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bca entrance essay Our professional staff is trained to treat your home and property as if it where their own. Unlike some other house painters, we fully protect the area so paint stays… Our professional staff is trained to treat your home and property as if it where their own. Unlike some other house painters, we fully protect the area so paint stays… These kinds of paintings involve big commercial complexes owned or rented by businesses. Professional painting services are provided for birmingham bank, official spaces#8230; These projects involve painting of interior and articles, exterior complexes of private homes. The painting is cells, done keeping in consideration the architecture and theme of the home. Obviously, the modification plans are discussed with the statement for an essay, owners first. These kinds of paintings involve big commercial complexes owned or rented by businesses. Professional painting services are provided for official spaces.

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Seattle house painters and commercial painting service Intercolor Painting LLC provides expert painting services for homes, commercial buildings, office buildings and beyond! Our experienced Seattle painting contractor crews are adept at performing interior and exterior painting alike. From new homes to a renovated office building, to an apartment or condo, or a large industrial building #8212; whatever your need, the team at bank, Seattle#8217;s Intercolor Painting will get the job done on time and on writing service the budget! Whether you need an entire apartment complex painted or simply need to birmingham cells essay bank revitalize your living room with a fresh coat of paint, our Seattle painting service will get the copy, job done right! No job is too large or too small. Bank. What#8217;s more, we only utilize the best premium paint brands, including Benjamin Moore, Sherman Williams, Parker, Rodda, Kelly Moore, and Miller , among others. At Intercolor Painting LLC, we hire only the most experienced painters, as customer satisfaction is among our top priorities! We work hard to writing service ensure the job is done properly and in a manner that meets your high standards! Our Seattle painting company is bonded , licensed and cells essay, insured to provide our clients with optimal peace of mind. It#8217;s just one additional method to ensure our clients are satisfied!

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And we weren't the only ones blown away by the job that Steve did -- our designer, who has been at his job for writing, decades was equally amazed. He took a small stack of Steve's cards to provide recommendations to his future clients. We give Intercolor painting our highest endorsement. Very pleased with the crew's professionalism, quality of work and courtesy extended during the job. Birmingham Cells. Steve was very easy to work with and I highly recommend him for any work you need completed.

I felt the price was very reasonable and copy without, Steve was able to accommodate some last minute changes. The job was a very large job and birmingham cells essay bank, it was accomplished in five days. The house hasn't look this good since we moved in. I was pleased with the outcome and the communication of the crew. I strongly encourage you to use Intercolor Painting LLC. Prompt bid and kept me informed on without scheduling. Painters accommodated early start time and cleaned up work site daily. Very happy. I hired them to do interior painting in cells essay bank my two story entry way. The deal was three painters for plath, one day.

They did a great job. They were careful with my furniture and protected the floor and birmingham cells essay, trim well. Most of the painting was two story. They worked all day and I am happy with the results. We hired Steve to do the interior painting. We wanted to have the house painted before we moved in and Steve was able to accommodate our request. He and his crew worked long hours to as french get the job done in 3 days. They showed up on time and birmingham cells bank, they were very responsive to any specific request we made.

We were very satisfied with the qualify of the work. Thesis. The house looks so much better after the paint job is done. They were able to accommodate my request on a rush basis as I was getting my condo ready for sale, which I was very grateful for. They did an birmingham cells excellent job of painting and left my condo spotless clean when they finished. I couldn't have asked for a better response to my needs and ended up with a beautiful job when done. I highly recommend Intercolor Painting to anyone looking for a top quality job. We are not satisfied unless you’re happy with our work, so we only use the highest quality paint available on the market.

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online dissertations and theses ndltd. Terms conditions Privacy policy Referral program. Please read these Terms and Conditions (“Terms” and/or “Terms and Conditions”) carefully before using the website (“Website”). Your access to and use of Website are conditioned on your full acceptance and compliance with these Terms and essay Conditions and sylvia plath thesis essay this Website Privacy Policy, which are published at and which are incorporated herein by birmingham cells essay reference (“Privacy Policy”). These Terms and without Conditions and Privacy Policy are applied to all visitors, users and others who access or use this Website. By accessing or using this Website, you agree to be bound by these Terms and birmingham bank Conditions and Privacy Policy. If you disagree with these Terms and dissertation Conditions and/or Privacy Policy or any part of them, you must not use this Website. Capitalized terms defined in these Terms and Conditions shall have no other meaning but set forward in this section.

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Services may include editing, proofreading, paraphrasing, or formatting existing papers of our Clients. Please note that rewriting an existing paper that contains 40% or more plagiarized content may qualify as providing you with a custom Paper and cells bank shall be charged for accordingly. Please note that Services may be provided only to the users who submit an as french phrases for essays appropriate order form at cells, the Website and thesis based may charge fees for cells essay, such Services. The Services are provided according to the provisions of these Terms and Conditions and the specific commercial provisions and policies (including Privacy Policy, Refund Policy, etc.) as detailed on scholarship 2013 the Website, and these provisions and policies may be amended or changed from time to time. The format of the birmingham bank, Papers we provide: 12 point Times New Roman; Bibliography on a separate page; Approximately 250 words per writing service, page;

One inch margin top, bottom, left, right; Title and essay bank Reference pages are free of as french phrases for essays, charge. In case Client needs a single-spaced Paper they are to pay a double fee. The standard Paper formatting includes a Title page , main content of the Paper, and a Reference page. Note that you pay only for the main content of the Paper, while a Title page and a Reference page are provided free of essay bank, charge. reserves the right to use any relevant materials available, such as books, journals, newspapers, interviews, online publications, etc., unless the Client indicates some specific sources to be used. PLACING AN ORDER. When placing your order, you must provide accurate and complete information. Scholarship! You are solely responsible for any possible consequences and birmingham cells essay misunderstandings, in case you provide us with inaccurate and/or incorrect and/or unfaithful information. Please be advised that you will be asked to copy essay without, give final confirmation to the instructions you provide in order details. Cells Bank! Your Paper instructions should be confirmed in your Order Tracking Area within 3 hours after placing your order (and within 1 hour for for essays, orders with urgency less than 24 hours).

Orders without instructions will not be worked on and may be delayed and you accept sole responsibility for such delay. guarantees that the delivered Paper will meet only birmingham essay confirmed requirements. Sylvia Statement For An Essay! You must not change the instructions once you have confirmed them. Any alterations to confirmed instructions are considered as additional order, thereby requiring additional payment. All payments are due upon receipt. If the payment is cells essay bank, not received or payment method is thesis essay, declined, the Client forfeits of Services. All fees are exclusive of all taxes and/or levies, and/or duties imposed by taxing authorities, and you shall be responsible for payment of all such taxes and/or levies, and/or duties. You agree to pay any such taxes that might be applicable to your use of the Services and birmingham cells essay bank payments made by you under these Terms. If at any time you contact your bank or credit card company and decline or otherwise reject the articles, charge of bank, any payment, this act will be considered as a breach of your obligation hereunder and format your use of the Services will be automatically terminated. Use of stolen credit card and/or any credit card fraud is considered to be a serious crime. closely cooperates with our payment provider to birmingham bank, prevent and fight online fraud.

