Appearance-related safety behaviors predict symptoms of body dysmorphic disorder following internet-based treatment.

Recent experimental evidence has found that appearance related safety behaviors (i.e., practices meant to avoid a perceived feared outcome) likely play a crucial role in maintaining symptoms of body dysmorphic disorder (BDD). The present study sought to determine if these behaviors predicted BDD symptom severity following treatment. Participants (N = 50) with BDD were randomized to either eight sessions of interpretation bias modification or progressive muscle relaxation. Both treatments led to reductions in BDD symptom severity and appearance-related safety behaviors, though moderate levels of safety behaviors persisted at both posttreatment and follow-up. Importantly, post-treatment appearance related safety behaviors significantly predicted BDD symptom severity at three-month follow-up. Taken together, the present findings suggest appearance related safety behaviors maintain BDD symptoms following effective computerized treatments and provide further evidence for their importance in the treatment of BDD.

Reliability and Validity of the Self-Report Version of the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder.

Despite its frequent use in research studies, the self-report version of the Yale-Brown Obsessive-Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS-SR) is yet to be formally validated. The present investigation sought to examine the psychometric properties of the BDD-YBOCS-SR across three different samples. In Study 1 (N = 847), we sought to explore the factor structure of the BDD-YBOCS-SR. In addition, we evaluated the convergent and divergent validity with similar self-report measures. In Study 2 (N = 187), the convergence of the BDD-YBOCS-SR with reactivity to an in vivo appearance-related task was observed. In Study 3, we compared scores on the BDD-YBOCS-SR between a clinical sample of individuals with BDD (n = 50) and a "healthy" control sample (n = 51). We further observed the BDD-YBOCS-SR's sensitivity to treatment and convergence with the rater-administered version in the clinical sample. The BDD-YBOCS-SR demonstrated strong psychometric properties across all three studies. Scores on the BDD-YBOCS-SR were found to be strongly associated with appearance anxiety, reactivity to the appearance task, and the rater-administered BDD-YBOCS. The present investigation provides support for the BDD-YBOCS-SR's utility in measuring body dysmorphic symptom severity for use in research and clinical settings.

A self-report assessment of appearance-related safety behaviours: Development and psychometric properties.

BACKGROUND: Individuals with appearance concerns may engage in maladaptive appearance-related safety behaviours aimed at checking, hiding or fixing perceived flaws in their appearance. AIMS: This investigation examined the psychometric properties of a newly developed measure of appearance-related safety behaviours across three different studies. METHOD: The first two studies utilized exploratory and confirmatory factor analysis, respectively, to understand the factor structure of the measure. The final version of the Appearance-Related Safety Behavior Scale (ARSB) consisted of 13 items and two subscales related to behavioural avoidance and appearance maintenance. RESULTS: Number of appearance-related safety behaviours was positively associated with body dysmorphic disorder symptomology and functional impairment, as well as social anxiety and eating disorder symptoms. The measure also demonstrated convergent validity with other appearance-related measures. Scores on the ARSB also predicted performance on an appearance-related behavioural task (time spent fixing appearance prior to having a picture taken). The third study found that scores on the ARSB were higher in a body dysmorphic disorder sample compared with healthy controls. Furthermore, change in scores on the ARSB was correlated with change in body dysmorphic disorder symptoms and impairment in a treatment study for body dysmorphic disorder. CONCLUSIONS: Clinical implications and potential uses of the measure as a clinical and research tool are discussed.

A Multimethod Analysis of Incompleteness and Visual "Not Just Right" Experiences in Body Dysmorphic Disorder.

Individuals with body dysmorphic disorder (BDD) often report engaging in repetitive behaviors aimed at reducing feelings of imperfection anchored to their appearance. "Not just right" experiences (NJREs) and incompleteness (INC) are constructs related to perfectionism that have traditionally been studied in obsessive-compulsive disorder, though recent research has also linked these phenomena to BDD. We sought to replicate and extend this research via two studies. Study 1 examined BDD symptoms, INC, as well as harm avoidance (HA) in an unselected sample (N = 179); moderate associations were observed between symptoms and both INC and HA. Participants also completed a novel visual NJRE task in which they were shown appearance-related and non-appearance-related images meant to evoke an NJRE response (i.e., discomfort and urge to "fix" stimuli). BDD symptoms predicted reactivity to appearance-related NJRE stimuli above negative affect. Study 2 compared INC, HA, and task reactivity in a BDD sample (N = 50) to nonpsychiatric controls (N = 44). The BDD group evidenced greater INC, HA, and reactivity to both appearance and nonappearance NJRE stimuli, relative to controls; however, group differences did not remain after controlling for age and negative affect. These studies broadly corroborate previous research highlighting NJREs and INC as potential vulnerability factors relevant to BDD, though these phenomena may not be specific to BDD symptoms.

Indices of change in exposure and response prevention for contamination-based OCD.

