title: Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials.
abstract: Body dysmorphic disorder (BDD) is a chronic and disabling psychiatric disorder unlikely to remit without treatment. A systematic review and meta-analysis of randomized controlled trials (RCTs) of cognitive-behavioral therapy (CBT) for BDD was conducted, including published and unpublished trials to 26th November 2015. Primary outcomes were validated BDD measures; secondary outcomes included depression and insight. Meta-regressions were conducted to examine potential effects of variables on the primary outcome, including socio-demographic variables, comorbidity, symptom severity/duration, concomitant medication, treatment duration, and methodological quality of the RCTs. Seven RCTs (N=299) met inclusion criteria. CBT was superior to waitlist or credible psychological placebo in reducing BDD (7 studies; delta=-1.22, 95% CI=-1.66 to -0.79) and depression symptoms (5 studies; delta=-0.49, 95% CI=-0.76 to -0.22). CBT was associated with improvements in insight/delusionality (4 studies; delta=-0.56, 95% CI=-0.93 to -0.19). Improvement in BDD was maintained after 2-4months follow-up (3 studies; delta=-0.89, 95% CI=-1.24 to -0.54). Meta-regression analyses did not reveal any significant predictors of outcome. CBT is an efficacious treatment for BDD but there is substantial room for improvement. The specificity and long-term effects of CBT for BDD require further evaluation using credible control conditions. Additional trials comparing CBT with pharmacological therapies, as well as their combination, are warranted. Tele-care options, such as Internet-based CBT, hold great promise to increase access to evidence-based treatment for a majority of patients who need it and should be evaluated further.
authors.affiliation: Regent's University London, School of Psychotherapy and Psychology, Faculty of Humanities, Arts and Social Sciences, London, UK. Electronic address: harrisona@regents.ac.uk.
authors.forename: Amy
authors.initials: A
authors.lastname: Harrison
authors.affiliation: Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lorena
authors.initials: L
authors.lastname: Fernández de la Cruz
authors.affiliation: Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jesper
authors.initials: J
authors.lastname: Enander
authors.affiliation: Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; FIDMAG Germanes Hospitalàries, CIBERSAM, Barcelona, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Radua
authors.affiliation: Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Mataix-Cols
mesh_terms: D057215:Body Dysmorphic Disorders / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Body dysmorphic disorder; Cognitive-behavioral therapy; Meta-analysis; Randomized controlled trial; Systematic review; Treatment