In case of sylvia plath for an, any online fraud, appropriate state authorities will be contacted immediately. By doing a chargeback, you agree to give up all your rights to the Paper automatically. At the birmingham essay bank, same time, you authorize to publish the completed Paper and editing start the authorship procedure that will allow us to determine if you have used any parts of the cells, Paper. The procedure may include contacting your school officials and/or posting your full details along with the service, completed Paper online. reserves the right to change its prices at any time in cells bank its sole discretion and such changes or modifications shall be posted online at essay, the Website and become effective immediately without need for further notice to any Client and/or user. We care about our Clients and birmingham essay bank are always looking for ways to offer them the best value for money. One method we use is a discount system. , at its sole discretion, shall have the as french phrases, right to provide our Clients with discount programs as described more fully and published on the Website. According to our loyalty program, you earn back 10% of your total bill in Points (1 currency unit (inter alia USD/ EUR/ GBP etc.) = 1 Point) after you make your first order.

Your Points are accumulated on birmingham your Credit Balance. “Credit Balance” is an account for Points of a Client which can be used for future purchases on the Website exclusively. Based Format! You can use your Points for your next purchases on the Website exclusively. Birmingham Cells Essay Bank! Your Points cannot be refunded. The discount may be obtained by the use of the promo code. Plath Thesis Essay! The amount of Points added to birmingham cells essay bank, the Credit Balance is thesis based essay, calculated on the basis of the order price excluding the applied discount (if any). Later, 5% of every next order (not including credits) is added to cells essay, your Credit Balance. will issue a refund to for an essay, you only according to these Terms. offers a 14-day money back period for Papers less than 20 pages and a 30-day period for cells essay, Papers more than 20 pages (”Refund Period”). Refund Period begins on the date of Client`s order deadline and expires on the last day of the Refund Period.

In case you are not satisfied with any of the format, Services, you can submit a refund request according to these Terms within the Refund Period. Birmingham! Once the Refund Period elapses, will not refund any amounts paid. If the order is not completed and/or the Paper is not downloaded or delivered in as french phrases its complete form by cells essay or to you, the full refund is issued at any time. Thesis Based Essay! In the event of order cancellation, the funds will be debited back only to the account of the initial payment within 5-7 business days from the time of cells bank, cancellation request. In other case assesses refund requests on a case-by-case basis as there are usually unique reasons as to why a refund request is made. Please note that if you request a refund, we may require documented proof that the quality of your order is low (e.g., scan copy of your instructor’s feedback, plagiarism report, etc.). Should you feel it necessary to make a refund request, we will immediately forward your order to our Quality Assurance Department. After comparing their findings with the reasons for dissatisfaction, the necessary corrective actions will be taken.

Any refund request must be made within the Refund Period. In case reimburses the money because of scholarship 2013, mistakes or some irrelevance to birmingham essay, the initial instructions, our Quality Assurance Department, at its sole discretion, evaluates the plath thesis statement, quality of the Paper and bank refunds an amount comparable to the percentage of incorrect content in essay contest 2013 the Paper and mistakes present in it. provides various methods of contact (i.e. email, telephone, message board, and live chat) to facilitate communication between you, us and the writer assigned to complete an order. Using any of cells bank, these methods, our Customer Support Center is available to you at writing service, any time and will respond to any refund request or other issue promptly. However, if such a request is not received using any of the aforementioned methods within the Refund Period, will not be obliged to honor or consider the above said request. Should the Paper delivery be delayed due to unexpected circumstances, from the side of , we may provide compensation for the breach of the order deadline in the form of a credit or a discount to be used towards your next order with us.

Please be informed that delivery time deviation is birmingham essay bank, not a subject to refund. Any revision request or complaint in dissertation regards to a Paper that has provided must be made within the revision period (“Revision Period”). offers a 14-day Revision Period for Papers less than 20 pages and a 30-day period for cells, Papers more than 20 pages. Copy Essay Without! Revision Period begins on the date of Client`s order deadline and expires on the last day of the Revision Period. Birmingham Bank! After that point, no revision and/or complaint will be accepted. recognizes that orders vary in size and complexity; as a result, dissertation, thesis and/or other sufficiently large assignment may be granted 30-day Revision Period. Sufficiency in the size of the copy essay without, Paper will be determined by in its sole discretion. In case a request for revision is not submitted within the Revision Period, tacitly accepts that the Client is cells bank, satisfied with the Paper and as french for essays requires no further actions to be taken in regards to the Paper unless extra payment is provided or a new order is birmingham essay, placed. Upon receiving your completed assignment you are entitled to a free revision should the plath statement for an, Paper fail to meet your instructions or defined the birmingham essay bank, requirements in any way. When this is the case, you are entitled to request as many revisions as may be required to make the Paper consistent and compliant with your instructions.

During the Revision Period the request for as french, revision may be made at any time. All revisions must be based on the original order instructions. If at the time of the revision request you provide new, additional, or differing instructions, this will be interpreted as an application for new Paper and thus, will require an additional payment. Furthermore, should you request a revision after the Revision Period, it will also be considered as a new order requiring an additional payment. We may require you to supply us with personal identifying information, and we may also legally consult other sources to obtain information about birmingham you. By accepting these Terms and thesis based essay Conditions, you authorize us to make any inquiries we consider necessary to validate the information that you provide us with. We may do this directly or by verifying your information against third party databases; or through other sources. Essentially, verification procedure involves, inter alia, confirming that the order is birmingham cells, authentic and that the editing, cardholder is aware of charges by placing a phone call to them, and in certain cases by requesting some additional documents to be submitted for verification to our Risk Department.

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We post Clients` testimonials on our Website which may contain personal information (first name or initials). Hereby by accessing or using this Website, you provide us with your consent to essay, post your first name/initials along with your testimonial on birmingham cells bank our Website. We ensure our posting these testimonials does not interfere with your confidentiality. If you wish to request the removal of copy, your testimonial, you may contact us at birmingham cells essay bank, [emailprotected] NOTIFICATION OF CHANGES. reserves the right to change these Terms and Conditions at contest scholarship 2013, any time and your continued use of the Website will signify your acceptance of any adjustment, improvements and/or alterations to these Terms and Conditions. You are, therefore, advised to re-read these Terms and birmingham cells bank Conditions on a regular basis. This web site is copy essay, owned and operated by birmingham cells essay bank Viatta Business Ltd. HEXO+ Self-Flying Camera Drone, with a suggested retail price of $1,249.00 USD («Main prize»). FreePage (single use) SMS inform (single use) Plagiarism Report (single use) 50$ to your bonus balance which you can use in 365 days 100$ to your bonus balance which you can use in essay 2013 365 days. 2. Promotional Period.

The promotion begins on 7.18.2017, at 9:00 am and ends on 7.28.2017 at 10:00 pm. This Privacy Policy (“Policy”) describes how information about essay You is copy without, collected, used and birmingham cells bank disclosed and psychology editing provides other important privacy information, describes when and how we may change this Policy, and tells You how to contact us with any questions or comments. We collect information about You and computer(s) You use when You use our Services or otherwise interact with us. “Personal Information” means information that we directly associate with a specific person or entity (for example: name; addresses; telephone numbers; email address; payment information; device location etc.). “Client”, “User”, “You” and “Your” refers to you, the birmingham cells essay bank, person accessing this Website and accepting these Privacy Policy.

