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

描述(申请人提供)：身体变形障碍(BDD)是一种严重的，通常是慢性和常见的疾病，包括痛苦或损害专注力与想象或轻微的外表缺陷。患有BDD的人功能非常差，住院率和自杀率很高。完全自杀率虽然是初步的，但似乎明显很高。大多数BDD患者接受外科、皮肤科或牙科治疗，但通常效果不佳。我们先前的工作表明，SRI对BDD通常是有效的，但患者可能不同意尝试药物治疗，或者可能无法从中受益。因此，迫切需要对这一严重障碍进行有效的心理社会干预。由于BDD在重要方面与其他障碍不同，针对其他障碍的心理治疗不适合BDD。目前还没有经过充分测试的任何类型的BDD心理社会治疗方法。对这种独特的疾病进行循证治疗是非常必要的。认知行为疗法(CBT)是唯一一种完全开发并准备进行正式测试的BDD心理社会疗法。来自病例系列的数据和使用等待名单对照的研究表明，针对BDD的CBT对BDD非常有希望。在R34的资助下，我们开发了一种个性化、模块化、手工化的CBT治疗(CBT-BDD)，专门针对BDD的独特和复杂症状。使用等待名单对照组的R34研究表明，CBT-BDD对患者可接受，实施可行，对BDD、相关症状和功能障碍似乎有效。然而，还没有研究充分测试CBT对BDD的疗效--例如，通过将其与另一种控制治疗师时间、注意力和其他非特定治疗元素的治疗进行比较。因此，临床和公共卫生迫切需要测试最有希望的BDD心理社会治疗方法。这个Collaborative R01应用程序的主要目标是进行第一项研究，以充分检验CBT对BDD的疗效。这项研究将比较我们的个性化和手工化CBT-BDD和手工化支持性心理治疗(SPT)。SPT似乎是BDD最常用的心理社会治疗方法，但它的应答率似乎很低。马萨诸塞州总医院/哈佛医学院和罗德岛医院/布朗大学将在24周内随机选择120名成年人接受CBT-BDD或SPT，随后进行为期3个月和6个月的随访评估。主要结果将是由盲目的独立评估者评估BDD严重程度的变化。次级目标将检查抑郁症状、BDD信念的妄想性、心理社会功能和生活质量的变化，以及BDD改善的预测因素。联合王国关于BDD的国家卫生服务治疗实践指南和关于BDD的Cochrane协作审查强调了治疗研究的匮乏，并呼吁对BDD进行更多的干预研究。这项拟议的研究将通过对一种独特的、致残的、常见的和研究不足的障碍进行任何心理社会治疗的首次充分测试，来填补知识和患者护理方面的重大空白。

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.