Online CBT Delivery With Therapist Guidance Effective in Treatment of Body Dysmorphic Disorder

Online-based cognitive behavior therapy provides effective treatment in body dysmorphic disorder and may decrease barriers for individuals who want to seek treatment.

An internet-based cognitive behavioral therapy (CBT) program displayed long-term efficacy in the treatment of body dysmorphic disorder (BDD), per study data published in BMJ Open.

Investigators conducted a naturalistic 2-year follow-up study of participants in a previously published trial investigating the efficacy of BDD-NET, an internet-based CBT program for the treatment of BDD. All participants in the original trial had a principal diagnosis of BDD of moderate severity per the BDD-Yale-Brown Obsessive-Compulsive Scale (BDD-YBOCS). BDD-NET provided a tailored online treatment experience to participants and comprised 8 interactive modules on psychoeducation, cognitive restructuring, and exposure and response prevention, among other psychiatric principles. All BDD-NET participants had access to therapists via the online platform for guidance and feedback. As a primary outcome measure, investigators captured BDD-YBOCS score at baseline, post-treatment, and at 3-, 6-, 12-, and 24-month follow-up time points. Responder status was defined as a 30% or greater reduction in baseline BDD-YBOCS score. As secondary outcome measures, depression symptoms, global functioning, and health-related quality of life were also assessed in patients.

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A total of 88 participants from the original trial contributed data to the study. The mean reduction from baseline to post-treatment on the BDD-YBOCS was −8.23 (95% CI, −9.92 to −6.54; P ≤.001). Effects were sustained through the 2-year follow-up period, for a mean reduction from baseline to 24 months of −13.42 points (95% CI, −15.57 to −11.27; P ≤.001). At 24 months’ follow-up, 69% of participants (95% CI, 57% to 80%) were classified as responders and 57% (95% CI, 45% to 69%) were classified as much improved or very much improved on the Clinical Global Impressions Scale. A total of 56% of the patient cohort (95% CI, 43% to 69%) no longer met Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, criteria for BDD. Depressive symptoms measured per the Montgomery-Åsberg Depression Rating Scale Self-Rated decreased significantly, with an average score reduction of −5.04 points (95% CI, −5.94 to −1.99; P ≤.001). Global functioning, as measured with the Global Assessment of Functioning scale, also improved by a mean value of 10.77 points (95% CI, 8.63 to 12.91; P ≤.001) from baseline to 24 months. Using the self-rated EQ5D EuroQol, investigators observed that improvements in health-related quality of life observed at 3- and 12-month follow-up were not sustained over 24 months.  

These data support the long-term efficacy of an online CBT delivery system for patients with BDD. This treatment mode may be particularly helpful in patients reluctant to seek in-person treatment due to shame or stigma.


Enander J, Ljótsson B, Anderhell L, et al. Long-term outcome of therapist-guided internet-based cognitive behavioural therapy for body dysmorphic disorder (BDDNET): a naturalistic 2-year follow-up after a randomised controlled trial. BMJ Open. 2019;9(1):e024307.