title: Modular cognitive-behavioral therapy for body dysmorphic disorder: a randomized controlled trial.
abstract: There are few effective treatments for body dysmorphic disorder (BDD) and a pressing need to develop such treatments. We examined the feasibility, acceptability, and efficacy of a manualized modular cognitive-behavioral therapy for BDD (CBT-BDD). CBT-BDD utilizes core elements relevant to all BDD patients (e.g., exposure, response prevention, perceptual retraining) and optional modules to address specific symptoms (e.g., surgery seeking). Thirty-six adults with BDD were randomized to 22 sessions of immediate individual CBT-BDD over 24 weeks (n=17) or to a 12-week waitlist (n=19). The Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS), Brown Assessment of Beliefs Scale, and Beck Depression Inventory-II were completed pretreatment, monthly, posttreatment, and at 3- and 6-month follow-up. The Sheehan Disability Scale and Client Satisfaction Inventory (CSI) were also administered. Response to treatment was defined as ≥30% reduction in BDD-YBOCS total from baseline. By week 12, 50% of participants receiving immediate CBT-BDD achieved response versus 12% of waitlisted participants (p=0.026). By posttreatment, 81% of all participants (immediate CBT-BDD plus waitlisted patients subsequently treated with CBT-BDD) met responder criteria. While no significant group differences in BDD symptom reduction emerged by Week 12, by posttreatment CBT-BDD resulted in significant decreases in BDD-YBOCS total over time (d=2.1, p<0.0001), with gains maintained during follow-up. Depression, insight, and disability also significantly improved. Patient satisfaction was high, with a mean CSI score of 87.3% (SD=12.8%) at posttreatment. CBT-BDD appears to be a feasible, acceptable, and efficacious treatment that warrants more rigorous investigation.
authors.affiliation: Massachusetts General Hospital and Harvard Medical School. Electronic address: wilhelm@psych.mgh.harvard.edu.
authors.forename: Sabine
authors.initials: S
authors.lastname: Wilhelm
authors.affiliation: Rhode Island Hospital and Alpert Medical School of Brown University.
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Phillips
authors.affiliation: Rhode Island Hospital and Alpert Medical School of Brown University.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Didie
authors.affiliation: Humboldt-Universität zu Berlin.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Buhlmann
authors.affiliation: Massachusetts General Hospital and Harvard Medical School.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Greenberg
authors.affiliation: Massachusetts General Hospital and Harvard Medical School.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Fama
authors.affiliation: Massachusetts General Hospital and Harvard Medical School.
authors.forename: Aparna
authors.initials: A
authors.lastname: Keshaviah
authors.affiliation: Boston University.
authors.forename: Gail
authors.initials: G
authors.lastname: Steketee
mesh_terms: D000124:Achievement; D000328:Adult; D057215:Body Dysmorphic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003071:Cognition / Q000502:physiology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: BDD; body dysmorphic disorder; body image; cognitive-behavioral therapy; treatment