Sabine Wilhelm

Sabine Wilhelm
Harvard Medical School | HMS · Department of Psychiatry

PhD

About

406
Publications
126,600
Reads
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20,694
Citations
Introduction
Sabine Wilhelm, Ph.D., is a Professor at Harvard Medical School (HMS), Donovan-Chien Family Professor in the Field of Psychology at Harvard Medical School, Chief of Psychology at Massachusetts General Hospital (MGH), Director of the Center for Obsessive Compulsive and Related Disorders (CORD) at MGH, and Director of the Center for Digital Mental Health in Psychiatry at MGH.
Additional affiliations
August 2014 - present
Massachusetts General Hospital
Position
  • Chief of Psychology
April 2013 - present
Harvard Medical School
Position
  • Professor (Full)
July 2007 - present
Massachusetts General Hospital
Position
  • Director, OCD and Related Disorders Program
Education
September 1990 - June 1995
Philipps University of Marburg
Field of study
  • Clinical Psychology

Publications

Publications (406)
Preprint
Full-text available
BACKGROUND Integrated digital interventions for the treatment of comorbid depression and substance use disorder have been developed, and evidence of their effectiveness is mixed. OBJECTIVE To better understand the potential underlying causes of these mixed findings, we described intervention characteristics, examined evidence-based treatment strat...
Article
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In tic disorders (TD), tic expression varies across the lifespan and as a function of contextual factors. This study explored connections between tic expression and contextual triggers across life periods in 74 adults (Mage = 23.2) with TDs. The Tic History and Coping Strategies form assessed retrospective self-reports of contextual antecedents, co...
Preprint
UNSTRUCTURED People with prior suicidal thoughts and behavior (STB) are often excluded from digital mental health intervention (DMHI) treatment trials. This may perpetuate barriers to care and reduce treatment generalizability, especially in populations with elevated rates of STB, like body dysmorphic disorder (BDD). To address this, a recent rando...
Article
Background: Current treatments for Tourette syndrome (TS) and persistent tic disorder (PTD) are often insufficiently effective, inaccessible, and frequently associated with adverse events. Thus, we must continue to develop and test effective, accessible, and safe treatment options. Objective: We aimed to conduct a pilot randomized controlled tri...
Article
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Given diverse symptom expression and high rates of comorbid conditions, the present study explored underlying commonalities among OCD-affected children and adolescents to better conceptualize disorder presentation and associated features. Data from 830 OCD-affected participants presenting to OCD specialty centers was aggregated. Dependent mixture m...
Article
Background Major depressive disorder affects approximately 1 in 5 adults during their lifetime and is the leading cause of disability worldwide. Yet, a minority receive adequate treatment due to person-level (eg, geographical distance to providers) and systems-level (eg, shortage of trained providers) barriers. Digital tools could improve this trea...
Article
Body dysmorphic disorder (BDD) is an underrecognized, challenging illness with severe comorbidities, demanding urgent advancements in treatment strategies. This state-of-the-science review describes current research on existing BDD treatments, beginning with a detailed discussion of cognitive-behavioral therapy (CBT), the primary psychosocial inter...
Article
Behavior therapy is a well-established and empirically supported treatment for tic disorders (TDs). However, concerns have been expressed about the negative effects of behavioral interventions, such as tic worsening, tic substitution, and excessive effort. This study explored perceived negative effects of tic management strategies in adults with TD...
Article
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Background Body dysmorphic disorder (BDD) is severe and undertreated. Digital mental health could be key to expanding access to evidence-based treatments, such as cognitive behavioral therapy for BDD (CBT-BDD). Coach guidance is posited to be essential for effective uptake of digital interventions. However, little is known about how different patie...
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Although psychological treatments are broadly recognized as evidence-based interventions for various mental disorders, challenges remain. For example, a substantial proportion of patients receiving such treatments do not fully recover, and many obstacles hinder the dissemination, implementation, and training of psychological treatments. These probl...
Article
A youth mental health crisis has been exacerbated significantly by the COVID‐19 pandemic. Teachers are often front‐line support for students in need. Yet teachers themselves are struggling, making it difficult to help their students. Cognitive behavioral interventions (CBIs) have been shown to reduce mental health symptoms in school settings. Learn...
