Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA; Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, USA.
J Psychiatr Res. 2022 Aug;152:7-13. doi: 10.1016/j.jpsychires.2022.06.001. Epub 2022 Jun 8.
Individuals with body dysmorphic disorder (BDD) suffer from distressing or impairing preoccupations with perceived imperfections in their appearance. This often-chronic condition is associated with significant functional impairment and elevated rates of psychiatric comorbidity and morbidity, including depression, substance use disorders, and suicidality. Cognitive behavioral therapy (CBT) for BDD has been shown to be efficacious. However, this intervention is long (up to 24 weeks) relative to many manualized approaches for other related conditions, there is a significant shortage of clinicians trained in CBT for BDD, and some patients drop out of treatment and/or do not respond. Thus, there is great interest in understanding and predicting who is most likely to respond, to better allocate clinical resources. This secondary data analysis of participants enrolled in prior uncontrolled and controlled studies of CBT for BDD explored whether early response to CBT, operationalized as percentage change in symptom severity within the first four weeks and the first 12 weeks of this 24-week treatment, predicts clinical outcomes for patients with BDD (n = 90). The findings indicated that minimal early symptom change was not indicative of eventual non-response. This suggests that patients and clinicians should not be discouraged by limited early improvement but should instead continue with a full course of treatment before reevaluating progress and alternative interventions. Overall, the results support the view that treatment success is more likely if a longer CBT protocol is followed. More work is needed to understand mechanisms of change and thus match optimal interventions to patient characteristics.
患有躯体变形障碍（BDD）的个体深受困扰或影响，对自己外表的感知缺陷过分关注。这种常为慢性的疾病与严重的功能障碍和更高的精神共病率和发病率相关，包括抑郁、物质使用障碍和自杀倾向。认知行为疗法（CBT）对 BDD 有效。然而，与许多其他相关疾病的手册化方法相比，这种干预措施时间较长（长达 24 周），接受过 BDD 的 CBT 培训的临床医生严重短缺，有些患者退出治疗和/或没有反应。因此，人们非常关注理解和预测哪些患者最有可能有反应，以便更好地分配临床资源。本研究对先前参加 CBT 治疗 BDD 的非对照和对照研究的参与者进行了二次数据分析，探讨了 CBT 治疗 BDD 患者的早期反应（定义为前四周和前 12 周症状严重程度的百分比变化）是否可以预测患者的临床结局（n=90）。研究结果表明，早期症状变化最小并不意味着最终无反应。这表明，患者和临床医生不应因早期改善有限而感到沮丧，而应在重新评估进展和替代干预措施之前继续完成完整的治疗疗程。总的来说，结果支持了如果遵循更长的 CBT 方案，则更有可能获得治疗成功的观点。还需要更多的工作来了解变化的机制，从而根据患者的特征匹配最佳的干预措施。