Any use of the above terminology or other words in the singular, plural, capitalization and/or he/she or they, are taken as interchangeable and therefore as referring to same. HOW INFORMATION ABOUT YOU IS COLLECTED. We collect information about You in service three primary ways: Information You Provide. We collect information that You provide to us when You apply for and use and/or purchase our Services or otherwise communicate with us.

For example, some of the ways You may provide information to us include: When You purchase our Services, the payment system will require your personal, contact, billing and credit information. When You establish or modify Your user account online, We may collect user identification information, passwords, and/or security question responses that You will use for cells, future sign-on. When You interact with our Customer Service representatives, enter information on our Website, submit survey responses, or pay for Services, we may also collect Personal Information and sylvia plath statement for an essay other information. Birmingham Essay! We may monitor and record phone calls, e-mails, live chats, or other communications between You and our Customer Service representatives or other employees or representatives. Information We Collect Automatically. We automatically collect a variety of information associated with Your use of our Services. Psychology! Each time You visit the Website, Personal Information is automatically gathered. In general, this information does not identify You personally.

Examples of birmingham essay bank, automatically collected personal information include, but are not limited to: IP address, Collection Date, Publisher Name, Connection Speed, Day of Week Time of Day (hour), Language settings, Country, City (relating to IP address, if available). For example, some of the ways we may automatically collect information include: Cookies and statement similar technologies. A “cookie” is a small text file that a web site can place on Your computer's hard drive in order, for example, to collect information about birmingham cells essay bank Your activities on without the Website. The cookie transmits this information back to cells essay, the Website's computer, which, generally speaking, is the only computer that can read it. We need to use cookies on phrases for essays the Website to enhance the user experience and avoid multiple logins or password authentication requests. We may use, or we may engage third-parties to use on birmingham bank our behalf, cookies or similar web tags (small data text files placed on your computer or device) or similar technologies to copy essay, identify Your computer or device and record Your preferences and other data so that our Website can personalize Your visit(s), see which areas and features of birmingham cells, our Website are popular, and improve our Website and Your experience. Depending upon Your computer, You may be able to set Your browser(s) to plath essay, reject cookies or delete cookies, but that may result in cells essay bank the loss of some functionality on the Website. We may also use web beacons (small graphic images on a web page or an HTML e-mail) to monitor interaction with our websites or e-mails. Web beacons are generally invisible because they are very small (only 1-by-1 pixel) and the same color as the background of the web page or e-mail message. Web Browsing Activity.

When accessing our Website, We automatically collect certain information about Your computer and Your visit, such as your IP address, browser type, date and time, the web page You visited before visiting our Website, Your activities and purchases on our Website, and other analytical information associated with the Website. Information From Other Sources. We may also obtain information about You from other sources. For example, We may receive credit information from third-party sources before initiating Your service. Thesis Based! We may also purchase or obtain Personal Information (for example, e-mail lists, postal mail lists, demographic and marketing data) from others. HOW WE USE INFORMATION WE COLLECT ABOUT YOU. We use the information We collect for a variety of business purposes, such as: To provide and bill for Services You purchase; To deliver and confirm Services You obtain from us; To verify Your identity and maintain a record of essay bank, Your transactions and without interactions with us; To provide customer services to You;

To create, modify, improve, enhance, remove or fix our Services and their performance; To identify and suggest products or services that might interest You; To make internal business decisions about cells current and future Service offerings; To provide You customized user experiences, including personalized Services offerings; To protect our rights, interests, safety and property and that of phrases for essays, our customers, service providers and other third parties; and. To comply with law or as required for legal purposes. We may use Personal Information for investigations or prevention of cells essay, fraud or network abuse. We may use information we collect to dissertation editing, contact You about our and/or third-party products, services, and offers that We believe You may find of cells bank, interest. We may contact You by telephone, postal mail, e-mail, or other methods. You may see advertisements when You visit our Website. We may help advertisers better reach our customers by providing certain customer information, including geographic information, language preferences or demographic information obtained from other companies.

This information is copy without, used by advertisers to determine which ads may be more relevant to You. However, we do not share Personal Information outside of our corporate family for advertising purposes without Your consent. WHEN WE SHARE INFORMATION COLLECTED ABOUT YOU. We do not sell, license, rent, or otherwise provide Your Personal Information to unaffiliated third-parties (parties outside our corporate family) without Your consent. We may, however, disclose Your information to cells essay bank, unaffiliated third-parties as follows: With Your Consent. We may disclose Personal Information about without You to third-parties with Your consent. We may obtain Your consent in writing; online, through “click-through” agreements; when You accept the terms of disclosures for certain Services; orally, when You interact with our customer service representatives. We encourage You not to share Your password. If You provide Your user account password and/or security question responses to third parties they will have access to Your Personal Information when they access Your user account with Your account password. To Our Service Providers.

We may disclose information to cells bank, third-party vendors and partners who complete transactions or perform services on our behalf (for example, credit/debit card processing, billing, customer service, auditing, and marketing). In a Business Transfer. We may sell, disclose, or transfer information about statement for an You as part of a corporate business transaction, such as a merger or acquisition, joint venture, corporate reorganization, financing, or sale of company assets, or in the unlikely event of insolvency, bankruptcy, or receivership, in which such information could be transferred to third-parties as a business asset in cells the transaction. For Legal Process Protection. We may disclose Personal Information, and other information about You, or Your communications, where we have a good faith belief that access, use, preservation or disclosure of such information is reasonably necessary: to satisfy any applicable law, regulation, legal process or enforceable governmental request; to enforce or apply agreements, or initiate, render, bill, and collect for services and thesis based format products (including to birmingham cells, collection agencies in articles writing order to obtain payment for our products and birmingham bank services); to protect our rights or interests, or property or safety or that of others; in connection with claims, disputes, or litigation – in psychology dissertation editing court or elsewhere; to facilitate or verify the bank, appropriate calculation of taxes, fees, or other obligations; or.

in an emergency situation. We may provide information that does not identify You personally to third-parties for sylvia thesis, marketing, advertising or other purposes. HOW WE STORE AND PROTECT THE INFORMATION COLLECTED ABOUT YOU. Protecting Your Information. We use a variety of physical, electronic, and procedural safeguards to cells essay, protect Personal Information from unauthorized access, use, or disclosure while it is under our control. Unfortunately, no data transmission over the internet can be guaranteed to be completely secure. As a result, although we will utilize such measures, we do not guarantee You against essay, the loss, misuse, or alteration of birmingham cells essay, Personal Information under our control, and You provide Personal Information to as french for essays, us at Your own risk. Cells! You should always take care with how You handle and disclose your Personal Information and should avoid sending Personal Information through insecure e-mail, social networks or other internet channels. Retention and Disposal. We retain information only for as long as we have a business or tax need or as applicable laws, regulations and/or government orders allow. Dissertation Editing! When we dispose of Personal Information, we use reasonable procedures designed to erase or render it unreadable (for example, shredding documents and birmingham cells wiping electronic media).

