Surprises as a mechanism of improvement in psychological treatment of body dysmorphic disorder in young people

Research and specific questionsBody dysmorphic disorder (BDD) is a common and impairing condition of adolescent onset, characterised by excessive appearance concerns, fear of negative evaluation and social withdrawal.

Cognitive behaviour therapy (CBT) is the recommended treatment for BDD, but up to half of the patients fail to respond to treatment, and we still know very little how the treatment works.This research proposal aims to answer what causal mechanisms underlie the improvement of BDD symptoms and how we can maximise the benefit of CBT for BDD.

Our hypothesis is that successful CBT for BDD induces positive surprises in social interactions, that is, the patient experiences social interactions that are better than they expected.We also argue that individuals with BDD are typically prevented from experiencing such positive surprises because of self-processing factors, i.e., actions they take to avoid anxiety and to monitor their physical appearance.

We therefore believe that the active ingredient of successful CBT for BDD is the manipulation of surprises and self-processing mechanisms.Data and methodThe study will be done in a tightly controlled experimental paradigm, which enables a direct manipulation of the suggested mechanism (surprises) and behaviours that may interfere with this mechanism (self-processing factors).

We aim to recruit 450 young people aged 14-24-years who experience elevated levels of BDD.Societal relevance and utilisationBDD is a disorder that can have devastating consequences for young people. Among those who manage to get access to treatment, many fail to respond sufficiently.

With a better understanding of what fundamental mechanism drives successful psychological treatments for BDD we can translate these insights back into clinically useful knowledge that is ethically viable and acceptable to young people.Plan for project realisationThe study will mainly be conducted at University College London (UCL) as part of a larger ongoing study on mechanisms in Cognitive Therapy funded with £3.2 Million by the Wellcome Trust (referred to as ‘the Surprise Study’).

Hence, the infrastructure for this project is already in place and I will work closely with the researchers who lead the Surprise Study.

Participants will be recruited from the community through established collaboration with schools, and advertisements online. The project is a collaboration between Karolinska Institutet and UCL, and funding is sought for three years.