Effects of Safety Behavior Fading on Appearance Concerns and Related Symptoms

Extant research suggests that safety behaviors (SBs) may be relevant to the development and maintenance of anxiety and obsessive-compulsive psychopathology; yet, their contribution to other forms of psychopathology, such as disorders of body image and appearance, has been relatively understudied. The proposed project aimed to extend upon previous research efforts by exploring the experimental effects of reducing the use of appearance-related SBs on subsequent appearance concerns and related symptoms. Specifically, this study examined the effects of SB fading over a two-week manipulation period in undergraduate female students with elevated appearance concerns (64.0% of whom met criteria for a psychiatric disorder involving social evaluative concerns relevant to appearance). Study variables of interest (e.g., body dysmorphic disorder [BDD] symptoms, social anxiety symptoms, body dissatisfaction) were assessed at the baseline, mid-manipulation, post-manipulation, and 2-week follow-up assessments. Compared to a no instructions control group, the SB fading group exhibited significantly lower BDD symptoms, social anxiety symptoms, body dissatisfaction, and maladaptive cognitions beliefs about appearance at the post and follow-up assessments. They also showed less reactivity to an in vivo appearance-related stressor. Exploratory analyses revealed that beliefs about appearance and SB use at the post-assessment each mediated the effects of condition on BDD symptoms at post. Furthermore, baseline BDD and social anxiety symptom severity separately moderated the relationship between condition and respective post-assessment symptom severity, such that SB fading had stronger effects on BDD and social anxiety symptoms among those high in baseline BDD and social anxiety symptoms, respectively. This study betters our understanding the role of SBs in BDD and other disorders characterized by body image disturbances and provides preliminary evidence for the potential clinical utility of decreasing appearance-related SBs.