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

描述（由申请人提供）：身体畸形障碍（BDD）是一种严重的，通常是慢性的，常见的疾病，包括对想象或轻微外观缺陷的痛苦或损害性关注。BDD患者的功能非常差，住院率和自杀率很高。完成自杀的比率虽然是初步的，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，但通常无效。我们之前的工作表明，SRIs通常对BDD有效，但患者可能不同意尝试药物治疗或可能无法从中受益。因此，迫切需要对这种严重疾病进行有效的社会心理干预。因为BDD在许多重要方面不同于其他疾病，所以针对其他疾病的心理治疗并不适合BDD。目前还没有经过充分测试的任何类型的BDD心理治疗方法。对这种独特疾病的循证治疗是非常需要的。认知行为疗法（CBT）是治疗BDD的唯一一种完全成熟的心理治疗方法，现在已准备好进行正式测试。来自病例序列和使用等候名单对照的研究数据表明，针对BDD的CBT治疗BDD非常有前景。在R34资助下，我们开发了一种个性化、模块化、手动的CBT治疗（CBT-BDD），专门针对BDD的独特和复杂症状。R34研究使用了一个等候名单控制组，表明CBT-BDD对患者是可接受的，可行的，并且对BDD、相关症状和功能障碍有效。然而，没有研究充分测试CBT对BDD的疗效——例如，将其与另一种控制治疗师时间、注意力和其他非特异性治疗因素的治疗方法进行比较。因此，临床和公共卫生迫切需要测试最有希望的BDD心理治疗方法。这个协作R01申请的主要目的是进行第一个充分检验CBT对BDD疗效的研究。本研究将比较我们的个性化和手动CBT-BDD与手动支持性心理治疗（SPT）。SPT似乎是最常用于BDD的心理社会治疗，但它的反应率似乎很低。麻省总医院/哈佛医学院和罗德岛医院/布朗大学将随机抽取120名成年人，在24周内接受CBT-BDD或SPT治疗，随后进行3个月和6个月的随访评估。主要结局将是BDD严重程度的改变，由盲法独立评估者评估。次要目的是检查抑郁症状的改变、BDD信念的妄想、社会心理功能和生活质量，以及BDD改善的预测因素。英国的国民健康服务BDD治疗实践指南和Cochrane协作对BDD的回顾强调了治疗研究的缺乏，并呼吁对BDD进行更多的干预研究。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疾病进行任何心理社会治疗的首次充分测试，填补知识和患者护理方面的主要空白。

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.