Body dysmorphic disorder is a mental health illness in which people are so pervasively preoccupied with their perceived flaws that it interferes with their day-to-day activities. Many people do not have access to cognitive behavioral therapy (CBT), which has strong efficacy against this disorder, but new research published in The BMJ suggests an internet-based version of psychotherapy could also be effective.

Body dysmorphia is an illness — often underdetected and underdiagnosed — that affects about 1 percent of the United States population, according to the Anxiety and Depression Association of America. The disorder causes a person to have a distorted view of how they look and to spend a lot of time worrying about their appearance — some even consider drastic measures to fix this imagined or slight defect. If left untreated, the disorder can lead to hospitalization, substance abuse, and suicide. Recommended treatments for the disorder include antidepressant medication and specialized CBT for body dysmorphia. According to Psychology Today, CBT effectively removes beliefs that prevent a person from feeling their best.

“There is, however, a gap between supply and demand of CBT because of various factors, such as a lack of trained therapists, direct and indirect costs associated with treatment, and geographical barriers that prevent people with body dysmorphic disorder from receiving specialized CBT,” the study authors wrote.

With the goal to increase access to care for body dysmorphic disorder, researchers evaluated the effectiveness of a therapist-guided, internet-based CBT program for body dysmorphic disorder (BDD-NET) compared with online supportive therapies — which usually dole out non-specific talking therapy.

Researchers recruited 94 adult patients with a diagnosis of body dysmorphic disorder and randomly assigned them to receive either BDD-NET or supportive therapy for 12 weeks. The participants did not have any face-to-face contact with a therapist during treatment and both groups were followed for three months after the end of treatment.

There were significant improvements in symptom severity, depression, and quality of life in those who received BDD-Net treatment compared with those in supportive therapy. For example, depressive symptoms decreased over the course of the trial with the specialized CBT treatment but not with supportive therapy.

These improvements were also maintained at least three months after treatment ended. At the end of the follow-up period, 56 percent of those receiving BDD-NET had a 30 percent or more reduction in symptoms compared with 13 percent of those receiving supportive therapy. And 39 percent of those receiving BDD-NET no longer met diagnostic criteria for body dysmorphic disorder.

Importantly, most participants in the BDD-Net group was very satisfied with their treatment. Patient satisfaction is paramount because if a patient is satisfied with their treatment they are more likely to adhere to long-term therapy.

Although BDD-NET was proven to be effective in treating people diagnosed with body dysmorphic disorder, previous studies have suggested mental health patients will reap more benefits if they are face-to-face with their therapist. A computer-assisted CBT program will be rendered ineffective if the patients are inattentive or lose interest after a while.

Limitations of the study include its small size, and the fact that not everyone with body dysmorphia might respond the same way because the sample only included patients who were being treated at specialist clinics.

Source: Enander J, Andersson E, Mataix-Cols D, et al. Therapist Guided Internet Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder: Single Blind Randomized Controlled Trial. The BMJ. 2016.