Preprint
BACKGROUND Major depressive disorder affects approximately 1 in 5 adults during their lifetime and is the leading cause of disability worldwide. Yet, a minority receive adequate treatment due to person-level (eg, geographical distance to providers) and systems-level (eg, shortage of trained providers) barriers. Digital tools could improve this trea...
Preprint
Full-text available
Background: Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity assoc...
Chapter
Obsessive-compulsive and related disorders include obsessive-compulsive disorder, hoarding disorder, body dysmorphic disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. This volume reviews the phenomenology and epidemiology of each of the disorders. Next, it reviews how the disorders are maintained, from bio...
Chapter
Cognitive-behavioral therapy (CBT) is a type of time-limited, goal-oriented psychological therapy that focuses on how thoughts, behaviors, and emotions interact with one another. Through CBT, patients learn to increase their awareness of thoughts, emotions, and behaviors, and practice specific cognitive and behavioral skills to then change maladapt...
Chapter
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric condition with a variable clinical presentation. In this chapter, we provide an overview of three empirically supported psychosocial treatments for OCD: cognitive therapy (CT), exposure and response prevention (ERP), and acceptance and commitment therapy (ACT). We first describe symp...
Article
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Smartphone psychotherapies are growing in popularity, yet little is understood about (1) how people prefer to engage with psychotherapy apps, or (2) which engagement patterns constitute effective engagement. The present study uses secondary data from a 12-week randomized waitlist-controlled trial of smartphone-delivered cognitive behavioral therapy...
Article
Body dysmorphic disorder (BDD) is common, severe, and often chronic. Cognitive behavioral therapy (CBT) is the first-line psychosocial treatment for BDD, with well-established efficacy. However, some patients do not improve with CBT, and little is known about how CBT confers its effects. Neurocognitive processes have been implicated in the etiology...
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Full-text available
Background Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones,...
Preprint
BACKGROUND Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones,...
Article
Full-text available
Introduction Dual system learning theories posit an overreliance characterizes obsessive–compulsive disorder on habitual decision-making at the expense of goal-directed learning. However, most studies on this topic used frequentist statistics and did not evaluate the discriminant validity of goal-directed learning indices. Methods We recruited 55...
Article
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Although youth and adults with obsessive-compulsive disorder (OCD) endorse elevated incidence of exposure to traumatic life events during childhood, the existing literature on adverse childhood experiences (ACEs) and OCD is mixed and studies focusing on pediatric OCD are limited. The present study examines the relationship between ACEs and OCD onse...
Article
Individuals with obsessive compulsive and related disorders (OCRDs), including obsessive compulsive disorder (OCD), body dysmorphic disorder (BDD), trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, and hoarding disorder, suffer from distressing or impairing obsessive preoccupation and/or time-consuming compulsive behavi...
Chapter
Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with a perceived defect in appearance that others would be unable to observe or would consider slight. BDD is accompanied by repetitive behaviors intended to hide, fix, or check on the perceived appearance flaw. This article provides an overview of the current understandi...
Article
Reconstructive breast surgery aims to improve body image following mastectomy, yet many women experience ongoing body image distress (BID). The relationship between the esthetic outcome of reconstructive surgery with BID has been underexplored in mastectomy. This study aimed to assess whether reconstruction outcome following mastectomy is associate...
Article
Tics peak in late childhood and decline during adolescence. Yet, for some with Tourette’s disorder (TD), tics persist into adulthood. We evaluated childhood predictors of adult tic severity and tic impairment, and change over time. Eighty adolescents/adults were evaluated 11 years following a randomized-controlled trial of behavior therapy. An inde...
Article
Our objective was to evaluate the feasibility and acceptability, and preliminary efficacy of a Modified Comprehensive Behavioral Intervention for Tics (MCBIT) therapy for youth with chronic tic disorders (CTD), co-occurring attention-deficit hyperactivity disorder (ADHD), and associated psychosocial impairment. Seventeen youth aged 10-17 with CTD a...
