Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials

TY - JOUR

T1 - Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials

AU - Harrison, Amy

AU - de la Cruz, Lorena Fernández

AU - Enander, Jesper

AU - Radua, Joaquim

AU - Mataix-Cols, David

PY - 2016/6/13

Y1 - 2016/6/13

N2 - Body dysmorphic disorder (BDD) is a chronic and disabling psychiatric disorder unlikely to remit without treatment. A systematic review and meta-analysis of randomized controlled trials (RCTs) of cognitive-behavioral therapy (CBT) for BDD was conducted, including published and unpublished trials to 26th November 2015. Primary outcomes were validated BDD measures; secondary outcomes included depression and insight. Meta-regressions were conducted to examine potential effects of variables on the primary outcome, including socio-demographic variables, comorbidity, symptom severity/duration, concomitant medication, treatment duration, and methodological quality of the RCTs. Seven RCTs (N = 299) met inclusion criteria. CBT was superior to waitlist or credible psychological placebo in reducing BDD (7 studies; delta = − 1.22, 95% CI = − 1.66 to − 0.79) and depression symptoms (5 studies; delta = − 0.49, 95% CI = − 0.76 to − 0.22). CBT was associated with improvements in insight/delusionality (4 studies; delta = − 0.56, 95% CI = − 0.93 to − 0.19). Improvement in BDD was maintained after 2–4 months follow-up (3 studies; delta = − 0.89, 95% CI = − 1.24 to − 0.54). Meta-regression analyses did not reveal any significant predictors of outcome. CBT is an efficacious treatment for BDD but there is substantial room for improvement. The specificity and long-term effects of CBT for BDD require further evaluation using credible control conditions. Additional trials comparing CBT with pharmacological therapies, as well as their combination, are warranted. Tele-care options, such as Internet-based CBT, hold great promise to increase access to evidence-based treatment for a majority of patients who need it, and should be evaluated further.

AB - Body dysmorphic disorder (BDD) is a chronic and disabling psychiatric disorder unlikely to remit without treatment. A systematic review and meta-analysis of randomized controlled trials (RCTs) of cognitive-behavioral therapy (CBT) for BDD was conducted, including published and unpublished trials to 26th November 2015. Primary outcomes were validated BDD measures; secondary outcomes included depression and insight. Meta-regressions were conducted to examine potential effects of variables on the primary outcome, including socio-demographic variables, comorbidity, symptom severity/duration, concomitant medication, treatment duration, and methodological quality of the RCTs. Seven RCTs (N = 299) met inclusion criteria. CBT was superior to waitlist or credible psychological placebo in reducing BDD (7 studies; delta = − 1.22, 95% CI = − 1.66 to − 0.79) and depression symptoms (5 studies; delta = − 0.49, 95% CI = − 0.76 to − 0.22). CBT was associated with improvements in insight/delusionality (4 studies; delta = − 0.56, 95% CI = − 0.93 to − 0.19). Improvement in BDD was maintained after 2–4 months follow-up (3 studies; delta = − 0.89, 95% CI = − 1.24 to − 0.54). Meta-regression analyses did not reveal any significant predictors of outcome. CBT is an efficacious treatment for BDD but there is substantial room for improvement. The specificity and long-term effects of CBT for BDD require further evaluation using credible control conditions. Additional trials comparing CBT with pharmacological therapies, as well as their combination, are warranted. Tele-care options, such as Internet-based CBT, hold great promise to increase access to evidence-based treatment for a majority of patients who need it, and should be evaluated further.

KW - Body Dysmorphic Disorder

KW - Cognitive-Behavioral Therapy

KW - Treatment

KW - Meta-analysis

KW - Systematic Review

KW - Randomized Controlled Trial

U2 - 10.1016/j.cpr.2016.05.007

DO - 10.1016/j.cpr.2016.05.007

M3 - Article

SN - 0272-7358

JO - Clinical Psychology Review

JF - Clinical Psychology Review

ER -