Browsing by Author "Sayar, Gokben Hizli"

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Cognitive Behavioral Therapy for Muscle Dysmorphia and Anabolic Steroid-Related Psychopathology: A Randomized Controlled Trial
(MDPI, 2025) Cinaroglu, Metin; Yilmazer, Eda; Ulker, Selami Varol; Sayar, Gokben Hizli
Background/Objectives: Muscle dysmorphia (MD), a subtype of body dysmorphic disorder, is prevalent among males who engage in the non-medical use of anabolic-androgenic steroids (AASs) and performance-enhancing drugs (PEDs). These individuals often experience severe psychopathology, including mood instability, compulsivity, and a distorted body image. Despite its clinical severity, no randomized controlled trials (RCTs) have evaluated structured psychological treatments in this subgroup. This study aimed to assess the efficacy of a manualized cognitive behavioral therapy (CBT) protocol in reducing MD symptoms and associated psychological distress among male steroid users. Results: Participants in the CBT group showed significant reductions in MD symptoms from the baseline to post-treatment (MDDI: p < 0.001, d = 1.12), with gains sustained at follow-up. Large effect sizes were also observed in secondary outcomes including depressive symptoms (PHQ-9: d = 0.98), psychological distress (K10: d = 0.93), disordered eating (EDE-Q: d = 0.74), and exercise addiction (EAI: d = 1.07). No significant changes were observed in the control group. Significant group x time interactions were found for all outcomes (all p < 0.01), indicating CBT's specific efficacy. Discussion: This study provides the first RCT evidence that CBT significantly reduces both core MD symptoms and steroid-related psychopathology in men engaged in AAS/PED misuse. Improvements extended to mood, body image perception, and compulsive exercise behaviors. These findings support CBT's transdiagnostic applicability in addressing both the cognitive-behavioral and affective dimensions of MD. Materials and Methods: In this parallel-group, open-label RCT, 59 male gym-goers with DSM-5-TR diagnoses of MD and a history of AAS/PED use were randomized to either a 12-week CBT intervention (n = 30) or a waitlist control group (n = 29). CBT sessions were delivered weekly online and targeted distorted muscularity beliefs, compulsive behaviors, and emotional dysregulation. Primary and secondary outcomes-Muscle Dysmorphic Disorder Inventory (MDDI), PHQ-9, K10, EDE-Q, EAI, and BIG-were assessed at the baseline, post-treatment, and 3-month follow-up. A repeated-measures ANOVA and paired t-tests were used to analyze time x group interactions. Conclusions: CBT offers an effective, scalable intervention for individuals with muscle dysmorphia complicated by anabolic steroid use. It promotes broad psychological improvement and may serve as a first-line treatment option in high-risk male fitness populations. Future studies should examine long-term outcomes and investigate implementation in diverse clinical and cultural contexts.
Comparing Cognitive Behavioral Therapy and Ericksonian Hypnotherapy for Subclinical Depression and Anxiety: A Randomized Controlled Trial
(Routledge Journals, Taylor & Francis Ltd, 2025) Cinaroglu, Metin; Yilmazer, Eda; Odabasi, Cemre; Ulker, Selami Varol; Sayar, Gokben Hizli
This randomized controlled trial examined the effectiveness of Cognitive Behavioral Therapy (CBT) and Ericksonian Hypnotherapy (EH) in reducing symptoms of depression and anxiety among individuals with subclinical levels of distress. A total of 150 participants were screened, and 45 eligible participants were randomized into three groups: CBT (n = 15), EH (n = 15), and a waitlist control group (n = 15). Interventions consisted of 12 weekly sessions, with assessments conducted at baseline, mid-intervention, and post-intervention using the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). Both CBT and EH significantly reduced symptoms of depression and anxiety compared to the control group, with no significant differences in efficacy between the two interventions. CBT's structured approach demonstrated consistent improvements across both depression and anxiety, while EH showed a slightly faster reduction in anxiety symptoms at mid-intervention, highlighting its potential for addressing somatic and cognitive dimensions of anxiety. This study extends previous findings by focusing on a non-clinical population, emphasizing the potential of these interventions as early strategies for preventing symptom escalation. Unlike prior work primarily targeting diagnosed populations, this research underscores the applicability of CBT and EH in addressing subthreshold distress. Limitations include a small sample size, lack of follow-up assessments, and reliance on self-reported measures. Future research should explore long-term outcomes, larger samples, and the integration of CBT and EH. These findings contribute to the growing body of evidence supporting diverse psychotherapeutic modalities for early mental health intervention.
