Intervention
compassion-focused
The treatment, ACTwC, was designed to target shame and self-criticism and
increase self-compassion, psychological flexibility, and quality of life in
patients suffering from BDD. A manual to guide each treatment session was
developed based on integrating research on BDD with theory and techniques from
ACT and compassion-focused therapies (see The intervention consisted of 12 individual therapy sessions, around 60 minutes
each; including psychoeducation on the treatment concepts (e.g.,
conceptualization of BDD from an ACT and compassion perspective); building
skills in present-centered, nonjudgmental awareness, especially of one’s own
suffering (e.g., through basic mindfulness training); experiential exercises
(aiming at fostering self-compassionate self-talk, defusion, acceptance, and
perspective taking abilities); training in acknowledging, eliciting, and
regulating previously avoided emotions of shame (e.g., exposure to internalized
shame through chair-work-techniques); practicing self-compassion in response to
shame and self-criticism and promotion of value-guided actions in daily
life.Treatment was delivered by three clinical psychologists with previous experience
in treating BDD patients. The first author, with expertise in BDD treatment,
developed the treatment manual in collaboration with experts in ACT, treated two
of the patients and also supervised the other two therapists weekly. Before
delivering treatment, the therapists received approximately 3 hours of training
in the manual. All treatment sessions were audio-recorded for weekly supervision
and therapist adherence to the treatment manual. Sessions were divided into
10 minute modules that were chosen randomly for adherence checks. Adherence to
the session content and structure as well as therapist adherence to ACT and
compassion principles were evaluated by the treatment developer using a
predefined adherence manual (available on request). Adherence level was rated as
either sufficient, or not sufficient. The majority of the modules (90%) was
judged as having been conducted in a sufficient manner.