Efficacy of App-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder with Coach Support: Initial Randomized Controlled Clinical Trial

Abstract

<b><i>Introduction:</i></b> Body dysmorphic disorder (BDD) is severe, chronic, and undertreated. Apps could substantially improve treatment access. <b><i>Objective:</i></b> We provide an initial test of the usability and efficacy of coach-supported app-based cognitive behavioral therapy (CBT) for BDD. The Perspectives app covers core treatment components: psychoeducation, cognitive restructuring, exposure with response prevention, mindfulness, attention retraining, and relapse prevention. <b><i>Methods:</i></b> A randomized waitlist-controlled trial was conducted. Adults (<i>N</i> = 80) with primary BDD were assigned to 12 weeks of Perspectives or waitlist. Coaches promoted engagement and answered questions via in-app messaging and phone calls. BDD severity was measured at baseline, mid-treatment, and end of treatment by blinded independent evaluators (Yale-Brown Obsessive Compulsive Scale Modified for BDD; BDD-YBOCS). Secondary outcomes included BDD-related insight, depression, quality of life, and functioning. <b><i>Results:</i></b> App uptake and satisfaction were high. In intent-to-treat analyses, Perspectives app-based CBT was associated with significantly lower BDD-YBOCS severity at end of treatment (M [SD]: 16.8 [7.5]) compared to the waitlist (26.7 [6.2]; <i>p</i> &#x3c; 0.001, <i>d</i> = 1.44). App-based CBT was associated with greater improvements across all secondary measures, with medium to large effects. <b><i>Conclusions:</i></b> Perspectives, supported by a bachelor’s-level coach, is an efficacious, scalable treatment for adults with BDD.