Sabine Wilhelm

Sabine Wilhelm
Harvard Medical School | HMS · Department of Psychiatry

PhD

About

358
Publications
98,037
Reads
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16,206
Citations
Introduction
Sabine Wilhelm, Ph.D., is a Professor at Harvard Medical School (HMS), and Chief of Psychology as well as Director of the Center for OCD and Related Disorders (CORD) at Massachusetts General Hospital (MGH). She is also the Director of the Center for Digital Mental Health in Psychiatry at MGH. Her recent research focuses on the use of cutting-edge technology to improve and personalize mental health care for a range of mental health concerns.
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 (358)
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...
Article
Full-text available
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
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
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 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 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
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...
Article
Full-text available
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
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
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...
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
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
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
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
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
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...
Article
Full-text available
Background: Although effective treatments are available, most individuals with body dysmorphic disorder (BDD) do not receive an appropriate diagnosis or treatment. We aimed to examine treatment utilization and barriers to treatment, and to identify associated socio-demographic and clinical characteristics. Methods: German individuals completed a...
Article
Full-text available
Individuals develop coping skills in response to body image distress; however, the degree to which body image improvements are mediated by skill acquisition is unknown. The current study assessed skills-based mediators of CBT-BISC (n = 22) versus enhanced treatment-as-usual (n = 22) for sexual minority men with HIV and body image disturbance. Skill...
Chapter
Obsessive-compulsive and related disorders (OCRDs) consist of a cluster of impairing psychological conditions including obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder, hair-pulling disorder (i.e., trichotillomania), skin-picking disorder (i.e., excoriation), and other specified and unspecified OCRDs (American...
Preprint
Objective: Appearance-related interpretation bias is postulated to play a role in the maintenance of body dissatisfaction, a risk factor for body dysmorphic disorder (BDD) and eating disorders (ED). Cognitive Bias Modification for Interpretation (CBM-I) has been shown to reduce interpretation bias and symptoms in emotional disorders. This study inv...
Preprint
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 underreported and underrecognized, creating a barrier to the accurate assessment of these symptoms. Consequently, more research...
Article
Gazing rituals and selective attention to perceived flaws during gazing are considered as maintaining factors in cognitive-behavioral models for body dysmorphic disorder (BDD). This study investigated different durations of BDD-like gazing at different facial stimuli (an unfamiliar face, the participant's own face, and the participant's own reflect...
Article
Full-text available
Background The number of clinical trials in body dysmorphic disorder (BDD) has steadily increased in recent years. As the number of studies grows, it is important to define the most empirically useful definitions for response and remission in order to enhance field-wide consistency and comparisons of treatment outcomes across studies. In this study...
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Importance Dimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates. Objective To examine whether a self-rep...
Article
Full-text available
Family accommodation (FA) has been linked with myriad negative outcomes in pediatric obsessive–compulsive disorder (OCD), but extant literature has yielded differential relationships between FA and clinical variables of interest. Consequently, this study examined the phenomenology, clinical profile, and effects of comorbid psychopathology on FA to...
Article
Full-text available
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 i...
Preprint
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
The apparent efficacy of d-cycloserine (DCS) for enhancing exposure treatment for anxiety disorders appears to have declined over the past 14 years. We examined whether variations in how DCS has been administered can account for this "declining effect". We also investigated the association between DCS administration characteristics and treatment ou...
Article
Despite the efficacy of cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD), most patients do not have access. This longitudinal study examined the effectiveness of disseminating CBT for OCD via: (a) the online, low-intensity Psychiatry Academy, targeting clinicians new to CBT for OCD, and (b) the in-person, intensive Interna...
