Empirically defining treatment response and remission in body dysmorphic disorder using a short self-report instrument

2020 ◽  
Author(s):  
Oskar Flygare ◽  
Long-Long Chen ◽  
Lorena Fernández de la Cruz ◽  
Jesper Enander ◽  
David Mataix-Cols ◽  
...  
Keyword(s):  
Treatment Response ◽  
Body Dysmorphic Disorder ◽  
Self Report ◽  
Behaviour Therapy ◽  
Obsessive Compulsive ◽  
Appearance Anxiety ◽  
Detection Analysis ◽  
Remission Status ◽  
Cognitive Behaviour ◽  
Signal Detection Analysis

Determining response or remission status in body dysmorphic disorder (BDD) usually requires a lengthy interview with a trained clinician. This study sought to establish empirically derived cut-offs to define treatment response and remission in BDD using a brief self-reported instrument, the Appearance Anxiety Inventory (AAI). Results from three clinical trials of BDD were pooled to create a sample of 123 individuals who had received cognitive behaviour therapy for BDD, delivered via the internet. The AAI was compared to gold-standard criteria for response and remission in BDD, based on the clinician-administered Yale-Brown Obsessive Compulsive Scale, modified for BDD (BDD-YBOCS), and evaluated using signal detection analysis. The results showed that a ≥40% reduction on the AAI best corresponded to treatment response, with a sensitivity of 0.71 and a specificity of 0.84. A score ≤13 at post-treatment was the optimal cut-off in determining full or partial remission from BDD, with a sensitivity of 0.75 and a specificity of 0.88. These findings provide benchmarks for using the AAI in BDD treatment evaluation when resource-intensive measures administered by clinicians are not feasible.

A Controlled Comparison of Cognitive—Behaviour Therapy, Diazepam and Placebo in the Management of Generalized Anxiety

1989 ◽  
Vol 17 (1) ◽  
pp. 1-14 ◽  
Author(s):  
K. G. Power ◽  
D. W. A. Jerrom ◽  
R. J. Simpson ◽  
M. J. Mitchell ◽  
V. Swanson
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Psychological Treatment ◽  
Subsequent Treatment ◽  
Self Report ◽  
Response To Treatment ◽  
Generalized Anxiety ◽  
Behaviour Therapy ◽  
Treatment Interventions ◽  
Group Response ◽  
Cognitive Behaviour

Generalized anxiety patients were randomly allocated to Cognitive-Behaviour Therapy, Diazepam or Placebo and managed in a primary care setting. Treatments were balanced for degree of psychologist/patient contact. A range of outcome measures, including patient self report, psychologist assessor and general practitioner ratings were used. Large variations within group response to treatment emerged. At the end of active treatment the superiority of Cognitive-Behaviour Therapy was suggested. Post-study psychotropic prescription and psychological treatment was assessed at a 12-month follow-up. The Cognitive-Behaviour group revealed the lowest incidence of subsequent treatment interventions.

scholarly journals Cost-effectiveness of internet-delivered cognitive behaviour therapy for body dysmorphic disorder: results from a randomised controlled trial

2021 ◽  
Author(s):  
Oskar Flygare ◽  
Erik Andersson ◽  
Gjermund Glimsdal ◽  
David Mataix-Cols ◽  
Diana Djurfeldt ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Outcome Measures ◽  
Cognitive Behaviour Therapy ◽  
Body Dysmorphic Disorder ◽  
Controlled Trial ◽  
Cost Utility ◽  
Secondary Outcome ◽  
Behaviour Therapy ◽  
Supportive Psychotherapy ◽  
Cognitive Behaviour

