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In this series, guests from across UCL and beyond share their innovative solutions and ideas for addressing societal challenges, discussing topics from a cross-disciplinary perspective and inspiring and encouraging us to think differently about issues of local, national and global concern.
Jade: Hello and welcome to Disruptive Voices from UCL Grand Challenges. I'm Jade Hunter, your host and the coordinator for UCL's Grand Challenge of Mental Health and well Being. In this episode we're exploring a project that's tackling an often overlooked issue, Body Dysmorphic disorder, or bdd. It's a condition where people become intensely focused on perceived flaws in their appearance, often things others wouldn't even notice. This can cause deep anxiety, shame and distress and for many it begins in their teenage years. BDD is more common than most people realise, especially amongst students, but it frequently goes undiagnosed. Even though effective treatments exist, access is limited and often delayed. Today our experts will discuss how their Grand Challenges funded strategic project aims to change that by improving early detection of BDD symptoms in students through scalable digital tools that can also support future research. So I'm joined by three brilliant guests today. Dr. Georgina Krebs, professor of Young People's Mental Health at UCL, Dr. Thomas Cardor, Associate professor in Creative Health at UCL Arts and Sciences, and Dr. Tom Osborne, senior Research Fellow in the Division of Psychology. So thank you all for joining me. Georgina, if we could start with you, could you tell me a bit about the background of the project please? So what's it all about? Why it matters and what you hope to achieve?
Georgina Krebs: Yes, thank you, Jade. so this project I guess really grew out of the observation that body Dysmorphic Disorder or bdd is one of the most under recognised and undertreated mental health difficulties. And we know this from numerous research studies, but also from speaking directly to people with lived experience of bdd. so what we often hear is that people are suffering in silence feeling for many, many years before they get the right kind of help. And that's if they get help at all. And this really matters because when BDD isn't picked up early, it tends to become more severe over time, more entrenched and as a result much harder to treat. And of course also during this time when people are experiencing BDD symptoms, it can have a devastating impact on their lives. so for example, university students with, are at a risk of becoming socially isolated, underachieving academically and potentially even dropping out of university altogether. so the good news when it comes to BDD is that there are effective treatments, particularly a talking therapy called cognitive behaviour therapy. But the problem is, as you've said, that access is very limited and it tends to be, only available to people with more severe symptoms. So with this project what we're trying to do is essentially shift the needle and intervene much earlier, trying to nip the problem in the bud if you like, before it takes a hold and before it causes knock on difficulties for students. And we plan to do this using digital tools that students can access easily and at a time that's convenient for them. hopefully enabling us to overcome some of the common barriers to help seeking. so that's our kind of overall goal. but in terms of what we're actually doing, we're developing a digital triage system to help identify students who might be experiencing body dysmorphic symptoms. And those with more severe difficulties will be signposted to mental health services for treatment. But those with milder body dysmorphic symptoms who wouldn't normally be able to access their therapy in the NHS for example will be offered a brief digital intervention. And these digital interventions we're developing, they're based on the active ingredients of cognitive behaviour therapy for BDD and the idea is that they'll target some of the core processes that we know keep body to small fixed symptoms going. and importantly as part of this project we're going to carefully evaluate the impact of these tools to make sure that they're genuinely helpful and worthwhile to the student population. And I think what's also really important about this project is that we're co designing it with students themselves. so we're doing this to make sure that what we build is actually relevant and feels acceptable and usable for the student population. so our ultimate big picture goal is to achieve a sort of scalable and low cost model for early intervention that universities could realistically adopt. hopefully not just for body dysmorphic symptoms but also we hope that this will serve as a kind of template, a blueprint for supporting other mental health difficulties in students in the long run as well as.
Jade: Thank you. That's so interesting. And hearing the ways that kind of signpost people with different levels of severity. I wonder if you could say something a bit about what that co design looks like with students. Has that started yet or is that planned?
Georgina Krebs: Yeah, it's something that we started right at the outset actually that we really wanted the perspectives of students to be integrated from a very early stage in the project. But it's something that we'll continue with along the way. so so far we' actually held two workshops where we've recruited a diverse range of students from UCL who've attended these workshops and helped think about different elements of the project. So we had one workshop where we focused particularly on the digital triage system and another where we thought about the interventions that we will be delivering. and we sort of structured these workshops based on theories of implementation, science so that we could really get a good handle on what might be some of the facilitators and what might be some of the barriers to students, engaging with these tools that we aim to create and then importantly drawing on the students perspectives to think about some of the solutions to the barriers. So really hoping that we're from the outset, as I said, designing something that is possible to implement and that will be used.