Article
Background: Obsessive-compulsive disorder (OCD) is an often disabling and chronic condition that is normally assessed using diagnostic interviews or lengthy self-report questionnaires. This makes routine screening in general health settings impractical, and as a result OCD is often under-(or mis-)recognized. The present study reports on the develo...
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In summary, we provide the field with empirically derived Y-BOCS severity benchmarks across the lifespan which will be useful in research and clinical settings (subclinical OCD: 0-13 points; mild OCD: 14-21 points; moderate OCD: 22-29 points; severe OCD: 30-40 points). However, due to the modest accuracy of the classifications, we caution against t...
Article
Individuals with body dysmorphic disorder (BDD) suffer from distressing or impairing preoccupations with perceived imperfections in their appearance. This often-chronic condition is associated with significant functional impairment and elevated rates of psychiatric comorbidity and morbidity, including depression, substance use disorders, and suicid...
Article
Full-text available
Introduction: Body dysmorphic disorder (BDD) is severe, chronic, and undertreated. Apps could substantially improve treatment access. Objective: We provide an initial test of the usability and efficacy of coach-supported app-based cognitive behavioral therapy (CBT) for BDD. The Perspectives app covers core treatment components: psychoeducation,...
Article
Full-text available
Background Smartphone app–based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies is lagging behind. In p...
Article
Background/objectives: The psychosocial impact of pediatric skin conditions can be difficult to assess accurately. There is currently no way to formally screen and provide stepped care specifically for psychosocial dysfunction or mental illness during dermatology clinics. The Psychosocial Screening Tool for Pediatric Dermatology (PDPS) was designe...
Article
Background The Obsessive-Compulsive Inventory-Children’s Version (OCI-CV) was developed to assess obsessive-compulsive symptoms in youth. Recent changes in the Diagnostic and Statistical Manual (DSM-5) exclude hoarding from inclusion in the diagnosis of obsessive-compulsive disorder (OCD). Accordingly, the present study examined the reliability, va...
Article
Background Serotonin-reuptake inhibitors (SRIs) are first-line pharmacotherapy for the treatment of body dysmorphic disorder (BDD), a common and severe disorder. However, prior research has not focused on or identified definitive predictors of SRI treatment outcomes. Leveraging precision medicine techniques such as machine learning can facilitate t...
Article
Full-text available
Maladaptive self-focused attention (SFA) is a bias toward internal thoughts, feelings, and physical states. Despite its role as a core maintaining factor of symptoms in cognitive theories of social anxiety and body dysmorphic disorders, studies have not examined its neural basis. In this study, we hypothesized that maladaptive SFA would be associat...
Article
The COVID-19 pandemic may exacerbate common symptoms of obsessive-compulsive disorder, such as fears of contamination or causing harm to others. To investigate the potential impact of COVID-19 on obsessive-compulsive (OC) symptoms, we utilized a frequent sampling prospective design to assess changes in OC symptoms between April 2020 and January 202...
Article
The Body Dysmorphic Disorder Symptom Scale (BDD-SS) is a self-report tool that captures an array of representative behavioral and cognitive symptoms commonly displayed by individuals with BDD. The BDD-SS is regularly used among experts in the field, though its utility as a measure of treatment response has not yet been formally evaluated. Results f...
Article
Background Body dysmorphic disorder (BDD) is a severe and undertreated condition. Although cognitive-behavioral therapy (CBT) is the first-line psychosocial treatment for this common disorder, how the intervention works is insufficiently understood. Specific pathways have been hypothesized, but only one small study has examined the precise nature o...
Article
Objective To determine the long-term durability of behavior therapy for tics among youth with Tourette’s disorder and persistent (chronic) motor or vocal tic disorders. Method Eighty of the 126 youth who participated in a randomized controlled trial of behavior therapy 11 years prior were recruited for this longitudinal follow-up. Consenting parti...
Preprint
BACKGROUND Smartphone app–based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies is lagging behind. In p...
Article
Background: Body image distress is frequently reported by women after mastectomy and is associated with negative health outcomes, such as reduced quality of life, elevated depression and anxiety symptoms, and impaired sexual functioning. To reduce body image distress after mastectomy, we must first understand the factors that contribute to its deve...
Article
Full-text available
The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive...