PRIVACY POLICY UPDATES. How We Communicate Changes to This Policy. We may update this Policy at any time to provide updates to phrases for essays, or clarification of our practices. If we make changes we may provide You with additional notice (such as adding a statement to the homepage of our Website or sending You a notification). Birmingham Essay! You should refer to this Policy often for the latest information and the effective date of any changes. This web site is owned and operated by Viatta Business Ltd . A Partner is an individual who refers customers. A Referral is an dissertation editing individual who requests a service via the referral link given by a Partner.

With the first order, a Referral acquires a 15% discount on birmingham cells essay bank the order, while a Partner receives $50 to the Referral Balance. With further purchases, a Partner earns 5% of the Referral’s total order price. All money earned with the Referral Program is articles, stored on your Referral Balance. A Partner can transfer the money to the Bonus Balance and use it to purchase a service. It is birmingham essay, possible to transfer the dissertation editing, sum to the Partner’s PayPal account (no less than $20).

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Therapist guided internet based cognitive behavioural therapy for cells body dysmorphic disorder: single blind randomised controlled trial. Objectives To evaluate the service efficacy of essay, therapist guided internet based cognitive behavioural therapy (CBT) programme for body dysmorphic disorder (BDD-NET) compared with online supportive therapy. Design A 12 week single blind parallel group randomised controlled trial. Setting Academic medical centre. Participants 94 self referred adult outpatients with a diagnosis of body dysmorphic disorder and a modified Yale-Brown obsessive compulsive scale (BDD-YBOCS) score of for essays, ?20. Concurrent psychotropic drug treatment was permitted if the dose had been stable for at least two months before enrolment and remained unchanged during the trial. Interventions Participants received either BDD-NET (n=47) or supportive therapy (n=47) delivered via the internet for 12 weeks. Main outcome measures The primary outcome was the BDD-YBOCS score after treatment and follow-up (three and six months from birmingham essay baseline) as evaluated by a masked assessor. Responder status was defined as a ?30% reduction in symptoms on the scale. Secondary outcomes were measures of depression (MADRS-S), global functioning (GAF), clinical global improvement (CGI-I), and quality of life (EQ5D). Copy. The six month follow-up time and all outcomes other than BDD-YBOCS and MADRS-S at 3 months were not pre-specified in the registration at clinicaltrials.gov because of an administrative error but were included in the original trial protocol approved by the regional ethics committee before the start of the trial.

Results BDD-NET was superior to supportive therapy and was associated with significant improvements in birmingham severity of symptoms of body dysmorphic disorder (BDD-YBOCS group difference ?7.1 points, 95% confidence interval ?9.8 to writing, ?4.4), depression (MADRS-S group difference ?4.5 points, ?7.5 to ?1.4), and other secondary measures. Birmingham. At follow-up, 56% of those receiving BDD-NET were classed as responders, compared with 13% receiving supportive therapy. The number needed to treat was 2.34 (1.71 to 4.35). Self reported satisfaction was high. Conclusions CBT can be delivered safely via the internet to patients with body dysmorphic disorder. BDD-NET has the thesis potential to birmingham cells, increase access to evidence based psychiatric care for thesis essay this mental disorder, in cells bank line with NICE priority recommendations. It could be particularly useful in a stepped care approach, in which general practitioner or other mental health professionals can offer treatment to people with mild to moderate symptoms at psychology editing low risk of suicide. Trial registration ClinicalTrials.gov ID: NCT02010619.

Body dysmorphic disorder (BDD) is a psychiatric disorder characterised by a pervasive preoccupation with perceived defects in physical appearance accompanied by avoidance and essay bank time consuming compulsive behaviours, such as mirror gazing and excessive camouflaging to hide perceived defects.1 If left untreated, this is a chronic and unremitting disorder that is editing associated with functional impairment across multiple life domains, relatively high rates of psychiatric admissions to hospital, substance dependence, and suicidality.2 3 4 Although the disorder is often underdetected and underdiagnosed within the mental health services,5 6 epidemiological studies show that it is a common mental health problem, with a prevalence ranging from 0.7% to 2.2% in birmingham essay bank the general population.7 8 9 10 It is thesis based essay common for those with body dysmorphic disorder to seek non-psychiatric care, such as dermatological treatment or plastic surgery, in an attempt to “fix” the perceived defects; however, such interventions rarely work and can lead to a deterioration of symptoms.11 12. Evidence based treatments for body dysmorphic disorder include psychopharmacological treatment and cognitive behaviour therapy (CBT).13 14 15 16 Guidance from the essay National Institute for based essay Health and Clinical Excellence (NICE) recommends that adults should be offered the cells bank choice of plath for an, either a course of a selective serotonin response inhibitor or specialised CBT that deals with the cells essay key features of the sylvia plath statement disorder.17 There is, however, a gap between supply and demand of CBT because of various factors, such as a lack of trained therapists, direct and bank indirect costs associated with treatment, and geographical barriers that prevent people with body dysmorphic disorder from receiving specialised CBT.18 19 20 In two surveys, only 10-17% of thesis based essay, people with body dysmorphic concerns reported that they had received an empirically supported psychotherapy (such as CBT), and 19-34% reported that they had received an SSRI.19 20 Thus, one of NICE’s key priorities for birmingham essay bank implementation—namely, that each primary care trust, mental healthcare trust, and children’s trust that provides mental health services should have access to as french phrases for essays, a specialist multidisciplinary team offering age appropriate care—is currently far from bank reality.17 The growth in demand for mental healthcare exceeds available National Health Service (NHS) resources in psychology editing the United Kingdom, and this gap is cells likely to increase up to 2020.21 Cost pressures require that providers find innovative ways to deliver services. The UK government’s mental health strategy “no health without mental health”22 recommends the increased use of information and communication technology to improve care and psychology dissertation editing access to services. UK government initiatives such as “Digital First” aim to reduce unnecessary face to face contact between patients and healthcare professionals.21 Many people with body dysmorphic disorder report that one important reason for not seeking treatment is related to feelings of bank, shame and psychology dissertation editing stigma associated with their concerns about appearance, making telecare options potentially suitable.19 20. Internet based CBT is a burgeoning area of mental health aimed at increasing access to specialised behavioural treatments. In some countries (such as Sweden, Australia, and the Netherlands) internet based CBT has been implemented as part of the regular healthcare system and birmingham essay is efficacious and cost effective for a wide range of mental health disorders.23 24 With the primary aim of increasing access to evidence based care for body dysmorphic disorder, we recently developed a therapist guided internet based CBT programme for body dysmorphic disorder (BDD-NET). In a pilot study, this was found to be safe, highly acceptable to patients, and potentially efficacious.25 Crucially, the treatment required only psychology dissertation, a fraction of the cells therapist time associated with regular CBT.

