When The Mirror Is Wrong

NCT07036744 | Recruiting

• 1 other identifier: 2022.12380.BD
• Study Type: interventional
• Target: 16
• Locations: 1 country
• Sites: 1

Brief Summary

Body Dysmorphic Disorder (BDD) is a severe psychiatric condition characterized by persistent and intrusive preoccupations with perceived flaws in physical appearance, which are typically unnoticeable or appear minor to others. BDD is associated with significant psychological distress, functional impairment, and reduced quality of life. Despite its prevalence and clinical severity, BDD remains frequently underdiagnosed and misdiagnosed. While Cognitive Behavioural Therapy (CBT) and Selective Serotonin Reuptake Inhibitors (SSRIs) are currently considered standard treatments, emerging evidence suggests that third-wave psychotherapies, such as Acceptance and Commitment Therapy (ACT) and Compassion-Focused Interventions, may offer additional benefits. This project aims to advance clinical care and scientific understanding of BDD by developing, implementing, and evaluating the preliminary efficacy of MIND-over-MIRROR-a novel group-based psychological intervention integrating ACT and compassion-based strategies for individuals exhibiting high levels of BDD symptomatology. The intervention consists of eight weekly sessions and one follow-up booster session, delivered in an online or hybrid format. A randomized feasibility study will be conducted to examine the intervention's acceptability, practicality, and preliminary clinical efficacy in adults aged 18 to 65 years. A multi-method assessment framework will be employed, with self-report measures collected at baseline, post-intervention, and 3-month follow-up. Additionally, participants from experimental and control groups will report on their weekly BDD symptomatology. Participants in the intervention group who consent will also undergo computerized behavioural tasks and functional neuroimaging using functional near-infrared spectroscopy (fNIRS) to explore neural and cognitive correlates of treatment outcomes. Improvements are expected in core clinical outcomes, including BDD symptom severity, and it is hypothesized that changes in targeted psychological processes (e.g., self-compassion) will mediate these effects. This study will contribute novel and clinically relevant data regarding the feasibility and potential effectiveness of contextual behavioural therapies for BDD, with implications for both research and practice.

Conditions

Body Dysmorphic Disorder

Keywords

Body Dysmorphic Disorder; Dysmorphic Concern; Acceptance and Commitment Therapy; Compassion; Psychological Flexibility; online group intervention

Outcome Measures

Primary Outcomes (2)

• Appearance Anxiety Inventory

  The Appearance Anxiety Inventory (AAI) is a brief 10 item self-report scale that assesses the cognitive and behavioral aspects of BDD in particular. This scale was specifically developed by the original authors as both an outcome and process measure, since it can track changes in these processes and behaviors during treatment. Besides its global score, the AAI includes three subscales: threat monitoring, camouflaging, and avoidance. Each item is scored on a 4-point scale ranging from not at all (0) to much more than most people (3). A score equal or above 21 is considered high risk body image anxiety and/or Body Dysmorphic Disorder.

  Baseline, Weeks 1-8, 3-month follow-up

• Dysmorphic Concern Questionnaire

  The DCQ measures a person's degree of dysmorphic concern (i.e., the excessive preoccupation or concern with a perceived minor defect in one's physical appearance). This is a self-report measure with seven items, reporting on cognitive and behavioural aspects of dysmorphic concern. Each item is phrased with the question, "Have you ever…?" (e.g., "…been very concerned about some aspect of your physical appearance"). Each item is scored on a 4-point scale ranging from not at all (0) to much more than most people (3).

  Baseline, Week 8, 3-month follow-up

Secondary Outcomes (5)

• Patient Health Questionnaire - 9

  Baseline, Week 8, 3-month follow-up

• Change in the Multidimensional Psychological Flexibility Inventory - 24

  Baseline, Week 8, 3-month follow-up

• Self-compassion Scale

  Baseline, Week 8, Follow-Up 3 Months

• Psychological Flexibility for Body Image

  Baseline, Week 8, Follow-Up 3 Months

• Forms of Self-criticizing/Attacking and Self-reassuring Scale

  Baseline, Week 8, Follow-Up 3 Months

Other Outcomes (2)

• Emotion Recognition Task

  Baseline and Follow-Up 3 Months

• Emotional Stroop task

  Baseline and Follow-Up 3 Months

Study Arms (2)

Control group

NO INTERVENTION

Participants who present significant Body Dysmorphia Symptomatology, as assessed during the screening stage (n ≥ 8) not subjected to any clinical psychology intervention during the period of the current trial. Participants in this group will be assessed at baseline, post-intervention \[immediately after session 8\], and at the 3-month follow-up. They will also be asked to monitor their weekly symptoms through a short self-report assessment.

Intervention group

EXPERIMENTAL

Participants who present significant Body Dysmorphia Symptomatology, as assessed during the screening stage (n ≥ 8) subjected to an online manualized group psychological intervention - Mind-over-Mirror. This group will be assessed at baseline, post-intervention \[immediately after session 8\], and at the 3-month follow-up). They will also be asked to monitor their weekly symptoms through a short self-report assessment.

Behavioral: MIND-over-MIRROR

Interventions

MIND-over-MIRROR BEHAVIORAL

An eight session (plus one follow-up booster session) on Acceptance and Commitment Therapy (ACT) with compassion developed specifically for BDD, in a group setting and applied remotely or in hybrid format.

Intervention group

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged between 18-65 years;
• Fluent Portuguese speakers;
• Over the cut-off score for the AAI (≥ 21) and the DCQ (≥ 9);

You may not qualify if:

• Pregnant;
• If medicated, not stabilized for at least 2 months
• Currently under other clinical psychology intervention;
• Current suicidal ideation;

Sponsors & Collaborators

• University of Coimbra: lead
• Foundation for Science and Technology, Portugal: collaborator

Study Sites (1)

CINEICC, Faculty of Psychology and Educational Sciences of the University of Coimbra

Coimbra, Coimbra District, 3000-115, Portugal

RECRUITING

MeSH Terms

Conditions

Body Dysmorphic Disorders

Condition Hierarchy (Ancestors)

Somatoform Disorders; Mental Disorders

Study Officials

• Maria Coimbra, MSc

  CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra

  PRINCIPAL INVESTIGATOR

• Cláudia Ferreira, PhD

  CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra

  PRINCIPAL INVESTIGATOR

• Ana Ganho-Ávila, Ph.D.

  CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Maria Coimbra, MSc

CONTACT

+351916775055; maria.rcoimbra@gmail.com

Cláudia Ferreira, Ph.D.

CONTACT

claudiaferreira@fpce.uc.pt

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Clinical Psychologist; PhD Fellow

Model Details: This project will follow a longitudinal design. Adults presenting with BDD symptomatology will be randomly allocated to the Control Group (no intervention; n ≥ 8) or to the Intervention Group (Mind-over-Mirror group intervention; n ≥ 8).

Study Record Dates

• First Submitted: June 16, 2025
• First Posted: June 25, 2025
• Study Start: January 29, 2025
• Primary Completion: January 30, 2026
• Study Completion: January 30, 2026
• Last Updated: June 29, 2025

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will not share

Locations

PT (1)