognitive therapy help me overcome BDD?
The thing about cognitive behavioral therapy that makes it different that helps people with BDD I think, is that it is not just about talking about it. It is actually about actively doing something to change the way you think and change your behavior. And so cognitive behavioral therapy is really successful when the person is doing homework. They have got to be doing some work on their own between sessions to everyday practice restructuring their thoughts because these things don't change quickly. One has to keep practicing doing them. Some of the tools that we use cognitively are number 1 to help them even identify where are some of these thoughts. In identifying them they are able to take a step back and observe how they are thinking rather than just being awash in their thoughts like their reality. And so taking a step back and saying, "I am thinking I am not feeling attractive today. Is that reality or is that my thought?" Just being able to identify and then identify whether there is some dysfunction thinking like, for example, wow that's a very all in one way of looking at it. People are either gorgeous or they are ugly. What about everybody in between. Identifying what kind of distortion they are thinking they are having and then coming up with an alternative thought like what is more rational. What's more rational is I may not be the most attractive person in the world. I am somewhat in the middle. I am certainly not the least attractive person in the world.
How do my beliefs affect my emotions and BDD?
The emotions are very much tied into the thoughts that they have about their appearance and about themselves. And so, because people with BDD really hold these convictions that they're defective, that their appearance is ugly, that nobody's going to love them... this affects their emotions. They'll often feel depressed, they'll feel ashamed, they'll feel hopeless about it, and it's very hard for the emotions to change because they hold those convictions so strongly.
Can substituting habits or rituals help in BDD?
Whenever you take away a behavior there's got to be something to replace it otherwise that same behavior is just going to keep coming back. So what we help people do is, for example, instead of avoiding going out we help them replace that with some activity they can do that's healthy, that makes them feel good about themselves, and an example might be instead of spending two hours a day on the internet researching cosmetic procedures, if you spend - first of all starting with spending less time and replace that with, say, going for a coffee with a friend or going to the gym.
What is the goal of behavioral experiments?
The goal of behavioral experiments is to test their belief about somebody. So even though they're called behavioral experiments they're really both combining a cognitive component, which is their beliefs or thoughts about something with a behavioral kind of testing. And so the goal is to say, well, you think that people will run away from you because you're so ugly, well why don't we test that out. And instead of avoiding and being house bound why don't you do going out for an hour of being around other people and see what happens. And then they can actually test out that belief; do people run away from you because they're so ugly?
Does the BDD patient get support during this behavioral experiments?
They are always more effective when there are therapists who will actually do it with the patient if they can. And so that's the thing about cognitive behavioral therapy. It's very active and interactive, and so the therapist hopefully will actually be able to go out with you maybe on some initial times and to troubleshoot and also offer support and help you stay in the situation rather than leaving it which then reinforces your beliefs.
I don't want to do behavioral experiments - Are they really necessary in my treatment?
Behavioral experiments are difficult to do. All the behavioral therapy is difficult to do, because it really involves changing doing things that in the short term have made you feel better and so by not doing those, you are going to feel a little bit worse, to begin with. But they are really, really essential because these behaviors, if they are not changed, they will just keep your thoughts ingrained the same way that they are and will keep you dysfunctional. But they absolutely have to change for you to get better.
How does social interaction help people with BDD?
Well, it's necessary for people with BDD to increase their social interaction because they've been usually avoiding other people for so long. So, they need to be around other people to 1) disconfirm their beliefs about how other people are reacting to them, and then 2) to actually start engaging in developing quality relationships and building on other things rather that they can feel good about, like being a friend or helping somebody.
What is 'mirror retraining'?
Mirror retraining is a technique. This was actually developed by Dr. Wilhelm at Harvard and she noticed that people seemed to have distortions in how they see their appearance and they also seemed to label their appearance with very emotionally laden terms. They go through and look in a mirror and describe what they see in more objective terms and it also helped them probably see things differently in more of a context. So, for example, by looking at the whole face and not just one part of the face then they can see that OK, this is how it fits in and it is this size in relation to my eyes, let's say, and that size is actually smaller.
How many therapy sessions will it take before I feel better?
People often wonder with BDD how soon are they going to start feeling better in therapy. And it's really different from person to person. Usually people don't feel better immediately. It is a process that really does have to evolve and it takes place over the course of many months and sometimes years.
Why isn't therapy improving my BDD?
Well, there can be a lot of reasons why therapy may not working and one is that if a person has expectation that it's going to start working right away. That is probably not be realistic. Sometimes therapy may not work for BDD because perhaps the therapist doesn't have as much experience with it and is not perhaps given the right techniques to do. Another may be that the person themselves are not following through on some of the assignments that they are doing and it is understandable because they are difficult assignments. But if they do none of them then they are not likely to get better. Just coming once a week or even twice a week and sitting in an office is not going to do it.
Are there any therapies other than cognitive behavioral therapy that work for BDD?
Everybody propagandizes light different approach and for some people con-behavioral therapy maybe the most appropriate. For other people that seem the BDD other types of therapy maybe be effective, and for, even other people maybe that doing con-behavioral therapy first be very helpful and decreasing, the behavior, kind of normal functional addressing symptoms and then second dynamic approach maybe helpful later on do addressing the course she is one covered.
Will I need therapy for BDD all my life?
Hopefully not, hopefully people don't have to stay in therapy all their life. It's really different person to person how long they'll need therapy. But I believe the goal of therapy should be to have the symptoms improve, address the underlying issues that may be fuelling the symptoms, become more functional and then graduate from therapy.