Evaluating a Group Cognitive Behavioural Therapy Program for Adults with Muscle Dysmorphia

This intervention is a pilot online 8-week group cognitive behavioural therapy (CBT) program for adults with muscle dysmorphia living in Australia. To date, no treatment studies have been conducted in muscle dysmorphia. The CBT program will be delivered online in a group format using Zoom with 8 90-minute weekly sessions. There is no control group for this pilot study, so it is a single-arm trial. We are aiming to recruit 8-14 participants who will be split across two treatment groups. Session attendance checklists will be used to monitor adherence to the intervention. The initial template for the program came from the Individual Intensive Outpatient Program and Overcoming Binge Eating groups run by the Peter Beumont Eating Disorders Non-Admitted Service at RPA Hospital, which are 8- and 10-week, respectively, structured group programs for outpatients with an eating disorder. Both programs are standardised and have been running at RPA Hospital for at least the past decade. Both programs are grounded in principles of CBT and have been modified in this study for the treatment of muscle dysmorphia. The program will be facilitated by a PhD student and registered general psychologist. The study facilitator will receive weekly clinical supervision from a registered clinical psychologist throughout the 8-week program. A brief summary of the content to be covered in each weekly session is outlined below: 1 - Introduction • Group orientation • Introduction to CBT • Setting SMART goals • Introduction to CBT formulation of muscle dysmorphia 2 – Addressing strict dieting and establishing flexible eating • Dieting and restrictive eating • Calorie/protein tracking • Behavioural experiment to address food avoidance and/or challenge dietary rules 3 – Addressing compulsive exercise • Healthy vs. unhealthy exercise • Compulsive exercise • Exposure and response prevention to challenge compulsive exercise 4 – Developing alternate emotion regulation strategies • Mood intolerance • Developing alternate emotion regulation strategies to diet/exercise 5 – Building up marginalised areas of life • Overvaluation of weight/shape • Identifying overvalued/marginalised areas of life (pie chart exercise) • Overvaluation of control of weight/shape 6 – Addressing checking and avoidance behaviours • Body image • Checking behaviours and response prevention • Avoidance behaviours and graded exposure hierarchy 7 – Addressing feeling small/skinny and comparison making • Feeling small or skinny • Cognitive reappraisal of feeling small • Comparison making and associated biases • Behavioural experiment(s) to address comparison making 8 – Relapse prevention planning • Realistic expectations of recovery • Dealing with relapse and setbacks • Relapse prevention planning