A Head-to-Head Comparison of Three Self-Help Techniques to Reduce Body-Focused Repetitive Behaviors

Abstract

Body-focused repetitive behaviors (BFRBs) include skin picking, trichotillomania, nail biting and cavitadaxia/lip-cheek biting, among other behaviors. For the first time, we compared three different self-help techniques aimed at reducing BFRBs. We explored the acceptance and preliminary efficacy of the approaches and whether the techniques exerted differential effects depending on BFRB-type. A total of 113 participants with at least one BFRB were randomly allocated to either habit reversal training (HRT; active elements: awareness and competing response training), decoupling (DC) or decoupling in sensu (DC-is). Reassessment was conducted 4 weeks later. The Generic Body-Focused Repetitive Behavior Scale (GBS) served as the primary outcome. The completion rate was best for DC-is (68.6%) as compared to HRT (57.1%) and DC (53.5%). A total of 34.8% of completers in the DC group showed an improvement of at least 35% on the GBS compared to 10.0% in the HRT and 23.3% in the DC-is group. In accordance with previous work, moderator analyses showed that improvement under DC is best for non-skin-pickers. A dose-effect relationship emerged, particularly for HRT. Subjective appraisal ratings were more favorable for DC-is and HRT than for DC. With respect to completion rate, subjective appraisal and symptom improvement, DC-is yielded consistently satisfactory results, whereas HRT showed good subjective but rather poor objective improvement. Those who performed DC, especially non-skin-pickers, showed good improvement but overall completion and subjective efficacy were low. Future studies should investigate whether the three techniques exert add-on effects when combined and whether demonstration via new media (e.g., video) will augment comprehensibility and thus efficacy of the techniques.

The Generic BFRB Scale-8 (GBS-8): a transdiagnostic scale to measure the severity of body-focused repetitive behaviours

“…In a large sample of college students, the majority (71.8%) reported at least one BFRB; 53% of those with subclinical forms had more than one BFRB (Houghton et al, 2018). Similar results emerged in a study by our research group on 113 individuals with BFRBs, where 53.1% reported more than one BFRB and 16.8% disclosed at least three BFRBs (Moritz et al, 2021). In a recent study of 52 children with BFRBs, 39% displayed more than one BFRB (Selles et al, 2018).…”

A randomized controlled trial on a novel behavioral treatment for individuals with skin picking and other body‐focused repetitive behaviors

“…The disorder is characterized by the compulsive manipulation of the skin, nails and/or hair, which the patient is unable to resist, frequently resulting in severe impairment. While no medication to date has been approved to treat BFRBs, behavioral treatments, especially habit reversal training (HRT), decoupling, and decoupling in sensu, have demonstrated some efficacy (the techniques are described here 2 ). This is the first study examining whether amalgamating these three techniques into a single self‐help manual reduces BFRB symptoms.…”

“…Participants, aged between 18 and 75 years with no history of schizophrenia or acute suicidality, were assessed online 6 weeks apart. The primary outcome was the Generic BFRB Scale 8 (GBS‐8) 2 . The WHOQOL‐BREF global quality‐of‐life item (QoL) 3 and the PHQ‐9 4 represented secondary outcomes (see description in the Appendix S1).…”

“…The primary outcome was the Generic BFRB Scale 8 (GBS-8). 2 The WHOQOL-BREF global quality-of-life item (QoL) 3 and the PHQ-9 4 represented secondary outcomes (see description in the Appendix S1). Participants in the intervention condition had to practice the self-help techniques independently.…”

Combination of Two Behavioral Techniques Reduces Craving in Problematic Alcohol Consumption by One Third: A Randomized Controlled Trial

“…As addiction and body-focused repetitive behaviors (BFRBs; e.g., trichotillomania, skin picking, nail biting) share important features (e.g., inability to resist urges), we have merged imaginal retraining with decoupling [10], a technique that has successfully decreased BFRBs in controlled trials [10-12] (see https://www.free-from-bfrb.org/videos/ for a video demonstrating the procedure), with the aim of augmenting treatment effects. In the present study, we compared the combined technique, named 3P (for pull-pause-push; the manual can be downloaded at www.uke.de/craving), to active control conditions for their effects on craving for alcohol.…”