Cognitive Behavioral Therapy Archives

Body Dysmorphic Disorder – Cognitive Behavioral Therapy – Exposure Worksheet

November 4, 2012 By Stephen

Here is the exposure worksheet I adapted from Feeling Good about the Way You Look: A Program for Overcoming Body Image Problems.

I have included an example of a completed CBT exposure worksheet below as well.

I hope to complete some of these exercises on line over the next several weeks. If you happen upon this post feel free to do one of these exposure worksheets with me in the comments section. I will be happy to help.

Exposure Worksheet – Cognitive Behavioral Therapy for BDD

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Completed Exposure Worksheet Sample – Cognitive Behavioral Therapy for BDD

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I you haven’t already, please read and follow the guidelines from Feeling Good about the Way You Look: A Program for Overcoming Body Image Problems.

It is an amazing book that I recommend along with counseling. It may work well alone if you are highly motivated and organized!

Hopeful – Using Cognitive Behavioral Techniques to Test My Body Image Concerns

November 4, 2012 By Stephen

After last nights depressing, over-tired post, today turned out to be a good day.

I have been going to church again, mostly for the kids, so that they may know God and understand that somebody may have their back in the bad times, and the good ones.

This has helped me through my BDD, and I figure it is best that they have God’s love to guide them as well.

Going to church helped to get me out of the house, my bedroom and my mind. Writing here on this blog is a lonely outlet, at the end of the day the only way to overcome my BDD is in the presence of others.

It is among others that I can prove (or more likely disprove) my many skin concerns.

Today, sitting in church, in full light, close to people, I could see that no one cared. My facial scar in full view may or may not have caught the attention of others who, in all honesty, seemed to care less. They were more concerned about what I had to say, and I am more concerned about what they have to say.

I feel good when I am out, yes I feel anxious, and yes, I feel self conscious but, at the end of the day, being out and about always has a positive net effect on my attitude.

I stayed after church to sit and write in the open air cafe, afterwards I attended a waffle party with some families that attend my daughters school. One of the dads commented on how he hadn’t seen me around (my daughter just started Kindergarten in October) and I made up some sorry excuse about late nights at work.

Honestly, there is no reason to tell others of my body image concerns. I know my wife was happy to see me there, as were my kids.

Face your Fear and it will Disappear?

My fears have not disappeared But today, out and about, at church, at a party, out on the bike, this afternoon, I started to feel better.

It is hard to believe how I can be on the edge of destruction one moment, and feeling so good the next. This is the nature of the beast when it comes to body dysmorphic disorder. My moods rise and fall like the ocean tides.

Moral of the story: Getting out and being around people is a known cure for depression which, I have along with my BDD. The Lexapro hasn’t seemed to help as much as I would have liked, but then again I need to increase my dose but haven’t been able to in fear of (believe it or not) what the pharmacist will think. This is incredibly irrational and is further proof why I shouldn’t be treating and prescribing for myself.

I skipped my first counseling session this week because I am a coward, and I was tired of talking about my scar.

I wrote a lot here and started to work a bit more on my art. I spent time with my children, I took my wife out on a date, I did avoid the mirrors and I had my wife take the one down at the front door… The last one I see as I head out of the house, it has been known to change my attitude pretty quickly.

My wife continues to be an amazing support of my BDD . She doesn’t give me a bad time about some of my avoidance rituals. She seems to understand what I am going through right now, I am so thankful for that.

I am exhausted, but I made some positive steps this week. My facial scar is hurting me today, I am not sure how much of that is in my mind. But maybe it is because I stretched it today, I showed it to the world, I overcame some fears. And I lived to see another day.

Cognitive-Behavioral Strategies for Improving Insight in Body Dysmorphic Disorder

November 2, 2012 By Stephen

Here are several cognitive-behavioral strategies that are described by the San Francisco Bay Area Center for Cognitive Therapy to improve insight into your BDD

Self-Monitoring

I ask the individual to monitor how his BDD symptoms vary over time. Every hour he rates (0-10) how strongly he believes, for example, that his nose is too large. He also notes what was happening at the time and how he was feeling. We then plot on graph paper the strength of the person’s belief, where 10 is “my nose is too large” and 0 is “my nose is fine.” Sometimes seeing his belief fluctuate by the hour helps the client recognize that he can’t always trust his view of himself.

Cognitive Restructuring

Individuals with BDD have distorted beliefs about their appearance, such as “I have to look perfect,’ or, “If I don’t look good, I’ll be rejected and alone.” Teaching individuals to identify and restructure these distorted beliefs can sometimes help the person gain enough insight to try other bognitive-behaviroal strategies.

Cognitive Distancing

Individuals with BDD have difficulty accepting that they have BDD because that would mean their appearance is okay. One young man who told me session after session that he did not have BDD. What he had was a left ear that was lower than the right ear. He insisted that only plastic surgery would correct the problem.

I commiserated with him and said that plastic surgery was certainly a logical solution to the problem of a true flaw in his appearance but that it was not a solution to BDD. The problem as I saw it was that every time his BDD flared up he bought into the belief that his appearance was flawed. I then taught him a cognitive distancing strategy described by Jeffrey Schwartz in his book titled Brain Lock: Free Yourself from Obsessive-Compulsive Behavior.

Schwartz describes the 4 Rs. I’ll cover the first three here. The first R is “relabel.” The client was taught to relabel any concern, thought, or belief about his appearance as a feature of the BDD, not proof of a physical flaw. He was then to use the second R (reattribute) to attribute every aspect of his experience (his thoughts, feelings, urges, and behaviors) to the BDD. He was then instructed to refocus (3rd R) or distract himself from the BDD thoughts.

An “as if” Attitude

At times I have asked a client to act “as if” he looks okay even if he doesn’t believe it. An “as if” attitude is particularly helpful when trying to get a client to try an exposure exercise that, because of his poor insight, he believes is useless.

I’ve asked clients to use the “as if” attitude to stay at a party when they have a strong urge to leave, to go to social situations when they are inclined to remain home alone, or to stop looking in a mirror when they feel that they must continue. One of my clients used this strategy to go to a party that he wanted to avoid by acting “as if” he was okay and “as if” going to the party would help his BDD and his depression. Once at the party, he was able to use his CB strategies to manage his BDD and that as the evening progressed, he was much less worried about his appearance.