Chapter
The current global crisis in mental health has seen psychiatry assume an increasingly integral role in healthcare. This comprehensive and accessible textbook provides an evidence-based foundation in psychiatry for medical students and serves as an excellent refresher for all mental health professionals. Written by medical school faculty and experts...
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Background Interpretation biases are suggested to be transdiagnostic phenomena, but have rarely been compared across different disorders and current concerns. Methods We investigated explicit, decision-based, and more implicit, reaction time-based interpretation bias in individuals with body dysmorphic disorder (BDD; N = 29), social anxiety disord...
Article
Family accommodation (FA) is key in the maintenance of OCD. However, most studies are cross-sectional, and have not identified long-term trajectories and correlates of FA changes over treatment. This study investigated changes in clinician-rated FA over 10 sessions of cognitive behavioral therapy (CBT) for 142 children with OCD, as well as several...
Article
Full-text available
Objective Body dysmorphic disorder (BDD) is associated with low self-esteem. The aim of this meta-analysis was to examine the strength of the cross-sectional relationship between BDD symptom severity and global self-esteem in individuals with BDD, mentally healthy controls, community or student samples, and cosmetic surgery patients. Moreover, the...
Article
Background To mitigate the psychological burdens of COVID-19 for frontline clinicians (FCs), we adapted an existing evidence-based resiliency program, Stress Management and Resilience Training Relaxation Response Program (SMART-3RP), for FCs. This analysis explores moderators of stress coping to determine which subgroups of FCs benefited most from...
Preprint
Full-text available
Background: Maladaptive self-focused attention (SFA) is a bias toward internal thoughts, feelings, and physical states. Despite its role as a core maintaining factor of symptoms in cognitive theories of social anxiety and body dysmorphic disorders, studies have not examined its neural basis. We hypothesized that maladaptive SFA would be associated...
Article
Although exposure and response prevention (ERP) is an effective treatment for obsessive compulsive disorder (OCD), it is unclear whether the decoupling of obsessions and compulsions is associated with treatment response. Accordingly, the present study examined change in the association between obsessions and compulsions during ERP for OCD as well a...
Article
Full-text available
Individuals with body dysmorphic disorder (BDD) often lack insight into the nature of their perceived appearance flaws that are slight, if they exist at all. Despite the generally held assumption that insight fluctuates over time within individuals with BDD, its temporal instability and associated features remain unstudied. We examined insight as a...
Article
Full-text available
Background Preliminary research suggests that a mindfulness-based treatment approach may be beneficial for adults with tic disorders. In the present study, we report on the feasibility, acceptability, safety, and symptomatic effect of a novel online mindfulness-based group intervention for adults with Tourette syndrome or persistent tic disorder. D...
Article
Full-text available
Background Little data exist on remission rates following psychotherapy for body dysmorphic disorder (BDD). Methods Using data from a large study of therapist‐delivered cognitive behavior therapy (CBT) versus supportive psychotherapy (SPT) for BDD (N = 120), we estimated remission rates at treatment endpoint, and rates of delayed remission, sustai...
Article
Behavior therapy is a first-line intervention for Tourette's Disorder (TD), and a key component is the practice of therapeutic skills between treatment visits (i.e., homework). This study examined the relationship between homework adherence during behavior therapy for TD and therapeutic outcomes, and explored baseline predictors of homework adheren...
Article
Background Research on predictors of treatment outcome in body dysmorphic disorder, a common and severe disorder, is very limited, and no prior studies have examined moderators of outcome. Because treatment is often but not always efficacious, it is important to identify who is more likely to benefit. We examined predictors and moderators of improv...
Article
Objective Treatment guidelines for Tourette's Disorder (TD) are based on patients' degree of tic severity and impairment. However, clear benchmarks for determining tic severity and impairment have not been established. This study examined benchmarks of tic severity and tic impairment using the Yale Global Tic Severity Scale (YGTSS) and the Clinical...
Preprint
Objective The aim of this meta-analysis was to examine the strength of the cross-sectional relationship between body dysmorphic disorder (BDD) symptom severity and global self-esteem in individuals with BDD, mentally healthy controls, community or student samples, and cosmetic surgery patients. Moreover, the role of depressive symptom severity in t...