We evaluated the efficacy of BDD-NET compared with online supportive therapy in the management of adults with body dysmorphic disorder. Supportive therapy was chosen as a control as most patients report that they receive non-specific talking therapy when they seek help.19 We hypothesised that BDD-NET would be superior to online supportive therapy in reducing symptoms, as well as other psychiatric symptoms, and improve quality of life. This was a single blind parallel group superiority trial conducted at Karolinska Institutet from November 2013 to January 2015. Participants were randomly assigned to thesis essay format, 12 weeks of BDD-NET (n=47) or online supportive therapy (n=47) in a 1:1 ratio without restriction. Essay. Both groups were followed for thesis statement for an essay three months after the end of treatment (six months from baseline). This follow-up point was not included in birmingham essay bank the trial registration (clinicaltrials.gov) due to an administrative error but was included in essay contest the original study protocol. Participants randomised to birmingham, supportive therapy were offered BDD-NET after the six month follow-up assessments. No changes to methods were made after the writing service trial started. Birmingham Cells. The study is reported in accordance to essay scholarship, the Consolidated Standards for Reporting Trials (CONSORT) statement for cells bank non-pharmacological treatments.26. Eligible participants were individuals with access to the internet, aged 18 or over, and with a principal diagnosis of body dysmorphic disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5),1 with a score of at psychology dissertation least 20 on the modified Yale-Brown obsessive-compulsive scale (BDD-YBOCS).27 Exclusion criteria were changes in psychotropic drug treatment within two months before enrolment, completed CBT for body dysmorphic disorder within the past 12 months, current substance dependence, bipolar disorder or psychosis, acute suicidal ideation, a severe personality disorder that could jeopardize participation in treatment (such as borderline personality disorder with self harm), and concurrent psychological treatment. Participants who were taking psychotropic drugs and had been taking a stable dose for at least two months before enrolment were asked to bank, keep their dose stable during the study period.

Recruitment and determination of eligibility. Participants were recruited from all over Sweden. Flyers were distributed to psychiatrists and psychology dissertation editing general practitioners throughout Sweden with information about the study. Birmingham Essay. In addition, the study was advertised in national newspapers. Interested applicants had to register on the study’s secure website and complete an thesis statement for an essay, online screening consisting of the Montgomery-Asberg depression rating scale self report (MADRS-S),28 alcohol use disorders identification test,29 drug user disorders identification test,30 body dysmorphic disorder questionnaire,31 and general background information. The body dysmorphic disorder questionnaire is a screening instrument that has shown excellent sensitivity and specificity.31 Potentially suitable participants underwent a structured diagnostic interview with a clinical psychologist or with a trained student in cells bank the final semester of a five year clinical psychology programme. The interviews were conducted over telephone, which is a reliable administration format for structured psychiatric assessments.32 To establish a diagnosis of body dysmorphic disorder, we used the structured clinical interview for DSM-IV axis I disorders, with an added question about the presence of repetitive behaviours to reflect the updates made to the diagnostic criteria of as french phrases, body dysmorphic disorder in DSM-5. The mini-international neuropsychiatric interview was used to birmingham cells bank, determine the thesis essay format presence of birmingham cells bank, other comorbid psychiatric disorders.33 All assessors had received extensive training in structured diagnostic interviews. Articles Writing Service. To ensure reliability of diagnostic procedure and eligibility criteria, a consultant psychiatrist reviewed each case and made the cells essay final decision on enrolment. BDD-NET is delivered through a tailored online platform with a dedicated hospital server with encrypted traffic and an authentication login function to guarantee participants’ confidentiality. Treatment lasted 12 weeks, and none of the participants had any face to face contact with a therapist.

The treatment protocol is based on a CBT model for psychology dissertation body dysmorphic disorder, emphasising the bank role of negatively reinforced avoidance and safety seeking behaviours (such as mirror checking and camouflaging perceived physical defects) as maintaining factors of body dysmorphic disorder. The treatment protocol has been validated in a previous trial, and the treatment effects are comparable with those gained in traditional face to face CBT.25 The main intervention in BDD-NET is systematic exposure to phrases for essays, fear eliciting situations or events combined with response prevention until anxiety and urges to ritualise subside (such as leaving home and refraining from compulsive mirror checking). In total, BDD-NET consists of birmingham cells, eight interactive modules delivered over 12 weeks, with the first five modules containing the core treatment components.23 Each module is devoted to service, a special theme and cells bank covers psychoeducation, a cognitive behaviour conceptualisation of body dysmorphic disorder, cognitive restructuring, exposure and response prevention, more on exposure and scholarship 2013 response prevention, values based behaviour change, difficulties encountered during treatment, and prevention of relapse. To progress to birmingham essay bank, the next module participants have to complete homework assignments (such as reading text material, answering a quiz at the end of based essay format, each module, filling out worksheets, or doing exposure and birmingham cells essay response prevention) and report to their therapist. The participants had contact with an identified therapist throughout the writing service entire treatment using a built-in email system on the BDD-NET webpage. Birmingham Cells. Participants could log in and send emails at any time. All homework assignments and questions from the participants were reviewed and answered within 36 hours, except on weekends. The role of the therapist was mainly to guide and coach the participant throughout the treatment, provide feedback on format homework assignments, answer questions from the participants, and consecutively grant access to the next treatment module. The participants were notified by an automated text message (SMS) when they had a new email in the treatment platform from their therapist. The therapists guiding the participants through the treatment were four clinical psychology students who had completed their basic clinical training (320 hours) and had provided therapy in milder cases under the supervision of a senior psychologist. The clinical psychology students had no prior experience of treating body dysmorphic disorder but were closely supervised by the lead author (JE) with weekly meetings throughout the trial.

The duration of therapist contact and sent emails was automatically recorded by the BDD-NET platform. Median therapist time spent weekly per participant reading and answering emails was 13.2 minutes. To ensure treatment integrity and adherence to protocol, the lead author monitored the bank messages sent by the therapists throughout the entire treatment, and contest scholarship 2013 provided supervision. Birmingham Cells Essay. Appendix 1 shows a screenshot of BDD-NET. Participants had access to the integrated email system on the BDD-NET webpage and unlimited access to an identified therapist. They were given the opportunity to talk freely about their experiences, thoughts, and feelings about sylvia for an, body dysmorphic disorder and cells how it affected their life. The therapist sent an email at least once a week, encouraging the participant to discuss distressing life events and to articles writing service, promote problem solving. The therapists used skills drawn from birmingham cells counselling techniques and included minimal encouragers, reflecting, empathising, and summarising. All emails from the participants were reviewed and answered within 36 hours, and participants were notified by an automated text message when they had a new email in the treatment platform. Treatment lasted 12 weeks, and none of the participants had any face to face contact with a therapist. Non-directive supportive therapy delivered via the internet has been shown to reduce symptoms associated with obsessive compulsive disorder,34 though there are no reports of articles, its efficacy for body dysmorphic disorder.

The supportive therapy served as a control for caregiver attention and the possible anxiety alleviating effect of sharing one’s distress with a therapist. The same therapists that guided participants through BDD-NET delivered the supportive therapy. Therapists spent a median of 6.3 minutes per participant per week reading and answering emails. To ensure treatment integrity, the lead author monitored the messages sent by the therapists throughout the entire treatment and provided supervision. No therapist drift (deviation from birmingham bank treatment protocol) was detected in either of the groups. Participants were randomised on statement essay a 1:1 ratio with simple randomisation with no constraints. To prevent potential selection bias related to the randomisation procedure, an external party not involved in cells bank the inclusion process used a true number service (www.random.org). Psychology Editing. Allocation concealment was ensured through randomisation after the decision to include each participant had been made.

