CBT for body dysmorphic disorder

Domain II · Behavioural & cognitive · Sabine Wilhelm, Katharine Phillips, Gail Steketee · 2013

What it is

CBT-BDD is an individual, modular cognitive-behavioural treatment for body dysmorphic disorder (BDD), adapted from CBT for OCD. Every patient gets a core set of modules: assessment, psychoeducation, case formulation, motivational enhancement, cognitive restructuring, exposure with ritual…

Format

• Format. Individual, roughly weekly, about 22 sessions over 24 weeks in the 2014 RCT (36 adults; 12-week waitlist comparison). The exact session length and how sessions were spaced across the 24 weeks were not confirmed. Weekly sessions of about an hour that taper later is a common reading, but it…
• Session map (manual table of contents)

Who practises it, and how they are trained or regulated

• Named variants (not followed here). A smartphone version from the same team (MGH, Wilhelm PI): about 12 weeks, eight components (education/assessment and model, self-monitoring, cognitive techniques, exposure, response prevention, mindfulness/perceptual retraining, valued activities, relapse prevention), motivational enhancement woven throughout, and a CBT-trained coach averaging under 15 minutes a week by message.…
• CBT-BDD is an individual, modular cognitive-behavioural treatment for body dysmorphic disorder (BDD), adapted from CBT for OCD. Every patient gets a core set of modules: assessment, psychoeducation, case formulation, motivational enhancement, cognitive restructuring, exposure with ritual prevention, perceptual (mirror) retraining, advanced cognitive work and relapse prevention. Optional modules are added when the…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• rises in ritual time or new camouflage. Act on them early.
• goals phrased as "look better" or "feel no anxiety". Turn them into actions.
• family conflict and hostility toward the symptoms. Coach a warm but firm tone.
• the client using the labels to attack themselves ("I'm so irrational"). Keep the tone curious.
• the client hearing "you're imagining it". Pre-empt this by saying you take the distress as real.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.