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Online CBT safe, effective for body dysmorphic disorder

A therapist-guided, internet-based cognitive behavioral therapy program for body dysmorphic disorder was efficacious, according to recent findings.

“Evidence based treatments for body dysmorphic disorder include psychopharmacological treatment and cognitive behavior therapy (CBT). Guidance from the National Institute for Health and Clinical Excellence (NICE) recommends that adults should be offered the choice of either a course of a selective serotonin response inhibitor or specialized CBT that deals with the key features of the disorder,” Jesper Enander, MSc, of Karolinska Institutet, Stockholm, Sweden, and colleagues wrote. “There is, however, a gap between supply and demand of CBT because of various factors, such as a lack of trained therapists, direct and indirect costs associated with treatment, and geographical barriers that prevent people with body dysmorphic disorder from receiving specialized CBT.”

To assess efficacy of a therapist-guided, internet-based CBT program for body dysmorphic disorder (BDD-NET), researchers conducted a 12-week single blind parallel group randomized controlled trial among 94 adults with body dysmorphic disorder. Study participants had a modified Yale-Brown obsessive compulsive scale (BDD-YBOCS) score of at least 20 at baseline. Half of the cohort received BDD-NET and half received supportive therapy delivered via the internet for 12 weeks.

BDD-NET consisted of eight interactive modules, each focused on a special theme, covering psychoeducation, a cognitive behavior conceptualization of body dysmorphic disorder, cognitive restructuring, exposure and response prevention, more on exposure and response prevention, values based behavior change, difficulties encountered during treatment, and prevention of relapse. Participants had to complete homework assignments and quizzes to progress to the next module. Therapists guided and coached participants throughout treatment, provided feedback and granted access to subsequent modules.

Participants who received supportive therapy received an email from therapists at least once a week, encouraging them to discuss distressing life events and promote problem solving. All emails from participants were reviewed and answered within 36 hours. Participants were notified about email replies via text message.

Individuals who received BDD-NET exhibited significant improvements in body dysmorphic symptom severity, with a group difference of –7.1 points (95% CI, –9.8 to –4.4) in BDD-YBOCS scores and –4.5 points (95% CI, –7.5 to –1.4) in MADRS-S depression scores.

At follow-up, 56% of the BDD-NET group were considered responders, compared with 13% of the supportive therapy group.

The number needed to treat was 2.34 (95% CI, 1.71-4.35).

Participants reported high satisfaction, according to researchers.

“BDD-NET is delivered online as a series of interactive modules, and the role of the therapist is mainly to encourage the participant to engage in the treatment, making it reasonable to assume that BDD-NET can be used in non-specialist settings. BDD-NET could be particularly useful in a stepped care approach, where mild to moderately affected patients can be offered BDD-NET by their general practitioner, or other health professionals, thus freeing resources for patients in more severe and complex cases to be treated in specialized settings,” the researchers concluded. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.