1. In a randomized control trial of over 90 patients with body dysmorphic disorder (BDD), the use of an internet-based cognitive behavioral therapy (CBT) program demonstrated significantly higher improvement in symptom severity compared to online supportive therapy.
Evidence Rating Level: 1 (Excellent)
Study Rundown: BDD is a psychiatric disorder characterized by compulsive behaviors and pre-occupations with defects in one’s own physical appearance. CBT have previously demonstrated to be effective in the treatment of BDD; however, there remains a significant wait time to receive CBT services in a number of developed countries. The goal of this single-blind, randomized controlled trial was to evaluate the effectiveness of therapist-guided internet-based cognitive behavioral therapy (BDD-NET) versus online supportive therapy.
The trial randomized 94 patients with a confirmed diagnosis of BDD to receive either BDD-NET or online supportive therapy for 12 weeks. At the end of the study period, there was a significantly higher number of patients that responded to treatment in the BDD-NET group compared to online supportive therapy. Patients who received BDD-NET demonstrated significant improvement in BDD symptom severity compared to patients who received supportive therapy. Additionally, patients randomized to BDD-NET demonstrated decreased depressive symptoms as well as a significant increase in global functioning. These effects persisted six months after the end of treatment. Overall, the number needed to treat for BDD-NET was 2.34 with no serious adverse events in the treatment group. The trial is limited by a small sample size and the use of self-referrals for recruitment, which may increase sample bias and decrease external generalizability. However, this was the largest RCT to date to analyze the effectiveness of BDD-NET and support the use of BDD-NET as a novel method of delivering CBT in the treatment of BDD.
In-Depth [randomized controlled trial]: This was a single-blind randomized controlled trial of BDD-NET compared to online supportive therapy. The study recruited 94 patients with BDD from a single center in Sweden who were randomly assigned to either BDD-NET (n = 47) or online supportive therapy (n = 47) for 12 weeks. Patients were self-referred to the study but were excluded if they started a psychiatric drug treatment two months within enrolment or have a concurrent bipolar disorder, psychosis, acute suicidal ideation, or severe personality disorder. The primary outcome of interest was the change in BDD symptom severity as assessed by the modified Yale-Brown Obsessive-Compulsive scale (BDD-YBOCS). The secondary outcomes included percentage of responders, defined as >30% reduction from baseline on the BDD-YBOCS, as well as global functioning improvement and quality of life. At the conclusion of the trial, patients randomized to BDD-NET demonstrated significantly improved symptom burden (BDD-YBOCS difference: −7.1 points; 95% CI: −9.8 to −4.4; p < 0.001). Additionally, patients randomized to BDD-NET demonstrated improvements in secondary outcomes of depression (difference: −4.5 points; 95% CI: −7.5 to −1.4; p = 0.002) and overall global function (difference: 6.27 points; 95% CI: 3.88 to 8.66; p < 0.001). These effects persisted 6 months after the conclusion of BDD-NET. Furthermore, those in the BDD-NET group reported higher self-satisfaction. Overall, 56% of the participants were classified as responders when compared to the 13% classed as responders in the group receiving supportive therapy.
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