Treatment Expectancy, Motivation Linked to CBT Response in Body Dysmorphic Disorder

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In body dysmorphic disorder, the higher a patient's readiness to change and confidence in cognitive behavioral therapy, the more likely the intervention will be successful.

Greater motivation and treatment expectancy, rather than baseline symptom severity, predicted cognitive behavior therapy (CBT) response in patients with body dysmorphic disorder (BDD), according to study data published in Behavior Therapy.

Investigators conducted a secondary analysis of pooled data from an uncontrolled pilot trial (n=12) and subsequent wait-list controlled trial (n=36). Participants were adults (≥18 years) with a primary diagnosis of BDD and a score of ≥24 on the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder. At baseline, patients completed a series of self-report measures and were administered the BDD-YBOCS by a clinician. Treatment was administered in the form of weekly individual CBT sessions for 18 to 22 weeks. To evaluate treatment response, patients were reassessed via the BDD-YBOCS during treatment (weeks 4, 8, and 16), immediately posttreatment (week 24), and at 3- and 6-months’ follow-up. Treatment response was classified as a BDD-YBOCS reduction ≥30% from baseline to posttreatment (week 24). Univariate logistic regression models were used to identify significant baseline predictors of BDD-YBOCS treatment response.

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Of the 44 participants who completed their CBT course and provided at least 1 postbaseline assessment, 32 (73%) were classified as treatment responders. The following baseline measures were significantly associated with treatment response at week 24: Brown Assessment of Beliefs Scale score, which represented BDD-related insight; University of Rhode Island Change Assessment Questionnaire readiness-to-change score, which captured patient enthusiasm for treatment and recovery; and treatment expectancy or patient confidence in the efficacy of treatment. The best predictive model of treatment response used University of Rhode Island Change Assessment Questionnaire readiness-to-change score and treatment expectancy as predictors. Of the 3 predictors, only the University of Rhode Island Change Assessment Questionnaire readiness-to-change score remained significant when combined with any other predictor. Notably, neither baseline BDD severity nor baseline depressive symptoms were predictors of treatment response, suggesting that even patients with severe BDD and depression may benefit from CBT.

Further study in a larger cohort is necessary to confirm these findings and explore the efficacy of CBT for BDD in patients with comorbidities other than depression.

Disclosures: See source for complete disclosure information.


Greenberg JL, Phillips KA, Steketee G, Hoeppner SS, Wilhelm S. Predictors of response to cognitive-behavioral therapy for body dysmorphia. Behav Ther. 2019;50(4):839-849.