1/2-CBT Versus Supportive Psychotherapy for Body Dysmorphic Disorder

1/2-CBT 与支持性心理治疗治疗身体变形障碍

• 批准号: 8183146
• 负责人: Sabine Wilhelm
• 金额: $ 43.65万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-05 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8183146
• 关键词: Adult; Aftercare; Appearance; Attention; Authorship; Belief; Blinded; Body Dysmorphic Disorder; Case Series; Case Study; Chronic; Clinical; Cognitive Therapy; Collaborations; Communication; Complex; Conflict (Psychology); Connecticut; Consult; Control Groups; Controlled Study; Data; Data Analyses; Defect; Dental; Dermatologic; Development; Disease; Distress; Educational workshop; Electronics; Elements; Emotions; Enrollment; Ensure; Epidemiologic Studies; Equipment and supply inventories; Ethnic Origin; Evidence based treatment; Foundations; Funding; General Hospitals; Grant; Hospitalization; Hospitals; Human Resources; Individual; Intervention; Intervention Studies; Knowledge; Location; Maine; Massachusetts; Measures; Mediating; Medical; Mental Depression; Monitor; Morbidity - disease rate; National Health Services; National Institute of Mental Health; Neurocognitive; Operative Surgical Procedures; Outcome Measure; Patient Care; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Practice Guidelines; Prevalence; Procedures; Protocols documentation; Psychotherapy; Public Health; Publications; Quality Control; Quality of life; Race; Randomized; Recruitment Activity; Relative (related person); Research; Rhode Island; Role; Rural; Safety; Sampling; Seminal; Severities; Site; Socioeconomic Status; Strategic Planning; Suicide; Supervision; Symptoms; Testing; Time; Training; United Kingdom; Universities; Withdrawal; Work; accomplished suicide; arm; base; comparative efficacy; data management; depressive symptoms; efficacy testing; follow-up; functional disability; improved; information processing; insight; medical schools; meetings; neuropsychological; physical conditioning; primary outcome; psychosocial; response; secondary outcome; skills; therapy development; treatment adherence

DESCRIPTION (provided by applicant): Body dysmorphic disorder (BDD) is a severe, often chronic, and common disorder consisting of distressing or impairing preoccupation with imagined or slight defects in appearance. Individuals with BDD have very poor functioning and high rates of hospitalization and suicidality. The rate of completed suicide, while preliminary, appears markedly high. A majority of patients receive surgical, dermatologic, or dental treatment for BDD, which is usually ineffective. Our prior work has shown that SRIs are often efficacious for BDD, but patients may not agree to try medication or may not benefit from it. Thus, there is a critical need for an efficacious psychosocial intervention for this severe disorder. Because BDD differs in important ways from other disorders, psychotherapies for other disorders are not adequate for BDD. There is no adequately tested psychosocial treatment of any type for BDD. An evidence-based treatment for this unique disorder is greatly needed. Cognitive-behavioral therapy (CBT) is the only psychosocial treatment for BDD that is fully developed and now ready for formal testing. Data from case series and studies using waitlist controls suggest that BDD- specific CBT is very promising for BDD. With an R34 grant, we developed a personalized, modular, manualized CBT treatment (CBT-BDD) that specifically targets BDD's unique and complex symptoms. The R34 study, which used a waitlist control group, suggests CBT-BDD is acceptable to patients, feasible to implement, and appears efficacious for BDD, associated symptoms, and functional disability. However, no study has adequately tested CBT's efficacy for BDD -- for example, by comparing it to another treatment that controls for therapist time, attention, and other non-specific treatment elements. Thus, there is a pressing clinical and public health need to test the most promising psychosocial treatment for BDD. This Collaborative R01 application's primary aim is to conduct the first study to adequately examine the efficacy of CBT for BDD. This study will compare our personalized and manualized CBT-BDD to manualized supportive psychotherapy (SPT). SPT appears to be the psychosocial treatment most often used for BDD, yet it appears to have a low response rate. Massachusetts General Hospital/Harvard Medical School and Rhode Island Hospital/Brown University will randomize 120 adults to CBT-BDD or SPT over 24 weeks followed by 3- and 6-month follow-up assessments. The primary outcome will be change in BDD severity assessed by a blinded Independent Evaluator. Secondary aims will examine change in depressive symptoms, delusionality of BDD beliefs, psychosocial functioning, and quality of life, as well as predictors of improvement in BDD. The United Kingdom's National Health Service treatment practice guideline on BDD and a Cochrane Collaboration review on BDD underscore the dearth of treatment research and call for more intervention research on BDD. The proposed study will fill a major gap in knowledge and patient care by conducting the first adequate test of any psychosocial treatment for a unique, disabling, common, and understudied disorder. PUBLIC HEALTH RELEVANCE: Body dysmorphic disorder (BDD) is a severe and common disorder characterized by high levels of functional impairment and markedly high rates of suicidality. The proposed study will be the first to adequately test the efficacy of the most promising psychosocial treatment for BDD -- cognitive behavioral therapy that specifically targets BDD's unique symptoms (CBT-BDD). Consistent with the NIMH strategic plan, we will test a new and personalized treatment for severely ill and suffering patients for whom no adequately tested psychosocial treatment of any type exists.

