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Modular CBT for Body Dysmorphic Disorder

A recent pilot study published in Behavior Therapy found that modular Cognitive Behavior Therapy (CBT) may help reduce symptom severity and depression in Body Dysmorphic Disorder (BDD). BDD is characterized by an often-delusional preoccupation with an imagined or slight defect in appearance that causes significant distress and impairment in daily functioning. The current study incorporates a broadly applicable CBT treatment manual with a specific focus on the BDD model and BDD symptoms.

Participants included twelve individuals, male and female, who met DSM-IV-TR criteria for BDD. Participants were randomly assigned to two treatment groups: one which received 18 therapy sessions and one which received 22 therapy sessions. Two licensed psychologists delivered manualized treatment via individual 60-minute sessions twice per week for the first four weeks, and once per week thereafter. CBT methods and techniques included psycho-education, cognitive restructuring, mindfulness/perceptual retraining, relapse prevention, as well as modular interventions tailored to each participant’s individual symptoms. Participants were encouraged to evaluate their negative and maladaptive thoughts and avoidance behaviors, identify adaptive and robust responses, and engage in homework assignments. Before and following treatment, participants were assessed with the Yale-Brown Obsessive Compulsive Scale Modified for BDD (BDD-YBOCS), the Clinical Global Impression Scale (CGI), the Brown Assessment of Beliefs Scale (BABS), the Beck Depression Inventory-II (BDI-II), and the Client Satisfaction Inventory (CSI).

Results, which include a decrease in BDD symptom severity and delusionality, improvement in depressive symptoms, and high retention and satisfaction rates, suggest that modular manualized CBT treatment for BDD is a practical, well-received, and effective treatment for this disorder. This modular approach maintains the integrity of the core procedures of manualized treatment while incorporating flexible treatment tailored to meet individual patient’s needs.

Sabine Wilhelm, Ph.D., and Gail Stetekee Ph.D., two of the authors, were nominated for and participated in the Beck Institute Scholar Supervision program.

Fama, J.M., Greenberg, J.L., Phillips, K. A., Steketee, G., Wilhelm, S. (2011). Modular Cognitive-Behavioral Therapy for Body Dysmorphic Disorder. Behavior Therapy, 42(4), 624-633.