Objectives: To evaluate the cost-effectiveness of internet-delivered cognitive behaviour therapy for body dysmorphic disorder (BDD-NET). Design: Secondary cost-effectiveness analysis from a randomised controlled trial on BDD-NET versus online supportive psychotherapy. Setting: Academic medical centre. Participants: Self-referred adult patients with a primary diagnosis of body dysmorphic disorder and a score of 20 or higher on the modified Yale-Brown obsessive compulsive scale (n = 94). Patients receiving concurrent psychotropic drug treatment were included if the dose had been stable for at least two months and remained unchanged during the trial. Interventions: Participants received either BDD-NET (n = 47) or online supportive psychotherapy (n = 47) for 12 weeks. Primary and secondary outcome measures: The primary outcome measures were cost-effectiveness and cost-utility from a societal perspective, using remission status from a diagnostic interview and quality-adjusted life years from EQ-5D, respectively. Secondary outcome measures were cost-effectiveness and cost-utility from a health care perspective and the clinics perspective. Results: Compared to supportive psychotherapy, BDD-NET produced one additional remission for an average societal cost of $4132. The cost-utility analysis showed that BDD-NET generated one additional QALY to an average cost of $14319 from a societal perspective. Conclusions: BDD-NET is a cost-effective treatment for body dysmorphic disorder, compared to online supportive psychotherapy. The efficacy and cost-effectiveness of BDD-NET should be directly compared to face-to-face cognitive behaviour therapy.

scholarly journals An Evaluation of a New Autism-Adapted Cognitive Behaviour Therapy Manual for Adolescents with Obsessive–Compulsive Disorder

2020 ◽  
Author(s):  
Amita Jassi ◽  
Lorena Fernández de la Cruz ◽  
Ailsa Russell ◽  
Georgina Krebs
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Cognitive Behaviour Therapy ◽  
Autism Spectrum ◽  
Behaviour Therapy ◽  
Obsessive Compulsive ◽  
Global Functioning ◽  
Compulsive Disorder ◽  
Cognitive Behaviour ◽  
Treatment Gains

Abstract Obsessive–compulsive disorder (OCD) and autism spectrum disorder (ASD) frequently co-occur. Standard cognitive behaviour therapy (CBT) for OCD outcomes are poorer in young people with ASD, compared to those without. The aim of this naturalistic study was to evaluate the effectiveness of a novel adolescent autism-adapted CBT manual for OCD in a specialist clinical setting. Additionally, we examined whether treatment gains were maintained at 3-month follow-up. Thirty-four adolescents underwent CBT; at the end of treatment, 51.51% were treatment responders and 21.21% were in remission. At 3-month follow-up, 52.94% were responders and 35.29% remitters. Significant improvements were also observed on a range of secondary measures, including family accommodation and global functioning. This study indicates this adapted package of CBT is associated with significant improvements in OCD outcomes, with superior outcomes to those reported in previous studies. Further investigation of the generalizability of these results, as well as dissemination to different settings, is warranted.

scholarly journals Empirically defining treatment response and remission in body dysmorphic disorder

2019 ◽  
pp. 1-7 ◽  
Author(s):  
Lorena Fernández de la Cruz ◽  
Jesper Enander ◽  
Christian Rück ◽  
Sabine Wilhelm ◽  
Katharine A. Phillips ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Treatment Response ◽  
Body Dysmorphic Disorder ◽  
Detection Methods ◽  
Obsessive Compulsive ◽  
Pooled Data ◽  
Randomized Controlled ◽  
Full Remission ◽  
End Of Treatment ◽  
The Usa

Abstract Background The number of clinical trials in body dysmorphic disorder (BDD) has steadily increased in recent years. As the number of studies grows, it is important to define the most empirically useful definitions for response and remission in order to enhance field-wide consistency and comparisons of treatment outcomes across studies. In this study, we aim to operationally define treatment response and remission in BDD. Method We pooled data from three randomized controlled trials of cognitive-behavior therapy (CBT) for BDD (combined n = 153) conducted at four academic sites in Sweden, the USA, and England. Using signal detection methods, we examined the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD–YBOCS) score that most reliably identified patients who responded to CBT and those who achieved remission from BDD symptoms at the end of treatment. Results A BDD–YBOCS reduction ⩾30% was most predictive of treatment response as defined by the Clinical Global Impression (CGI) – Improvement scale (sensitivity 0.89, specificity 0.91, 91% correctly classified). At post-treatment, a BDD–YBOCS score ⩽16 was the best predictor of full or partial symptom remission (sensitivity 0.85, specificity 0.99, 97% correctly classified), defined by the CGI – Severity scale. Conclusion Based on these results, we propose conceptual and operational definitions of response and full or partial remission in BDD. A consensus regarding these constructs will improve the interpretation and comparison of future clinical trials, as well as improve communication among researchers, clinicians, and patients. Further research is needed, especially regarding definitions of full remission, recovery, and relapse.

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