描述（由申请人提供）：身体畸形疾病（BDD）是一种严重的，通常是慢性且常见的疾病，包括苦恼或损害外观上有想象中或轻微缺陷的痛苦或损害。 BDD患者的功能非常差，住院和自杀率很高。自杀的速度虽然初步，但显着高。大多数患者接受BDD的手术，皮肤病或牙科治疗，通常是无效的。我们先前的工作表明，SRI通常对BDD有效，但患者可能不同意尝试药物或可能不会从中受益。因此，对于这种严重疾病的有效的社会心理干预迫切需要。由于BDD与其他疾病的重要方式不同，因此其他疾病的心理治疗不足以适合BDD。 BDD的任何类型都没有经过适当测试的心理社会治疗。非常需要针对这种独特疾病的循证治疗。 认知行为疗法（CBT）是BDD的唯一心理社会疗法，该治疗已完全开发，现在可以进行正式测试。案例系列的数据和使用候补名单控件的研究表明，BDD对BDD非常有前途。有了R34赠款，我们开发了一种个性化的，模块化的，手动的CBT治疗（CBT-BDD），该治疗专门针对BDD的独特且复杂的症状。使用候补名单对照组的R34研究表明，患者可以接受CBT-BDD，可以实施可行，并且似乎有效地对BDD，相关症状和功能障碍。但是，没有研究对CBT对BDD的疗效进行了充分测试 - 例如，将其与控制治疗师时间，注意力和其他非特异性治疗元素的另一种治疗方法进行比较。因此，有一个紧迫的临床和公共卫生需要测试BDD最有希望的社会心理治疗。 该协作R01应用程序的主要目的是进行首次研究，以充分检查CBT对BDD的功效。这项研究将将我们的个性化和手动CBT-BDD与手动支持心理治疗（SPT）进行比较。 SPT似乎是最常用于BDD的社会心理治疗，但它的反应率似乎很低。马萨诸塞州综合医院/哈佛医学院和罗德岛医院/布朗大学将在24周内将120名成年人随机为CBT-BDD或SPT，然后进行3个月和6个月的随访评估。主要结果将是由盲人独立评估者评估的BDD严重程度的变化。次要目标将检查抑郁症状，BDD信念的妄想，社会心理功能和生活质量的变化，以及BDD改善的预测指标。 英国的国家卫生服务治疗方法BDD和BDD的Cochrane合作评论指南强调了治疗研究的缺乏，并呼吁对BDD进行更多干预研究。拟议的研究将通过对任何社会心理治疗进行首次适当测试来填补知识和患者护理的重大空白，以实现独特，残疾，常见和研究的疾病。 公共卫生相关性：身体畸形障碍（BDD）是一种严重而常见的疾病，其特征是功能障碍高，自杀率显着高。拟议的研究将是第一个充分测试BDD最有希望的社会心理治疗功效的疗效 - 认知行为疗法，该疗法专门针对BDD的独特症状（CBT-BDD）。与NIMH战略计划一致，我们将测试一种新的和个性化的治疗方法，以针对严重患者和遭受痛苦的患者的痛苦，对任何类型的患者进行了充分测试的患者。