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Internet-based, therapist-guided, cognitive-behavioural therapy for body dysmorphic disorder with global eligibility for inclusion: an uncontrolled pilot study

Gentile, Andrew J; La Lima, Christopher; Flygare, Oskar; Enander, Jesper; Wilhelm, Sabine; Mataix-Cols, David; Rück, Christian
OBJECTIVES/OBJECTIVE:Cognitive-behavioural therapy (CBT) has been shown to be an effective treatment for body dysmorphic disorder (BDD), but access to treatment around the world is limited. One way to increase access is to administer CBT remotely via the internet. This study represents the first effort to remotely deliver a therapist-supported, internet-based CBT treatment with no restrictions on enrolment based on geographical location, and it aims to assess whether this treatment can be delivered safely across international borders, with outcomes comparable to previous BDD-NET trials. DESIGN/METHODS:Uncontrolled clinical trial. PARTICIPANTS/METHODS:Patients (n=32) in nine different countries were recruited primarily through internet advertisements. INTERVENTION/METHODS:BDD-NET is a 12-week treatment, consisting of eight treatment modules previously shown to be effective in a Swedish version. SETTING/METHODS:Therapists based at a single, secondary care centre in Sweden provided active guidance and feedback throughout the treatment via asynchronous electronic messages. MAIN OUTCOME MEASURE/METHODS:The clinician-administered Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS). Symptom severity was assessed pretreatment, mid-treatment (6 weeks), post-treatment and at the 3-month follow-up. RESULTS:There were significant improvements on BDD-YBOCS scores (F(3, 71.63)=31.79, p<0.001), that were maintained at 3-month follow-up. Mean differences from baseline in BDD-YBOCS scores were -8.12 (week 6), -12.63 (post-treatment) and -11.71 (3-month follow-up). 47% and 50% of participants were considered treatment responders at post-treatment and 3-month follow-up, respectively. Additionally, remission rates were 28% at post-treatment and 44% at 3-month follow-up. The treatment was also deemed acceptable by patients. CONCLUSIONS:The results suggest that BDD-NET can be safely and effectively delivered across international borders to a culturally diverse sample. Larger scale randomised controlled trials with more participants from non-Western cultures are warranted to further validate the cross-cultural generalisability of this treatment. TRIAL REGISTRATION NUMBER/BACKGROUND:NCT03517384.
PMID: 30904854
ISSN: 2044-6055
CID: 4037382

Augmenting Buried in Treasures with in-home uncluttering practice: Pilot study in hoarding disorder

Linkovski, Omer; Zwerling, Jordana; Cordell, Elisabeth; Sonnenfeld, Danae; Willis, Henry; La Lima, Christopher N; Baker, Colleen; Ghazzaoui, Rassil; Girson, Robyn; Sanchez, Catherine; Wright, Brianna; Alford, Mason; Varias, Andrea; Filippou-Frye, Maria; Shen, Hanyang; Jo, Booil; Shuer, Lee; Frost, Randy O; Rodriguez, Carolyn I
Hoarding disorder is characterized by difficulty parting with possessions and by clutter that impairs the functionality of living spaces. Cognitive behavioral therapy conducted by a therapist (individual or in a group) for hoarding symptoms has shown promise. For those who cannot afford or access the services of a therapist, one alternative is an evidence-based, highly structured, short-term, skills-based group using CBT principles but led by non-professional facilitators (the Buried in Treasures [BIT] Workshop). BIT has achieved improvement rates similar to those of psychologist-led CBT. Regardless of modality, however, clinically relevant symptoms remain after treatment, and new approaches to augment existing treatments are needed. Based on two recent studies - one reporting that personalized care and accountability made treatments more acceptable to individuals with hoarding disorder and another reporting that greater number of home sessions were associated with better clinical outcomes, we tested the feasibility and effectiveness of adding personalized, in-home uncluttering sessions to the final weeks of BIT. Participants (n = 5) had 15 sessions of BIT and up to 20 hours of in-home uncluttering. Reductions in hoarding symptoms, clutter, and impairment of daily activities were observed. Treatment response rate was comparable to rates in other BIT studies, with continued improvement in clutter level after in-home uncluttering sessions. This small study suggests that adding in-home uncluttering sessions to BIT is feasible and effective.
PMID: 30419524
ISSN: 1879-1379
CID: 3490112

Acceptability, Feasibility, and Effectiveness of Internet-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in New York

Patel, Sapana R; Wheaton, Michael G; Andersson, Erik; Rück, Christian; Schmidt, Andrew B; La Lima, Christopher N; Galfavy, Hanga; Pascucci, Olivia; Myers, Robert W; Dixon, Lisa B; Simpson, Helen Blair
Cognitive-behavioral therapy (CBT), consisting of exposure and response prevention (EX/RP), is both efficacious and preferred by patients with obsessive-compulsive disorder (OCD), yet few receive this treatment in practice. This study describes the implementation of an Internet-based CBT program (ICBT) developed in Sweden in individuals seeking OCD treatment in New York. After translating and adapting the Swedish ICBT for OCD, we conducted an open trial with 40 adults with OCD. Using the RE-AIM implementation science framework, we assessed the acceptability, feasibility, and effectiveness of ICBT. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Of 40 enrolled, 28 participants completed the 10-week ICBT. In the intent-to-treat sample (N = 40), Y-BOCS scores decreased significantly over time (F = 28.12, df = 2, 49, p < . 001). Depressive severity (F = 5.87, df = 2, 48, p < . 001), and quality of life (F = 12.34, df = 2, 48, p < . 001) also improved. Sensitivity analyses among treatment completers (N = 28) confirmed the intent-to-treat results, with a large effect size for Y-BOCS change (Cohen's d = 1.38). ICBT took less time to implement than face-to face EX/RP and participants were very to mostly satisfied with ICBT. On a par with results in Sweden, the adapted ICBT program reduced OCD and depressive symptoms and improved quality of life among individuals with moderate to severe OCD. Given its acceptability and feasibility, ICBT deserves further study as a way to increase access to CBT for OCD in the United States.
PMID: 29937263
ISSN: 1878-1888
CID: 4037372

Implementing internet-based cognitive behavioral therapy for obsessive compulsive disorder: A case report [Case Report]

Patel, S; La Lima, C; Schmidt, AB
ISSN: 2374-0124
CID: 4037392