The efficacy of psychological treatments on body dysmorphic disorder: a meta-analysis and trial sequential analysis of randomized controlled trials

This meta-analysis and trial sequential analysis (TSA) of randomized controlled trials (RCTs) on the psychological treatment of body dysmorphic disorder (BDD) was conducted to evaluate the intervention effects and robustness of the evidence. This study included 15 RCTs up until 15 June 2024, with 905 participants. Results showed significant improvements in BDD symptoms (g = - 0.97), depression (g = - 0.51), anxiety (g = - 0.72), insight/delusion (g = - 0.57), psychosocial functioning (g = 0.45), and quality of life (g = 0.44), with effects sustained from 1 to 6 months follow-up. RCTs with a waitlist/inactive control reported larger effect sizes for post-intervention BDD symptoms compared to those with a placebo/active control group. In addition, studies with low risk of bias demonstrate larger effect sizes for post-intervention psychosocial functioning compared to studies with some concerns. Notably, the presence of exposure and response prevention in the treatment, as well as the mode of delivery (face-to-face or digital), did not have a significant impact on the intervention outcomes. Females exhibited greater effect sizes in post-intervention BDD symptoms and psychosocial functioning than males. With increasing age, the effect size for insight/delusion symptoms diminished. Longer session duration was associated with larger effect sizes for BDD symptoms, depression at post-treatment, and depression at follow-up. TSA indicated robust evidence for depression at post-treatment and BDD symptoms, while the remaining outcome variables did not meet the desired level of evidence. In conclusion, this study underscores the effectiveness of psychological treatments in reducing BDD symptoms and improving related outcomes, highlighting the need for further research to confirm the impact of these therapies on other outcomes.