Article
Full-text available
Previous research shows that individuals with body dysmorphic disorder (BDD) misinterpret ambiguous social information in a negative and threatening manner. These erroneous threat appraisals are thought to maintain disorder symptomatology and psychosocial impairment by reinforcing individuals' distorted self-image and ideas of social undesirability...
Article
Full-text available
Body dysmorphic disorder (BDD) is characterized by a preoccupation with a perceived appearance flaw or flaws that are not observable to others. BDD is associated with distress and impairment of functioning. Psychiatric comorbidities, including depression, social anxiety, and obsessive-compulsive disorder are common and impact treatment. Treatment s...
Article
Full-text available
Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment fo...
Article
Although considerable research has highlighted the importance of cognitive and metacognitive beliefs in adult obsessive-compulsive disorder (OCD), there has been limited investigation of these beliefs in pediatric OCD. The present study investigated the clinical correlates of cognitive and metacognitive beliefs in pediatric OCD. Previous studies fo...
Article
Background and objectives: There is conflicting research on how comorbid depression impacts the treatment of obsessive compulsive disorder (OCD) with exposure with response prevention. To better understand this relationship, the current study tests theoretical claims that greater depression limits motivation to engage in exposures, restricts habit...
Article
Full-text available
Body dysmorphic disorder (BDD) is associated with severe comorbidity and impairment. Muscle dysmorphia (MD) is a subtype of BDD which has rarely been assessed outside of undergraduate student samples. Further, there are limited data comparing MD to other psychiatric disorders, including BDD. Thus, the aim of the current study is to explore differen...
Article
Objective Little is known about the optimal treatment of avoidant/restrictive food intake disorder (ARFID). The purpose of this study was to evaluate feasibility, acceptability, and proof‐of‐concept for cognitive‐behavioral therapy for ARFID (CBT‐AR) in children and adolescents. Method Males and females (ages 10–17 years) were offered 20–30 sessio...
Article
Objectives This study examined the phenomenology and predictors of early response and remission among youth with obsessive-compulsive disorder (OCD) receiving cognitive-behavioral therapy (CBT). Methods One hundred and thirty-nine youth with a current primary diagnosis of OCD participated in this study. Participants received 10 sessions of CBT aug...
Article
The current study examined the temporal precedence of change in obsessive-compulsive symptoms and change in depressive symptoms during the course of an Exposure and Response Prevention (ERP) for pediatric OCD. Participants included 142 children and adolescents (7–17 years; mean age = 12.39, SD = 2.92; 51.40% female; 60.40% Non-Hispanic White) with...
Article
Objective Scrupulosity is a manifestation of obsessive‐compulsive disorder (OCD) characterized by religious or moral core fears. Clinicians often struggle to treat scrupulosity, which may be associated with several features known to predict poor treatment outcome. The purpose of this study was to examine these features in participants with scrupulo...
Article
Full-text available
Background Smartphone-delivered cognitive behavioral therapy (CBT) is becoming more common, but research on the topic remains in its infancy. Little is known about how people typically engage with smartphone CBT or which engagement and mobility patterns may optimize treatment. Passive smartphone data offer a unique opportunity to gain insight into...
Article
Full-text available
Although cognitive-behavioral therapy (CBT) is highly efficacious for body dysmorphic disorder (BDD), not all patients benefit, and mechanisms underlying response remain unknown. In this first report of the mechanisms underlying improvement with CBT for BDD, we examined whether cognitive (maladaptive beliefs, perfectionism, schemas) and behavioral...
Article
Full-text available
Objective Appearance‐related interpretation bias is postulated to play a role in the maintenance of body dissatisfaction (BD), a risk factor for body dysmorphic disorder (BDD), and eating disorders (ED). Cognitive bias modification for interpretation (CBM‐I) has been shown to reduce maladaptive interpretation bias and symptoms in various emotional...
Article
Full-text available
Background: Social anxiety disorder is a highly prevalent and burdensome condition. Persons with social anxiety frequently avoid seeking physician support and rarely receive treatment. Social anxiety symptoms are frequently under-reported and under-recognized, creating a barrier to the accurate assessment of these symptoms. Consequently, more resea...