Jeffrey T. Reiter

Cognitive-behavioral body image therapy for body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a distressing body image disorder that involves excessive preoccupation with physical appearance in a normal appearing person. Prior case reports of behavior therapy were encouraging, but no controlled evaluation of behavior therapy or any other type of treatment had been conducted. In the present study, 54 BDD subjects were randomly assigned to cognitive behavior therapy or no treatment. Patients were treated in small groups for eight 2-hour sessions. Therapy involved modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. Body dysmorphic disorder symptoms were significantly decreased in therapy subjects and the disorder was eliminated in 82% of cases at posttreatment and 77% at follow-up. Overall psychological symptoms and self-esteem also improved in therapy subjects.

Cognitive behavior therapy for negative body image in obese women

Negative body image is a major concern of overweight persons, yet current obesity treatment programs have not addressed this problem. In the present study, 51 obese women were randomly assigned to cognitive behavioral body image therapy (CBT) or no-treatment. Patients were treated in small groups for 8 two-hour sessions. Therapy included information to challenge negative stereotypes of obesity, modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. No assistance was provided to change eating or exercise behaviors. CBT subjects showed significantly improved body image. Psychological symptoms, self-esteem, overeating, and eating guilt also improved. Weight was unchanged for most subjects and unrelated to treatment outcome overall.

Assessment of body image in eating disorders with the Body Dysmorphic Disorder Examination

The Body Dysmorphic Disorder Examination (BDDE) has several advantages for the assessment of body image in eating disorder patients. It measures distressing self-consciousness, preoccupation with appearance, overvalued ideas about the importance of appearance to ones self-worth, and body image avoidance and checking behaviors. The BDDE is relevant for any type of appearance complaint and is not limited to weight or body shape concerns. The BDDE measures the useful targets for body image therapy. In a sample of eating disorder patients, the Body Dysmorphic Disorder Exam had good internal consistency and was significantly correlated with other measures of body image. It added new information to the discrimination of women with eating disorders from clinical and nonclinical controls beyond that provided by other measures of body image.

Prescription Drug Abuse in Primary Care

The abuse and misuse of controlled substances (mostly opioids, but to a lesser extent benzodiazepines and stimulants) is a serious public health problem that is commonly encountered in primary care. Concerns about controlled substances include the potential for abuse, misuse, tolerance, and diversion, as well as iatrogenic effects. Long-term effectiveness of these substances is also not established. However, PCPs often feel pressure to prescribe them. This chapter provides an overview of the opioid abuse epidemic, including the scope of the problem and the roots of it, and also provides essential information about the properties of the various controlled substances.

Behavioral Consultation and Primary Care: The “Why Now?” and “How?”

The primary care system has been labeled the “de facto mental health-care system” of the country. Primary care providers (PCP) supply about half of the nation’s psychiatric care, but also routinely see patients who have psychiatric and/or substance abuse disorders that go untreated. Patients with other behaviorally influenced problems such as lifestyle-based somatic complaints, subthreshold syndromes, preventive care needs, and chronic diseases also present throughout the day in primary care. Yet, with brief visits, multiple demands per visit, and insufficiently trained staff and providers, primary care is poorly equipped to deal with these problems.

The Right Book at the Right Time

Perhaps the best way to summarize the new book from Christopher Hunter, Jeff Goodie, Mark Oordt, and Anne Dobmeyer, Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention, is to label it the right book at the right time. This important addition to the growing library of primary care behavioral health (PCBH) texts does more than inform and assist those mental health professionals working in primary care. It also, by its very nature, represents the evolution of the PCBH field.

Examples of Consultations With Older Adults

The greatest challenges of aging well are those related to mastery of the art of losing. As we age, we lose friends, family members, some physical and mental abilities, economic earning power, and activities basic to independent functioning, such as driving. Unfortunately, our society does little to prepare its members for these experiences or to link them to activities that use the strengths of aging, such as wisdom and ample leisure time. Further, many health care reimbursement policies effectively work against the values of our senior citizens (such as remaining in their homes, maintaining contact with their friends, and being able to afford medications that help them preserve health). It’s no wonder that as many as one in four adults experience mental health problems in old age.

An Overview of Primary Care Behavioral Health Consultation

For a number of years, we worked in traditional specialty mental health care (MH) settings. Like most MH providers, we worked hard, kept up on clinical innovations, and had the best interests of our clients at heart.We most certainly had clients who progressed and many who appreciated our assistance.However, we couldn’t help but wonder what happened to clients who didn’t show for follow-up appointments. On a typical day we and our co-workers would have seven clients scheduled, of which two or three wouldn’t show.What happened to the no-shows? Were they still struggling? Why didn’t they come in? Further, we felt frustrated that by the end of the day we might have only seen a handful of clients (many of whom were the same clients seen week after week). Thus, how many people were we really helping? First-time clients often failed to show as well, which was frustrating because the wait list was typically lengthy. We rationalized that a “noshow” meant the client probably wasn’t ready for change. Yet, the questions also nagged of whether the wait might have deterred the client, and how the client was doing if he or she wasn’t getting care from us.

Cognitive-behavioral body image therapy for body dysmorphic disorder: Correction.

Body dysmorphic disorder (BDD) is a distressing body image disorder that involves excessive preoccupation with physical appearance in a normal appearing person. Prior case reports of behavior therapy were encouraging, but no controlled evaluation of behavior therapy or any other type of treatment had been conducted. In the present study, 54 BDD subjects were randomly assigned to cognitive behavior therapy or no treatment. Patients were treated in small groups for eight 2-hour sessions. Therapy involved modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. Body dysmorphic disorder symptoms were significantly decreased in therapy subjects and the disorder was eliminated in 82% of cases at posttreatment and 77% at follow-up. Overall psychological symptoms and self-esteem also improved in therapy subjects.

A Primer on Primary Care

This chapter provides readers with an introduction of the evolution of primary care from physician-centric to team-based care, in line with the aspirations of the Patient-Centered Medical Home (PCMH) model. Large healthcare systems such as the Department of Defense have led the way in demonstrating the value of PCBH implementation as a part of this larger development. Community health centers are now required to integrate behavioral health providers into PC to receive federal funds for expansion. All of these factors are helping primary care better address the needs of an increasing large number of people seeking care as the result of healthcare reform.