Applied Psychology

Applied Psychology

The Effect of Cognitive-Behavioral Therapy on Attentional Bias in Individuals with Body Dysmorphic Disorder Symptoms: A Semi-Experimental Study

Document Type : Original Article

Authors
Sara Ghanbari 1
Zainab Mihandoost 2
Shahram Mami 2
Vahid Ahmadi 3
Homeira Soleimannejad 3
1 Department of Psychology, Il.c, Islamic Azad University, Ilam, Iran.
2 Department of Psychology, Ilam Branch, Islamic Azad University, Ilam, Iran.
3 Department of Psychology, Ilam Branch, Islamic Azad University, Ilam, Iran
10.48308/apsy.2025.238879.1782
Abstract
Aim: This study examined the effectiveness of cognitive-behavioral therapy (CBT) in reducing attentional bias among individuals with symptoms of body dysmorphic disorder (BDD).
 
Method: A quasi-experimental pretest–posttest–follow-up design with a control group was employed. The statistical population included clients attending cosmetic clinics in Kermanshah in 2023. Thirty-six eligible participants were selected through convenience sampling and randomly assigned to experimental and control groups (18 per group). The experimental group received ten CBT sessions based on Beck and Beck’s protocol (2011), whereas the control group received no intervention. Attentional bias was assessed using the Attention Focus Questionnaire. Data were analyzed using repeated-measures ANOVA and Bonferroni post hoc tests in SPSS-26.
 
Results: Significant effects were found for time (η² = 0.98, p < 0.001), group (η² = 0.97, p < 0.001), and the interaction between time and group (η² = 0.97, p < 0.001) on attentional bias scores. Bonferroni analyses indicated significant reductions in attentional bias from pretest to posttest and follow-up. No significant difference was observed between posttest and follow-up scores (p > 0.05), indicating maintenance of treatment effects.
 
Conclusion: CBT effectively reduced attentional bias associated with BDD symptoms. The findings support the use of CBT in clinical and educational settings for both treatment and prevention of body dysmorphic symptoms.
 
