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d-Cycloserine-Augmented Behavior Therapy for Body Dysmorphic Disorder: A Preliminary Efficacy Trial

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Abstract

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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Acknowledgements

We would like to thank the reviewers, whose comments on an earlier version of this manuscript contributed to substantial improvements in the paper.

Funding

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.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA

    Hilary Weingarden, Ilana Ladis, Susanne Hoeppner, Jessica Rasmussen, Jennifer Ragan, Darin D. Dougherty & Sabine Wilhelm

  2. Department of Medicine, Renal Division, Brigham and Women’s Hospital, Boston, MA, USA

    Suraj S. Mothi

  3. Department of Psychology, Bowdoin College, Brunswick, ME, USA

    Hannah E. Reese

  4. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Kiara Timpano

  5. Department of Psychology, Swarthmore College, Swarthmore, PA, USA

    Jedidiah Siev

  6. Mclean Hospital & Harvard Medical School, Belmont, MA, USA

    Darin D. Dougherty

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  1. Hilary Weingarden
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  11. Sabine Wilhelm
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Correspondence to Hilary Weingarden.

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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.

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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

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