Immediately after randomisation, participants received information about which treatment they had been allocated to and how they could log on birmingham cells bank to the as french secure website. Cells Essay Bank. Assessors in phrases the trial remained masked to treatment allocation at baseline and three and six month follow-up. Because of the nature of the intervention, participants and therapists were not blinded to treatment. All participants were assessed at baseline and then received 12 weeks of birmingham bank, treatment. Follow-up times were three and six months from baseline (after treatment and three months after treatment, respectively). Based Format. After the six month follow-up, participants in the supportive therapy group were offered BDD-NET and reassessed after receiving 12 weeks of additional treatment with BDD-NET. Participants also completed online self report measures at these time points, a method that has been shown to be as reliable and as valid as written administration.35 36.

The primary outcome was change in birmingham cells bank severity of symptoms of body dysmorphic disorder assessed with the BDD-YBOCS administered by a clinician.27 The BDD-YBOCS can be considered the ideal for assessing symptom severity and has a total score of 0-48, with a higher score indicating more severe disorder. To ensure quality of psychology editing, assessments, clinicians in essay this trial practiced together on editing case examples with excellent reliability between raters (intraclass correlation 0.95, 95% confidence interval 0.89 to 0.98). Secondary outcomes included responder status defined as an empirically derived cut off point of ?30% reduction from cells baseline on the BDD-YBOCS.37 Remission was defined as patients who no longer met diagnostic criteria for body dysmorphic disorder. Depressive symptoms were assessed with the copy without MADRS-S.28 Clinician rated global functioning and improvement was assessed with the cells essay global assessment of functioning scale (GAF)38 and essay the clinical global improvement scale (CGI-I).39 Quality of life was assessed with the EQ5D EuroQol (EQ5D).40 All outcomes other than BDD-YBOCS and MADRS-S at cells essay three months were not pre-specified in the registration at articles clinicaltrials.gov because of an bank, administrative error but were included in the original trial protocol approved by the regional ethics committee before the start of the trial. The occurrences of adverse events were recorded mid-treatment and after treatment with a self report form.41 Treatment credibility and based essay expectancy of essay, improvement were recorded at week two with the C scale (included post hoc after trial registration).42. We received input from patients from the BDD-NET pilot trial on the treatment material.

No patients were involved in setting the research question or the outcome measures, nor were they involved in developing plans for recruitment, design, or implementation of the service study. Birmingham Essay Bank. No patients were asked to advise on interpretation or writing up of results. We carefully assessed the burden of the writing trial interventions on the patients by collecting information about adverse events, quality of life, and time spent on cells essay bank the treatment. We plan to dissertation, disseminate the results of the research to study participants and to the Swedish OCD Foundation. Power calculation and statistical analysis. We powered the birmingham cells essay bank study to be able to detect at articles least a medium standardised effect size (Cohen’s d). We based power calculations on a previous pilot trial of BDD-NET and birmingham cells essay the efficacy of essay, online supportive therapy for essay bank obsessive compulsive disorder.25 34 A sample size of sylvia plath thesis for an, 39 per group was required to give 80% power and a two sided 5% significance for detecting a mean difference between groups of at least 4 and a standard deviation of essay, 6.24 on the BDD-YBOCS between BDD-NET and supportive therapy. We anticipated a potential 10% dropout rate, giving a planned sample size of at least 44 per group, or 88 in copy total.

There were no planned interim analyses or rules for stopping. Analyses were by intention to cells bank, treat, with participants analysed in the group to which they had been randomised. Missing data were deemed to be missing at random by using Little’s missing completely at random test. Copy Without. Linear mixed models with maximum likelihood estimations were used to birmingham cells essay, evaluate the effect of treatment group on the different outcomes. As French Phrases. Such models take into account the cells differences in rate of change and differences in for essays trajectories of change between individuals with repeated responses and essay bank use all the available data for each participant.43 The fixed part of the model included a treatment indicator variable (supportive therapy/BDD-NET), a time indicator variable (three or six months), and an interaction effect of treatment ? time to allow for thesis format differential change between the two groups from the three to the six month follow-up. Baseline (before treatment) scores on each outcome measure were included as covariates. Participant varying intercepts were included as a random effect in cells essay the model. As therapist support time varied between the two treatment arms, it was included as an psychology dissertation editing, additional covariate in the model. Because it did not predict outcome, however, (P=0.11-0.98) it was dropped from the final model. We used ? 2 tests for categorical data and independent t tests for birmingham cells bank assessing differences between groups when time was not a factor on the outcome variable. We carried out post hoc analysis of participants in the supportive therapy arm who later crossed over to BDD-NET after the six month follow-up using paired t tests.

Effect sizes within and essay between groups were calculated as Cohen’s d. All statistical analyses were done in birmingham essay bank STATA 13.1. Figure 1 ? shows the flow of participants through the trial. At follow-up at three and based six months there was a 1% and 9% loss of data, respectively. Little’s test suggested that the missing data met the assumption for essay bank missing at random (? 2 =42.57, df=52, P=0.82). There were no significant differences in dropout rates across conditions at after treatment (? 2 =1.01, df=1, P=0.32) or at the six month follow-up (? 2 =1.11, df=1, P=0.29), and dropouts did not significantly differ from completers on baseline demographics or on symptom measures. The two groups did not significantly differ on essay 2013 any baseline characteristics (P=0.08-1.00; tables 1 and 2 ? ). Fig 1 Flow of participants with body dysmorphic disorder (BDD) through study of birmingham essay bank, therapist guided internet based cognitive behavioural therapy (BDD-NET) Sociodemographic characteristics of participants with body dysmorphic disorder according to allocation to copy, internet based cognitive behavioural therapy (BDD-NET) or supportive therapy.

Figures are number (percentage) of participants unless stated otherwise. Clinical characteristics of participants with body dysmorphic disorder according to allocation to internet based cognitive behavioural therapy (BDD-NET) or supportive therapy. Bank. Figures are number (percentage) of participants unless stated otherwise. BDD-YBOCS scores were significantly lower for writing service BDD-NET than for supportive therapy, both at the end of treatment (three months) and at six months (table 3 ? and fig 2 ? ). The standardised effect size between groups was large at both time points (Cohen’s d=0.95 at three months and 0.87 at six months). The effect size within groups at six months was 1.42 (95% confidence interval 0.95 to 1.89) for BDD-NET and essay 0.55 (0.13 to 0.96) for supportive therapy.

Estimated means, group differences (BDD-NET v supportive therapy), and effect sizes for primary and secondary outcomes at thesis based essay format follow-up. Fig 2 Effect of treatment over cells bank time on Yale-Brown obsessive compulsive scale modified for body dysmorphic disorder (BDD-YBOCS) with 95% confidence intervals. Contest Scholarship. Scores are shown at baseline, after treatment (3 months), and follow-up (6 months) according to treatment group. Six month follow-up point was not registered at clinicaltrials.gov because of administrative error. Depressive symptoms, measured with the birmingham bank MADRS-S, decreased over scholarship 2013 the course of the trial with BDD-NET but not with supportive therapy, and there was a significant difference between groups at essay both follow-up times (table 3 ? ). At three months, the as french phrases effect size between groups was small (Cohen’s d =0.43), whereas at six months it was medium ( d =0.58) There was also a significant correlation between the birmingham change in symptoms of body dysmorphic disorder and change in depressive symptoms at both follow-up times ( r s (92)=0.46, P0.001) and r s (80)=0.41, P0.001, respectively).

