CBT is Effective for Body Dysmorphic Disorder

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

Wilhelm, S., Phillips, K. A., Didie, E., Buhlmann, U., Greenberg, J. L., Fama, J. M., & … Steketee, G. (2013). Modular cognitive-behavioral therapy for body dysmorphic disorder: A randomized controlled trial. Behavior Therapy, doi:10.1016/j.beth.2013.12.007


Modular CBT for Body Dysmorphic Disorder

A recent pilot study published in Behavior Therapy found that modular Cognitive Behavior Therapy (CBT) may help reduce symptom severity and depression in Body Dysmorphic Disorder (BDD). BDD is characterized by an often-delusional preoccupation with an imagined or slight defect in appearance that causes significant distress and impairment in daily functioning. The current study incorporates a broadly applicable CBT treatment manual with a specific focus on the BDD model and BDD symptoms.

Participants included twelve individuals, male and female, who met DSM-IV-TR criteria for BDD. Participants were randomly assigned to two treatment groups: one which received 18 therapy sessions and one which received 22 therapy sessions. Two licensed psychologists delivered manualized treatment via individual 60-minute sessions twice per week for the first four weeks, and once per week thereafter. CBT methods and techniques included psycho-education, cognitive restructuring, mindfulness/perceptual retraining, relapse prevention, as well as modular interventions tailored to each participant’s individual symptoms. Participants were encouraged to evaluate their negative and maladaptive thoughts and avoidance behaviors, identify adaptive and robust responses, and engage in homework assignments. Before and following treatment, participants were assessed with the Yale-Brown Obsessive Compulsive Scale Modified for BDD (BDD-YBOCS), the Clinical Global Impression Scale (CGI), the Brown Assessment of Beliefs Scale (BABS), the Beck Depression Inventory-II (BDI-II), and the Client Satisfaction Inventory (CSI).

Results, which include a decrease in BDD symptom severity and delusionality, improvement in depressive symptoms, and high retention and satisfaction rates, suggest that modular manualized CBT treatment for BDD is a practical, well-received, and effective treatment for this disorder. This modular approach maintains the integrity of the core procedures of manualized treatment while incorporating flexible treatment tailored to meet individual patient’s needs.

Sabine Wilhelm, Ph.D., and Gail Stetekee Ph.D., two of the authors, were nominated for and participated in the Beck Institute Scholar Supervision program.

Fama, J.M., Greenberg, J.L., Phillips, K. A., Steketee, G., Wilhelm, S. (2011). Modular Cognitive-Behavioral Therapy for Body Dysmorphic Disorder. Behavior Therapy, 42(4), 624-633.