Overview of Evidence-Based Treatment: Psychotherapy

Cognitive behavioral therapy (CBT) is the most robustly studied psychotherapy for body dysmorphic disorder (BDD). Clinical trials have traditionally combined techniques from cognitive therapy (CT; e.g., metacognition and interpretation biases) and behavioral therapy (BT; e.g., exposure and safety behavior fading). However, standalone CT or BT, transdiagnostic (e.g., Unified Protocol; Schema Therapy), and third-wave CBT approaches (e.g., acceptance and mindfulness-based therapies) have also proven effective in alleviating BDD symptoms and associated outcomes. Further, treatment can be effectively delivered across a variety of formats including group or individual, weekly or intensive, face-to-face or technology-assisted. Given the known barriers to care for this population (e.g., shame, cost, lack of specialist access, and logistical considerations) and observed variability in treatment response, the effort to optimize therapeutic content and delivery strategies for BDD is ongoing. Encouragingly, recent mobile health initiatives including internet and app-delivered CBT show promise for overcoming common barriers to BDD treatment access by minimizing clinician time needed to achieve meaningful outcomes. Continued refinement of clinical decision-making for this debilitating illness will likely require larger-scale treatment comparisons, mechanistic studies, and development and testing of stepped-care initiatives. This chapter outlines the evolution of CBT for BDD and the extant empirical support for cognitive-behavioral approaches to the condition.