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Body Dysmorphic DisordersNCT05078320

Internet-delivered Cognitive-behaviour Therapy for Adolescents With Body Dysmorphic Disorder

A study testing Exposure and response prevention (ERP) in people with Body Dysmorphic Disorders and Dysmorphophobia, run by Karolinska Institutet at 1 site in Sweden.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this trial is to investigate whether a therapist-guided Internet-delivered cognitive behaviour therapy (ICBT) programme is feasible for adolescents with body dysmorphic disorder (BDD). The aim is to evaluate feasibility and provide preliminary efficacy data. Read more about this study

Who is it for?
Ages 12 to 17 years
Conditions the study is for
Body Dysmorphic Disorders, Dysmorphophobia
What is being tested?
Exposure and response prevention (ERP)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
20 participants
Where
1 siteSweden
Study dates
22 Oct 2021to 26 Jun 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 12 to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Age 12 to 17 years, confirmed by the caregiver and subsequently by the patient record system Take Care.
  • A diagnosis of BDD, based on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), confirmed by the assessor at the pre-treatment assessment.
  • A total BDD severity score on the BDD-YBOCS-A ≥24. confirmed by the clinician-reported BDD-YBOCS-A performed at the pre-treatment assessment.
  • A minimum of one available caregiver (parent) to support the child/adolescent throughout the treatment. Confirmed by the caregiver at the telephone screening or/and pre-treatment assessment.
  • Regular access to a desktop or laptop computer connected to the Internet, with the ability to receive e-mails, as well as a mobile phone to receive SMS (one of each per family is enough). Confirmed by the caregiver at the telephone screening or/and pre-treatment assessment.

Who cannot join

  • Previous CBT for BDD for a minimum of eight sessions with a qualified therapist within the 12 months prior to assessment. Confirmed by the caregiver at the telephone screening and/or pre-treatment assessment.
  • Simultaneous psychological treatment for BDD, confirmed by the caregiver at the telephone screening and/or pre-treatment assessment.
  • Initiation, adjustment or change of any selective serotonin reuptake inhibitors (SSRI) within the six weeks prior to the pre-treatment assessment. Confirmed by the caregiver at the telephone screening and/or pre-treatment assessment.
  • A diagnosis of organic brain disorder, intellectual disability or a psychiatric disorder (such as psychosis, bipolar disorder or eating disorder) that could interfere with the completion of the treatment. Confirmed by the caregiver at the telephone screening and/or pre-treatment assessment, with help of information from the caregiver and the child/adolescent, and the MINI-KID interview.
  • Immediate risk to self or others requiring urgent medical attention, such as current risk of suicide or self-injurious behaviours. Confirmed by the assessor at the telephone screening and/or face-to-face or video conference pre-treatment assessment, with help of information from the caregiver and the child/adolescent, and the suicide questions on the MINI-KID interview.
  • Child and caregiver not able to read and communicate in Swedish. Confirmed by the caregiver or assessor at the telephone screening and/or pre-treatment assessment.

Trial locations and contacts

1 site in 1 country.

Sweden1 site
  • Karolinska Institutet

    Stockholm, 11330

Other trials in Sweden

About this study

Official title: Internet-delivered Cognitive-behaviour Therapy for Adolescents With Body Dysmorphic Disorder: A Feasibility Trial

The purpose of this trial is to investigate whether a therapist-guided Internet-delivered cognitive behaviour therapy (ICBT) programme is feasible for adolescents with body dysmorphic disorder (BDD). The aim is to evaluate feasibility and provide preliminary efficacy data.

Read the detailed description

Rationale for study: BDD is a prevalent and impairing condition that can be effectively treated with cognitive-behaviour therapy (CBT). However, CBT for BDD is a highly specialised treatment and a majority of adolescents do not have access to it. ICBT can be a way to increase the availability of effective psychological treatments. No study to date has evaluated the feasibility of ICBT for adolescent BDD, but the experience in adults with BDD treated with ICBT is encouraging.

Objectives: To investigate whether a therapist-guided Internet-delivered cognitive behaviour therapy (ICBT) programme is feasible for adolescents with body dysmorphic disorder (BDD). Specifically, the aim is to:(a) establish participant retention, ease of recruitment, acceptability, credibility, and satisfaction, (b) evaluate potential adverse events, and (c) provide preliminary efficacy data.

Trial design and methods: Participants will be recruited nationally and will be offered 12 modules of ICBT for BDD, delivered over a period of 14 weeks. Participants will be assessed before, during, and after treatment, and up to 12 months after the end of the treatment. ICBT non-responders, assessed at post-treatment and one-, two-, and three-months after completing treatment, will be offered CBT delivered via video format (at post-treatment and after the 1MFU and the 2MFU) or traditional face-to-face (F2F) CBT at the OCD and Related Disorders Clinic for Children and Adolescents in Stockholm (after the 3MFU).

