We have just published a new article, describing the pilot trial of internet-delivered cognitive behavior therapy for body dysmorphic disorder (BDD-NET) with global eligibility for inclusion! This means that patients from all over the world could participate in the study, and we had participants in 9 different countries.

The results were comparable to our previous studies on BDD-NET, with a large effect on the BDD-YBOCS at post-treatment (d = 2.57) that was maintained at follow-up (d = 2.39). At post-treatment, 28% of participants were in remission from their BDD. This number increased to 44% at the 3-month follow-up.

Challenges doing a global treatment study

We talk about some of the challenges involved in the discussion section. The first one is legislation: the current system with regional ethics review boards is insufficient when a single site delivers treatment in multiple countries. The second on is managing at-risk patients from afar. We contacted local mental health practitioners who could expedite a safety plan if necessary, a strategy that worked well for us. Finally, we need to consider cultural differences. Our treatment has been developed and validated in Western cultures, and the participants in the study were mostly from Western cultures, so we cannot say that BDD-NET is an effective treatment for anyone, anywhere.


“This is, to our knowledge, the first investigation of a fully remote, therapist-guided psychological treatment with recruitment efforts deployed on a global scale. We found large reductions in core BDD symptomatology, with 44% of patients in remission at follow-up. Participants accepted the treatment and rated their therapist as supportive in the majority of cases. Future trials should evaluate the specific effects of BDD-NET compared with a credible control condition and strive to include more participants from non-Western cultures. In summary, we found that an internet-delivered treatment for BDD can be delivered fully remotely with intact treatment effects, and in a safe way, across countries.”