Efficacy of Cognitive Behaviour Therapy versus Anxiety Management for Body Dysmorphic Disorder: A Randomised Controlled Trial

Abstract

Background: The evidence base for the efficacy of cognitive behaviour therapy (CBT) for treating body dysmorphic disorder (BDD) is weak. Aims: To determine whether CBT is more effective than anxiety management (AM) in an outpatient setting. Method: This was a single-blind stratified parallel-group randomised controlled trial. The primary endpoint was at 12 weeks, and the Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS) was the primary outcome measure. Secondary measures for BDD included the Brown Assessment of Beliefs Scale (BABS), the Appearance Anxiety Inventory (AAI) and the Body Image Quality of Life Inventory (BIQLI). The outcome measures were collected at baseline and week 12. The CBT group, unlike the AM group, had 4 further weekly sessions that were analysed for their added value. Both groups then completed measures at their 1-month follow-up. Forty-six participants with a DSM-IV diagnosis of BDD, including those with delusional BDD, were randomly allocated to either CBT or AM. Results: At 12 weeks, CBT was found to be significantly superior to AM on the BDD-YBOCS [β = -7.19; SE (β) = 2.61; p < 0.01; 95% CI = -12.31 to -2.07; d = 0.99] as well as the secondary outcome measures of the BABS, AAI and BIQLI. Further benefits occurred by week 16 within the CBT group. There were no differences in outcome for those with delusional BDD or depression. Conclusions: CBT is an effective intervention for people with BDD even with delusional beliefs or depression and is more effective than AM over 12 weeks.

Dysfunctional Metacogntive Beliefs in Body Dysmorphic Disorder

“…Findings showed that BDD has a significant positive relationship with thought fusion, metaworry, and dysfunctional metacognition, which is consistent with previous studies [7,9,[19][20][21][22].…”

“…The metacognition components of body dysmorphic disorder include the strategies for metacognitive controlling such as suppressing thoughts about being ugly, worries about dysmorphic, rumination avoiding, reassurance seeking or excessive grooming [7]. According to Veale et al [22], in BDDs, metacognition is a noticeable issue in information processing, and it possibly aids maintenance of symptoms. Considering the relationships between metacognitive components and body dysmorphic disorder, it is worth of notice that the scores of components could successfully predict the disorder [5,9,23].…”

Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials

“…the standardized difference in mean decrease) was directly retrieved from the papers (Enander et al, In press;Veale et al, 2014;Wilhelm et al, 2014) or derived from the reported statistics (Rabiei, Mulkens, Kalantari, Molavi, & Bahrami, 2012).…”

“…All studies included adults with BDD except for which included an adolescent sample. The majority of studies involved individually delivered face-to-face CBT sessions including ERP and differing amounts of additional cognitive techniques, compared to no treatment/waitlist (Rabiei et al, 2012;Rosen et al, 1995;Veale et al, 1996;Wilhelm et al, 2014), an enhanced waitlist , or a credible psychological placebo (Enander et al, 2016;Veale et al, 2014). One study compared meta-cognitive therapy based on Wells (2000) with a waitlist control and was the only RCT that did not explicitly mention ERP (Rabiei et al, A C C E P T E D M A N U S C R I P T…”

Appearance comparison in individuals with body dysmorphic disorder and controls

“…In addition, a recent randomized controlled trial found that CBT was significantly superior to anxiety management in reducing BDD symptoms at 12 weeks (Veale et al, 2014). In terms of specific strategies, Neziroglu et al (2008) propose that treatment aimed at helping BDD patients reduce excessive appearance comparison can include encouragement to extend their range of attention, for example by focusing their attention on all the sensory stimuli in their surrounding environment, by concentrating on the content of conversations during social interactions, and by attending to the whole of a person's appearance, rather than specific features.…”