{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T20:18:57Z","timestamp":1788207537250,"version":"build-2803163510"},"reference-count":44,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007687","name":"Svenska L\u00e4kares\u00e4llskapet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Regional agreement on medical training and clinical research (ALF) between the Stockholm County Council and Karolinska Institutet"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,10,11]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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\u2013behavioural 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Academic medical centre.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcomes<\/jats:title>\n                    <jats:p>The primary outcome was the BDD-Yale-Brown Obsessive-Compulsive Scale (YBOCS). Responder status was defined as a \u226530%\u2009reduction 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BDD-NET is an effective treatment for BDD, and the patients\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT02010619\" ext-link-type=\"clintrialgov\">NCT02010619<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-024307","type":"journal-article","created":{"date-parts":[[2019,1,15]],"date-time":"2019-01-15T14:56:10Z","timestamp":1547564170000},"page":"e024307","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":31,"title":["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"],"prefix":"10.1136","volume":"9","clinical-trial-number":[{"clinical-trial-number":"nct02010619","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1897-5549","authenticated-orcid":false,"given":"Jesper","family":"Enander","sequence":"first","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brj\u00e1nn","family":"Lj\u00f3tsson","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Anderhell","sequence":"additional","affiliation":[{"name":"Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Runeborg","sequence":"additional","affiliation":[{"name":"Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2017-3940","authenticated-orcid":false,"given":"Oskar","family":"Flygare","sequence":"additional","affiliation":[{"name":"Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oskar","family":"Cottman","sequence":"additional","affiliation":[{"name":"Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Andersson","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Dahl\u00e9n","sequence":"additional","affiliation":[{"name":"Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linn","family":"Lichtenstein","sequence":"additional","affiliation":[{"name":"Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volen Z","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mataix-Cols","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8742-0168","authenticated-orcid":false,"given":"Christian","family":"R\u00fcck","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,1,15]]},"reference":[{"key":"2025121515051398000_9.1.e024307.1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. The diagnostic and statistical manual of mental disorders. 5th edn. Arlington, VA: American Psychiatric Publishing, 2013.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"2025121515051398000_9.1.e024307.2","doi-asserted-by":"crossref","first-page":"517","DOI":"10.4088\/JCP.v62n07a03","article-title":"Prevalence and clinical features of body dysmorphic disorder in adolescent and adult psychiatric inpatients","volume":"62","author":"Grant","year":"2001","journal-title":"J Clin Psychiatry"},{"key":"2025121515051398000_9.1.e024307.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.bodyim.2016.07.003"},{"key":"2025121515051398000_9.1.e024307.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2013.03.019"},{"key":"2025121515051398000_9.1.e024307.5","first-page":"1","article-title":"Prevalence and heritability of body dysmorphic symptoms in adolescents and young adults: a population-based nationwide twin study","volume":"40","author":"Enander","year":"2018","journal-title":"Psychol Med"},{"key":"2025121515051398000_9.1.e024307.6","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291712001730"},{"key":"2025121515051398000_9.1.e024307.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2004.10.004"},{"key":"2025121515051398000_9.1.e024307.8","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.163.7.1280"},{"key":"2025121515051398000_9.1.e024307.9","unstructured":"National Collaborating Centre for Mental Health (UK). Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. Leicester (UK): British Psychological Society, 2006."},{"key":"2025121515051398000_9.1.e024307.10","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.112.122978"},{"key":"2025121515051398000_9.1.e024307.11","first-page":"CD005332","article-title":"Pharmacotherapy and psychotherapy for body dysmorphic disorder","volume":"1","author":"Ipser","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121515051398000_9.1.e024307.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2016.05.007"},{"key":"2025121515051398000_9.1.e024307.13","doi-asserted-by":"publisher","DOI":"10.1177\/0145445599234006"},{"key":"2025121515051398000_9.1.e024307.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2015.06.003"},{"key":"2025121515051398000_9.1.e024307.