Cognitive behavioral therapy (CBT) is the leading psychotherapeutic treatment for body dysmorphic disorder (BDD), yet not all patients improve. To address the treatment response gap, CBT may be augmented with cognitive enhancers such as d-cycloserine (DCS). DCS-augmented behavior therapy has been tested with mixed results in related disorders. To initially test whether DCS may augment CBT for BDD, we conducted the first preliminary efficacy trial of DCS versus placebo-augmented CBT for BDD, via a randomized, double-blind study. We analyzed data using mixed-effects models in a modified intent-to-treat sample (N = 26). Over 10 weeks of treatment, primary (BDD severity) and secondary (insight, depression) outcomes improved significantly across both conditions, but there were no significant group differences in response. Exploratory analysis revealed that BDD-related distress, specifically, reduced significantly more in the DCS condition compared to placebo. This is the first study testing DCS-augmented CBT for BDD. Implications, limitations, and future directions are discussed.
Trial registry: ClinicalTrials.gov Identifier NCT00842309
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We would like to thank the reviewers, whose comments on an earlier version of this manuscript contributed to substantial improvements in the paper.
This work was supported by the Neil and Anna Rasmussen Foundation and the David Judah Fund. The funding sources played no role in design of this study; the collection, analysis, and interpretation of data; the writing of this report; or the decision to submit this article for publication.
Conflict of interest
Drs. Weingarden and Wilhelm and Ms. Ladis have received salary support from Telefonica Alpha, Inc. Dr. Wilhelm has received research support in the form of free medication and matching placebo from Forest Laboratories for clinical trials funded by the NIH. Dr. Wilhelm is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies; she has received royalties from Elsevier Publications, Guilford Publications, New Harbinger Publications, and Oxford University Press. Dr. Wilhelm has also received speaking honorarium from various academic institutions and foundations, including the International Obsessive Compulsive Disorder Foundation and the Tourette Association of America. In addition, she received payment from the Association for Behavioral and Cognitive Therapies for her role as Associate Editor for the Behavior Therapy journal, as well as from John Wiley & Sons, Inc. for her role as Associate Editor on the journal Depression & Anxiety. Dr. Wilhelm has also received salary support from Novartis. Dr. Dougherty has received research support from Medtronic and LivaNova. Suraj S. Mothi, Susanne Hoeppner, Hannah E. Reese, Kiara Timpano, Jedidiah Siev, Jessica Rasmussen and Jennifer Ragan declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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Weingarden, H., Mothi, S.S., Ladis, I. et al. d-Cycloserine-Augmented Behavior Therapy for Body Dysmorphic Disorder: A Preliminary Efficacy Trial. Cogn Ther Res 43, 937–947 (2019). https://doi.org/10.1007/s10608-019-10015-0
- Body dysmorphic disorder
- Behavior therapy
- Cognitive enhancers