Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials

摘要

Body dysmorphic disorder (BDD) is a chronic and disabling psychiatric disorder unlikely to remit without treatment A systematic review and meta-analysis of randomized controlled trials (RCTs) of cognitive-behavioral therapy (CBT) for BDD was conducted, including published and unpublished trials to 26th November 2015. Primary outcomes were validated BDD measures; secondary outcomes included depression and insight Meta regressions were conducted to examine potential effects of variables on the primary outcome, including sociodemographic variables, comorbidity, symptom severity/duration, concomitant medication, treatment duration, and methodological quality of the RCTs. Seven RCfs (N = 299) met inclusion criteria. CBT was superior to waitlist or credible psychological placebo in reducing BDD (7 studies; delta = -1.22, 95% CI = -1.66 to -0.79) and depression symptoms (5 studies; delta = -0.49, 95% CI = -076 to -0.22). CBT was associated with improvements in insight/delusionality (4 studies; delta = -0.56, 95% CI = -0.93 to -0.19). Improvement in BDD was maintained after 2-4 months follow-up (3 studies; delta = -0.89, 95% CI = -124 to -054). Meta-regression analyses did not reveal any significant predictors of outcome. CBT is an efficacious treatment for BDD but there is substantial room for improvement The specificity and long-term effects of CBT for BDD require further evaluation using credible control conditions. Additional trials comparing CBT with pharmacological therapies, as well as their combination, are warranted. Tele-care options, such as Internet-based CBT, hold great promise to increase access to evidence-based treatment for a majority of patients who need it and should be evaluated further. (C) 2016 Elsevier Ltd. All rights reserved.