Modular cognitive-behavioral therapy for body dysmorphic disorder: a randomized controlled trial

Behav Ther. 2014 May;45(3):314-27. doi: 10.1016/j.beth.2013.12.007. Epub 2013 Dec 29.

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.

Keywords: BDD; body dysmorphic disorder; body image; cognitive-behavioral therapy; treatment.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Achievement*
  • Adult
  • Body Dysmorphic Disorders / diagnosis
  • Body Dysmorphic Disorders / psychology
  • Body Dysmorphic Disorders / therapy*
  • Cognition / physiology*
  • Cognitive Behavioral Therapy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Personality Inventory*
  • Psychiatric Status Rating Scales
  • Retrospective Studies
  • Severity of Illness Index
  • Treatment Outcome