Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: A Comparative Investigation

Body dysmorphic disorder (BDD) is characterized by an intense preoccupation with a perceived or imagined defect. Although scientific treatment literature supports the efficacy of cognitive-behavioral treatment, few systematic studies have been conducted to date. We evaluated the systematic application of a combination of cognitive therapy and behavior therapy, specifically exposure and response prevention (ERP), and compared it to a regime of only ERP to assess whether the addition of cognitive therapy improves treatment response. A total of 10 participants were randomly assigned to two treatment conditions. Participants either received four weeks of cognitive treatment followed by four weeks of in vivo ERP or eight weeks of in vivo ERP alone. Treatment was conducted on an intensive basis, with individual sessions held three times a week for 90 minutes for a total of 24 sessions in eight weeks. At midpoint, four weeks of cognitive or behavioral therapy (12 sessions) resulted in significant improvements on measures of overall BDD symptoms, anxiety, and depression, but not on satisfaction with various body parts, maladaptive appearance beliefs, and social distress. At posttreatment, results indicated that ERP was equally effective as a combination of cognitive and behavior therapy. At eight weeks significant improvement was noted on all measures except satisfaction with various body parts and quality of life. It appears that eight weeks of treatment is better than four, and that cognitive therapy does not enhance treatment outcome. Recommendations for future research evaluating variables which influence treatment outcome are discussed.