Keywords
Body Dysmorphic Disorder
Attentional Bias
Attention Focus
Cognitive-Behavioral Therapy
Subjects
Aliasgari, S., Farhangi, A., & Sedaghat, M. (2024). Comparison of the effectiveness of schema therapy and cognitive-behavioral therapy on body dysmorphic disorder in young women with body dysmorphic disorder. Journal of Psychological Dynamics and Mood Disorders, 3(1): 30-40. [Link]
Beck, J. S., & Beck, A. T. (2011). Cognitive behavior therapy: Basics and beyond. New York: Guilford Publishing. [Link]
Bonell, S., Barlow, F. K., & Griffiths, S. (2021). The cosmetic surgery paradox: Toward a contemporary understanding of cosmetic surgery popularization and attitudes. Body Image, 38(1): 230-240. [Link]
Çınaroğlu, M., Yılmazer, E., Ülker, S. V., Ahlatcıoğlu, E. N., & Sayar, G. H. (2024). Efficacy of cognitive-behavioral therapy in reducing muscle dysmorphia symptoms among Turkish gym goers: A pilot study. Acta Psychologica, 250(1): 104-112. [Link]
Couper, S. L., Moulton, S. J., Hogg, F. J., & Power, K. G. (2021). Interpersonal functioning and body image dissatisfaction in patients referred for NHS aesthetic surgery: A mediating role between emotion regulation and perfectionism? Journal of Plastic, Reconstructive & Aesthetic Surgery, 74(9): 2283-2289. [Link]
Gholami, S., Omidi Moghadam, E., Ghadampour, E., & Bayat Mazlaghani, M. (2025). Psychometric properties of the revised Yale–Brown obsessive compulsive disorder scale for body dysmorphic disorder in transgenders. Iranian Journal of Psychiatric Nursing, 13(1): 79–92. [Link]
Ghosh, T., & Blair, E. (2025). The management of body dysmorphic disorder in adolescents: A systematic literature review. Open Health, 6(1): 20-25. [Link]
Golestanibakht, T., Babaie, E., & Masoumzadeh, Z. (2022). The effectiveness of cognitive-behavioral therapy on body dysmorphic disorder and perfectionism concerns in students with physical deformity concerns. Journal of Ilam University of Medical Sciences, 30(6): 83-92. [Link]
Grennan, G., Zhao, Y., & Fang, A. (2023). Applying a drift diffusion model to test the effect of oxytocin on attentional biases in body dysmorphic disorder. Journal of Obsessive-Compulsive and Related Disorders, 39(1): 1008-10041. [Link]
Hang, Y., Xu, L., Wang, C., Zhang, G., & Zhang, N. (2021). Can attention bias modification augment the effect of CBT for anxiety disorders? A systematic review and meta-analysis. Psychiatry Research, 299(1): 1138-1192. [Link]
Hedayati, F., & Torkan, H. (2021). Predicting multiple relationships of attention, post-event processing and interpretation (self-related) with social anxiety of Isfahan students. Applied Psychology, 15(1): 25-47. [Link]
Hosseinpour, H., Soleymani, E., & Isazadegan, A. (2025). Enhancing the efficacy of cognitive behavioral therapy with attentional bias modification to reduce worry and emotion regulation difficulties in women with generalized anxiety disorder. Shefaye Khatam, 13(2): 20-30. [Link]
Jalil-Abkenar, S. S. (2025). The Effectiveness of Schema-Based Parenting on Parental Acceptance and Fatigue in Mothers of Students with Intellectual Disability. Applied Psychology, 19(2): 80-102.  [Link]
Karsan, S., Diaz-Fong, J. P., Ly, R., Hellemann, G., & Feusner, J. D. (2024). Quantifying body size estimation accuracy and body dissatisfaction in body dysmorphic disorder using a digital avatar. Comprehensive Psychiatry, 135(1): 1525-1529. [Link]
Kerry, C., Mann, P., Babaei, N., Katz, J., Pirbaglou, M., & Ritvo, P. (2024). Web-based therapist-guided mindfulness-based cognitive behavioral therapy for body dysmorphic disorder: Pilot randomized controlled trial. JMIR Mental Health, 11(1): 552-563. [Link]
Khayyer, M., Ostovar, S., Latifian, M., Taghavi, M. R., & Samani, S. (2008). The study of mediating effects of self-focused attention and social self-efficacy on links between social anxiety and judgment biases. Iranian Journal of Psychiatry and Clinical Psychology, 14(1): 24-32. [Link]
Khodabakhsh, M., Banihasan, M., & Izadi, F. (2024). The effectiveness of internet-based cognitive behavioral therapy on fear of negative evaluation, attention bias and intolerance of uncertainty in individuals with social anxiety disorder: A clinical trial. Community Health Journal, 17(4): 47-57. [Link]
Khodadad Hatkehposhti, Z., Hasanzadeh, R., & Emadian, S. O. (2022). Comparison of the effectiveness of cognitive-behavioral therapy and emotional schema therapy on neuroticism and dysfunctional attitudes in cardiovascular patients. Journal of Applied Family Therapy, 3(3): 280-296. [Link]
Majidinezhad, M., Pirmoradi, M., & Zahedi Tajrishi, K. (2023). The effect of transcranial direct current stimulation (tDCS) on attentional bias and affect in adults with major depressive disorder (MDD). Applied Psychology, 17(1): 11-35. [Link]
McNally, R. J. (2019). Attentional bias for threat: Crisis or opportunity?. Clinical Psychology Review, 69(1): 4-13. [Link]
Oyerinde, E. O., & Mangal, J. P. (2025). Beyond the mirror: Body dysmorphic disorder and emerging dysmorphias in aesthetic surgery. Clinics in Plastic Surgery, 52(3): 333-340. [Link]
Patel, T. A., Summers, B. J., & Cougle, J. R. (2024). The scientific status of safety behaviors in body dysmorphic disorder. Journal of Obsessive-Compulsive and Related Disorders, 43(1): 1009-1011. [Link]
Phillips, K. A., Hollander, E., Rasmussen, S. A., Aronowitz, B. R., DeCaria, C., & Goodman, W. K. (1997). A severity rating scale for body dysmorphic disorder: Development, reliability, and validity of a modified version of the Yale–Brown Obsessive Compulsive Scale. Psychopharmacology Bulletin, 33(1): 17-22. [Link]
Pourkaveh Dehkordi, E., Khan Mohammadi, A., & Abbasi Asfajir, A. A. (2020). Meta-analysis of the causes of Iranian women’s tendency to cosmetic surgery. Health Psychology, 9(34): 7-24. [Link]
Rück, C., Mataix-Cols, D., Feusner, J. D., Shavitt, R. G., Veale, D., Krebs, G., & Fernández de la Cruz, L. (2024). Body dysmorphic disorder. Nature Reviews Disease Primers, 10(1): 1-15. [Link]
Sadeghzadeh, R., Razani, M., & Piriaei, H. (2024). Comparing the effectiveness of cognitive-behavioral therapy and metacognitive therapy on resilience and quality of life in patients with obsessive-compulsive disorder. Applied Psychology, 18(1): 36-62. [Link]
Schmidt, M., Schoenenberg, K., Engelkamp, J. E., Staufenbiel, T., Martin, A., Ebert, D. D., & Hartmann, A. S. (2025). Efficacy of an internet-based, therapist-guided cognitive behavioral therapy intervention for adolescents and young adults with body dysmorphic disorder: A randomized controlled trial. BMC Psychiatry, 25(1): 374-389. [Link]
Usefpoor, V., Mahmoud Alilou, M., & Esmaeilpour, K. (2025). Comparison of attentional bias in people with symptoms of obsessive-compulsive disorder (washer, checker), symptoms of generalized anxiety disorder and normal people. Journal of Psychological Science, 24(147): 83-100. [Link]
Walker, C. E., Krumhuber, E. G., Dayan, S., & Furnham, A. (2021). Effects of social media use on desire for cosmetic surgery among young women. Current Psychology, 40(1): 3355-3364. [Link]
Wilhelm, S., Weingarden, H., Greenberg, J. L., Hoeppner, S. S., Snorrason, I., Bernstein, E. E., McCoy, T. H., & Harrison, O. T. (2022). Efficacy of app-based cognitive behavioral therapy for body dysmorphic disorder with coach support: Initial randomized controlled clinical trial. Psychotherapy and Psychosomatics, 91(4): 277-285. [Link]
Wong, W., Rangaprakash, D., Diaz-Fong, J. P., Rotstein, N. M., Hellemann, G. S., & Feusner, J. D. (2022). Neural and behavioral effects of modification of visual attention in body dysmorphic disorder. Translational Psychiatry, 12(1): 325-336. [Link]
Woody, S. R., Chambless, D. L., & Glass, C. R. (1997). Self-focused attention in the treatment of social phobia. Behavior Research and Therapy, 35(2): 117-129. [Link]