'Not just right' experiences moderate the effects of interpretation training for individuals with body dysmorphic disorder

•Tested whether NJREs moderate the effect of computerized IBM training for BDD.•IBM led to lower BDD symptoms only among those low in pre-treatment NJREs.•NJREs did not moderate effects of condition on interpretation bias change.•Findings underscore the potential importance of NJREs to BDD phenomenology.•Elevated NJREs may represent a barrier to cognitively-oriented treatment for BDD.

Individuals with Body Dysmorphic Disorder (BDD) have a tendency to interpret ambiguous information in a negative or threatening manner. These individuals also report 'not just right' experiences (NJREs), or uncomfortable feelings of incompleteness/imperfection, which may represent a vulnerability factor distinct from interpretation biases (IBs) in their influence on BDD symptoms. We developed a computerized interpretation bias modification (IBM) training program that was effective in reducing BDD symptoms (Summers & Cougle, 2016). The current study examined whether pre-treatment NJREs would moderate the effects of IBM on IBs and BDD symptoms. Individuals with BDD (N = 40) were administered four sessions of IBM or a placebo control (PC) condition. Relative to PC, IBM led to lower BDD symptoms following treatment, though this effect was only present among individuals with low pre-treatment NJREs; individuals high in pre-treatment NJREs did not benefit from the intervention. NJREs did not significantly moderate the effects of condition on IBs, though the direction of these findings was similar. Pre-treatment depression and anxiety did not predict treatment outcome, suggesting specificity of NJREs as a moderator. Overall, findings suggest that individuals with BDD with high levels of co-occurring NJREs may not respond as well to IBM or other cognitively-oriented treatment approaches.