Predicting response to a smartphone-based cognitive-behavioral therapy for body dysmorphic disorder
Predicting response to a smartphone-based cognitive-behavioral therapy for body dysmorphic disorder
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DOI：
10.1016/j.jad.2024.03.044
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发表时间：
2024-03-30
影响因子：
6.6
通讯作者：
Wilhelm，Sabine
中科院分区：
文献类型：
--
作者：
Greenberg，Jennifer L.;Weingarden，Hilary;Wilhelm，Sabine
研究背景躯体畸形恐惧症（BDD）是一种严重的慢性疾病，如果不及时治疗，会导致严重的身体损害。智能手机认知行为疗法（CBT）对BDD是有效的，可以减少关键的治疗障碍（例如，缺乏临床医生、成本、耻辱）。虽然有希望，很少有人知道谁是或多或少可能受益于这种approach.MethodsThis是一个随机的，等待名单对照试验的智能手机CBT BDD的二次数据分析。参与者（N= 80）在全国范围内招募并随机接受为期12周的教练指导的BDD应用程序CBT，无论是立即还是在12周的等待名单之后。该分析的主要结局是每个随机化组（n= 74）在主动应用程序使用阶段随时间推移（基线、第6周、第12周）的BDD严重程度（BDD-YBOCS）。次要结局包括治疗反应（BDD-YBOCS降低≥ 30%）和缓解（总BDD-YBOCS ≤16）。（与延迟）CBT预测更好的结果（症状改善），性别认同也是如此（症状改善），更高的基线治疗可信度和预期（应答，缓解），基线BDD严重程度较低（缓解）和性少数地位（与异性恋者相比;局限性包括相对较小的样本，22%的脱落率，结论这些结果突出了智能手机CBT在历史上边缘化人群中的潜在优势，以及努力加快治疗获得的重要性，在治疗开始时增强对治疗的信心，并发展分层护理模式，以优化治疗分配和疗效。
BackgroundBody dysmorphic disorder (BDD) is a severe, chronic disorder if untreated. Smartphone cognitive behavioral therapy (CBT) for BDD is efficacious and can reduce key treatment barriers (e.g., lack of clinicians, cost, stigma). While promising, little is known about who is more or less likely to benefit from this approach.MethodsThis is a secondary data analysis of a randomized, waitlist-controlled trial of smartphone CBT for BDD. Participants (N= 80) were recruited nationally and randomized to receive a 12-week, coach-guided CBT for BDD app, either immediately or after a 12-week waitlist. The main outcome for this analysis was BDD severity (BDD-YBOCS) over time (baseline, week 6, week 12) during the active app use phase in each randomized group (n= 74). Secondary outcomes included treatment response (≥30 % reduction in BDD-YBOCS) and remission (total BDD-YBOCS ≤16) at end-of-treatment.ResultsImmediate (vs. delayed) CBT predicted better outcomes (symptom improvement), as did gender identity (symptom improvement), higher baseline treatment credibility and expectancy (response, remission), lower baseline BDD severity (remission), and sexual minority status (vs. heterosexual; response, remission).LimitationsLimitations include the relatively small sample, drop-out rate of 22 %, and limited gender and racial-ethnic diversity.ConclusionsThese results highlight a potential advantage of smartphone CBT in historically marginalized populations, and the importance of efforts to hasten treatment access, bolster confidence in the treatment at treatment onset, and develop stratified care models to optimize treatment allocation and efficacy.