Wilhelm and colleagues have produced a very well structured and comprehensive cognitive-behavioural manual for the treatment of body dysmorphic disorder in adults. They refer readers to Greenberg et al. (Reference Greenberg, Markowitz, Petronko, Taylor, Wilhlem and Wilson2010) for modifications required in the treatment of younger patients. The authors intend the manual for therapists who have training and experience in CBT. The level of step-by-step detail that is provided on session structure and content make it a very useful guide for less experienced therapists, while the organizational clarity of the manual makes it an accessible reference resource for the more experienced therapist.

The manual contains 18 chapters divided into 4 sections. Section 1 covers the fundamentals of body dysmorphic disorder and its treatment, including definitions, diagnosis, special considerations in treating BDD, enhancing motivation and a treatment overview. Section 2 covers the introductory treatment sessions, including CBT assessment, case formulation and goal setting. Section 3 covers the core treatment components in 6 chapters. These are evaluating self-defeating thoughts, exposure, ritual prevention, perceptual retraining for mirror checking, advanced cognitive strategies (core belief work), and termination/relapse prevention and booster sessions. Section 4 covers the optional modules of skin-picking and hair-pulling, weight, shape and muscularity, cosmetic treatment, and depression.

The theoretical orientation of the treatment manual is both cognitive and behavioural. While there are dedicated chapters on thought challenging and core belief work there is also a significant emphasis on behavioural interventions. Exposure tasks are designed as behavioural experiments in which the client tests out negative beliefs but, in line with behavioural principles, the exposure tasks are approached in a hierarchy of situations from the least to the most distressing, and they are introduced with a behavioural rationale of habituation. Within the chapter on ritual prevention the difference between safety behaviours (a cognitive concept meaning behaviours that are performed to prevent negative outcomes) and compulsive behaviours (a behavioural concept meaning behaviours that are performed to reduce or undo negative feelings), is not made explicit, and behavioural experiments are integrated into exposure tasks rather than being treated separately. This contrasts with the cognitive behavioural manual on body dysmorphic disorder developed by Veale and Neziroglu (Reference Veale and Neziroglu2010) which distinguishes as separate treatment components graded exposure (with response prevention) from behavioural experiments (without safety behaviours), and where the whole therapy is framed in terms of the cognitive testing out of two alternative theories of what the problem is (whether one of appearance or worry). There is a relatively stronger emphasis on behavioural interventions in the manual under review in comparison with the more cognitive emphasis in the manual by Veale and Neziroglu (Reference Veale and Neziroglu2010). Another difference between the two manuals is that the treatment programme by Veale and Neziroglu (Reference Veale and Neziroglu2010) places emphasis on addressing cognitive processes such as worry, rumination and self-attacking, with less emphasis than Wilhelm and colleagues on the verbal re-structuring of cognitive content (such as “everyone thinks my skin looks disgusting”). Veale and Neziroglu (Reference Veale and Neziroglu2010) also have a module on imagery work. Hence this manual by Wilhelm and colleagues, with its distinct emphases, is a complementary addition to the existing literature.

One of the very nice features of the manual is the generous supply of clearly indexed questionnaires, information sheets and therapy forms for use in assessment and treatment. Another is that standard aspects of cognitive therapy are helpfully adapted for specific use in the treatment of body dysmorphic disorder. For example, there is a list of thinking errors as applied to BDD, which is adapted from the work of Judith Beck and Tom Cash. For the less experienced therapist there is very clear guidance on the basics of CBT, including agenda-setting, note-taking and homework setting. Terms are defined in accessible, non-technical, language. The manual is also scattered with examples of therapist-client dialogue to provide an impression of how to manage common situations, such as the patient who tries to persuade the therapist to agree that they are ugly.

In summary, this is a highly readable and very well-resourced manual, written by a very experienced authorship, and providing a valuable text for novice and experienced CBT therapists alike on the cognitive behavioural treatment of body dysmorphic disorder.