Session 1: Introduction

CONTENT

​

1) Brief Introduction to the Program (approx. 5 mins)​

​​

• ​Introduction of facilitator and client.

• Online outpatient 8-week individual program designed according to principles of cognitive-behavioural therapy (CBT).

• Focuses on addressing the cognitive and behavioural factors maintaining muscle dysmorphia.

• The program is designed to support you to reduce your symptoms of muscle dysmorphia and increase quality of life.

 

 

​

2) Confirmation of Dates/Times (approx. 5 mins)

​

• Run through scheduled dates/times for individual sessions.

• Confirm that participant can attend all eight treatment sessions over the next eight weeks.

• If applicable, discuss barriers to regular attendance and collaboratively problem-solve potential difficulties.

 

 

​

3) Confidentiality and Telehealth Guidelines
(approx. 5 mins)

​

• Discuss confidentiality guidelines and confirm that participant will adhere to all stated expectations of confidentiality.

• Discuss TeleHealth guidelines (e.g., camera on for the duration of each session, send a private message on zoom if need to turn camera off, must arrive on time, must be in a consistent location each week, etc).

• Confirm the location from which participants will be attending sessions each week.

 

 

​

4) Introduction to CBT (approx. 15 mins)

 

Questions to ask client:

• Have you ever heard of cognitive-behavioural therapy (CBT)? Have you ever participated in a CBT program? What was your experience of it? What do you know about CBT?

 

• CBT has both a cognitive component (e.g., challenging unhelpful thoughts/cognitions that maintain MD) and a behavioural component (e.g., reducing symptoms or behaviours that maintain MD like mirror checking).

• CBT is the gold-standard treatment for adults with an eating disorder and also adults with general body dysmorphic disorder unrelated to muscularity

   

• MD falls between these two illness groups so we speculate that CBT will also be effective for MD.

• CBT focuses less on the past and reasons for developing MD and more on what factors maintain the disorder in the “here-and-now”.

• CBT is an active treatment that requires lots of effort – we provide you with the skills to challenge your disorder, but you will need to put them into practice both within and outside sessions (i.e., you only get out what you put into the program).

   

You will be facing a lot of your fears and you may feel anxious/uncomfortable at times – this is a sign that we are on the right track and are challenging cognitions/behaviours maintaining your disorder.

 

Questions to ask client:

• Do you have any questions about CBT or what is involved in this program?

• What have been some positive and negative characteristics of past therapy (if applicable?)

 

​

 

5) Setting SMART Goals (approx. 10 mins)
 

• Explain the concept of SMART goals: (1) Specific + (2) Measurable + (3) Attainable + (4) Results-Based + (5) Time-Based.

 

Questions to ask client:

• What are you hoping will change by doing this treatment program?

• What specific behaviours or symptoms would you like to change?

• If you woke up tomorrow and your MD was gone, how would you feel? What would be different about your life?

  Example: By the end of this program, I would like to be able to reduce my weighing to once per week and mirror checking to once per day.

   

• Set 3-5 SMART goals for the program.

 

​

 

6) Developing a CBT Formulation (approx. 20 mins)
 

• This formulation focuses on what keeps MD going rather than why it developed in the first place – we need to address what is keeping it going and make behavioural change before returning to underlying causes.

 

Questions to ask client:

• What do you think is the most central part of your MD? What is the aspect that annoys you the most?

   

• Potential key maintaining factors for MD are:

  (1) overvaluation of shape and control of eating/exercise + (2) strict dieting + (3) strict exercise routines + (4) supplement/steroid use + (5) compulsive body checking (e.g., mirrors + weight scales + pinching fat).

   

• Collaboratively develop a formulation with the client based on their individual experience of MD.

• The below offers a generic template that you may use as a guide or if you get stuck with an individual client. It may be helpful (time permitting) to add predisposing factors based on early childhood experiences above this formulation.

 

​​​​​​​​​​​​​​​​Questions to ask client:

• Which aspects of this formulation resonate most with you?

   

Not everyone’s experience of MD will be the same, but everyone with MD has maintaining factors that keep the disorder going.

​

• We focus on addressing each of these maintaining factors in this treatment program (e.g., addressing compulsive exercise in one session, reducing excessive mirror checking in another). 

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

 

 

7) Setting Goals/Homework
 

• Review MD formulation.

• Review SMART goals and adjust if needed.