治疗师指导的基于互联网的认知行为疗法治疗躯体变形障碍（BDD-NET）的长期结果：一项随机对照试验后的自然 2 年随访。
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.
机构信息
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
出版信息
BMJ Open. 2019 Jan 15;9(1):e024307. doi: 10.1136/bmjopen-2018-024307.
OBJECTIVES
Most patients with body dysmorphic disorder (BDD) do not receive evidence-based treatment. A randomised controlled trial (RCT) has found that a therapist-guided internet-based cognitive-behavioural therapy (CBT) programme for BDD (BDD-NET) can be delivered safely via the internet with significant improvements in BDD symptom severity in the short term. The purpose of this study was to evaluate if the therapeutic gains of BDD-NET are maintained 2 years after treatment.
SETTING
Academic medical centre.
PARTICIPANTS
A naturalistic 2-year follow-up study of the 88 self-referred adult outpatients with a diagnosis of BDD that had received BDD-NET within the context of the RCT.
PRIMARY AND SECONDARY OUTCOMES
The primary outcome was the BDD-Yale-Brown Obsessive-Compulsive Scale (YBOCS). Responder status was defined as a ≥30% reduction in symptoms. Remission was defined as no longer meeting Diagnostic and Statistical Manual of Mental Disorders 5th edition criteria for BDD. Secondary outcomes included measures of depression, global functioning and quality of life.
RESULTS
The efficacy of BDD-NET was sustained long- term, with further improvements observed on the BDD-YBOCS during the follow-up period. At follow-up, 69% (95% CI 57% to 80%) were classified as responders and 56% (95% CI 43% to 69%) were in remission. Gains on depressive symptoms and global functioning were also sustained but not quality of life. A majority of participants reported that the main reason for seeking help for their BDD was the possibility to access the treatment from home.
CONCLUSION
BDD-NET is an effective treatment for BDD, and the patients' gains are maintained in the long term. BDD-NET has the potential to increase access to CBT and may lower the threshold for BDD sufferers to seek help in the first place.
TRIAL REGISTRATION NUMBER
NCT02010619.
目的
大多数体像障碍（BDD）患者未接受循证治疗。一项随机对照试验（RCT）发现，针对 BDD 的治疗师指导的基于互联网的认知行为疗法（CBT）方案（BDD-NET）可以通过互联网安全地提供，并且在短期内可以显著改善 BDD 症状的严重程度。本研究的目的是评估 BDD-NET 的治疗效果是否在治疗后 2 年得到维持。
地点
学术医疗中心。
参与者
这是一项针对 RCT 中接受 BDD-NET 治疗的 88 名自我转诊的成年 BDD 门诊患者的自然随访 2 年研究。
主要和次要结果
主要结局是 BDD-Yale-Brown 强迫量表（YBOCS）。应答者状态定义为症状减少≥30%。缓解定义为不再符合精神障碍诊断与统计手册第 5 版 BDD 标准。次要结局包括抑郁、整体功能和生活质量的测量。
结果
BDD-NET 的疗效长期维持，在随访期间 BDD-YBOCS 观察到进一步的改善。在随访时，69%（95%置信区间 57%至 80%）被归类为应答者，56%（95%置信区间 43%至 69%）处于缓解状态。抑郁症状和整体功能的改善也得到了维持，但生活质量没有得到维持。大多数参与者表示，他们寻求 BDD 帮助的主要原因是有可能在家中接受治疗。
结论
BDD-NET 是一种有效的 BDD 治疗方法，患者的长期疗效得到维持。BDD-NET 有可能增加 CBT 的可及性，并可能降低 BDD 患者寻求帮助的门槛。
试验注册
NCT02010619。
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