Acceptance and Commitment Therapy

Addressing Shame in Body Dysmorphic Disorder: A Promising New Approach 

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Body Dysmorphic Disorder (BDD) is a severe mental health condition characterized by an obsessive focus on perceived flaws in one’s appearance, often leading to significant distress and impairment in daily functioning. While Cognitive Behavioral Therapy (CBT) has been the gold standard treatment for BDD, many individuals do not respond adequately to this approach. Recent research suggests that shame plays a critical role in the development and maintenance of BDD symptoms. Therefore, targeting shame directly may enhance treatment outcomes for those suffering from this debilitating disorder. 

In a pioneering study published in Behavior Modification, a team of researchers including Jason Luoma PhD, from Portland Psychotherapy, developed and tested an innovative therapeutic approach that combines Acceptance and Commitment Therapy (ACT) with compassion-focused approaches to address shame in individuals with BDD. This approach, called ACT with Compassion (ACTwC), is designed to reduce shame and self-criticism while increasing psychological flexibility and self-compassion. 

The Role of Shame in BDD 

Shame is a powerful emotion that involves seeing oneself as fundamentally flawed and unworthy. In BDD, this emotion is often tied to the perceived defects in one’s appearance, driving behaviors such as excessive mirror checking, comparing oneself to others, and social avoidance. These behaviors not only reinforce the negative self-view but also contribute to the persistence and severity of BDD symptoms. Research has consistently shown that higher levels of shame are associated with worse outcomes in BDD, including greater symptom severity, lower quality of life, and higher rates of depression. 

Despite the clear link between shame and BDD, traditional CBT does not specifically target shame, focusing instead on changing maladaptive thoughts and behaviors. The researchers recognized this gap and sought to create a treatment that would directly address the underlying shame fueling BDD symptoms. 

The ACT with Compassion Approach 

ACT with Compassion (ACTwC) integrates the principles of ACT, which encourages individuals to accept difficult emotions and commit to actions aligned with their values, with compassion-focused elements. The treatment protocol developed by the team involves 12 individual therapy sessions, each about 60 minutes long, delivered over weeks. 

The intervention includes psychoeducation about BDD and shame, mindfulness training, and experiential exercises designed to foster self-compassion and psychological flexibility. Patients are encouraged to confront and accept their feelings of shame rather than avoiding them, and to develop a kinder, more compassionate relationship with themselves. 

Promising Results from the Pilot Study 

The pilot study conducted by the researchers involved five participants diagnosed with BDD. The results were encouraging: four of the five participants showed significant reductions in BDD behaviors and self-criticism by the end of the treatment. Moreover, three participants reported decreases in body-related shame, and these improvements were maintained at a six-month follow-up. 

In addition to reductions in shame and self-criticism, participants experienced significant improvements in overall BDD symptoms, depressive symptoms, and quality of life. The treatment was well received, with participants rating it as highly credible and expressing satisfaction with the therapy. 

Implications for Future Treatment 

The findings from this study suggest that ACT with Compassion could be a promising new approach to treating BDD, particularly for individuals who struggle with intense shame and self-criticism. By directly targeting these underlying emotional drivers, this approach may offer a more effective treatment option for those who have not responded to traditional CBT. 

As with any new therapeutic approach, further research is needed to confirm these findings and to refine the treatment protocol. Larger, randomized controlled trials will be necessary to establish the efficacy of ACTwC compared to other treatments. However, the initial results are promising and suggest that this approach could help improve the lives of individuals suffering from BDD. 

You can find an open access version of this article here. 

The Newest Study Supported by Portland Psychotherapy: Helping People with the Stigma of Injection Drug Use and HIV in Russia

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Stigma is a pervasive problem that can negatively impact healthcare outcomes for those affected by it. Stigmatized groups, such as people living with HIV who inject drugs, can face many barriers to care that stem from societal attitudes toward their condition. HIV and substance use stigma, when combined, can lead to further avoidance of care and poor health outcomes.

The findings from the SCRIPT (Stigma Coping to Reduce HIV Risks and Improve substance use Prevention and Treatment) study were recently published. This study was conducted by Karsten Lunze, MD, of Boston University Medical School, in collaboration with Jason Luoma, the CEO of Portland Psychotherapy. This study aimed to test an intervention developed by Dr. Luoma to help people cope with intersectional HIV and substance use stigma. The research studied people with HIV who inject drugs, who often face significant barriers to accessing care due to both HIV and substance use stigma.

To develop the intervention, the research team modified an Acceptance and Commitment Therapy (ACT) approach to target people with HIV who inject drugs. ACT is a type of cognitive-behavioral therapy that focuses on accepting difficult emotions and thoughts rather than trying to eliminate them. By teaching people how to cope with stigma through acceptance-based approaches, the study aims to reduce the link between internalized attitudes, fears, and shame, and healthcare avoidance behaviors.

The SCRIPT study aimed to evaluate the intervention’s effects on HIV and substance use stigma, care engagement, and injection drug use frequency. The study will also assess the intervention’s implementation by looking at participant satisfaction, intervention fidelity, and uptake.

The study found that people who received the intervention were more likely to start HIV and substance use treatment than those who did not receive the intervention. The increase in care engagement may be due to the fact that the intervention helped people to cope with stigma and reduced their avoidance of healthcare settings. The intervention was not designed to directly reduce shame and fears related to stigma, but rather focused on helping people to cope with stigma and improve their behavior and care seeking.

The implications for practice are that acceptance-based approaches can be effective in reducing stigma and improving care engagement in people with HIV who inject drugs. Healthcare providers should be trained to recognize and address intersectional stigma in their patients and use interventions that incorporate acceptance-based approaches to reduce stigma’s negative impact.

Portland Psychotherapy’s involvement in this study exemplifies the organization’s commitment to using its resources to address societal problems. By supporting research that aims to improve healthcare outcomes for stigmatized populations, Portland Psychotherapy is helping to make a positive impact on the community.

New Acceptance and Commitment Therapy Resources for the Public

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At Portland Psychotherapy, for years we’ve been maintaining a list of the best ACT resources for the public that we know about. We have links to video, self help courses, meditation recordings, apps, and much more. I recently went out and searched the web for additional Acceptance and Commitment Therapy (ACT) resources to update our … Read more

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