The Efficacy of Cognitive Behavioural Therapy in the Management of Body Dysmorphic Disorder: A Systematic Review and...

Body Dysmorphic Disorder (BDD) is a condition characterised by intrusive thoughts of ugliness and deformity. The efficacy of cognitive behavioural therapy (CBT) in treating BDD remains debatable despite results from several randomised controlled trials (RCTs). This study evaluated the current evidence on the efficacy of CBT compared to placebo or other interventions for treating BDD. We conducted a systematic review and meta-analysis of RCTs. Following a database search, the quality effects (QE) model was used to synthesise standardised mean differences and 95% confidence intervals for outcomes including BDD symptoms, insight, depression, body image, anxiety, global functioning and quality of life. Stratified analyses were based on outcome scale, CBT delivery mode and modality, control group type and country. Heterogeneity was assessed using the I² statistic and publication bias using funnel and Doi plots and the LFK (Luis Furuya-Kanamori) index and the trim-and-fill analysis. Evidence quality was evaluated using the GRADE framework. The meta-analysis included 19 RCTs (978 participants), demonstrating that CBT significantly improved BDD symptoms (SMD = -1.17, CI: -1.92, -0.43, I² = 93.3%), body image (SMD = -1.90, CI: -4.22, -0.42, I² = 97.2%) and global functioning (SMD = 0.63, CI: 0.28, 0.98, I² = 65.0%). CBT showed non-significant effects on insight (SMD = -0.93, CI: -2.09, 0.22, I² = 96.7%), depression (SMD = -0.73, CI: -1.56, 0.10, I² = 94.8%) and quality of life (SMD = 0.87, CI: -0.35, 2.09, I² = 94.4%). In conclusion, CBT was efficacious in alleviating BDD symptoms, anxiety, body image concerns and improving global functioning. Face-to-face, online and non-specialised CBT for BDD were also efficacious; however, further investigation is needed to explore the sources of the observed heterogeneity.