Modular cognitive-behavioral therapy for body dysmorphic disorder: A randomized controlled trial
Open accessAbstract
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<0.0001), with gains maintained during follow-up. Depression, insight, and disability also significantly improved. Patient satisfaction was high, with a mean CSI score of 87.3% (SD=12.8%) at posttreatment. CBT-BDD appears to be a feasible, acceptable, and efficacious treatment that warrants more rigorous investigation.
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Some patients may require a higher number of CBT sessions.
“For example, some patients may require a higher number of sessions.”
From Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials (2016) · cites this paper as Wilhelm et al., 2014
Uncontrolled trial data suggest that adding additional sessions beyond the standard 8-14 sessions employed in previous trials may lead to further improvement in BDD symptoms.
“There is some uncontrolled trial data to suggest that adding additional sessions (beyond the standard 8-14 sessions employed in previous trials) may lead to further improvement in BDD symptoms (Veale et al., 2014; Wilhelm et al., 2014).”
From Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials (2016) · cites this paper as Wilhelm et al., 2014
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- Authors
- Wilhelm, S., Phillips, K. A., Didie, E., Buhlmann, U., Greenberg, J. L., Fama, J. M., Keshaviah, A., & Steketee, G.
- Affiliations
- Harvard University (US)
- Brown University (US)
- Humboldt-Universität zu Berlin (DE)
- Boston University (US)
- Corresponding author
- Wilhelm, Sabine
- ORCID
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2014-05
- Volume
- 45
- Issue
- 3
- Pages
- 314-327
- ISSN
- 0005-7894 (ISSN-L)
- PMC
- PMC4283214
- OpenAlex
- W1966470720
- Cited by
- 238
- References
- 56
- Citations by year
- 2026: 18 · 2025: 9 · 2024: 25 · 2023: 17 · 2022: 11 · 2021: 36 · 2020: 12 · 2019: 17 · 2018: 13 · 2017: 17 · 2016: 20 · 2015: 37 · 2014: 6
- FWCI
- 31.47
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34MH070490)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- body dysmorphic disorder, cognitive behavioral therapy, treatment efficacy, treatment acceptability, exposure and response prevention, depression, insight, disability, patient satisfaction, waitlist control
- MeSH terms
- Achievement, Adult, Cognition, Female, Follow-Up Studies, Humans, Male, Personality Inventory, Psychiatric Status Rating Scales, Retrospective Studies, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Body Dysmorphic Disorders
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