Cognitive-Behavioral Therapy and Supportive Psychotherapy for Body Dysmorphic Disorder

Mass General Brigham

Status

Completed

Conditions

Obsessive-Compulsive Spectrum Disorder

Somatoform Disorders

Anxiety Disorders

Body Dysmorphic Disorder

Treatments

Behavioral: Supportive Psychotherapy

Behavioral: Cognitive Behavioral Therapy

Study type

Interventional

Funder types

Other

NIH

Identifiers

NCT01453439

2010-P-001021/2 (Other Identifier)

R01MH091078 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The purpose of this study is to learn more about two different types of psychotherapy to help individuals who have body dysmorphic disorder (BDD). BDD is a severe, often chronic, and common disorder consisting of distressing or impairing preoccupation with perceived defects in one's physical appearance. Individuals with BDD have very poor psychosocial functioning and high rates of hospitalization and suicidality. Because BDD differs in important ways from other disorders, psychotherapies for other disorders are not adequate for BDD. Despite BDD's severity, there is no adequately tested psychosocial treatment (psychotherapy) of any type for this disorder. This study will compare the effectiveness of Cognitive Behavioral Therapy and Supportive Psychotherapy as well as predictors of improvement.

Full description

Body Dysmorphic Disorder (BDD) is a common and severe disorder in which a person is preoccupied by perceived defects in his or her appearance. The purpose of this research study is to learn more about two different forms of therapy to help individuals with BDD: cognitive behavioral therapy (CBT), a promising new treatment for BDD, and supportive psychotherapy (SPT), the most commonly received therapy for BDD. The investigators would like to find out which treatment is more effective for BDD. The investigators will also examine patient characteristics that may predict response to treatment.

Participants will be randomly assigned (like the flip of a coin) to receive 22 sessions (over 24 weeks) of either CBT or SPT. Both treatments teach participants about BDD. CBT focuses on helping participants to develop more adaptive thoughts and beliefs and to gradually reduce avoidance and compulsive (repetitive) behaviors. SPT focuses on relationships, feelings, and other factors that may affect BDD symptoms (e.g., work, stress), and helps participants to cope with challenges in their life by improving self-esteem and positive coping.

For each participant, this study will last for 12 months. CBT and SPT sessions occur for 22 sessions over 24 weeks. The severity of participants' BDD-related symptoms and other symptoms will be assessed at the end of treatment (week 24), and at 3- and 6-months after treatment ends.

Enrollment

120 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Outpatient men and women age 18 and older
DSM-IV BDD or its delusional variant for at least 6 months
BDD is the most problematic psychiatric disorder (in the patient's and clinician's opinion) and the primary reason for seeking treatment
Score of 24 or higher on the BDD-Yale-Brown Obsessive Compulsive Scale

Exclusion criteria

Current clinically significant suicidality and/or score on the BDI-II suicide item (#9) > 1
Any clinical features requiring a higher level of care
Mental retardation or borderline intellectual functioning (estimated IQ < 80 on the Wechsler Abbreviated Scale of Intelligence) or dementia, brain damage, or other cognitive impairment that would interfere with ability to engage in CBT
DSM-IV substance abuse or dependence within the past 3 months; or a positive urine drug screen for any illicit substances of abuse
Current manic episode
Psychotic disorder
Borderline personality disorder
Body image concerns accounted for by an eating disorder
Previous treatment with > 10 sessions of CBT for BDD
Subjects cannot be receiving any other psychotherapy or begin such treatment during the study
Patients can be receiving psychotropic medication if they have taken a stable dose for at least two months before the study baseline assessment and the dose remains stable during the study.
Presence of any behavior (e.g., violence) that would interfere with full cooperation with the protocol.