Article
Background Although behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional ou...
Article
Full-text available
Objective: Obsessive-compulsive disorder (OCD) is a heterogeneous condition with well-established symptom dimensions across the lifespan. The objective of the present study was to use network analysis to investigate the internal structure of these dimensions in unselected schoolchildren and in youth with OCD. Method: We estimated the network struc...
Article
Full-text available
Body dysmorphic disorder (BDD) has a severe presentation and chronic course when untreated. Although effective BDD treatments exist, most individuals do not have access to them. We therefore developed and pilot tested the first smartphone-delivered individual cognitive-behavioral therapy (CBT) treatment for adults with BDD. The digital service was...
Article
Full-text available
Our field has come a long way in establishing cognitive-behavioral therapy as the empirically supported treatment of choice for a wide range of mental and behavioral health problems. Nevertheless, most individuals with mental disorders do not receive any care at all, and those who do often have difficulty accessing care that is consistently high in...
Article
Taboo OCD is associated with less symptom reduction following exposure treatment, compared to response rates for those with other OCD dimensions. To enhance treatment response for those with taboo OCD, researchers must identify novel ways to augment exposure. In line with the Broaden-and-Build theory, heightened positive affect prior to an exposure...
Article
Body dysmorphic disorder (BDD) is a common and distressing or impairing preoccupation with a perceived defect in physical appearance. Individuals with BDD engage in time-consuming rituals to check, hide, or “fix” their appearance or alleviate distress. BDD is associated with substantial psychosocial impairment and high rates of depression, hospital...
Article
Objective: Insight and avoidance are commonly discussed factors in obsessive-compulsive disorder (OCD) that have demonstrated associations with increased severity as well as reduced treatment response in adults, but have not been sufficiently examined in pediatric OCD. The present study examines the impacts of avoidance, insight, and impairment re...
Preprint
Interpretation biases are suggested to be transdiagnostic phenomenona, but have rarely been compared across disorders and current concerns. We investigated explicit, decision-based and implicit, reaction time-based interpretation bias in body dysmorphic disorder (BDD; N = 29), social anxiety disorder (SAD; N = 36), generalized anxiety disorder (GAD...
Article
Development of digital biomarkers holds promise for enabling scalable, time-sensitive, and cost-effective strategies to monitor symptom severity among those with major depressive disorder. The current study examined the use of passive movement and light data from wearable devices to assess depression severity in 15 patients with major depressive di...
Article
Background: While cognitive behavior therapy (CBT) is an effective treatment for many children and adolescents with Obsessive Compulsive Disorder (OCD), therapeutic response is variable. Fear conditioning and extinction are central constructs underlying exposure-based CBT. Fear extinction learning assessed prior to CBT may be a useful predictor of...
Article
Background and objectives: This study examined the occurrence of sudden gains (or reversal of gains) among children with obsessive-compulsive disorder (OCD) during the course of cognitive-behavioral therapy (CBT), as well as the association of sudden gains with treatment response, treatment group, and pre-treatment clinical characteristics. Metho...
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Full-text available
Objectives: Cognitive-behavioural therapy (CBT) has been shown to be an effective treatment for body dysmorphic disorder (BDD), but access to treatment around the world is limited. One way to increase access is to administer CBT remotely via the internet. This study represents the first effort to remotely deliver a therapist-supported, internet-ba...
Article
Importance Cognitive behavioral therapy (CBT), the best-studied treatment for body dysmorphic disorder (BDD), has to date not been compared with therapist-delivered supportive psychotherapy, the most commonly received psychosocial treatment for BDD. Objective To determine whether CBT for BDD (CBT-BDD) is superior to supportive psychotherapy in red...
Article
Cognitive theories of obsessive compulsive disorder (OCD) propose that obsessive beliefs bias individuals’ perception of OC-relevant threats, which in turn maintain OCD symptoms. However, no prior research has directly tested this mediational model in a clinical sample. The current study bridges this gap in the literature. Sixty adults with OCD com...
Article
Full-text available
Current approaches to psychiatric assessment are resource-intensive, requiring time-consuming evaluation by a trained clinician. Development of digital biomarkers holds promise for enabling scalable, time-sensitive, and cost-effective assessment of both psychiatric diagnosis and symptom change. The present study aimed to identify robust digital bio...