Of the 51 participants with a diagnosis of major depressive disorder at baseline, 32/57 (56%) no longer met diagnostic criteria for depression at three months and 27/57 (47%) were still in recovery at the six month follow-up. Post hoc analysis of global functioning and quality of life showed that there was an writing, increase in global functioning with BDD-NET but not with supportive therapy, with a significant group difference on the global assessment of functioning scale at both three and six months (table 3 ? ). Birmingham Cells Essay. At three months, there were no significant differences between groups on phrases health related quality of life (EQ5D). At six months, however, the health related quality of life (EQ-5D) had further improved in BDD-NET, and there was a significant difference between groups, favouring BDD-NET (table 3 ? ). Appendix 2 shows the observed means and standard deviations at the different time points for primary and bank secondary outcomes. The proportion of participants classified as responders was significantly higher in writing the BDD-NET group at three months (25/46 (54%) v 3/47 (6%), ? 2 =25.42, df=1, P0.001) and at six months (23/41 (56%) v 6/45 (3%), ? 2 =17.55, df=1, P0.001). At the six month follow-up, 23/41 (56%) of the participants in the BDD-NET group were classified as improved or much improved on the clinical global improvement scale, compared with 7/45 (16%) in the supportive therapy group (? 2 =15.52, df=1, P0.001).

The number needed to treat was 2.34 (95% confidence interval 1.71 to 4.35). The number of participants no longer meeting criteria for body dysmorphic disorder was 15/46 (32%) versus 1/47 (2%; ? 2 =15.16, df=1, P0.001) at three months, and 16/41 (39%) versus 4/45 (9%; ? 2 =10.92, df=1, P0.001) at six months, always favouring BDD-NET. Treatment credibility, expectancy, and acceptability. After two weeks, participants randomised to birmingham cells essay, BDD-NET rated the treatment as more credible than participants randomised to as french, supportive therapy ( t (85)=?2.42, P=0.02), but this did not translate in greater expectancy of improvement ( t (85)=?0.58, P=0.57). Participants deemed BDD-NET highly acceptable; 13/45 (29%) were very pleased with the treatment provided, 21/45 (47%) were pleased, 9/45 (20%) were indifferent or somewhat displeased, and 2/45 (4%) were very displeased.

In total, 37/45 (82%) reported that if they were in need of cells bank, additional CBT in thesis essay the future they would use BDD-NET, and 40/45 (89%) would recommend BDD-NET to a friend with similar problems. After the six month follow-up, all participants who had received supportive therapy were offered BDD-NET. Birmingham Essay. Two participants were lost to follow-up, and four declined. Participants who crossed over to BDD-NET (n=41) showed a significant decrease on the BDD-YBOCS after receiving BDD-NET, with a mean reduction of ?7.14 (95% confidence interval ?9.06 to ?5.23, P0.001; fig 3 ? ). Of the people who crossed over, 14/35 (43%) were classified as responders, and 10/35 (29%) no longer met diagnostic criteria after receiving BDD-NET. Fig 3 Mean scores of participants initially randomised to supportive therapy who crossed over to BDD-NET (n=41) and received 12 weeks of additional treatment after 6 month follow-up. Similar improvements were observed on the MADRS-S with a mean reduction of ?2.18 (95% confidence interval ?4.29 to ?0.07; P=0.043) and the global assessment of psychology editing, functioning, with mean improvement of 4.69 (2.93 to 6.45; P0.001). On the EQ5D, there was a non-significant increase of 0.04 points (?0.05 to 0.14; P=0.378). Birmingham Cells Essay Bank. The four participants in the supportive therapy group who declined to copy without, cross over to BDD-NET had made significant improvements after receiving supportive therapy, and birmingham cells three of them were classified as responders.

Adverse events and protocol deviations. No serious adverse events (that is, events leading to acute health risks demanding admission to as french phrases for essays, hospital) were reported. Fifteen (32%) participants in the BDD-NET group and six (13%) in the supportive therapy group reported mild adverse events (that is, increased levels of anxiety and general negative wellbeing) at the beginning of the trial, which had subsided for everyone at essay three months, except for four participants in thesis essay format the BDD-NET group. Of these, two participants reported increased sleep disturbances because of heightened anxiety levels attributed to the exposure exercises, one reported depressive mood, and one reported that the cells essay insight gained throughout the treatment regarding time spent on concerns about appearance was emotionally painful but also enhanced motivation to make changes. Three of the participants reported that the adverse event had little impact on their general wellbeing, except one who thought that the adverse event (sleep disturbances) had a moderate impact on wellbeing. The occurrence of adverse events during treatment was not related to responder status at follow-up (? 2 =0.91, df=1, P=0.34). All participants taking psychotropic drugs at baseline reported that they had kept their dose stable during the treatment period. After the start of treatment, one participant in the BDD-NET group had been prescribed an antidepressant but was classified as a non-responder at the three month follow-up. None of the other participants reported that they had received any other type of healthcare during the writing service duration of the trial. From the three to cells bank, the six month follow-up, three participants in the BDD-NET group and two participants in writing service the supportive therapy group had received additional healthcare in the form of CBT, pharmacological treatment, or both. In this trial, we compared the efficacy of BDD-NET, a novel therapist guided internet based CBT programme for body dysmorphic disorder, with online supportive therapy, a kind of non-specific talking therapy that mimics the psychosocial support that most patients with body dysmorphic disorder report receiving in birmingham essay bank the real world.19 20 Overall, BDD-NET was superior to supportive therapy and thesis essay format was associated with significant improvements in symptom severity, depression, global functioning, and quality of life.

These gains were maintained for at birmingham least three months after the end of treatment. At that point, 56% of those receiving BDD-NET were classed as responders, and 39% no longer met diagnostic criteria for body dysmorphic disorder. The number needed to plath thesis statement for an, treat to achieve one responder was 2.34. Participants in the supportive therapy group who crossed over to BDD-NET after six months also improved robustly on primary and secondary outcome measures. No serious adverse events were reported. Some participants reported mild adverse events (such as heightened anxiety levels associated with exposure tasks) during the trial, but these were generally short lived and birmingham bank were not associated with responder status at the end of treatment. Most participants were satisfied with BDD-NET, despite no face to face contact with a therapist, and deemed the treatment as highly acceptable. The results indicate that BDD-NET has potential to greatly increase access to evidence based psychiatric treatment for patients with body dysmorphic disorder, in line with the NICE priority recommendations.17. Strengths and thesis based essay limitations of study.

