In the current issue of P&P, David Veale and associates in the UK report on a new psychological treatment for those who feel ugly, the so called body dysmorphic disorder (BDD).
The evidence base for the efficacy of cognitive behavioral therapy (CBT) for is weak. Thus, Authors aimed to determine whether CBT was more effective than anxiety management (AM) in treating body dysmorphic disorder.
A single-blind stratified parallel-group randomized controlled trial was conducted with a 12 week follow up as primary endpoint and the Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS) as 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 CBT group, unlike the AM group, had 4 further weekly sessions that were analyzed 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.
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. Overall, these findings showed that CBT is an effective intervention for people with BDD even with delusional beliefs or depression and is more effective than AM over a 12 week period.