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Long-term outcome of therapist-guided internet-based cognitive behavioural therapy for body dysmorphic disorder (BDD-NET): a naturalistic 2-year follow-up after a randomised controlled trial
  1. Jesper Enander1,
  2. Brjánn Ljótsson1,2,
  3. Lina Anderhell2,
  4. Martin Runeborg2,
  5. Oskar Flygare2,
  6. Oskar Cottman2,
  7. Erik Andersson1,2,
  8. Sofia Dahlén3,
  9. Linn Lichtenstein3,
  10. Volen Z Ivanov1,3,
  11. David Mataix-Cols1,3,
  12. Christian Rück1,3
  1. 1 Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  2. 2 Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  3. 3 Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
  1. Correspondence to Dr Jesper Enander; jesper.enander{at}


Objectives Most patients with body dysmorphic disorder (BDD) do not receive evidence-based treatment. A randomised controlled trial (RCT) has found that a therapist-guided internet-based cognitive–behavioural therapy (CBT) programme for BDD (BDD-NET) can be delivered safely via the internet with significant improvements in BDD symptom severity in the short term. The purpose of this study was to evaluate if the therapeutic gains of BDD-NET are maintained 2 years after treatment.

Setting Academic medical centre.

Participants A naturalistic 2-year follow-up study of the 88 self-referred adult outpatients with a diagnosis of BDD that had received BDD-NET within the context of the RCT.

Primary and secondary outcomes The primary outcome was the BDD-Yale-Brown Obsessive-Compulsive Scale (YBOCS). Responder status was defined as a ≥30% reduction in symptoms. Remission was defined as no longer meeting Diagnostic and Statistical Manual of Mental Disorders 5th edition criteria for BDD. Secondary outcomes included measures of depression, global functioning and quality of life.

Results The efficacy of BDD-NET was sustained long- term, with further improvements observed on the BDD-YBOCS during the follow-up period. At follow-up, 69% (95% CI 57% to 80%) were classified as responders and 56% (95% CI 43% to 69%) were in remission. Gains on depressive symptoms and global functioning were also sustained but not quality of life. A majority of participants reported that the main reason for seeking help for their BDD was the possibility to access the treatment from home.

Conclusion BDD-NET is an effective treatment for BDD, and the patients’ gains are maintained in the long term. BDD-NET has the potential to increase access to CBT and may lower the threshold for BDD sufferers to seek help in the first place.

Trial registration number NCT02010619.

  • body dysmorphic disorder
  • long-term
  • follow-up
  • cognitive behaviour therapy
  • obsessive-compulsive disorder
  • treatment

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  • Contributors JE and CR had the original idea for the study and, with DM-C and BL, designed the trial variables and obtained the funding. JE and CR were responsible for study supervision. All authors were responsible for the acquisition of the data. JE and BL carried out the statistical analysis. JE drafted the manuscript, which was revised by BL, LA, MR, OF, OC, EA, SD, LL, VZI, DM-C and CR. All researchers were independent of the funders.

  • Funding This study was funded through the regional agreement on medical training and clinical research (ALF) between the Stockholm County Council and Karolinska Institutet, the Swedish Research Council (grant No: K2013-61X-22168-01-3) and the Swedish Society of Medicine (Söderströmska Königska sjukhemmet, grant no: SLS3B4451).

  • Disclaimer The funders had no part in the study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The regional ethical review board in Stockholm approved the study (registration ID: 2013/1773-31/4).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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