Category: Obsessive Compulsive and Related Disorders


Mechanisms of Change in CBT for Body Dysmorphic Disorder

Friday, November 17
1:45 PM - 3:15 PM
Location: Sapphire Ballroom K & L, Level 4, Sapphire Level

Keywords: Body Dysmorphic Disorder | Cognitive Schemas / Beliefs | Mediation / Mediators
Presentation Type: Symposium

Cognitive-behavioral therapy (CBT) is the most empirically supported psychological treatment for body dysmorphic disorder (BDD). Yet, not all patients benefit, and the mechanisms of change underlying successful treatment remain unknown. The present study examined whether cognitive changes in maladaptive beliefs about appearance, perfectionism, and maladaptive schemas (specifically, defectiveness/shame and self-oriented perfectionism) mediate improvement during CBT among individuals with BDD. To our knowledge, this is the first study to examine mechanisms of change underlying CBT for BDD. Forty-fiveparticipants with BDD (27 female, 39 Caucasian, mean age = 35 years) were enrolled in a multisite treatment development study of CBT for BDD. To examine mechanisms of change, we operationalized mediation by examining how changes in proposed mediators predicted changes in BDD symptom severity. We conducted two mediation analyses to examine between-subjects changes in mediators between CBT and waitlist conditions for data up to week 12, and to examine within-subject changes in mediators for those treated with 24 weeks of CBT. BDD checking symptoms were a significant mediator in the between-subjects analysis, accounting for 43% of the total effect. Proposed mediators accounted for 1-31% of the total effect of CBT in the within-subjects analysis. According to subsequent sensitivity analyses in which change scores were calculated from the session prior to when each mediator was targeted (rather than from baseline), maladaptive beliefs about appearance and defectiveness/shame emerged as statistically significant mediators explaining 39% and 34% of the total effect of CBT, respectively. This study found that cognitive changes mediated BDD symptom reduction in CBT. Targeting these mechanisms in future treatment trials may enhance symptom improvement during CBT.

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