CBT for BDD, Higher Remission Rates Compared to Supportive Psychotherapy

August 13, 2021

Ruta Nonacs, MD PhD

In total, 52% of the CBT group and 27% of the SPT group experienced a sustained remission of their symptoms at six months.

Body dysmorphic disorder (BDD) is a psychiatric disorder consisting of distressing or impairing preoccupations with nonexistent or slight defects in appearance, combined with repetitive behaviors performed in response to appearance concerns (e.g., mirror checking, excessive grooming). BDD is often associated with significant functional impairment and poor quality of life and increased risk for attempted and completed suicide.

While there is data to support the use of cognitive behavioral therapy (CBT) for the treatment of BDD, we have little data on how effective CBT is in terms of inducing remission and preventing recurrence of symptoms. Previous studies have typically reported effectiveness in terms of response rates (i.e., a 30% or greater reduction on the Yale-Brown Obsessive Compulsive Scale Modified for BDD). These studies did not examine rates of remission (i.e., becoming symptom-free). This has clinical relevance as patients, especially those with more severe illness, can be treatment responders yet still have significant symptoms which affect their ability to function and quality of life.

Using data from a randomized controlled trial where 120 patients received either therapist-delivered cognitive behavior therapy (CBT) or supportive psychotherapy (SPT) for BDD over a period of 24 weeks, Hilary Weingarden, PhD and her colleagues at the Center for OCD and Related Disorders (CORD) at Massachusetts General Hospital estimated remission rates at treatment endpoint, rates of delayed remission, sustained remission, and recurrence after six months of follow-up. Remission was defined as a score 16 or less on the BDD-YBOCS.

Full or partial remission at the end of treatment were significantly more common among patients receiving treatment with CBT (68%) compared to those receiving supportive psychotherapy (42%). At the 6-month follow-up, an additional 10% (CBT) and 14% (SPT) experienced a delayed remission. Recurrence rates were similar in the two groups: 20% for CBT and 14% for SPT.

In total, 52% of the CBT group and 27% of the SPT group experienced a sustained remission of their symptoms at six months. Remission was never achieved by 18% in the CBT group and 45% in the SPT group. Participants in remission at the end of treatment experienced significant improvements in levels of functional impairment, depression severity, BDD-related insight, and quality of life compared to the non-remitters.

The current study provides the best available estimates of remission rates following treatment with therapist-delivered CBT and supportive psychotherapy for BDD. While the original study suggested similar response rates for CBT and supportive psychotherapy, the two therapies clearly differ when it comes to sustained remission. In addition, the authors note that prior studies indicate that the patient’s expectancy of treatment success and credibility of the treatment are important predictors of outcome (Greenberg et al, 2019), thus it may be helpful for clinicians to share positive information regarding remission rates at the outset of treatment.