Jade: Wonderful, thank you. And then so Thomas, I wonder if you could say a little bit about why detection and early intervention is so important for university students.
Thomas Kador: Yes, absolutely. thanks Jade. And Georgina has sort of outlined some of the specific points in relation to body dysmorphic symptoms in terms of the intensifying symptoms over time. So the longer they are left the more difficult it will become to treat. The more behaviours are established, the longer they are established and become sort of part of almost the makeup of how a person operates, the more difficult it will be to address those challenges. so that's from a very specific body dysmorphic symptoms perspective. It's really important the earlier they are detected they can be then addressed especially through CBT as Georgina has outlined. But maybe more broadly if you think about the student population, I mean we all working in universities, we know how diverse the cohorts are and how different students are. And I think there might be a perception out there that lots of people, when they come into university they have a continuous party, right? They have a three or four years of a really great time. the reality sadly for many of our students is very different. And it's a huge transition for young adults, late teenagers to come into the university environment. Often not exclusively of course, but often from a quite a sheltered, well structured home and education environment where everything, especially if they come to the A level process, everything is very much structured and pretty much handed to them. Whereas they are now to an extent on their own and let loose. And that is a huge transition and often associated with moving away from home, sometimes moving country. So there is a whole cocktail of things coming together and very many of our students feel very lonely and isolated. There's a whole risk of social isolation among students. that kind of intensifies the already well discussed phenomenon, that some People refer to as, a teenage mental health crisis that we experiencing in the west, in the UK as well as other Western countries in particular, where young adults and teenage mental health seems to be suffering, there is a huge problem with anxieties, and depressive symptoms as well as across the young adult population. And that's then really intensified with that transition. So I think university students are especially vulnerable and very often they also are, in a new setting where they don't quite know who to talk to and where to get support and what does that support look like. And then, because some of the support structures, in universities can also then be overwhelmed with this large influx of young people all seeking support. So there's a whole mixture of issues. But also on the flip side, once there are at least supports there at university and once students are leaving higher education and going into the world of work, wherever they move on to, then it might be even more difficult at that point to intervene in their mental health because then there is no more structure, pretty much, or it depends on the workplace and so on. So if you can catch them while they're at university, then we can start building those supports, while they're in that environment. Whereas after going off in lots of different directions, it's going to be even more difficult and the symptoms will just become progressively worse. So the whole range of that. But it's that key transition that's so important, moving to university, the vulnerability that leads to their social isolation, but also then the opportunity we have to intervene while they're here with us at the university. While there are people who do, have a sort of see themselves like ourselves, as lecturers, having a caring, a duty of care to some degree for students, which is then very different from the world of work where students will move on to.
Jade: Thank you. That's so interesting thinking about it as this kind of key transitional time where you can kind of really put things in place that scaffold for a bit later on as well.
Thomas Kador: Yeah.
Jade: So I guess, Tom, like, moving forward, what are the bigger picture goals once you've gathered and analysed the findings?
Tom Osborn: Thanks, Jade. so, yeah, there are probably sort of really three areas that we're thinking, that this would be, that this could make a contribution to. So, as both Georgina and Thomas, sort of hinted at, one quite common problem is that students often find that, they're not really sure whether what they're experiencing warrants help from a service. and if it does, where they should go, what's Trustworthy, what would generally be helpful and effective. and so by working really closely with students, throughout this process, both through co designing it and evaluating what we develop, we really hope that we can develop something that's credible, trustworthy and useful to help students with those decisions so whether their needs really do warrant help from a health service, and where they can go to get that help. Secondly, as Georgina was speaking about, particularly for bdd, but also to varying degrees other mental health difficulties, accessing treatment can be difficult, and there are more limited or fewer more sort of preventative interventions. so it's difficult to sort of intervene early and try and catch some of these issues before they become something more substantial. And by us doing a fairly rigorous evaluation of the things, the tools and also the early intervention, the digital early intervention, we hope for this to be sort of a first step towards developing an evidence base for this ah, type of preventative intervention in bdd. And through evaluating both of them we hope that this could potentially provide sort of a blueprint for how we can help with other mental health difficulties in students and maybe sort of in young adults more broadly. and then thirdly I think there's increasing recognition that for us to really sort of achieve sort of a step change if you like, in the way that we help young people with their mental health difficulties, we really need to incorporate young people and students in the way that we develop these types of interventions so incorporating their needs and expectations and priorities. and by doing that we hope not only that what's developed is relevant and effective but also that it's engaging, that it doesn't sort of lead to any unintended consequences that can sometimes happen from sort of poorly developed interventions potentially. so those are sort of the three areas that we hope and broadly we hope that what we develop will be something by focusing on all of those things early on we hope that universities. This is something that could be adopted quite easily, by universities.
