title: Accept, distract, or reframe? An exploratory experimental comparison of strategies for coping with intrusive body image thoughts in anorexia nervosa and body dysmorphic disorder.
abstract: Negative body image is the hallmark of anorexia nervosa (AN) and body dysmorphic disorder (BDD). One aspect of body image, appearance-related thoughts, have shown to be a major contributor to relapse, thus further investigation of successful treatment strategies targeting these maladaptive thoughts are warranted. The present study tested an acceptance/mindfulness (AC), a cognitive restructuring (CR), and a distraction strategy with regard to their short-term effectiveness of reducing the frequency of thought occurrence and associated outcomes in participants with AN (n=20), BDD (n=21), and healthy controls (HC; n=22). Although all strategies led to a significant reduction of thought frequency, there was no group × strategy interaction effect in their reduction. Positive affect increased in the BDD group through the AC strategy, but decreased in healthy controls. Acceptance of the thought increased in the CR strategy in AN, whereas that strategy seemed to work least for BDD. Healthy controls showed most acceptance when using distraction. Taken together, the study suggests that all strategies might have their benefits and that it might be worthwhile further investigating differential indication of the strategies with regard to diagnosis and individual factors.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Hartmann
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Thomas
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Greenberg
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Rosenfield
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Sabine
authors.initials: S
authors.lastname: Wilhelm
mesh_terms: D064869:Acceptance and Commitment Therapy; D000223:Adaptation, Psychological; D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D001288:Attention; D057215:Body Dysmorphic Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D001828:Body Image; D015928:Cognitive Behavioral Therapy / Q000379:methods; D034201:Computers, Handheld; D005260:Female; D006801:Humans; D008297:Male; D064866:Mindfulness; D010552:Personality Assessment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acceptance; Anorexia nervosa; Body dysmorphic disorder; Body image; Cognitive restructuring; Distraction