The primary outcome is feasibility, as measured by examining rates of participant retention, treatment completion and adherence to treatment content, treatment acceptability, treatment credibility, treatment satisfaction and adverse events during the treatment.

Secondary outcomes include improvement in clinician-reported BDD symptoms, as well as improvement in other clinical measures assessing disorder severity, disorder improvement, self-reported BDD symptoms, depressive symptoms, and functional impairment.

Sample: 20 adolescents and their primary caregivers.

Statistical analysis: Retention, acceptability, credibility, and treatment satisfaction. For retention and acceptability, information on ease of recruitment, number of completed modules, and attrition rates will collected and presented in a descriptive manner. Results from a credibility scale will be summarized in group means and standard deviations. Results from a treatment satisfaction scale will be summarized in group means and standard deviation. Potential adverse events: Type and impact of all potential adverse events will be measured with a specific scale and presented descriptively. Preliminary efficacy: Clinical measures of treatment outcomes will be measured via clinician-reported and self- and parent-reported measures and analysed through linear mixed models to detect within group change over time. Within-group effect sizes will be estimated with Cohen's d. Treatment response: The proportion of treatment responders will be calculated. Treatment response will be defined as a ≥30% reduction on the BDD-YBOCS-A, respective to the baseline score. Further, the investigators will also calculate how many participants are on full or partial symptom remission, defined as a score ⩽16 on the BDD-YBOCS-A.

Being tested
Exposure and response prevention (ERP)
Keywords
Body dysmorphic disorder, Dysmorphophobia, Cognitive-behavioral therapy, Internet-delivered treatments, Adolescents, Treatment outcomes
Medical subject headings
Body Dysmorphic Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Exposure and response prevention (ERP)Behavioural

    The treatment is Internet-delivered and therapist-guided, involving both the adolescent and at least one parent. The treatment consists of two separate sets of modules, one for the adolescent and one for the parent, each with separate logins. The ICBT intervention consists of 12 modules, delivered over a maximum of 14 weeks.

    The main goal of treatment is to help the young person to stop avoiding anxiety-provoking situations by undertaking exposure tasks and to stop doing unhelpful repetitive behaviours and rituals, known as response prevention. Every module also contains homework tasks that mainly consists of exposure and response prevention (ERP).

    Parents are also often involved in the patients' rituals and avoidant behaviours (known as family accommodation), which may contribute to maintain the BDD symptoms. Involving parents facilitates modification of these unhelpful patterns.

Study groups in NCT05078320
Study groupRoleWhat they receive
Internet-delivered cognitive-behaviour therapy for adolescents with body dysmorphic disorderExperimentalCognitive-behaviour therapy, Exposure and response prevention (ERP)
Receives: Behavioral: Exposure and response prevention (ERP)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Treatment credibility questionnaire

    Questionnaire developed by the research team. Used to assess treatment credibility. Separate versions for the child/adolescent and the parent are used. Range: 0-12, high scores means better outcome.

    Measured: Mid-treatment (3 weeks post-baseline)

  2. Treatment satisfaction questionnaire

    Questionnaire developed by the research team. Used to assess treatment satisfaction. Separate versions for the child/adolescent and the parent are used. Range: 0-36, high scores means better outcome.

    Measured: 3-month follow-up.

  3. internet intervention Patient Adherence Scale (iiPAS) Mid-treatment

    Used to assess the child/adolescent's adherence to the internet-delivered treatment. Range: 0-20, high scores means better outcome.

    Measured: Mid-treatment (6 weeks post-baseline)

  4. internet intervention Patient Adherence Scale (iiPAS) Post-treatment

    Used to assess the child/adolescent's adherence to the internet-delivered treatment. Range: 0-20, high scores means better outcome.

    Measured: Week 14.

  5. Negative effects questionnaire - Mid-treatment

    Used to assess side effects/adverse events for the child/adolescent. Parent-reported. Range: 0-100, low scores means better outcome.

    Measured: Week 6

  6. Negative effects questionnaire - Post-treatment

    Used to assess side effects/adverse events for the child/adolescent. Parent-reported. Range: 0-100, low scores means better outcome.

    Measured: Week 14

  7. Negative effects questionnaire - 3 months follow-up

    Used to assess side effects/adverse events for the child/adolescent. Parent-reported. Range: 0-100, low scores means better outcome.

    Measured: 3 months follow-up

  8. Ease of recruitment: Time to recruit

    Time to recruit 20 participants.

    Measured: From start of recruitment until 20 participants have been included. Anticipated time frame: 2-3 months

  9. Ease of recruitment: Amount of participants accepting participation after screening

    Amount of participants accepting/declining participation after telephone screening

    Measured: From start of recruitment until 20 participants have been included. Anticipated time frame: 2-3 months

  10. Ease of recruitment: Amount of participants accepting participation after assessment

    Amount of participants accepting/declining participation after initial assessment.

