Freedom of Information Request – Ref: 252-2024
Thank you for your recent Freedom of Information request. Please find our response below.
You asked:
Please identify the Talking Therapies service that you are answering on behalf of.
Our response:
Gloucestershire NHS Talking Therapies Service
You asked:
Please may you inform us whether Body Dysmorphic Disorder (BDD) appears on your drop-down menu as a diagnosis/ problem descriptor on for example IAPTus or PC-MIS software for measuring outcomes?
Our response:
Body Dysmorphic Disorder (BDD) does not appear on drop-down menu as a diagnosis or problem descriptor
You asked:
If it is not on the drop-down menu, can you identify people with BDD in a different way (for example, the number who have completed the Body Image Questionnaire for BDD)?
Our response:
We can identify people who have scores for the Body Image Questionnaire (BIQ)
You asked:
Do you use a digital front door like Limbic to screen clients? If yes, which one do you use, and does it directly screen for BDD?
Our response:
No
You asked:
Please inform us whether your staff ask the recommended screening question to help identify people with BDD? (The “Talking Therapies manual for anxiety and depression” recommends a question “Have you worried a lot about your appearance or the way a bodily feature looked and wish you could think about it less?”. ) If you do not use the recommended question, do you routinely screen for BDD with a different question or leave it up to therapists to identify if it appears clinically relevant? (if yes, what is the question)?
Our response:
“Are you very concerned about the appearance of some part(s) of your body which you consider to be especially unattractive?”
However our updated IA that is due to be rolled out is using the NHS TT screening question
You asked:
If you use a screening question to try to identify people with BDD, at what stage do you ask the question. e.g., (a) first contact/triage, (b) at assessment at step 2 guided self-help (c) at assessment for step 3 (high intensity)?
Our response:
At initial assessment
You asked:
Please inform us if you use the recommended Anxiety Disorder Specific Measure (ADSM) “The Body Image Questionnaire” (BIQ) in people with BDD to determine outcomes during therapy? If not, do you use the PHQ9 and GAD7 for BDD or something else?
Our response:
We use the BIQ
You asked:
- For people discharged in the year 1st April 2023 – 31st March 2024, please inform us of the total number of people you discharged (all diagnoses, at least one contact) and the total number of people discharged for BDD as the main problem.
- For people discharged in the year 1st April 2023 – 31st March 2024, please inform us of the total number of people you took on for therapy (all diagnoses, at least 2 contacts) and the total number of people with BDD that you took on for therapy (at least 2 contacts) that were discharged.
- Of those that you took on for therapy, what proportion / numbers of people with BDD received treatment at Step 2 with a PWP? If treatment is with a PWP, what proportion and number is a generic CBT for anxiety/ depression or other approach, and what proportion and number received a specific computer program or workbook for BDD? Please specify which one you use.
- Of those with BDD who received treatment at Step 2 with a PWP, what was the average number of sessions for generic CBT for anxiety/ depression and for a specific computer program or workbook for BDD?
- For people discharged from the 1st April 2023 to 31st March 2024 with the last treatment type being step 3, what was the average number of sessions in the episode for those treated with BDD and the average for all other diagnoses in the service?
- For people discharged in the year 1st April 2023 – 31st March 2024, please inform us of the number of people with BDD who had 2 Body Image Questionnaires completed prior to discharge (and the number who had the GAD7 instead of the BIQ) at Step 2 and at Step 3 (high intensity)?
- For people discharged in the year 1st April 2023 – 31st March 2024, what percentage and number of people with BDD in the treated sample achieve reliable improvement at Step 2 and Step 3? (Note the reliable change on the BIQ is ≥10 – please state if you are using the GAD7 for reliable improvement). How does that compare to the percentage and number who achieve reliable improvement on all the other diagnoses in the service?
- For people discharged in the year 1st April 2023 – 31st March 2024, what was the mean and standard deviation and number of clients of the Body Image Questionnaire in those taken on for treatment at Step 2 and at Step 3?
- For people discharged in the year 1st April 2023 – 31st March 2024, what was the mean and standard deviation and number of clients with BDD on the Body Image Questionnaire after treatment at Step 2 and at Step 3?
For people discharged in the year 1st April 2023 – 31st March 2024, what proportion and number achieve reliable improvement and recovery after treatment (≤ 40 is no longer a case) with BDD on the Body Image Questionnaire at Step 2 and Step 3?
Our response:
Gloucestershire Health and Care NHS Foundation Trust are unable to answer these questions as there isn’t an option in the clinical system to select body dysmorphic disorder as a diagnosis or problem descriptor. Therefore, we are unable to identify patients who have body dysmorphic disorder. Although, we can identify people who have body image questionnaire scores, we are unable to identify people where body dysmorphic disorder is their main problem. People may be being treated for other conditions. We also cannot specify at what point in the persons Talking Therapy pathway they completed a body image questionnaire.
You asked:
How many of your CBT therapists have attended a top up workshop or any other training in treating BDD?
Our response:
Gloucestershire Health and Care NHS Foundation Trust do not track or report on that information so we are not able to supply you with a number
You asked:
Please can you do a survey of your CBT therapists in your service and ask them:
“How much of a priority do you think is training in BDD compared to other problems in your service?”
- Not a priority
- Low priority
- Medium priority
- High priority
- Essential
Our response:
Under the FOI Act we are obliged to provide information that falls within the act upon request, if we hold it. We are not obliged to carry out an action such as a survey on behalf of a FOI requester under that Act.
If you however would like for this survey to happen then you can of course make the request direct to the service who may consider it in the course of their work.
Next steps:
Should you have any queries in relation to our response, please do not hesitate to contact us. If you are unhappy with the response you have received in relation to your request and wish to ask us to review our response, you should write to:
Louise Moss
Head of Legal Services / Associate Director of Corporate Governance
c/o Gloucestershire Health and Care NHS Foundation Trust
Edward Jenner Court
1010 Pioneer Avenue
Gloucester Business Park
Brockworth, GL3 4AW
E-mail: louise.moss@ghc.nhs.uk
If you are not content with the outcome of any review, you may apply directly to the Information Commissioner’s Office (ICO) for further advice/guidance. Generally, the ICO will not consider your case unless you have exhausted your enquiries with the Trust which should include considering the use of the Trust’s formal complaints procedure. The ICO can be contacted at: The Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF.