Does rational role-play enhance the outcome of exposure therapy in dysmorphophobia? A case study

Abstract

Background. Dysmorphophobia may improve after a variety or combination of treatments, but which elements of a treatment are useful is usually not certain. Method. In a single out-patient case study rational role-play ('paradoxical discourse') was added to exposure plus cognitive restructuring (CR) for a dysmorphic delusion study comprised of 20-minute sessions one week apart. Results. Previous exposure plus attempted CR had improved anxiety, phobias, work and social leisure, but not dysmorphic belief. Added brief rational role-play was followed by resolution of the dysmorphic belief. All measures remained much improved at 18-month follow-up. Conclusions. Rational role-play deserves a controlled trial in dysmorphophobia and other problems and exploration of its mechanism of action.