Jade: Brilliant. And then sort of a question for all of you really. So how does this work relate to the grand challenge of mental health and wellbeing at ucl? How does collaboration between disciplines strengthen projects like this?
Georgina Krebs: I think this project fits very closely, or aligns very well with the UCL grand challenge of mental health and wellbeing, because it's focusing on mental health in young people, particularly a student population and because we're focusing on early intervention, which is one of the priority areas. So we know that most mental health problems develop in adolescence and early, ah, adulthood. yet when it comes to treatment, we're often sort of intervening quite late in somebody's journey, as we've talked about already. So by trying to sort of intervene earlier, we're hoping that we can reduce the kind of secondary problems that people might develop and also optimise outcomes by sort of taking this approach. One of the core aims of the Grand Challenge is to support innovations that lead to real change. And that's exactly what we're trying to do here. so we're really focusing on something that can realistically be adopted in a university setting, rather than, ah, sort of something that's of scientific interest but doesn't have an immediate kind of benefit or impact. and then I think the other way in which it aligns is the sort of interdisciplinary approach. So we're bringing together clinical psychology, implementation science, creative health and students themselves. So we're hoping to, go beyond the question of just does this work clinically, but also asking does it make sense to students, will they actually engage with it and can this realistically be used in a university setting? I wonder if Thomas might want to add to what I've said.
Dr. Thomas Kador: Yeah, maybe a little bit. I mean, just in terms of the, the genuine interdisciplinary approach, I think in regard to this and in a way, any other mental health grand challenge that we might want to address, I think that's really important. As Georgina has outlined. In this particular case we have clinical psychology, implementation science, creative health and then creative health in itself is already an interdisciplinary construct of looking at creative humanities, artistic approaches, and how they impact on, on health and well being on the clinical world. So I think that cross fertilisation is really fundamental and the Grand Challenges scheme, I think, has recognised that health, as well as so many other aspects of contemporary life is very often very siloed, that we find people work within certain parameters and even the language reflects that. So people in different silos speak different languages. And I think it's so important for us to break that down and find ways of communicating across these silos. And that can only work when we have people genuinely working together who come from these different backgrounds or some of us maybe have, a combination of backgrounds and a few of those have had our toes dipped into a few of those fields already. So we have a sense of some of those different frameworks, those different epistemologies, things of looking at the world Even and different languages. So I think therefore these interdisciplinary connections are really vital. and I think the students will benefit from that. The young people who we are trying to support with that because we can help them find and the co production element with them is even more important in that sense because we can work together on finding the language that actually works for young people regardless of their backgrounds, regardless of what they study and therefore what language they speak, what appeals to them. Whether they are a clinical student or an architecture student or history student, or a nursing student, it shouldn't matter. So I think that interdisciplinary connection and the importance of it maps right through from the bottom up if you want, with the participants, the students, the co production all the way to the way we cooperate across these different divides and hopefully breaking them down a little bit.
Jade: Brilliant. And is there anything that you'd like to add to that, Tom?
Tom Osborn: I guess the one thing that I would add is the Grand Challenge itself is very much embedded within ucl and it has sort of an intention, as far as I understand it, to be of benefit to the UCL community. and so I guess sort of through the way that we're leading this project is sort of trying to embody those values as well. so by involving students and having something that is hopefully of value to them.
