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，包括痛苦或损害的外观想象或轻微缺陷的关注。BDD患者的功能非常差，住院率和自杀率很高。自杀既遂率虽然是初步的，但似乎明显很高。大多数患者接受手术，皮肤科或牙科治疗BDD，这通常是无效的。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治疗或可能不会从中受益，因此，迫切需要对这种严重疾病进行有效的心理社会干预。由于BDD在重要方面与其他疾病不同，其他疾病的心理疗法不足以治疗BDD。没有任何类型的BDD的充分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的唯一一种心理社会治疗方法，它已经完全成熟，现在已经准备好进行正式测试。来自病例系列和使用等待列表对照的研究的数据表明，BDD特异性CBT对BDD非常有希望。在R34资助下，我们开发了一种个性化，模块化，手动化的CBT治疗（CBT-BDD），专门针对BDD独特而复杂的症状。R34研究使用了等候名单对照组，表明CBT-BDD对患者来说是可以接受的，实施起来是可行的，并且对BDD、相关症状和功能障碍似乎有效。然而，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，注意力和其他非特异性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。 这个协作R 01应用程序的主要目的是进行第一项研究，以充分检查CBT对BDD的疗效。本研究将比较我们的个性化和手动CBT-BDD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，但它似乎有一个低响应率。马萨诸塞州总医院/哈佛医学院和罗得岛医院/布朗大学将在24周内随机分配120名成人接受CBT-BDD或SPT，随后进行3个月和6个月的随访评估。主要结局将是盲态独立评价者评估的BDD严重程度变化。次要目标将检查抑郁症状的变化，BDD信念的妄想，心理社会功能和生活质量，以及BDD改善的预测因素。 英国国家卫生服务局关于BDD的治疗实践指南和科克伦合作组织关于BDD的综述强调了治疗研究的缺乏，并呼吁对BDD进行更多的干预研究。这项拟议的研究将填补知识和患者护理方面的重大空白，对一种独特的、致残的、常见的和未充分研究的疾病进行首次充分的心理社会治疗测试。 公共卫生相关性：躯体畸形恐惧症（BDD）是一种严重而常见的疾病，其特征是高度的功能障碍和明显高的自杀率。这项拟议的研究将是第一个充分测试最有希望的BDD心理社会治疗效果的研究-专门针对BDD独特症状的认知行为疗法（CBT-BDD）。根据NIMH的战略计划，我们将测试一种新的和个性化的治疗方法，用于那些没有经过充分测试的任何类型的心理社会治疗的重症和痛苦患者。

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.