Schmidt Michaela, Schoenenberg Katrin, Engelkamp Julia E, Staufenbiel Thomas, Martin Alexandra, Ebert David D, Hartmann Andrea S
Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany.
Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Kiel University, Kiel, Germany.
BMC Psychiatry. 2025 Apr 14;25(1):374. doi: 10.1186/s12888-025-06797-1.
Body dysmorphic disorder (BDD) is particularly prevalent yet highly understudied and undertreated in adolescence. This study evaluates the efficacy of an internet-based, therapist-guided cognitive behavioral therapy (CBT) for adolescents and young adults with BDD compared to supportive online therapy as an active control condition.
In a single-blind, randomized controlled trial, N = 45 adolescents (aged 15-21 years) of all genders from German-speaking countries were assigned to 12 sessions of internet-based CBT (iCBT) or 12 weeks of supportive online therapy. The primary outcome was change in expert-rated BDD symptom severity from pre- to post-intervention (Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder, BDD-YBOCS). Secondary outcomes included the remission and responder rate, changes in delusionality of appearance beliefs (BABS), self-rated BDD symptom severity (FKS), BDD cognitions (FKDK), quality of life (KINDL-R), and depressive symptoms (PHQ-9) from pre to post and to a 4-week follow-up.
iCBT was more efficient than supportive online therapy on the BDD-YBOCS (p =.002), with a large between-group effect size at post-intervention (Hedges' g (SE) = 0.93 (0.42)), and on all secondary measures (p <.05), except for depressive symptoms (p =.068). All secondary outcome measures also showed significant improvements from pre to post iCBT, with moderate to large effect sizes, and gains were stable until the 4-week follow-up period. iCBT participants showed higher remission (61.5%) and responder rates (66.7%), compared to controls (0% and 26.7%), but only the difference in remission reached significance.
The results indicate the efficacy of internet-based CBT in comparison to an active control condition, thus contributing to the limited intervention research in adolescent BDD and adding a much-needed treatment option.
The trial was pre-registered on 2020/06/08 at the German Clinical Trials Register, DRKS00022055.
躯体变形障碍（BDD）在青少年中尤为普遍，但研究和治疗严重不足。本研究评估了一种基于互联网、由治疗师指导的认知行为疗法（CBT）对患有BDD的青少年和青年的疗效，并与作为积极对照的支持性在线疗法进行比较。
在一项单盲随机对照试验中，来自德语国家的45名各性别的青少年（年龄15 - 21岁）被分配接受12节基于互联网的CBT（iCBT）或12周的支持性在线疗法。主要结局是干预前后专家评定的BDD症状严重程度的变化（针对躯体变形障碍修改的耶鲁 - 布朗强迫量表，BDD - YBOCS）。次要结局包括缓解率和反应率、外貌信念妄想性（BABS）的变化、自评BDD症状严重程度（FKS）、BDD认知（FKDK）、生活质量（KINDL - R）以及从干预前到干预后及4周随访的抑郁症状（PHQ - 9）。
在BDD - YBOCS上，iCBT比支持性在线疗法更有效（p = 0.002），干预后组间效应量较大（Hedges' g（SE）= 0.93（0.42）），在所有次要指标上也是如此（p < 0.05），除了抑郁症状（p = 0.068）。所有次要结局指标在iCBT干预前后也显示出显著改善，效应量为中度至较大，且改善在4周随访期内保持稳定。与对照组（0%和26.7%）相比，iCBT参与者的缓解率（61.5%）和反应率（66.7%）更高，但只有缓解率的差异具有统计学意义。
结果表明，与积极对照相比，基于互联网的CBT具有疗效，从而为青少年BDD有限的干预研究做出了贡献，并增加了急需的治疗选择。
该试验于2020年6月8日在德国临床试验注册中心进行预注册，注册号为DRKS00022055。