Jade: Thank you, that sounds great. It sounds like such a fascinating project and so interesting to think about that sort of level of interdisciplinarity that runs throughout the whole project, whether it's you know, between your expertise or whether it's through the students backgrounds too. So yeah, thank you for sharing more on that. So my final question then would be how can students, practitioners or other researchers learn more about the project or get more involved?
Tom Osborn: So I guess firstly as we've sort of highlighted already very much, we're working with students to develop this project and as Georgina said we've currently done quite a bit of co design work with students so we've recruited students to be part of a student advisory board as we move forward. So the projects will be running over up until the middle of next year. There will also be other opportunities for students to get involved in that either through participating in the study or contributing in other ways. Also we'd really sort of welcome conversations for many other sort of academics who are interested in the project as a result of hearing the podcast or who've seen information about the study, as we start to publicise it a bit more we'll be launching sort of a Student Facing Identity and hopefully publicising the information about the study, in the coming months. So there will be ways to get involved that way. and then I guess we'll also be presenting details about the study and some early findings, at conferences this year. So, the Smarten, Student Mental Health Network, King's Golledge, later this spring and likely the Grand Challenge Conference, hopefully later this year as well.
Jade: Brilliant, thank you. Is there anything that you'd like to add, Thomas or Georgina?
Georgina Krebs: I suppose just to kind of reiterate, as Tom had said, that those conferences will be a really exciting opportunity for us to share this project with quite a wide audience and at an early stage, which I think is something that's really nice. Sometimes when you're working on a project it's only towards the end when you have your results and your sort of data through that you have the opportunity to present. So for us it's really nice that we, we're able to connect with people at this early stage in the project where there's still kind of lots of potential to shape it. So yeah, very open to conversations, with people who are interested.
Thomas Kador: I think it's also, I don't think we can emphasise the potential benefits of the co production element enough as well that we consider the students who are working with us as researchers and ah, they're helping us. Without them it would not be possible in many ways to actually come up with these M models that we are trying to trial. But also the participating students will hopefully come away from this with a greater awareness of some of the issues around BDD and symptoms of body dysmorphia and the importance of early detection. And they don't live in vacuums. Right. They have conversations with other students and families and so on. So hopefully in that sense also, so the work can spread around the work that this project is focusing on and more broadly about young people, mental health. And so hopefully the students can informally go forward as ambassadors in a way for some of those issues and concerns with great awareness and with new insights that they can share with their peers and their families. And I think that's a really important knowledge sharing that will happen on an informal level, hopefully as well.
Georgina Krebs: I think that's a really nice point. And it's so important for a condition like body dysmorphic disorder where awareness is quite limited and to the extent that its messages are out there in the public domain, they're not always accurate, or a sort of true reflection of what this condition is like. So I think, yeah, opportunities to be able to discuss it. And as Thomas has said, for that to, organically spread accurate information is actually kind of really important in and of itself.
Jade: Thank you. It's really interesting about that kind of level of, I guess, informal impact as well and what that impact could have on sort of others lived experiences. Is there anything that you'd like to add that you feel like we haven't covered?
Tom Osborn: I was just going to add to Thomas's, great point. I mean, obviously we're a university and so we hope that also sort of both informally learning about btd, but also about being involved in research and the research process. You know, it will provide an opportunity for students to learn about that. Yeah, hopefully lots of benefits.
Jade: Yeah, there's lots of opportunities for students to kind of, really develop as part of being involved in the project. Thank you all. Really interesting to hear more about the project and it sounds like there's so many ways that it will move forward. Amazing to think about it kind of being used for other conditions and supporting students at UCL as well. So. Yeah. Thank you for sharing.
Georgina Krebs: Thank you for having me. Us.
Tom Osborn: Thank you.
Thomas Kador: Yeah, thanks.
Jade: Thank you all for joining me today. It's been really fascinating hearing more about this interdisciplinary project which is focused on a scalable intervention and has scope for greater changes for university students at such an important transitional life stage. You've been listening to Disruptive Voices. This episode was presented by me, Jade Hunter, produced by Decibelle Creative and edited by Annabel Buckland at Decibelle Creative. If you'd like to hear more of these fascinating discussions from Disruptive Voices, make sure you're subscribed to this podcast so you don't miss future episodes. Come and discover more online and keep up with the latest grand challenges, news, events and research. Just Google UCL Grand Challenges