Efficacy of Cognitive-Behavioral Therapy in Reducing Muscle Dysmorphia Symptoms Among Turkish Gym Goers: A Pilot Study
(Elsevier, 2024) Cinaroglu, Metin; Yilmazer, Eda; Ulker, Selami Varol; Ahlatcioglu, Esra Noyan; Sayar, Gokben Hizli
Muscle dysmorphia (MD) is a disorder marked by an obsessive focus on muscularity, often leading to excessive exercise, rigid dieting, and use of performance-enhancing drugs (PEDs). While Cognitive-Behavioral Therapy (CBT) is known to be effective for various body image disorders, its specific effects on individuals with MD have been less studied. This qualitative case series involved seven male participants, aged 35-55, all diagnosed with MD and with a history of anabolic steroid use, undergoing a 12-week manualized CBT intervention. The study aimed to explore how CBT impacts their body image perceptions, exercise behaviors, steroid use, and emotional responses. Data were collected through participant feedback during therapy sessions, with thematic analysis revealing significant shifts in body image perception and reductions in compulsive behaviors and steroid use. Despite these improvements, participants experienced feelings of loss and anxiety as they modified their routines, and some reported relapses under stress, indicating the chronic nature of MD. The findings suggest that CBT effectively reshapes cognitive and behavioral patterns in MD sufferers but also highlight the need for ongoing support to manage the disorder's emotional complexities and prevent relapses. Future research should focus on long-term and individualized therapeutic approaches to better support those with muscle dysmorphia.
Multimodal Neurophysiological Responses to Body Image Stimuli in Men with Muscle Dysmorphia and Steroid Use
(Elsevier, 2025) Cinaroglu, Metin; Yilmazer, Eda; Ulker, Selami Varol; Sayar, Gokben Hizli
Muscle dysmorphia (MD), a subtype of body dysmorphic disorder (BDD), involves a pathological preoccupation with muscularity and is commonly linked to anabolic steroid and performance-enhancing drugs (PEDs) use. Despite its rising prevalence, the neurophysiological and affective mechanisms underlying MD, particularly in steroid users, remain underexplored. This study examined 71 male strength-training participants (35 with BDD/ steroid use; 36 controls) during a passive viewing task of muscular, average, and slender male physiques while recording electroencephalography (EEG), electrodermal activity (EDA), and eye-tracking data. Psychometric assessments captured muscularity concerns (Muscle Dysmorphic Disorder Inventory, MDDI), anxiety (State-Trait Anxiety Inventory, STAI), obsessive-compulsive symptoms (Obsessive-Compulsive Inventory-Revised, OCI-R), appearance-related anxiety (Social Appearance Anxiety Scale, SAAS; Social Physique Anxiety Scale, SPAS), and selfesteem (Self-Liking/Self-Competence Scale-Revised, SLCS-R). The BDD/MD group showed significantly heightened responses to muscular stimuli across all modalities. EEG results revealed increased P300 and late positive potential (LPP) amplitudes, along with greater left-lateralized frontal alpha asymmetry. Eye-tracking indicated longer fixation durations and more frequent fixations on muscular images. EDA results showed elevated levels of autonomic arousal. Between-group differences in psychometric measures were substantial, with large effect sizes. Correlational analyses demonstrated significant associations between MD severity and neurophysiological markers, including LPP amplitude, frontal asymmetry, and EDA reactivity. These findings suggest that men with MD and steroid/PEDs use exhibit amplified attentional, emotional, and physiological reactivity to muscular body images. The integration of EEG, EDA, and eye-tracking provides novel insights into the neurocognitive-affective profile of BDD/MD, emphasizing the salience of idealized physiques in this population. Results support the potential utility of multimodal measures as objective indicators for assessing body image disturbance and underscore the need for targeted interventions addressing perceptual and emotional dysregulation in BDD/MD.
Psychological Impact of the 2023 Kahramanmaras Earthquakes on Non-Victims: A Cross-Sectional Study
(BMC, 2025) Cinaroglu, Metin; Yilmazer, Eda; Sayar, Gokben Hizli
The 2023 Kahramanmara & scedil; earthquakes, with magnitudes of 7.7 and 7.6, caused extensive destruction and psychological distress across southeastern Turkey. This study explores the psychological impact on non-victims, particularly Istanbul residents, focusing on mental health outcomes and coping mechanisms. A cross-sectional survey was conducted from March to May 2024 with 721 participants from various Turkish cities, including a significant portion from Istanbul. Validated psychological scales such as the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Warwick-Edinburgh Mental Well-being Scale (WEMWBS), and PTSD Checklist for DSM-5 (PCL-5) measured depression, anxiety, well-being, and PTSD symptoms. Sociodemographic factors like age, gender, occupation, income, education level, and previous earthquake experience were also analyzed. Results showed significant psychological distress among non-victims: 51.9% reported high levels of distress, with 24% meeting PTSD criteria, 30% exhibiting moderate to severe depression, and 28% experiencing significant anxiety. Higher income and education levels correlated with better mental health outcomes. Higher education levels were linked to lower PTSD risk (beta = -0.20, p < 0.01) and fewer depression symptoms (beta = -0.15, p < 0.05). Higher income was associated with lower depression scores (beta = -0.20, p < 0.01) and fewer PTSD symptoms (beta = -0.15, p < 0.05). Age positively correlated with well-being (r = 0.68, p < 0.001) and negatively with PTSD symptoms (r = -0.15, p < 0.05). Comparisons with victim studies of major earthquakes, such as the 1995 Great Hanshin-Awaji earthquake, the 1999 Marmara earthquake, the 2008 Wenchuan earthquake, and the 2000 Iceland earthquakes, revealed similar profound psychological impacts. This highlights the need for comprehensive mental health interventions for both direct and indirect exposures. This study underscores the necessity for inclusive mental health strategies to enhance resilience and well-being, ensuring robust recovery after catastrophic events.