Despite its modest size, this study represents the largest randomised controlled trial ever conducted in people with body dysmorphic disorder. The inclusion of birmingham cells essay bank, a control intervention with high ecological validity, the use of masked assessors, and minimal data loss are other strengths of the study. One potential limitation of the trial is that the dissertation results might not be generalisable to everyone with body dysmorphic disorder as the participants were self referred and most had reasonably good insight. We also took the precaution, on cells essay safety grounds, of excluding participants with substance dependence and severe suicidal ideation. Thus, despite the fact that most participants had been ill for many years, had had previous contact with mental health services, and a fifth had undergone plastic surgery, participants in this trial might have been particularly motivated to engage in psychotherapy compared with more severely affected and delusional patients seen in specialist clinics.

As body dysmorphic disorder is articles service severely under-recognised and undertreated, however, it might take many years before patients receive the correct diagnosis and birmingham cells bank are referred for specialist treatment. This means that patients seen in specialist clinics often represent the extreme end of the severity continuum. From this perspective, our sample could be more representative of the people with body dysmorphic disorder in general than those seen in specialist clinics. Another potential limitation is that participants were informed that if they were randomised to supportive therapy, they would be offered BDD-NET after the six month follow-up assessment, although they were not explicitly told that we expected BDD-NET to be superior to articles service, supportive therapy. Birmingham Bank. It is still possible that some well informed participants knew about the NICE recommendations and this introduced a bias. Thesis Essay. Participants randomised to BDD-NET found the birmingham essay treatment more credible than participants in essay contest scholarship the supportive therapy group, but perceived credibility did not translate to cells essay, greater expectancy of improvement as there were no differences between groups on how much participants thought they would improve at end of treatment. On average, participants in the supportive therapy group sent fewer emails to their therapist, resulting in less overall therapist contact throughout the active phase of the trial. Thesis Based Format. The estimated differences in treatment effects, however, remained unchanged when we adjusted for cells bank the amount of therapist contact. Overall, our results are in line with previous studies of face to face CBT for body dysmorphic disorder.14 15 The proportion of thesis essay, comorbidities were the same in our sample as in cells essay bank previous clinical trials, though symptoms of depression were on writing service average of mild severity compared with moderate to severe depression as seen in the two recent randomised controlled trials of CBT for birmingham bank body dysmorphic disorder.14 15 BDD-NET is not intended for service the most risky and severe end of the spectrum.

Conclusions and policy implications. The therapists providing online support had no previous experience of treating body dysmorphic disorder, which indicates that this form of treatment delivery could be easily scalable. Essay. BDD-NET is delivered online as a series of interactive modules, and service the role of the therapist is cells essay bank mainly to encourage the participant to engage in the treatment, making it reasonable to assume that BDD-NET can be used in non-specialist settings. Sylvia Plath Essay. BDD-NET could be particularly useful in essay a stepped care approach, where mild to moderately affected patients can be offered BDD-NET by their general practitioner, or other health professionals, thus freeing resources for essay contest scholarship 2013 patients in more severe and complex cases to be treated in specialised settings. Logistic barriers are also eliminated, as patients receiving BDD-NET do not have to travel to birmingham, the clinic once a week to receive the thesis based essay treatment.

This makes BDD-NET particularly promising in cells essay more rural areas, where the phrases for essays access to trained CBT therapists is limited.18 Future stepped care trials of BDD-NET in non-specialist settings are warranted. What is already known on birmingham bank this topic. The NICE guidelines recommend cognitive behavioural therapy (CBT) for body dysmorphic disorder but most affected people do not have access to sylvia plath thesis for an essay, this treatment. Internet based CBT is a burgeoning part of birmingham cells essay bank, mental health aimed at increasing access to 2013, evidence based treatments for a range of mental disorders and other conditions. A pilot study suggested that therapist guided internet based CBT could be a highly acceptable, feasible, and birmingham essay potentially cost effective treatment option for body dysmorphic disorder. This large randomised controlled trial evaluated the contest efficacy of therapist guided internet based CBT for body dysmorphic disorder (BDD-NET) BDD-NET was associated with significant improvements in symptom severity, despite no face to face contact with a therapist, and gains were maintained for at birmingham essay least three months after the end of treatment.

We thank the participants of the articles writing BDD-NET trial and essay bank Monica Hellberg, Sofia Eriksson, Vania Panes Lundmark, Martin Runeborg, Lina Anderhell Lorena Fernandez de la Cruz, and Matteo Bottai for their invaluable help. Contributors: JE and CR had the contest 2013 original idea for the study and, with DM-C and BJ, designed the trial variables and obtained the funding. JE and CR were responsible for study supervision. All authors were responsible for the acquisition of the data. Essay Bank. JE, EA, and CR carried out the statistical analysis.

JE drafted the manuscript, which was revised by all authors. All researchers were independent of the funders. The funders had no part in the study design, in the collection, analysis, and interpretation of data, in the writing of the report or in the decision to submit the article for publication. JE and CR are guarantors. Funding: This study was funded through the regional agreement on medical training and clinical research (ALF) between the Stockholm County Council and Karolinska Institutet, the Swedish Research Council (grant No: K2013-61X-22168-01-3), and the Swedish Society of Medicine (Soderstromska Konigska sjukhemmet, grant No: SLS3B4451).

Competing interests: All authors have completed the ICMJE uniform disclosure form at articles writing service www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in bank the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Ethical approval: The regional ethical review board in Stockholm approved the protocol (registration ID: 2013/1773-31/4). All participants gave written informed consent. Transparency: The lead author affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that and dissertation editing discrepancies from the study as planned (and if relevant, registered) have been explained. Data sharing: No additional data available. This is an bank, Open Access article distributed in contest scholarship accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to birmingham cells, distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

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Some of my friends suggested I just read it already. After all, how could the real-life review be worse than the birmingham essay, one in my head? That seemed believable for a moment. Then I ran into my downstairs neighbors, who had just gotten home from a vacation. “When we read what he said,” one of them told me, “we wanted to fly back from Mexico and copy essay, hug you.” A few days later, I got a handwritten letter from my mom’s college roommate. “Dear Amanda,” she said. Cells Bank! “I saw your play, and I, for one, thought you were terrific. Some critics are just cruel.” I slogged through the rest of the editing, run. I wish I could say I handled it with courage. Birmingham Cells Essay! I didn’t. In fact, Patrick came to my dressing room about a week after the review to say, essentially, keep your head in the game. Stick with me.

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During our breaks, Jill warned me about the perils of being married to a writer. She also told me to hurry up and get pregnant. I think she’d be happy to know that our apartment is based, now furnished — filled to the brim with a decade’s worth of stuff — including three children. I came close to bank, reading the review about seven million times. But now I’m attached to my vow not to do it, which has taken on a life of its own.

Like being a vegetarian, every now and then you remember the reason — the original driving force — but over time, it becomes part of who you are and requires almost no effort to stay the writing service, course. In case you’re curious, The Times kindly archives the review online forever and cells, ever. Please don’t tell me what it says. The actress and as french for essays, writer is starring in essay the new IFC series “Brockmire.” A version of this article appears in print on April 9, 2017, on Page AR6 of the editing, New York edition with the headline: … I (Didn’t) Read a Scathing Review. Order Reprints | Today's Paper | Subscribe. We#8217;re interested in your feedback on essay, this page.

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