Efficacy and Posttreatment Effects of Therapist-Delivered Cognitive Behavioral Therapy vs Supportive Psychotherapy for Adults With Body Dysmorphic Disorder

Abstract

IMPORTANCE Cognitive behavioral therapy (CBT), the best-studied treatment for body dysmorphic disorder (BDD), has to date not been compared with therapist-delivered supportive psychotherapy, the most commonly received psychosocial treatment for BDD. OBJECTIVE To determine whether CBT for BDD (CBT-BDD) is superior to supportive psychotherapy in reducing BDD symptom severity and associated BDD-related insight, depressive symptoms, functional impairment, and quality of life, and whether these effects are durable. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial conducted at Massachusetts General Hospital and Rhode Island Hospital recruited adults with BDD between October 24, 2011, and July 7, 2016. Participants (n = 120) were randomized to the CBT-BDD arm (n = 61) or the supportive psychotherapy arm (n = 59). Weekly treatments were administered at either hospital for 24 weeks, followed by 3-and 6-month follow-up assessments. Measures were administered by blinded independent raters. Intention-to-treat statistical analyses were performed from February 9, 2017, to September 22, 2018. INTERVENTIONS Cognitive behavioral therapy for BDD, a modular skills-based treatment, addresses the unique symptoms of the disorder. Supportive psychotherapy is a nondirective therapy that emphasizes the therapeutic relationship and self-esteem; supportive psychotherapy was enhanced with BDD-specific psychoeducation and treatment rationale. MAIN OUTCOMES AND MEASURES The primary outcome was BDD symptom severity measured by the change in score on the Yale-Brown Obsessive-Compulsive Scale Modified for BDD from baseline to end of treatment. Secondary outcomes were the associated symptoms and these were assessed using the

Conformity to masculine norms and symptom severity among men diagnosed with muscle dysmorphia vs. body dysmorphic disorder

“…There are no known empirically supported treatments for MD, per se; however, cognitive behavioral therapy (CBT) for BDD has demonstrated strong empirical support for its efficacy [ 33 ]. Modular-based CBT for BDD is a promising treatment which includes a module on MD; however, to date, there is no data on whether the efficacy of CBT varies as a function of MD diagnosis [ 34 , 35 ]. Findings from the current study may indicate that addressing masculinity in therapy may be a fruitful approach.…”

Psychosocial and Lifestyle-Associated Skin Diseases

“…In the meantime, symptom-specific therapy management has been developed for body dysmorphic disorders (Lahousen et al 2017). Early recognition of the disease and fast indication for a psychosomatic or psychiatric treatment are important factors with regard to the efficacy of treatment (Wilhelm et al 2019).…”

Body dysmorphic disorder: a treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology

“…In this context, a recent 24-week RCT (Wilhelm et al, 2019) comparing supportive psychotherapy (SPT) with CBT for BDD (CBT-BDD) addresses many of these methodological constraints. The study was adequately powered (n = 120); the intervention was manualized and specifically developed for BDD; randomization and blinding were of high quality; and analyses employed intention-to-treat.…”