AMSTERDAM – An intensive cognitive-behavioral therapy group treatment program proved very effective for body dysmorphic disorder, with 75% of participants responding, in a study reported by researchers from the Netherlands at the annual congress of the European College of Neuropsychopharmacology.
“We found that our intensive group CBT [cognitive-behavioral therapy] program was an effective strategy in treating severe BDD [body dysmorphic disorder] and symptoms associated with BDD, which can be quite disabling,” said C.A. Molenaar, a doctoral candidate at the University of Amsterdam.
BDD affects approximately 1%-2% of the general population. CBT is currently the treatment of choice, based on altering negative appraisals of body imaging and core beliefs as well as extinction of conditioned fear. But BDD is a complex disorder that can involve delusional beliefs, extensive rituals, and widespread avoidance behaviors. The investigators hypothesized that a more intensive treatment program would be more effective than standard CBT and designed a pilot study to test this approach.
The study involved 12 patients (mean age 30 years) with severe BDD who were enrolled in an 18-week program that included four group sessions per day for one day per week. All but two patients had received medication, without sufficient effects on BDD symptoms, and most had received individual therapy. Global Assessment of Functioning scores varied from 30 to 60, with a mean of 48 points.
The sessions provided psychoeducation about BDD, exposure and response prevention, cognitive therapy, and mirror retraining and refocusing. Assessments were made at baseline, midpoint, and post treatment for BDD symptoms, delusional beliefs, and symptoms of depression and anxiety. Response was measured by the BDD-Yale Brown Obsessive Compulsive Scale (YBOCS).
Significant improvements were observed in all symptoms. Nine of the 12 patients were classified as responders on the BDD-YBOCS (greater than 25% reduction from baseline levels). After treatment, BDD symptoms of preoccupation and compulsive behavior, as measured by the BDD-YBOCS, decreased significantly by a mean of 10.17 points (P less than .005), which was a 36% reduction.
In addition, delusionality as measured by the Brown Assessment of Beliefs Scale decreased by a mean of 5.4 points (P less than .015), a 40% reduction. Depressive symptoms decreased by a mean of 5.0 points on the Hamilton Rating Scale for Depression (HAM-D) (P less than .005), a 27% reduction, and anxiety symptoms decreased by 7.1 points on the Hamilton Anxiety Rating Scale (P less than .044), a 23% reduction.
“We feel these are very good results, based not only on the main scale of severity but also on scales of depression and anxiety,” Ms. Molinaar said in an interview.
She said the program is not only efficacious but probably more cost effective than individual therapy, which will be evaluated in a future study. Furthermore, the group experience might contribute to the success of the program, she maintained.
“Patients were very anxious at the start, but after a few sessions their anxiety diminished and they were very open to each other,” she said. “We believe this is one reason why group therapy works.”
No disclosures were reported.