Treatment of Body Dysmorphic Disorder with cognitive therapy and task concentration training: six case studies

Patients with Body Dysmorphic Disorder (BDD) are preoccupied with an imagined
defect in their appearance or, in the case of a slight physical anomaly, the
concern is markedly excessive. Furthermore, the patient is hindered in his/her
social and/or occupational functioning and are the symptoms not better
accounted for by any other disorder (like an eating disorder).
At present, cognitive-behavioural therapy for BDD focuses on changing
irrational cognitions. Next, exposure techniques are applied to help decrease
excessive avoidance and control behaviour. However, it seems logical to also
directly deal with the self-focused attention that is so obviously present in
the disorder.
In former studies on maintaining mechanisms and treatment of social phobia and
fear of blushing, it became evident that Task Concentration Training (TCT; a
technique in which the patient is taught to redirect his/her attention more
external and less towards him/herself) was successful in reducing anxiety and
avoidance.

The aim of this study is to investigate the effectiveness of TCT in addition to
cognitive therapy, for patients with BDD. This is done at first by 6 single
case studies, after which a longer treatment project will be submitted. The
case studies are varied; they all receive 5 sessions of TCT at some moment (2
patients receive 5 sessions in the beginning, 2 patients receive 5 sessions in
the middle, and 2 patients receive 5 sessions at the end of the treatment).
This way, it can be investigated whether adding 5 sessions of TCT to CT is
effective in treating patients with BDD, and it can be examined whether it
matters in what phase TCT is introduced.

6 patients diagnosed with Body Dysmorphic Disorder according to the DSM-IV
(SCID-I interview) will participate in this research. The research takes the
form of a series of single case experimental designs.

The intervention consists of 15 sessions; In 10 sessions cognitive therapy is
done and in 5 sessions Task Concentration Training (TCT) is given. The 5 TCT
sessions will be given either at the beginning, in the middle or at the end of
treatment.
Two patients per variant will be participating.

Patients will take part in measurements during 7 hours (distributed over 6
moments in time and spread over 1,5 jaar). These measurement mainly concern
filling out questionnaires. Furthermore, patients take part only once in an
interview about personality disiorders (duration 1-2 hours).
There is a 5-week baseline period before the start of the therapy, in which the
patient makes daily registrations about several variables. In general, there
will be a waiting-list before the start of therapy and this will be filled with
the baseline period.