background Body dysmorphic disorder (BDD) is a severe psychiatric disorder with egosyntonic and sometimes delusional beliefs, extensive rituals and extensive avoidance behaviours. Though guidelines prescribe individual cognitive behavioral therapy (CBT), this treatment is often time-consuming, with experienced therapists difficult to find and waiting lists rising.
aim This study evaluates the efficacy of a combination treatment consisting of group CBT (GCBT) and pharmacotherapy for BDD. Since group therapy is a novel approach, efficacy of GCBT alone will be evaluated as well.
method Fourteen patients with BDD after receiving a stable dose of SRI for a period of 16 weeks enrolled in an 18-week CBT group program. This included four group sessions a week consisting of 1. Psycho education 2. Exposure and response prevention (ERP) 3. Cognitive therapy (CT) and 4. mirror retraining and refocusing. Severity of bdd symptoms (BDD-YBOCS), depressive (HAM-D) and anxiety (HAM-A) symptoms as well as degree of insight versus delusionality (BABS) were assessed at baseline, pre and post GCBT. Results were analysed using a one-way repeated-measures ANOVA for the Intent-To-Treat (ITT) and completer set of patients for both the combination of GCBT and pharmacotherapy and GCBT alone.
results Significant improvements from baseline to end of CBT group treatment in BDDsymptoms were found on the BDD-YBOCS in the ITT and Completer analysis (p <.000). Furthermore, results show significant reductions in depressive (p <.000) and anxiety (ham-a (p <.001) symptoms and delusionality (BABS) (p <.004). For the gcbt condition alone we also found significant reductions from pre to post gcbt on all outcome measurements (BDD-YBOCS, p <.000; HAM-D, p <.009; HAM-A, p <.0.47 and BABS, p <.0.18).
conclusion The results of this study indicate that weekly gcbt with or without pharmacotherapy is very effective in treating severe BDD. Remarkably, only GCBT and not medication contributed to an increase in levels of insight.