Few studies have examined indices of change in treatment for obsessive compulsive disorder (OCD). The current study evaluated within- and between-session trajectories of fear, disgust, and urge to wash in exposure and response prevention (ERP) for contamination-based OCD and tested whether change in these indices were associated with treatment outcomes. Forty-one participants (75.6% female) engaged in three sessions of ERP for contamination OCD. Participants provided ratings of fear, disgust, and urge to wash during each session, and contamination symptoms were assessed at pre- and post-treatment and two-week follow-up. Fear, disgust, and urge to wash all significantly decreased both within and between sessions. Both fear and disgust declined significantly faster than urge to wash within session, though declines in fear and disgust did not significantly differ from each other. Within-session changes in fear were significantly associated with reduced symptoms at post-treatment, whereas within-session changes in disgust were associated with symptoms at two-week follow-up. The current study highlights the roles of fear and disgust in the context of ERP as unique indicators of treatment outcome for contamination-based OCD. Only within-session fear was uniquely associated with treatment outcome at post, while within-session disgust predicted outcome at follow-up. Theoretical and clinical implications are discussed.

Text message safety behavior reduction for social anxiety: A randomized controlled trial.

OBJECTIVE: Cognitive models of social anxiety disorder propose that maladaptive safety behaviors (SBs; i.e., behaviors intended to avoid, prevent, or manage threat) play an important maintaining role in the disorder. Though targeting these behaviors for elimination is one component of contemporary cognitive-behavioral therapies for social anxiety, it has rarely been examined as a specific treatment strategy, and, to our knowledge, it has not yet been examined in isolation as an intervention for social anxiety. The current study evaluated an SB reduction intervention for social anxiety that consisted of brief text message reminders. METHOD: Individuals with elevated social anxiety (N = 94) were recruited from across the United States and randomized to receive one of two 1-month text message interventions consisting of 16 text message reminders to avoid SBs or focus on the present. Symptoms were assessed at pre- and posttreatment, as well as at 1-month follow-up. RESULTS: Both treatments were associated with substantial symptom reduction. Compared to the present-focused text message condition, SB elimination led to lower SB frequency at posttreatment (sr² = .044, p = .048) and lower social anxiety at follow-up (sr² = .096, p = .005). CONCLUSIONS: These preliminary findings provide novel evidence for the importance of SBs in social anxiety and suggest text message SB reduction may be an effective, highly accessible intervention for individuals with social anxiety. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Interpretation Bias Modification Versus Progressive Muscle Relaxation for Social Anxiety Disorder: A Web-Based Controlled Trial.

Computerized interpretation bias modification (IBM) programs show promise for the treatment of anxiety disorders, though they have rarely been compared to active treatments. The goal of the present study was to compare the efficacy of IBM to progressive muscle relaxation (PMR) for the treatment of social anxiety disorder (SAD). Sixty-four participants with SAD were recruited from across the United States and randomly assigned to 8 internet-delivered twice-weekly sessions of IBM or PMR. Participants were administered assessments of primary symptom outcomes and interpersonal suicide risk factors at posttreatment and 3-month follow-up. IBM led to significantly lower negative interpretation bias than PMR at posttreatment but not follow-up. Both conditions experienced comparable reductions in social anxiety from pretreatment to follow-up (IBM d = 1.37, PMR d = 1.28). They also experienced significant reductions in depression and general anxiety that did not differ from one another. Additionally, IBM led to greater reductions in thwarted belongingness than PMR at posttreatment but not follow-up. Overall, these findings suggest IBM is not more effective than PMR for reducing social anxiety, though there was some evidence of its superiority in decreasing suicide risk. Limitations and directions for future research are discussed.

Effects of safety behavior fading on appearance concerns and related symptoms.

OBJECTIVE: Appearance-related safety behaviors (SBs; e.g., mirror checking, grooming) have been implicated in body dysmorphic disorder (BDD), eating disorders, and social anxiety disorder. The proposed project aimed to extend previous research efforts by exploring the experimental effects of reducing engagement in appearance-related SBs on appearance concerns and related symptoms. METHOD: Eighty-four undergraduate female participants with elevated appearance concerns were randomly assigned to a SB fading group or a no instructions control group. For 2 weeks, participants in the SB fading condition were sent daily reminders via text message to decrease their engagement in appearance-related SBs, whereas participants in the control group completed assessments only. Self-report assessments of study variables of interest were administered at baseline, midmanipulation, postmanipulation, and 2-week follow-up. Participants also completed an appearance-related in vivo stressor task at post, during which participants rated their reactivity to having their photographs taken from various angles. RESULTS: Compared to the control group, the SB fading group exhibited significantly lower social anxiety, BDD symptoms, body dissatisfaction, and maladaptive cognitions at the postmanipulation and follow-up assessments. SB fading had stronger effects on BDD symptoms at postmanipulation among those high versus those low in baseline BDD symptoms. The SB fading group also showed less reactivity to some aspects of the in vivo appearance-related stressor task. CONCLUSIONS: This study provides strong evidence for the importance of appearance-related SBs in the maintenance of BDD and other disorders characterized by body image disturbances. Findings point to the potential utility of decreasing appearance-related SBs as a transdiagnostic treatment strategy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A multi-method analysis of incompleteness in behavioral treatment of contamination-based OCD.

