Category: Obsessive Compulsive and Related Disorders

Symposium

CBT Versus Supportive Psychotherapy for Body Dysmorphic Disorder: A Randomized Controlled Trial

Friday, November 17
8:30 AM - 10:00 AM
Location: Sapphire Ballroom M & N, Level 4, Sapphire Level

Keywords: Body Dysmorphic Disorder | Treatment Development | Randomized Controlled Trial
Presentation Type: Symposium

Background:  Body Dysmorphic Disorder (BDD) is common, distressing and typically markedly impairing. In person cognitive behavioral therapy (CBT), although promising, has not been evaluated in large-scale controlled trials. Methods:  Across two sites, 120 participants with BDD were randomized to receive weekly therapy sessions of either CBT or supportive psychotherapy (SPT) for 24 weeks.  The primary outcome was change in BDD symptom severity from baseline to the end of treatment, based on the Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS) assessed by clinicians blinded to treatment assignment. We analyzed outcomes using intent-to-treat (ITT) linear latent growth curve analyses.


Results:  At baseline, mean BDD symptoms were in the moderate-severe range (BDD-YBOCS M±SD: 31.9±4.8, range 20-45).   Over the course of treatment, BDD-YBOCS scores decreased significantly in both treatment groups (BDD-YBOCS M±SD at week 24: 13.3±9.5 in CBT vs. 18.7±9.8 in SPT), although the effect was stronger in the CBT group (weekly slope: -0.77±0.06, slope effect size dCBT=-3.85) than in the SPT group (weekly slope: -0.53±0.06, dSPT=-2.62; treatment by time F1,94=8.26, p=0.0050; slope difference: -0.25±0.09, ddiff=-1.23).


The treatment response rates for CBT vs. SPT were 84.1% vs. 58.3% among treatment completers and 67.2% vs 52.5% among all participants (in intention-to treat analyses).  The rate of early termination from all causes did not differ significantly between treatment groups (27.9% CBT vs. 18.6% SPT; Wald X2=1.39, p=0.24), though terminations tended to occur earlier in CBT than in SPT. Insight (BABS), depression (BDI-II), and global functioning (SDS)  improved with both treatments.  Quality of life (Q-LES-Q SF) also increased with both treatments, but had a slightly higher rate of improvement in CBT.


Conclusion: To our knowledge, this is the largest treatment study that has been conducted in BDD so far. Compared to supportive psychotherapy, CBT resulted in greater reductions in symptom severity among moderately to severely symptomatic psychiatric outpatients with BDD.

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