Long-term Outcomes of Smartphone-delivered Cognitive Behavior Therapy for Body Dysmorphic Disorder: A One-year Naturalistic Follow-up

Overview

Journal Internet Interv

Date 2025 Feb 11

PMID 39931043

Authors

Ivar Snorrason

Susanne S Hoeppner

Dalton Klare

Hilary Weingarden

Jennifer L Greenberg

Rebecca M Berger-Gutierrez

Emily E Bernstein

Rachel C Vanderkruik

Oliver Harrison

Sabine Wilhelm

Affiliations

Soon will be listed here.

Abstract

Background: Body dysmorphic disorder (BDD) is an often chronic and impairing psychiatric condition. Research shows that smartphone-delivered cognitive behavior therapy (CBT) with coaching may be a scalable and effective treatment for BDD. However, evidence for long-term gain maintenance is limited.

Objectives: The aim of the current study was to examine the long-term outcomes of a smartphone-based CBT for BDD.

Method: Adults with a primary diagnosis of BDD who completed a 12-week course of smartphone-delivered CBT with coach support were evaluated 3- and 12-months posttreatment. Symptom severity, remission and responder status were assessed with the clinician-rated Yale-Brown Obsessive-Compulsive Scale modified for BDD (BDD-YBOCS). Secondary outcomes were also evaluated and included BDD-related insight, depression, functioning and quality of life. Data were analyzed using four different approaches to missing data, with maximum likelihood estimation as the main approach.

Results: There was significant attrition from posttreatment ( = 57) to 3-month ( = 49) and 12-month ( = 33) follow-up. The mean BDD-YBOCS severity score remained stable during the follow-up period [Estimated Mean (SE) at posttreatment, 3-months, and 12-months = 18.7(1.1), 18.9(1.2) and 18.8(1.3), respectively]. The proportion of participants responding to treatment and in remission remained relatively unchanged as well (63 % responders and 46 % remitters at posttreatment, 54 % and 35 % at 3-month follow-up, and 61 % and 37 % at 12-month follow-up, respectively). Posttreatment gains in BDD-related insight, functioning, and quality of life were maintained; there were small increases in depression (ES = 0.36) from posttreatment to 12-month follow-up.

Conclusions: Improvements after coach-supported smartphone-based CBT for BDD are maintained one year after treatment.

References

Krebs G, Fernandez de la Cruz L, Monzani B, Bowyer L, Anson M, Cadman J . Long-Term Outcomes of Cognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder. Behav Ther. 2017; 48(4):462-473. DOI: 10.1016/j.beth.2017.01.001. View

Phillips K, Hart A, Menard W, Eisen J . Psychometric evaluation of the Brown Assessment of Beliefs Scale in body dysmorphic disorder. J Nerv Ment Dis. 2013; 201(7):640-3. PMC: 3725596. DOI: 10.1097/NMD.0b013e3182983041. View

Ritter V, Schuller J, Berkmann E, von Soosten-Hollings-Lilge L, Stangier U . Efficacy of Cognitive Therapy for Body Dysmorphic Disorder: A Randomized Controlled Pilot Trial. Behav Ther. 2023; 54(1):65-76. DOI: 10.1016/j.beth.2022.07.006. View

Mohr D, Lattie E, Tomasino K, Kwasny M, Kaiser S, Gray E . A randomized noninferiority trial evaluating remotely-delivered stepped care for depression using internet cognitive behavioral therapy (CBT) and telephone CBT. Behav Res Ther. 2019; 123:103485. PMC: 6916718. DOI: 10.1016/j.brat.2019.103485. View

McKay D . Two-year follow-up of behavioral treatment and maintenance for body dysmorphic disorder. Behav Modif. 1999; 23(4):620-9. DOI: 10.1177/0145445599234006. View

Veale D, Miles S, Anson M . Long-Term Outcome of Cognitive Behavior Therapy for Body Dysmorphic Disorder: A Naturalistic Case Series of 1 to 4 Years After a Controlled Trial. Behav Ther. 2015; 46(6):775-85. DOI: 10.1016/j.beth.2015.06.003. View

Mataix-Cols D, Fernandez de la Cruz L, Isomura K, Anson M, Turner C, Monzani B . A Pilot Randomized Controlled Trial of Cognitive-Behavioral Therapy for Adolescents With Body Dysmorphic Disorder. J Am Acad Child Adolesc Psychiatry. 2015; 54(11):895-904. DOI: 10.1016/j.jaac.2015.08.011. View

