Patel Tapan A, Cougle Jesse R
Florida State University.
Florida State University.
Behav Ther. 2025 Mar;56(2):352-365. doi: 10.1016/j.beth.2024.05.010. Epub 2024 Jun 5.
Appearance concerns are a key feature in body dysmorphic disorder and eating disorders, and they have been found to be a common feature of social anxiety disorder. Given the lack of transdiagnostic treatments for appearance concerns, we developed a preliminary text-based intervention targeting appearance-related safety behaviors (ARSBs; i.e., maladaptive behavioral strategies that seek to mitigate the feared consequences of the evaluation of appearance). The intervention utilized a daily text-message protocol where individuals are asked to fade their behaviors, provided encouragement, and log ARSB use in the past day. We evaluated the efficacy of ARSB fading in two successive cohorts of women with elevated appearance concerns (Study 1 N = 38, Study 2 N = 39). We found that across both studies participants experienced large reductions in appearance concerns (d = .93-1.36) and eating disorder symptoms (d = 1.06-1.20) that were maintained 1 month after treatment. Further, participants experienced small-to-medium reductions in social anxiety (d = 0.38-0.58) and depression (d = 0.52-0.96) from pre- to posttreatment. Notably, there were missing data in both studies (31%-50%), but multiple imputation was used to observe stability of effects. We also collected and incorporated feedback on the treatment to optimize the treatment before conducting the second trial. While these changes did not lead to significant differences in study outcomes, the second cohort demonstrated greater adherence to treatment and found the treatment to be more credible than the first cohort. Further, we found that greater baseline ARSBs predicted greater pre- to follow-up changes in appearance concerns. Taken together, text-based ARSB fading appears to be a promising treatment, and further research on the treatment appears warranted.
外表担忧是身体变形障碍和饮食失调的一个关键特征，并且已被发现是社交焦虑障碍的一个常见特征。鉴于缺乏针对外表担忧的跨诊断治疗方法，我们开发了一种基于文本的初步干预措施，旨在针对与外表相关的安全行为（ARSBs；即试图减轻对外表评估的恐惧后果的适应不良行为策略）。该干预措施采用每日短信协议，要求个体减少其行为，给予鼓励，并记录过去一天中ARSB的使用情况。我们在两个连续的外表担忧程度较高的女性队列中评估了ARSB减少的效果（研究1，N = 38；研究2，N = 39）。我们发现，在两项研究中，参与者的外表担忧（d = 0.93 - 1.36）和饮食失调症状（d = 1.06 - 1.20）都有大幅减少，且在治疗后1个月仍保持。此外，从治疗前到治疗后，参与者的社交焦虑（d = 0.38 - 0.58）和抑郁（d = 0.52 - 0.96）有小到中度的减少。值得注意的是，两项研究中都存在缺失数据（31% - 50%），但使用了多重填补法来观察效果的稳定性。我们还收集并纳入了对治疗的反馈，以便在进行第二次试验前优化治疗。虽然这些改变并未导致研究结果出现显著差异，但第二个队列显示出对治疗的更高依从性，并认为该治疗比第一个队列更可信。此外，我们发现更高的基线ARSB预示着外表担忧从基线到随访有更大的变化。综上所述，基于文本的ARSB减少似乎是一种有前景的治疗方法，对该治疗方法的进一步研究似乎很有必要。
