Therapist-guided, Internet-based cognitive–behavioural therapy for body dysmorphic disorder (BDD-NET): a feasibility study

Abstract

ObjectivesCognitive–behavioural therapy (CBT) is an effective treatment for body dysmorphic disorder (BDD). However, most sufferers do not have access to this treatment. One way to increase access to CBT is to administer treatment remotely via the Internet. This study piloted a novel therapist-supported, Internet-based CBT program for BDD (BDD-NET).DesignUncontrolled clinical trial.ParticipantsPatients (N=23) were recruited through self-referral and assessed face to face at a clinic specialising in obsessive–compulsive and related disorders. Suitable patients were offered secure access to BDD-NET.InterventionBDD-NET is a 12-week treatment program based on current psychological models of BDD that includes psychoeducation, functional analysis, cognitive restructuring, exposure and response prevention, and relapse prevention modules. A dedicated therapist provides active guidance and feedback throughout the entire process.Main outcome measureThe clinician-administered Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS). Symptom severity was assessed pretreatment, post-treatment and at the 3-month follow-up.ResultsBDD-NET was deemed highly acceptable by patients and led to significant improvements on the BDD-YBOCS (p=<0.001) with a large within-group effect size (Cohen's d=2.01, 95% CI 1.05 to 2.97). At post-treatment, 82% of the patients were classified as responders (defined as≥30% improvement on the BDD-YBOCS). These gains were maintained at the 3-month follow-up. Secondary outcome measures of depression, global functioning and quality of life also showed significant improvements with moderate to large effect sizes. On average, therapists spent 10 min per patient per week providing support.ConclusionsThe results suggest that BDD-NET has the potential to greatly increase access to CBT, at least for low-risk individuals with moderately severe BDD symptoms and reasonably good insight. A randomised controlled trial of BDD-NET is warranted.Trial registration numberClinicaltrials.gov registration ID NCT01850433.

Internet-based, therapist-guided, cognitive–behavioural therapy for body dysmorphic disorder with global eligibility for inclusion: an uncontrolled pilot study

“…Current results are in line with previous evaluations of BDD-NET as well as face-to-face CBT for BDD 15–17. These findings suggest that delivering BDD-NET across borders in a new language, to a more culturally diverse patient population, had little to no impact on treatment effects.…”

“…The aim of this investigation was to evaluate the feasibility and safety of a global treatment initiative using an English-language version of BDD-NET 15 16. This uncontrolled pilot study was intended to assess different aspects of conducting the study remotely and across international borders; including recruitment, assessment and treatment delivery.…”

“…BDD-NET, a 12-week internet-delivered CBT intervention for BDD, was evaluated in Sweden in a pilot study (n=23) and then in a randomised controlled trial (n=94), and showed sustained effects at 2-year follow-up 15 16 36. It was translated to English for the current study in order to reach an international sample (For a full description of the treatment content, see refs15 16). Throughout treatment, patients had unlimited access to their therapist from Monday to Friday via asynchronous electronic text messages.…”

“…While ICBT has been studied for nearly 20 years,12 there has been an upsurge of promising research on technology-based mental health interventions during the past several years 13 14. Recently, BDD-NET, a therapist-guided, ICBT programme for BDD, was developed to improve access to evidence-based care, and the treatment has been shown to be safe, efficacious and highly acceptable by patients 15 16. The treatment is delivered through a secure tailored online platform that contains the treatment content.…”

Acceptance-Based Exposure Therapy for Body Dysmorphic Disorder: A Pilot Study

“…The small existing body of research, which consists of case reports, case series and a few studies using waitlist control groups, shows preliminary support for the effectiveness of cognitive behavioral therapy (CBT) for BDD, with effect sizes ranging from d= 1.01 to 2.18 (Enander et al, 2014, Ipser, Sander, & Stein, 2009Wilhelm et al, 2013;Williams, Hadjistavropoulus, & Sharpe, 2006). Moreover, pharmacological treatment appears to be effective (Williams et al, 2006), but no studies comparing pharmacological treatments with psychological treatments have been conducted.…”