Seeing in the Mind's eye: Imagery rescripting for patients with body dysmorphic disorder. A single case series

• Imagery rescripting reduced negative affect, distress, vividness and encapsulated beliefs for five BDD patients at post and follow-up.
• A significant 26% improvement in BDD severity was found for the whole group at follow-up.
• Four of six patients were treatment responders.
• A significant 24% reduction in depressive symptoms was observed for the whole group at follow-up.
• Future controlled studies with larger sample sizes are needed to confirm the efficacy of imagery rescripting in BDD.

BackgroundIntrusive images of appearance play an important role in the maintenance of body dysmorphic disorder (BDD) and are often linked to negative autobiographical experiences. However, to date there is no study examining the use and efficacy of imagery rescripting in BDD.MethodThis study investigated imagery rescripting in six patients with BDD, using a single case series A–B design. The intervention consisted of two treatment sessions (T1, T2). BDD and depressive symptoms were evaluated prior to (T1), post (T2) and two weeks after intervention (FU), using the Yale -Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS), the Body Dysmorphic Symptoms Inventory, and the Beck Depression Inventory.ResultsAt post-treatment, significant reductions in negative affect, distress, vividness and encapsulated beliefs associated with images and memories as well as an increased control were observed for five of six patients. These were maintained or decreased at two weeks follow-up. Scores on the BDD-YBOCS indicated a significant 26% improvement in BDD severity at follow-up for the whole group. Considering response as a ≥30% reduction in BDD-YBOCS score, four of six patients were classified as treatment responders. At follow-up, significant improvements in BDD and depressive symptoms were observed for the whole group.LimitationsThe small sample size and the lack of a control group limit the generalizability of our results.ConclusionsThe findings indicate the potential efficacy of imagery rescripting, and highlight the need for further controlled trials. Imagery rescripting should be considered as a treatment technique within the cognitive framework of BDD.