    Measured: From start of recruitment until 20 participants have been included. Anticipated time frame: 2-3 months

  11. Number of completed chapters in the internet treatment platform

    Number of completed chapters is automatically logged in the internet treatment platform. Separate data for children and parents.

    Measured: Week 14

  12. Participant retention

    Number of included participants completing treatment.

    Measured: Week 14.

Secondary outcomes (11)
  1. Yale-Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder, Adolescent version (BDD-YBOCS-A)

    Used to assess BDD symptom severity. Clinician-rated, semi-structured interview. Range: 0-48, low scores means better outcome.

    Measured: Baseline; week 14; 1-, 2-, 3-, 6- and 12-month follow-up.

  2. Clinical Global Impression - Severity (CGI-S)

    Used to provide an overall rating of the BDD severity. Clinician-rated. Range: 1-7, low scores means better outcome.

    Measured: Baseline; week 14; 3-, 6- and 12-month follow-up.

  3. Clinical Global Impression - Improvement (CGI-I)

    Used to assess global improvement. Clinician-rated. Range: 1-7, low scores means better outcome.

    Measured: Week 14; 3-, 6- and 12-month follow-up.

  4. Children's Global Assessment Scale (CGAS)

    Used to assess global improvement. Clinician-rated. Range: 1-100, high scores means better outcome.

    Measured: Baseline; week 14; 3-, 6- and 12-month follow-up.

  5. Appearance Anxiety Index (AAI)

    A self-reported measure that covers cognitions and behaviours typical of BDD. Range: 0-40, low scores means better outcome.

    Measured: Baseline; week 3, 6, 9, 14; 3-, 6- and 12-month follow-up.

  6. Short Mood and Feeling Questionnaire - child version (SMFQ) + additional suicide item

    Used to assess depressive symptoms and suicidal ideation. Child/adolescent-reported. Range: 0-29, low scores means better outcome.

    Measured: Baseline; week 3, 6, 9, 14; 3-, 6- and 12-month follow-up.

  7. Short Mood and Feeling Questionnaire - parental version (SMFQ) + additional suicide item

    Used to assess depressive symptoms and suicidal ideation in the adolescent. Parent-reported. Range: 0-29, low scores means better outcome.

    Measured: Baseline; week 3, 6, 9, 14; 3-, 6- and 12-month follow-up.

  8. The Work and Social Adjustment Scale - Youth Version (WSAS-Y)

    A self-reported instrument assessing functional impairment. Range: 0-40, low scores means better outcome.

    Measured: Baseline; week 6, 14; 3-, 6- and 12-month follow-up.

  9. The Work and Social Adjustment Scale - Parent Version (WSAS-P)

    A parent-reported instrument assessing functional impairment in the adolescent. Range: 0-40, low scores means better outcome.

    Measured: Baseline; week 6, 14; 3-, 6- and 12-month follow-up.

  10. CRAFFT (acronym for the key words Car, Relax, Alone, Forget, Friends and Trouble)

    A short self-reported instrument used to identify substance use and substance use disorder. Range: 0-6, low scores means better outcome.

    Measured: Baseline; week 14; 3-, 6- and 12-month follow-up.

  11. KIDSCREEN-10

    Used to assess quality of life. Separate versions for the child/adolescent and the parent are used. Range: 10-50, high scores means better outcome.

    Measured: Baseline; week 14; 3-, 6- and 12-month follow-up.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 Oct 2021
  2. Study start22 Oct 2021
  3. Primary completion6 Sep 2022
  4. Study completion26 Jun 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
20 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05078320
Sponsor's protocol ID
2021-01942
Status last verified
Oct 2023
First submitted
20 Sep 2021
Last updated
4 Oct 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Mataix-Cols D, Fernandez de la Cruz L, Isomura K, Anson M, Turner C, Monzani B, Cadman J, Bowyer L, Heyman I, Veale D, Krebs G. A Pilot Randomized Controlled Trial of Cognitive-Behavioral Therapy for Adolescents With Body Dysmorphic Disorder. J Am Acad Child Adolesc Psychiatry. 2015 Nov;54(11):895-904. doi: 10.1016/j.jaac.2015.08.011. Epub 2015 Sep 3.

    PubMed 26506580

Questions about this trial

What is this clinical trial studying?

A study testing Exposure and response prevention (ERP) in people with Body Dysmorphic Disorders and Dysmorphophobia, run by Karolinska Institutet at 1 site in Sweden.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Treatment credibility questionnaire (time frame: Mid-treatment (3 weeks post-baseline)). The study lists 12 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05078320, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Oct 2023.

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