Disseminating cognitive-behavioral therapy for body dysmorphic disorder: Evaluating the efficacy of online provider training

Background Body dysmorphic disorder (BDD) is a severe psychiatric condition affecting approximately 2% of the population, yet access to evidence-based cognitive behavioral therapy (CBT) is limited due to insufficient clinician training. Web-based training offers a solution for disseminating specialized treatment skills, but real-world effectiveness data are lacking. This study evaluated a brief, online CBT training program for BDD delivered under naturalistic conditions. Methods Between 2017 and 2023, 166 clinicians enrolled in a 4-week web-based training covering BDD assessment and CBT treatment techniques. The training included video lectures, case examples, discussion boards, and optional Q&A sessions. Participants completed surveys at baseline, post-training, and 6-month follow-up assessing self-reported confidence assessing and treating BDD, beliefs about CBT, self-reported implementation of evidence-based practices (EBPs), and perceived barriers. Mixed-effects models evaluated changes over time, and regression analyses examined predictors of dropout and outcomes. Results Clinicians demonstrated significant improvements from baseline to post-training in self-reported confidence assessing BDD (EMM difference = 31.1), confidence treating BDD (EMM difference = 37.7), positive beliefs about CBT (EMM difference = 7.9), and EBP implementation (EMM difference = 6.2%; all p < .001). Gains were maintained at 6-month follow-up. Several barriers showed descriptive decreases, though none reached statistical significance. Baseline EBP use was the only significant predictor of outcomes: clinicians with lower baseline EBP use showed greater improvement in assessment confidence but smaller gains in CBT-related beliefs. Conclusions Brief web-based training can enhance clinician self-reported confidence and readiness to deliver CBT for BDD, supporting dissemination of specialized skills. However, high attrition and reliance on self-report highlight challenges inherent to naturalistic training evaluation.