Predictors of Response to Cognitive-Behavioral Therapy for Body Dysmorphic Disorder (2019) Greenberg et al

[JohnTheJack]

Study here:
https://www.sciencedirect.com/science/article/abs/pii/S0005789419300012?via=ihub

Abstract
Body dysmorphic disorder (BDD) is a common and distressing or impairing preoccupation with a perceived defect in physical appearance. Individuals with BDD engage in time-consuming rituals to check, hide, or “fix” their appearance or alleviate distress.

BDD is associated with substantial psychosocial impairment and high rates of depression, hospitalization, and suicidality. Cognitive-behavioral therapy (CBT) is the treatment of choice for BDD, but not everyone benefits.

We examined predictors of CBT-related improvement, an important topic that has received very limited investigation. Treatment was delivered in weekly individual sessions over 18–22 weeks.

Results indicated that greater motivation/readiness to change (University of Rhode Island Change Assessment Questionnaire), greater treatment expectancy (Treatment Credibility/Expectancy Questionnaire), and better baseline BDD-related insight (Brown Assessment of Beliefs Scale) significantly predicted better CBT response at posttreatment.

Baseline BDD symptom severity and depression did not predict outcome, suggesting that even patients with more severe BDD and depressive symptoms can benefit from CBT for BDD. Efforts should be aimed at enhancing readiness to change and confidence in the treatment at treatment onset as well as addressing the poor insight that often characterizes BDD.

It seems to me to be saying that there are greater self-report responses in those who expect CBT to work.

If you tell people the treatment is effective, they'll say it is, no matter how severe the symptoms. Hmm. PACE? Lightning Process?

 

[rvallee]

I still have a hard time accepting that there are people out there who think this is serious research. This is a cult, not science. Alchemy was seriously more rigorous than this.

The words sound smart but they mean nothing. Just an endless circle jerk over the color of the emperor's naked ass sequins.

 

[Hoopoe]

Efforts should be aimed at enhancing readiness to change and confidence in the treatment at treatment onset as well as addressing the poor insight that often characterizes BDD.

How would that look like?

Are you ready to change?

The treatment is fantastically effective.

Prepare to live a new life free of illness.

All you need is put in good effort and we guarantee it will work.

They seem to be in the process of discovering faith healing.

 

[James Morris-Lent]

I wonder if the use of questionnaire results as both outcome and predictor should be disallowed. It seems rather... squishy, if that's the word.

 

[duncan]

I wonder if the use of questionnaire results as both outcome and predictor should be disallowed. It seems rather... squishy, if that's the word.

Yes. But what do you do in a world characterized by subjective symptoms, more or less, so far?

I've seen subjective symptoms marginalized and ridiculed, and it's difficult.

The answer may rest in the wording of the questionnaire.

 

[James Morris-Lent]

@duncan

I agree that subjective outcomes are crucially important in chronic illness. I think I'd say make sure that of the links that make up your analysis, only one can be made up of only subjective measures. More than that and you have a leap of faith and probably some incestuous interplay between each set of questions, it seems to me.

Just a thought. Who knows. I'll let it roll around.

 

[duncan]

I think I'd say make sure that of the links that make up your analysis, only one can be made up of only subjective measures. More than that and you have a leap of faith and probably some incestuous interplay between each set of questions, it seems to me.

It is what it is.

Can we revisit in 10 years?

 

[rvallee]

I wonder if the use of questionnaire results as both outcome and predictor should be disallowed. It seems rather... squishy, if that's the word.

Even worse is that the "treatments" aim to influence the very same things that are "measured" (not really sure measure applies when it's qualitative). It's a method for maximal bias. This is how not to science 101.