Psychological Impact of the 2023 Kahramanmaraş Earthquakes: A Systematic Review and Meta-Analysis of PTSD, Depression, and Anxiety Among Turkish Adults
(Frontiers Media SA, 2025) Cinaroglu, Metin; Yilmazer, Eda; Ahlatcioglu, Esra Noyan; Ulker, Selami Varol; Sayar, Gokben Hizli
Background The twin earthquakes that struck Kahramanmara & scedil;, T & uuml;rkiye, on February 6, 2023, caused widespread devastation and loss of life. Beyond the physical destruction, such large-scale disasters often result in significant psychological trauma. This study systematically reviewed and meta-analyzed the prevalence and severity of probable post-traumatic stress disorder (PTSD), depression, and anxiety among adult Turkish survivors during the first 18 months post-disaster. Methods Following PRISMA 2020 guidelines, a systematic search of Web of Science, PubMed, and Scopus was conducted for peer-reviewed studies published between February 6, 2023, and May 30, 2025. Eligible studies included quantitative assessments of PTSD, depression, or anxiety using validated Turkish-language scales, with general adult population samples (N >= 370). Eight studies (N = 5,965) met inclusion criteria. A random-effects meta-analysis was conducted for studies reporting prevalence of probable PTSD, while depression and anxiety outcomes were synthesized descriptively due to limited and heterogeneous data. Risk factors for psychological morbidity were also extracted and analyzed. This review was registered with PROSPERO (CRD42025644127). Results The pooled prevalence of probable PTSD was 41% (95% CI: 32-52%). Reported PTSD rates ranged from 29 to 54%, and symptom severity remained high throughout the first year. Depression and anxiety were also widespread, with up to 40% screening positive for depression and 40-50% reporting moderate-to-severe anxiety symptoms. Comorbidity between PTSD, depression, and anxiety was common. Significant risk factors included female gender, bereavement, home destruction, displacement, job loss, and low social support. Resilience was protective in some studies, though findings were inconsistent. Conclusion Eighteen months after the 2023 Kahramanmara & scedil; earthquakes, Turkish adult survivors continued to experience high levels of probable PTSD, depression, and anxiety. These findings highlight a prolonged mental health crisis and underscore the urgent need for sustained, targeted psychosocial interventions. Integrating mental health support into disaster preparedness and long-term recovery efforts is essential for mitigating psychiatric morbidity in future disasters.Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42025644127.
Validation of the Turkish Yale-Brown Obsessive-Compulsive Scale and Self-Report Version: Psychometric Evidence from Clinical and Non-Clinical Populations
(Taylor & Francis Ltd, 2026) Cinaroglu, Metin; Yilmazer, Eda; Ulker, Selami Varol; Unubol, Huseyin; Sayar, Gokben Hizli
Background Obsessive - compulsive disorder (OCD) is a chronic condition that disrupts functioning and quality of life. The Yale - Brown Obsessive - Compulsive Scale (Y-BOCS; clinician-administered) and its Self-Report version (Y-BOCS-SR) are recognised gold standards for assessing OCD severity. Previous Turkish adaptations have been partial, limited by small samples or by validating only one format. This study provides the first comprehensive Turkish validation of both instruments.MethodsThe sample comprised 950 adults: 158 with DSM-5-TR - diagnosed OCD and 792 non-clinical adults. Translation followed a multi-phase process involving clinicians and a linguistics expert. Participants completed the Turkish Y-BOCS, Y-BOCS-SR, and additional OCD measures (OCI-R, VOCI, PI-R).ResultsThe clinician-administered Turkish Y-BOCS demonstrated excellent reliability (alpha = 0.91; ICC = 0.88) and strong psychometric validity, including a stable two-factor structure distinguishing obsessions and compulsions. The self-report version showed comparably high internal consistency (alpha = 0.90) and strong convergence with the clinician-administered scale. Convergent and criterion validity were robust, with high sensitivity and specificity. Cross-cultural comparisons further supported consistency and generalisability.ConclusionsThis study establishes both the clinician-administered and self-report Turkish Y-BOCS as reliable, valid, and culturally sensitive tools for assessing OCD severity in clinical and research contexts.