Internet-delivered Cognitive-behaviour Therapy for Adolescents With Body Dysmorphic Disorder
Condition: Body Dysmorphic Disorders; Dysmorphophobia
MeSH terms: Body Dysmorphic Disorders
Study type: Interventional

Summary: 
      The purpose of this trial is to investigate whether a therapist-guided Internet-delivered
      cognitive behaviour therapy (ICBT) programme is feasible for adolescents with body dysmorphic
      disorder (BDD). The aim is to evaluate feasibility and provide preliminary efficacy data.
    

Detailed description: 
      Rationale for study: BDD is a prevalent and impairing condition that can be effectively
      treated with cognitive-behaviour therapy (CBT). However, CBT for BDD is a highly specialised
      treatment and a majority of adolescents do not have access to it. ICBT can be a way to
      increase the availability of effective psychological treatments. No study to date has
      evaluated the feasibility of ICBT for adolescent BDD, but the experience in adults with BDD
      treated with ICBT is encouraging.

      Objectives: To investigate whether a therapist-guided Internet-delivered cognitive behaviour
      therapy (ICBT) programme is feasible for adolescents with body dysmorphic disorder (BDD).
      Specifically, the aim is to:(a) establish participant retention, ease of recruitment,
      acceptability, credibility, and satisfaction, (b) evaluate potential adverse events, and (c)
      provide preliminary efficacy data.

      Trial design and methods: Participants will be recruited nationally and will be offered 12
      modules of ICBT for BDD, delivered over a period of 14 weeks. Participants will be assessed
      before, during, and after treatment, and up to 12 months after the end of the treatment. ICBT
      non-responders, assessed at post-treatment and one-, two-, and three-months after completing
      treatment, will be offered CBT delivered via video format (at post-treatment and after the
      1MFU and the 2MFU) or traditional face-to-face (F2F) CBT at the OCD and Related Disorders
      Clinic for Children and Adolescents in Stockholm (after the 3MFU).

      The primary outcome is feasibility, as measured by examining rates of participant retention,
      treatment completion and adherence to treatment content, treatment acceptability, treatment
      credibility, treatment satisfaction and adverse events during the treatment.

      Secondary outcomes include improvement in clinician-reported BDD symptoms, as well as
      improvement in other clinical measures assessing disorder severity, disorder improvement,
      self-reported BDD symptoms, depressive symptoms, and functional impairment.

      Sample: 20 adolescents and their primary caregivers.

      Statistical analysis: Retention, acceptability, credibility, and treatment satisfaction. For
      retention and acceptability, information on ease of recruitment, number of completed modules,
      and attrition rates will collected and presented in a descriptive manner. Results from a
      credibility scale will be summarized in group means and standard deviations. Results from a
      treatment satisfaction scale will be summarized in group means and standard deviation.
      Potential adverse events: Type and impact of all potential adverse events will be measured
      with a specific scale and presented descriptively. Preliminary efficacy: Clinical measures of
      treatment outcomes will be measured via clinician-reported and self- and parent-reported
      measures and analysed through linear mixed models to detect within group change over time.
      Within-group effect sizes will be estimated with Cohen's d. Treatment response: The
      proportion of treatment responders will be calculated. Treatment response will be defined as
      a ≥30% reduction on the BDD-YBOCS-A, respective to the baseline score. Further, the
      investigators will also calculate how many participants are on full or partial symptom
      remission, defined as a score ⩽16 on the BDD-YBOCS-A.
    

Intervention name(s): Exposure and response prevention (ERP)
Intervention type(s): Behavioral
Intervention description(s): The treatment is Internet-delivered and therapist-guided, involving both the adolescent and at least one parent. The treatment consists of two separate sets of modules, one for the adolescent and one for the parent, each with separate logins. The ICBT intervention consists of 12 modules, delivered over a maximum of 14 weeks.
The main goal of treatment is to help the young person to stop avoiding anxiety-provoking situations by undertaking exposure tasks and to stop doing unhelpful repetitive behaviours and rituals, known as response prevention. Every module also contains homework tasks that mainly consists of exposure and response prevention (ERP).
Parents are also often involved in the patients' rituals and avoidant behaviours (known as family accommodation), which may contribute to maintain the BDD symptoms. Involving parents facilitates modification of these unhelpful patterns.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Body dysmorphic disorder; Dysmorphophobia; Cognitive-behavioral therapy; Internet-delivered treatments; Adolescents; Treatment outcomes