Background: Body Dysmorphic Disorder (BDD) is a debilitating mental illness that leads to significant functional impairment. Cognitive-behavioral therapy (CBT) is an empirically supported treatment shown to reduce BDD and associated symptoms, but most people suffering from BDD do not have access to it. To address limited access to evidence-based treatments, internet-based CBT (ICBT) was created. It is a growing CBT platform that has demonstrated efficacy with a number of disorders, including BDD. ICBT for BDD (BDD-NET) has been developed to treat BDD, and has been tested in one pilot study and one randomized controlled trial (RCT) against an active comparison group, showing promising results. Currently, BDD-NET only exists in a Swedish platform and is only available to patients in Sweden. Objectives: The current study aimed to test an English-language version of BDD-NET, utilizing global inclusion, in order to begin to establish a more accessible BDD treatment option for English-speakers across national borders and geographic locations. It was hypothesized that subjects would improve in BDD and associated symptoms, be satisfied with treatment, and be willing and able to complete the BDD-NET core treatment modules. Treatment: BDD-NET contains core CBT strategies such as exposure with response prevention (EX/RP) and cognitive restructuring, and is conducted through the internet on a confidential platform. Patients complete psychoeducational readings, written work, and home practice of CBT strategies with therapist guidance through a confidential messaging system. Design: The current study is an uncontrolled clinical trial with within-subjects repeated measures design. Participants included 21 self-referred adults diagnosed with BDD. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS), administered at baseline, mid-treatment, and post-treatment. Secondary outcomes were depression, global functioning, client satisfaction with BDD-NET, treatment credibility, therapeutic alliance, and treatment engagement and completion. Outcomes were analyzed using a multivariate approach to repeated measures, as well as paired-sample t-tests. Proportions of patients completing core modules (1-5) of BDD-NET and discontinuing treatment early were calculated. Clinical assessments of treatment effects and feedback from participants were utilized to aid in development on the BDD-NET treatment protocol. Results: Participants deemed BDD-NET as acceptable and reported that they were able to utilize BDD-NET treatment resources. BDD-NET was associated with significant improvements in BDD-YBOCS scores (p<.001), with a large within-group effect size ( d = 1.71). Fifty-seven percent of participants who completed post-assessments were responders (≥ 30% reduction on the BDD-YBOCS), and 36% were in remission from BDD. Depression and global functioning improved from pre- to post-treatment, with large effect sizes. Conclusions: BDD-NET has great potential to largely increase access to evidence-based psychiatric treatment for English-speaking patients with BDD across national borders and from a variety of cultural backgrounds. BDD-NET may be particularly helpful in targeting patients with barriers to care. A randomized controlled trial of an English-language version of BDD-NET is warranted.
|Advisor:||Dill, Charles, O'Brien, Richard|
|Commitee:||Gilbert, Kimberly, Ohr, Phyllis, Rück, Christian, Wilhelm, Sabine|
|School Location:||United States -- New York|
|Source:||DAI-B 79/02(E), Dissertation Abstracts International|
|Subjects:||Psychology, Clinical psychology|
|Keywords:||Body dysmorphic disorder, Cognitive behavioral therapy, Dysmorphic concerns, Feasibility, Global, Internet|
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