February 20, 2019
2 min read

CBT, supportive psychotherapy improve body dysmorphia severity

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Adults with body dysmorphic disorder benefited from both cognitive behavioral therapy and supportive psychotherapy, findings published in JAMA Psychiatry revealed.

However, CBT for body dysmorphic disorder (BDD) was associated with more consistent improvement in symptom severity and quality of life, according to the results.

“Six randomized clinical trials have demonstrated the efficacy of cognitive behavioral therapy for BDD in adults. However, previous trials of CBT for BDD were limited by small, restrictive samples,” Sabine Wilhelm, PhD, from the department of psychiatry, Massachusetts General Hospital, and colleagues wrote. “Therapist-delivered supportive psychotherapy is the psychosocial treatment most commonly received by individuals with BDD, yet its efficacy for this disorder has never been tested.”

Researchers compared CBT for BDD (CBT-BDD; n = 61) with supportive psychotherapy (n = 59) for decreasing BDD symptom severity and associated BDD-related insight, depressive symptoms, functional impairment and quality of life among 120 adults with BDD in a two-site, randomized clinical trial.

Briefly, CBT-BDD was a modular skills–based treatment that addressed the unique symptoms of the disorder, and supportive psychotherapy, which emphasized a therapeutic relationship and self-esteem, was enhanced with BDD-specific psychoeducation and treatment rationale, according to the researchers.

Participants were randomized to CBT-BDD or supportive psychotherapy with weekly treatments administered at one of two hospitals for 24 weeks, followed by assessments after 3 and 6 months. Wilhelm and colleagues measured change in BDD symptom severity via the Yale-Brown Obsessive-Compulsive Scale Modified for BDD from baseline to end of treatment, as well as change in associated symptoms via the Brown Assessment of Beliefs Scale, Beck Depression Inventory–Second Edition, Sheehan Disability Scale, and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form.

At both treatment sites, CBT-BDD and supportive psychotherapy resulted in statistically significant decreases in the severity of BDD; however, the rate of improvement differed by treatment and site, according to the findings.

At one site, the investigators observed no difference in the effectiveness between CBT-BDD and supportive psychotherapy (estimated mean slopes = –18.6 vs. –16.7; P = .48). At the other, treatment with CBT-BDD resulted in greater reductions in disorder symptom severity than treatment with supportive psychotherapy (estimated mean slopes = –18.6 vs. –7.6; P < .001).

Although both treatment groups at both treatment sites saw improvements in BDD-related insight, depressive symptoms and functional impairment, only participants at one treatment site saw improvements in quality of life, the results showed.

Throughout the 6-month follow-up, Wilhelm and colleagues found no post-treatment symptom changes.

“Additional studies of BDD treatment are needed, especially large studies that examine the transportability of these treatments to real-world settings, such as community mental health centers,” the researchers wrote. “Future studies should also examine patient- and therapist-level predictors and moderators of treatment response and identify mechanisms of therapeutic change.”

To figure out why BDD-CBT was more successful than supportive psychotherapy at one site but not another, future research must isolate elements of the treatment, Douglas S. Mennin, PhD, from Columbia University, wrote in a related editorial.

“The study by Wilhelm et al goes a long way to improving outcomes for a population with particularly refractory symptoms,” he wrote. “Important next steps for ensuring durable outcomes for the most people will be determining the essential elements for clinically significant improvement and how these elements produce change for different patients.”

Disclosure: Please see the study for a list of the authors’ relevant financial disclosures. Mennin reports no relevant financial disclosures.