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Mechanisms of Change in Cognitive Behavioral Therapy for Body Dysmorphic Disorder
Angela Fang1, Gail Steketee2, Aparna Keshaviah3
1Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Cognitive Therapy and Research
|November 30, 2023
Summary
Cognitive-behavioral therapy (CBT) for body dysmorphic disorder (BDD) works by reducing maladaptive beliefs and repetitive behaviors like checking and grooming. These changes, not initial differences, explain symptom improvement over time.
Area of Science:
- Psychiatry
- Clinical Psychology
- Behavioral Science
Background:
- Cognitive-behavioral therapy (CBT) is effective for body dysmorphic disorder (BDD), but response mechanisms are unclear.
- Understanding how CBT works is crucial for improving treatment efficacy in BDD patients.
Purpose of the Study:
- To investigate cognitive and behavioral changes as mediators of CBT's effect on BDD symptom reduction.
- To examine both between-subject and within-subject mediation of CBT's impact on BDD.
Main Methods:
- Forty-five participants with BDD were analyzed.
- Two mediation analyses were conducted: between-subject (CBT vs. waitlist) and within-subject (longitudinal change during CBT).
- Cognitive factors (maladaptive beliefs, perfectionism, schemas) and behavioral factors (checking, grooming, avoidance) were assessed.
Main Results:
- No significant mediators were found in the between-subject analysis comparing CBT to a waitlist.
- Within-subject analyses revealed that reductions in checking, grooming, avoidance behaviors, and maladaptive beliefs mediated symptom improvement over 24 weeks of CBT.
- These findings support the hypothesized mechanisms of change in CBT for BDD.
Conclusions:
- Symptom reduction in BDD during CBT is linked to changes in specific cognitive and behavioral mechanisms.
- Targeting maladaptive beliefs and behaviors like checking, grooming, and avoidance may enhance CBT outcomes for BDD.
- Further research can refine CBT protocols by focusing on these identified mediators.
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