The researchers aimed to assess the effectiveness of a single session of imagery re-scripting (ImR) in people with body dysmorphic disorder (BDD) whose body-image concerns were deemed to be related to emotional memories. The researchers reported inclusion criteria (e.g. a diagnosis of BDD) and exclusion criteria (e.g. cormorbid psychosis) but did not report excluding any participants.
A single-case experimental-design was used, with randomisation of six participants to different baseline durations. Following data collection during the baseline phase, participants were given a control intervention which involved them talking about a difficult memory. Data collection continued for 14 days, at which point, the ImR intervention was administered. Data was collected for a further seven days and again at follow-up (at three months and six months).
Using a daily record sheet, participants rated (on scales from zero to 100) their degree of preoccupation, distress and checking behaviour (related to their BDD) and the extent to which they believed their difficulties were psychological. During the different phases of the study, participants also completed the Yale–Brown Obsessive Compulsive Scale modified for BDD (BDD-YBOCS) and the Beck Depression Inventory (BDI) to assess their severity of BDD and depression, respectively.
The authors hypothesised that the intervention would result in significant improvements in the primary outcome measures (the daily measures of preoccupation and distress). They reported an additional aim was to assess the effectiveness of the intervention on the other outcomes.
Daily data was plotted in graphs and analysed visually and statistically (using the Tau-U test to examine the degree to which the data overlapped between phases of the study). BDD-YBOCS and BDI data was analysed for reliable and clinically-significant change using established procedures. For four participants, the intervention had a significant improvement on the primary outcomes and on checking behaviour and psychological interpretation. Their BDD-YBOCS scores showed a reliable improvement and a clinically-significant improvement at six months. Three had BDI scores that showed a reliable improvement; one of which was clinically-significant. The authors concluded the findings were promising but noted limitations with the study (such as the absence of integrity checks).
The study was unique in assessing the effectiveness of ImR in people with BDD and produced some encouraging findings that should encourage further research. A strength was that the authors considered the theoretical mechanism of action of the intervention and matched this to a specific population: people with BBD who experience imagery linked to emotional memories. However, it was not clear how the researchers concluded there was an association between each participant’s emotional memories and his or her BDD presentation. In addition to improving replicability, further consideration of this association could have shed further light on the mechanism of action of ImR by informing ideographic data collection. For example, if a participant experienced shame when recalling a memory of being bullied about their appearance (and the authors judged this was relevant to their BDD), the participant might have wished to monitor his or her sense of shame to know whether this changed following the intervention.