Wilhelm S, Weingarden H, Ladis I, Braddick V, Shin J, Jacobson N . Cognitive-Behavioral Therapy in the Digital Age: Presidential Address. Behav Ther. 2020; 51(1):1-14. PMC: 7155747. DOI: 10.1016/j.beth.2019.08.001. View

Greenberg J, Jacobson N, Hoeppner S, Bernstein E, Snorrason I, Schwartzberg A . Early response to cognitive behavioral therapy for body dysmorphic disorder as a predictor of outcomes. J Psychiatr Res. 2022; 152:7-13. PMC: 9447469. DOI: 10.1016/j.jpsychires.2022.06.001. View

10.

Wilhelm S, Phillips K, Greenberg J, OKeefe S, Hoeppner S, Keshaviah A . Efficacy and Posttreatment Effects of Therapist-Delivered Cognitive Behavioral Therapy vs Supportive Psychotherapy for Adults With Body Dysmorphic Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2019; 76(4):363-373. PMC: 6450292. DOI: 10.1001/jamapsychiatry.2018.4156. View

11.

Enander J, Andersson E, Mataix-Cols D, Lichtenstein L, Alstrom K, Andersson G . Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder: single blind randomised controlled trial. BMJ. 2016; 352:i241. PMC: 4737850. DOI: 10.1136/bmj.i241. View

12.

Fernandez de la Cruz L, Enander J, Ruck C, Wilhelm S, Phillips K, Steketee G . Empirically defining treatment response and remission in body dysmorphic disorder. Psychol Med. 2019; 51(1):83-89. PMC: 7190405. DOI: 10.1017/S0033291719003003. View

13.

Snorrason I, Jaroszewski A, Greenberg J, Weingarden H, Summers B, Fang A . Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder: Factor Structure and Construct Validity of Subfactors. J Obsessive Compuls Relat Disord. 2025; 42. PMC: 11759490. DOI: 10.1016/j.jocrd.2024.100881. View

14.

Rautio D, Andren P, Gumpert M, Jolstedt M, Jassi A, Krebs G . Therapist-guided, Internet-delivered cognitive behaviour therapy for adolescents with body dysmorphic disorder: A feasibility trial with long-term follow-up. Internet Interv. 2023; 34:100688. PMC: 10685040. DOI: 10.1016/j.invent.2023.100688. View

15.

Weingarden H, Hoeppner S, Snorrason I, Greenberg J, Phillips K, Wilhelm S . Rates of remission, sustained remission, and recurrence in a randomized controlled trial of cognitive behavioral therapy versus supportive psychotherapy for body dysmorphic disorder. Depress Anxiety. 2021; . PMC: 8443701. DOI: 10.1002/da.23148. View

16.

Bernstein E, Weingarden H, Wolfe E, Hall M, Snorrason I, Wilhelm S . Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review. J Med Internet Res. 2022; 24(4):e33307. PMC: 9034419. DOI: 10.2196/33307. View

17.

Enander J, Ljotsson B, Anderhell L, Runeborg M, Flygare O, Cottman O . Long-term outcome of therapist-guided internet-based cognitive behavioural therapy for body dysmorphic disorder (BDD-NET): a naturalistic 2-year follow-up after a randomised controlled trial. BMJ Open. 2019; 9(1):e024307. PMC: 6340432. DOI: 10.1136/bmjopen-2018-024307. View

18.

Spinelli M, Endicott J, Goetz R . Disagreement between therapist raters and independent evaluators in a controlled clinical trial of interpersonal psychotherapy for depressed pregnant women. J Psychiatr Pract. 2015; 21(2):114-23. DOI: 10.1097/01.pra.0000462604.79606.4e. View

19.

Toh W, Castle D, Mountjoy R, Buchanan B, Farhall J, Rossell S . Insight in body dysmorphic disorder (BDD) relative to obsessive-compulsive disorder (OCD) and psychotic disorders: Revisiting this issue in light of DSM-5. Compr Psychiatry. 2017; 77:100-108. DOI: 10.1016/j.comppsych.2017.06.004. View

20.

Rush A, Bernstein I, Trivedi M, Carmody T, Wisniewski S, Mundt J . An evaluation of the quick inventory of depressive symptomatology and the hamilton rating scale for depression: a sequenced treatment alternatives to relieve depression trial report. Biol Psychiatry. 2005; 59(6):493-501. PMC: 2929841. DOI: 10.1016/j.biopsych.2005.08.022. View