Therapist guided Internet based cognitive behavioural therapy for body dysmorphic disorder: Single blind randomised controlled trial
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OBJECTIVES: To evaluate the efficacy of therapist guided internet based cognitive behavioural therapy (CBT) programme for body dysmorphic disorder (BDD-NET) compared with online supportive therapy. DESIGN: A 12 week single blind parallel group randomised controlled trial. SETTING: Academic medical centre. PARTICIPANTS: 94 self referred adult outpatients with a diagnosis of body dysmorphic disorder and a modified Yale-Brown obsessive compulsive scale (BDD-YBOCS) score of ≥ 20. Concurrent psychotropic drug treatment was permitted if the dose had been stable for at least two months before enrolment and remained unchanged during the trial. INTERVENTIONS: Participants received either BDD-NET (n=47) or supportive therapy (n=47) delivered via the internet for 12 weeks. MAIN OUTCOME MEASURES: The primary outcome was the BDD-YBOCS score after treatment and follow-up (three and six months from baseline) as evaluated by a masked assessor. Responder status was defined as a ≥ 30% reduction in symptoms on the scale. Secondary outcomes were measures of depression (MADRS-S), global functioning (GAF), clinical global improvement (CGI-I), and quality of life (EQ5D). The six month follow-up time and all outcomes other than BDD-YBOCS and MADRS-S at 3 months were not pre-specified in the registration at clinicaltrials.gov because of an administrative error but were included in the original trial protocol approved by the regional ethics committee before the start of the trial. RESULTS: BDD-NET was superior to supportive therapy and was associated with significant improvements in severity of symptoms of body dysmorphic disorder (BDD-YBOCS group difference -7.1 points, 95% confidence interval -9.8 to -4.4), depression (MADRS-S group difference -4.5 points, -7.5 to -1.4), and other secondary measures. At follow-up, 56% of those receiving BDD-NET were classed as responders, compared with 13% receiving supportive therapy. The number needed to treat was 2.34 (1.71 to 4.35). Self reported satisfaction was high. CONCLUSIONS: CBT can be delivered safely via the internet to patients with body dysmorphic disorder. BDD-NET has the potential to increase access to evidence based psychiatric care for this mental disorder, in line with NICE priority recommendations. It could be particularly useful in a stepped care approach, in which general practitioner or other mental health professionals can offer treatment to people with mild to moderate symptoms at low risk of suicide.Trial registration ClinicalTrials.gov ID: NCT02010619.
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Internet-delivery increases reach and access with satisfactory treatment effects.
“Geographical reach was 40 km (median) for the clinical patients and 400 km (median) for self-referred patients, adding to previous research illustrating the utility of internet-delivery to increase reach and access with satisfactory treatment effects (55,56).”
From Internet-delivered acceptance and commitment therapy (iACT) for chronic pain—feasibility and preliminary effects in clinical and self-referred patients (2020) · cites this paper as [55]
Data from a relatively large RCT suggest that Internet-based CBT can be a highly acceptable, safe, and efficacious way to reach a large majority of patients previously unable to access CBT.
“Data from a relatively large RCT (Enander et al., 2016) suggest that this can be a highly acceptable, safe, and efficacious way to reach a large majority of patients previously unable to access CBT.”
From Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials (2016) · cites this paper as Enander et al., 2016
Guided self-management of symptoms (e.g. via online delivered psychotherapy or smartphones) could bridge this gap, addresses many of the logistical and shame related barriers we identified and has already shown promising effects in BDD.
“Guided self-management of symptoms, e.g. via online delivered psychotherapy or smartphones, could bridge this gap, addresses many of the logistical and shame related barriers we identified and has already shown promising effects in BDD [53–55].”
From Treatment utilization and treatment barriers in individuals with body dysmorphic disorder (2020) · cites this paper as [53]
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- Authors
- Enander, J., Andersson, E., Mataix-Cols, D., Lichtenstein, L., Alström, K., Andersson, G., Ljótsson, B., & Rück, C.
- Affiliations
- Karolinska Institutet (SE)
- Linköping University (SE)
- Corresponding author
- Enander, Jesper
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2016-02-02
- Volume
- 352
- Pages
- i241
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC4737850
- OpenAlex
- W2253482453
- Cited by
- 129
- References
- 50
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 19 · 2023: 13 · 2022: 13 · 2021: 13 · 2020: 13 · 2019: 11 · 2018: 14 · 2017: 12 · 2016: 4
- FWCI
- 18.28
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Karolinska Institutet
- Stockholms Läns Landsting
- Vetenskapsrådet (K2013-61X-22168-01-3)
- Svenska Läkaresällskapet (SLS3B4451)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- body dysmorphic disorder, internet-based cognitive behavioral therapy, supportive therapy, depression, quality of life, stepped care, access to mental health care, number needed to treat
- MeSH terms
- Adolescent, Adult, Aged, Depression, Female, Humans, Male, Middle Aged, Quality of Life, Remission Induction, Social Support, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome, Internet, Directive Counseling, Young Adult, Body Dysmorphic Disorders
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