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04-02-2020 | Original Article

Mechanisms of Change in Cognitive Behavioral Therapy for Body Dysmorphic Disorder

Auteurs: Angela Fang, Gail Steketee, Aparna Keshaviah, Elizabeth Didie, Katharine A. Phillips, Sabine Wilhelm

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 3/2020

Abstract

Although cognitive-behavioral therapy (CBT) is highly efficacious for body dysmorphic disorder (BDD), not all patients benefit, and mechanisms underlying response remain unknown. In this first report of the mechanisms underlying improvement with CBT for BDD, we examined whether cognitive (maladaptive beliefs, perfectionism, schemas) and behavioral (checking, grooming, avoidance behaviors) changes mediate the effect of CBT on BDD symptom reduction. Forty-five participants with BDD who enrolled in a CBT for BDD treatment development study were included in two sets of analyses: (1) between-subject mediation of the effect of 12 weeks of CBT versus waitlist, and (2) within-subject mediation of longitudinal change in BDD symptom severity during 24 weeks of CBT. No significant mediators emerged in the between-subject analysis. Checking, grooming, avoidance behaviors, and maladaptive beliefs mediated within-subject improvements over time. Findings suggest that BDD symptom reduction occurs through the very mechanisms that have been hypothesized to maintain BDD in CBT models. Targeting certain cognitive (beliefs about appearance) and behavioral (checking, grooming, and avoidance behaviors) mechanisms in future treatment trials may enhance symptom improvement during CBT.

National Clinical Trials Registration Identifier # NCT00106223.

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It is worth noting that, although using pre- (week 0) and post- (week 24) treatment scores ignores the additional data points collected for the mediator over the course of treatment, we used this methodology instead of a linear growth curve model (to estimate individual slopes for each participant using all available data points) because the relationship between the outcome (BDD-YBOCS) and mediators was non-linear.

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Titel: Mechanisms of Change in Cognitive Behavioral Therapy for Body Dysmorphic Disorder
Auteurs: Angela Fang
Gail Steketee
Aparna Keshaviah
Elizabeth Didie
Katharine A. Phillips
Sabine Wilhelm
Publicatiedatum: 04-02-2020
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 3/2020
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-020-10080-w

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