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2017.01.001"},{"key":"2025121515051398000_9.1.e024307.16","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1017\/S1352465813000568","article-title":"Geographic inequity in the availability of cognitive behavioural therapy in England and Wales: a 10-year update","volume":"42","author":"Cavanagh","year":"2014","journal-title":"Behav Cogn Psychother"},{"key":"2025121515051398000_9.1.e024307.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2010.10.002"},{"key":"2025121515051398000_9.1.e024307.18","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0b013e31821245ce"},{"key":"2025121515051398000_9.1.e024307.19","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.163.5.907"},{"key":"2025121515051398000_9.1.e024307.20","doi-asserted-by":"publisher","DOI":"10.1586\/erp.12.67"},{"key":"2025121515051398000_9.1.e024307.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-009327","article-title":"Cost effectiveness of internet-based cognitive behaviour therapy and behavioural stress management for severe health anxiety","volume":"6","author":"Hedman","year":"2016","journal-title":"BMJ Open"},{"key":"2025121515051398000_9.1.e024307.22","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jocrd.2014.12.004","article-title":"Cost-effectiveness of internet-based cognitive behavior therapy for obsessive-compulsive disorder: results from a randomized controlled trial","volume":"4","author":"Andersson","year":"2015","journal-title":"J Obsessive Compuls Relat Disord"},{"key":"2025121515051398000_9.1.e024307.23","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-005923"},{"key":"2025121515051398000_9.1.e024307.24","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i241"},{"key":"2025121515051398000_9.1.e024307.25","first-page":"17","article-title":"A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale","volume":"33","author":"Phillips","year":"1997","journal-title":"Psychopharmacol Bull"},{"key":"2025121515051398000_9.1.e024307.26","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.154.11.1593"},{"key":"2025121515051398000_9.1.e024307.27","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-9338(99)80239-9"},{"key":"2025121515051398000_9.1.e024307.28","first-page":"1","article-title":"Psychometric evaluation of the Yale\u2013Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS)","volume":"3","author":"Phillips","year":"2014","journal-title":"J Compuls Relat Disord"},{"key":"2025121515051398000_9.1.e024307.29","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/j.1600-0447.1994.tb01480.x","article-title":"A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale","volume":"89","author":"Svanborg","year":"1994","journal-title":"Acta Psychiatr Scand"},{"key":"2025121515051398000_9.1.e024307.30","unstructured":"American Psychiatric Association. Diagnostic and statistical manual of mental disorders: Dsm-iv-tr. Washington, DC: American Psychiatric Association, 2000."},{"key":"2025121515051398000_9.1.e024307.31","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8510(90)90421-9"},{"key":"2025121515051398000_9.1.e024307.32","unstructured":"Verbeke G , Molenberghs G . Linear mixed models for longitudinal data: Springer Science & Business Media, 2009."},{"key":"2025121515051398000_9.1.e024307.33","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4067"},{"key":"2025121515051398000_9.1.e024307.34","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-12-184"},{"key":"2025121515051398000_9.1.e024307.35","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780100410"},{"key":"2025121515051398000_9.1.e024307.36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2393"},{"key":"2025121515051398000_9.1.e024307.37","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/1471-2288-10-79","article-title":"Multiple imputation for estimation of an occurrence rate in cohorts with attrition and discrete follow-up time points: a simulation study","volume":"10","author":"Soullier","year":"2010","journal-title":"BMC Med Res Methodol"},{"key":"2025121515051398000_9.1.e024307.38","doi-asserted-by":"crossref","unstructured":"Allison PD . Missing data. Thousand Oaks: Sage Publications, 2002.","DOI":"10.4135\/9781412985079"},{"key":"2025121515051398000_9.1.e024307.39","doi-asserted-by":"publisher","DOI":"10.1037\/0033-295X.84.2.191"},{"key":"2025121515051398000_9.1.e024307.40","doi-asserted-by":"publisher","DOI":"10.1002\/hec.1125"},{"key":"2025121515051398000_9.1.e024307.41","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-004-0689-y"},{"key":"2025121515051398000_9.1.e024307.42","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1002\/da.22118","article-title":"The effectiveness of booster sessions in CBT treatment for child and adolescent mood and anxiety disorders","volume":"30","author":"Gearing","year":"2013","journal-title":"Depress Anxiety"},{"key":"2025121515051398000_9.1.e024307.43","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291714000543"},{"key":"2025121515051398000_9.1.e024307.44","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2008.10.018"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-024307","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T23:05:24Z","timestamp":1765839924000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-024307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1,15]]},"published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1136\/bmjopen-2018-024307"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-024307","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1]]}}}