Contamination fear and washing compulsions are among the most common symptoms of obsessive compulsive disorder (OCD). Though these symptoms have traditionally been viewed as being driven by a desire to avoid harm, recent research has highlighted the importance of feelings of incompleteness (INC) or not-just right experiences (NJREs) in this symptom dimension. However, no study to date has examined the extent to which INC/NJREs may be associated with treatment response for contamination symptoms. The current study used a multi-method approach to examine the role of INC/NJREs in treatment of contamination symptoms. Participants (n = 88) with elevated contamination symptoms, half of whom met for an OCD diagnosis, engaged in three sessions of exposure and response prevention (ERP) targeting contamination fears, and completed self-report and in vivo measures of INC/NJRES and contamination symptoms. ERP was associated with significant reductions in INC/NJREs. Further, changes in INC were associated with changes in contamination symptoms, independent of changes in harm avoidance. Greater discomfort in response to an in vivo NJRE task at pre-treatment predicted poor treatment response, though a self-report measure of INC did not predict response. These findings provide novel evidence for the importance of INC/NJREs in contamination-based OCD and its treatment.

An Internet-based controlled trial of interpretation bias modification versus progressive muscle relaxation for body dysmorphic disorder.

OBJECTIVE: The current study extended upon previous research efforts by evaluating the utility and feasibility of an 8-session Internet-based interpretation bias modification (IBM) training protocol targeting evaluation- and appearance-related threat biases characteristic of the disorder compared to a progressive muscle relaxation (PMR) condition for treatment of body dysmorphic disorder (BDD). METHOD: Fifty participants with BDD were recruited from across the United States and randomly assigned to eight sessions of either IBM or PMR. Assessments of interpretation bias, BDD symptoms, depression, and anxiety were administered at pretreatment, 1-week posttreatment, and 3-month follow-up. RESULTS: Compared to the PMR group, individuals in the IBM condition reported less negative/threat interpretation biases and greater positive/benign interpretation biases at posttreatment and follow-up. There were no significant differences between groups with regard to BDD symptoms, depression, or anxiety. Clinically significant improvement was common in both conditions (IBM = 64.0%; PMR = 52.0%), though it did not differ between them. CONCLUSIONS: Contrary to our hypothesis, IBM did not outperform PMR with regard to BDD symptom reduction, though both treatments yielded significant improvements on symptom outcomes. Findings suggest that IBM and/or PMR may be promising treatment strategies for BDD, perhaps adjunctively. Overall, these findings provide helpful future directions for IBM research and provide an additional lens through which to examine its potential effectiveness for BDD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An initial investigation of the unique relationship between disgust propensity and body dysmorphic disorder.

Disgust is a universal emotion that has received recent empirical attention for its potential role in various forms of psychopathology. We conducted two studies using varying methods to explore the relationship between disgust propensity, a construct related to obsessive-compulsive symptomatology, and symptoms of body dysmorphic disorder (BDD). Study 1 found a significant and unique (i.e., above and beyond co-occurring depression and anxiety) relationship between higher disgust propensity and more severe BDD symptoms, as measured by a standardized self-report and via an in-vivo task aimed at eliciting BDD-related concerns (N = 200). In Study 2, a clinical sample of individuals with BDD (N = 50) reported higher disgust propensity compared to mentally healthy controls (N = 36). This finding remained significant when controlling for depression and anxiety. Findings are the first to our knowledge to demonstrate a relationship between disgust propensity and BDD symptoms and provide directions for future research exploring the role of disgust in BDD.

My Child's thoughts frighten me: Maladaptive effects associated with parents' interpretation and management of children's intrusive thoughts.

BACKGROUND AND OBJECTIVES: Environmental factors explain substantial variance in youth's obsessive-compulsive symptoms (OCS) and much of this research has focused upon overt parenting behaviors (e.g., accommodation). No work, however, has examined how parents' internal processes (e.g., perception of children's intrusions) influence youth's OCS. Based upon the cognitive theory of obsessions, we propose that parents' misappraisal of children's intrusions as threatening will be positively associated with (a) the number of maladaptive intrusion management strategies recommended by the parent, as well as (b) children's obsessive beliefs, (c) interpretation biases, and (d) OCS severity. METHODS: Twenty-seven children (M = 12.81; SD = 3.43) and the parent most involved in childcare completed diagnostic interviews and self-report questionnaires. In the laboratory, we induced obsessional anxiety in youth through a standardized in vivo paradigm (e.g., think about a personalized harm-related negative event occurring). Parents rated how they interpreted their children's unwanted thought and the intrusion management strategies they would recommend. RESULTS: Parents who interpreted their children's intrusions as threatening recommended more maladaptive intrusion management strategies and their misappraisal positively and significantly correlated with the severity of children's obsessive beliefs, interpretation biases, and OCS, even after controlling for co-occurring internalizing symptoms. LIMITATIONS: Small sample and cross-sectional design precludes causal conclusions. CONCLUSIONS: Parents' misinterpretation of children's intrusions may operate as a mechanism by which OCS are generationally transmitted. Results can inform OC prevention programs that target parents' cognitive biases in their own psychotherapy.