30/07/2026
Although during early stages of therapy for Body Dysmorphic Disorder, Sophie intelectually retained many of the cognitive insights and coping strategies, she increasingly described feeling unable to access them during periods of emotional distress. She understood that her thoughts were often biased, recognised many of her appearance-related safety behaviours, and could frequently identify alternative interpretations. Yet these skills no longer seemed sufficient to regulate the intensity of her emotional experience.
Rather than viewing this as evidence that therapy had failed, NA-CBT approached it as evidence that the neuroaffective conditions within which these cognitive skills operated had fundamentally changed. Over recent years Sophie had experienced the cumulative impact of persistent insomnia, menopausal transition, occupational loss, increasing social isolation, repeated cosmetic procedures, prolonged legal proceedings, reduced physical activity, and the gradual erosion of interpersonal support. Each experience contributed not simply to “stress,” but to an increasing burden on the systems responsible for physiological regulation, emotional processing, and cognitive flexibility. Within NeuroAffective-CBT, this accumulation is conceptualised as neuroaffective load (Mirea, 2018).
Free Article:
Body Dysmorphic Disorder (BDD) is a severe and often chronic condition characterised by persistent preoccupation with perceived defects in physical appearance, repetitive safety behaviours, and marked impairment in psychological, occupational, and
