Habit-reversal training: a psychotherapeutic approach in treating body-focused repetitive behaviour disorders

Abstract

Body Focused Repetitive Behavior Disorders (BFRBDs) are recurrent, compulsive, destructive behaviors directed towards the body. Although studies have demonstrated a 12.27%-13.7% prevalence rate, researchers found that dermatologists and psychiatrists show a lack of knowledge regarding psychodermatology resources and information about BFRBDs like trichotillomania (TTM). For treatments, there is a dearth of research investigating the clinical applications of various self-help training such as Decoupling (DC) and decoupling in sensu (DC-is) and Habit Reversal Training (HRT). HRT is a five-component behavioral intervention that aims to develop a competing response to a specific unwanted behavior. Many studies have found substantial support for HRT’s efficacy in treating a variety of maladaptive repetitive behaviors including onychotillomania, TTM, skin picking disorder, and chronic cheek biting. Additionally, many psychotherapies have augmented HRT. Psychotherapies include Acceptance and commitment therapy (ACT), dialectical behavior therapy, psychodynamic psychotherapy, mindfulness mediation, and cognitive psychophysiological model. A recently investigated variant of HRT, DC-is, had consistently satisfactory objective and subjective improvement in treating BFRBDs while HRT showed good subjective but poor objective improvement compared to DC. HRT and HRT variants are effective therapeutic treatments for BFRBDs however, further randomized double-blinded and placebo-controlled trials are required to examine HRT’s therapeutic profile.