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Cognitive Behavioral Therapy and Exposure and Response Prevention

Cognitive Behavioral Therapy (CBT) is considered the treatment of choice for BDD. Additional exposure and response prevention treatment, conducted at the same time, is seen as ideal. Since BDD is associated with maladaptive schemata, it could be considered quite beneficial to challenge existing beliefs and replace them with healthier and more rational ones-this is where the cognitive aspect of CBT comes in. A patient might complain to a therapist about complications in her life caused by a bumpy, long, and misshapen nose. The therapist would play the job of devil's advocate, questioning whether the nose is truly that deformed, could perhaps be seen in a more positive light, or if it really matters one way or another if a nose is attractive or not. Over time, the patient learns to tackle anxiety-provoking situations with a healthier outlook by analyzing her thinking process. She recognizes irrational thoughts while they are running rampant and can challenge them with rational, positive self-talk.

Exposure and Response Prevention is concerned with changing behaviors as well as the typical response to them. A patient might be asked to write up a hierarchal list of feared and avoided situations, and then select an item near the middle, which would provoke anxiety, but nothing severe enough to cause a BDD attack which could potentially lead to suicidal ideation. The patient is then coaxed to use his rational thinking, gained through cognitive techniques, and face the feared situation which, over time, will be seen in a much more realistic light and seem less threatening-this is known as habituation. Response prevention involves quitting ritualistic behaviors that were previously used by the BDDer to cope. For instance, if a patient is repetitively checking his reflection in the mirror for eight hours a day, the therapist might encourage him to cut down this time by half, until ultimately, it may be ceased altogether. Theoretically, the more practice a patient gets at preventing his usual response, the easier it becomes to avoid ritualistic behaviors.

One study which treated a variety of patients with both the aforementioned techniques found that experimental subjects faired remarkably better than the treatment-free control group. Although most subjects still felt rather unattractive, significant positive changes in cognitive functioning were observed-this was apparent by their decreased scores on the Overvalued Ideation Scale. Most treated patients felt less vulnerable to the scrutiny of strangers in public and also less distressed about their appearance concerns overall. Future studies are currently being planned to illustrate the usefulness of each therapeutic technique individually.


Additional Information on CBT and E&R Prevention
For an excellent, four part tutorial on using Cognitive Behavioral Therapy to battle BDD, visit the tutorials section on Dr. Burns' website!

Here is a link to another great website, dedicated to Cognitive Behavioral Therapy. You can learn more about its history, its uses, and find doctors near you that specialize in this type of therapy!