Two-year Follow-up of Habit Reversal Training and Decoupling in a Sample with Body-Focused Repetitive Behaviors

Abstract

Background Self-help habit reversal training and decoupling are effective in improving body-focused repetitive behaviors (BFRBs). However, most studies to date on self-help techniques have assessed short-term effects only. The present study aimed to elucidate whether treatment effects would be sustained over a longer period of time. Methods We conducted a 2-year follow-up study of a cohort of 391 participants with mixed BFRBs who were initially randomized to four conditions (wait list control, habit reversal training, decoupling, decoupling in sensu). At post assessment, participants were allowed to use other treatment techniques, enabling us to explore treatment effects in those who continued to use the initial method only versus those who used additional techniques. The Generic Body-Focused Repetitive Behavior Scale (GBS-36) served as the primary outcome. Results Improvements achieved at post assessment were maintained at follow-up for all experimental conditions, with decoupling showing significantly greater treatment gains at follow-up relative to the wait list control group (last observation carried forward: p = .004, complete cases: p = .015). Depression at follow-up slightly improved compared to baseline and post assessment similarly across all conditions, arguing against “symptom displacement” to other psychopathological syndromes. Retention rates were similarly low across the four conditions (48.5–54.6%), making bias unlikely (but not firmly excluding it). Participants who adhered to the initial protocol until follow-up showed a pattern of improvement similar to those using additional techniques. Discussion Our study speaks for the long-term effectiveness of behavioral self-help techniques to reduce BFRBs, particularly decoupling. Of note, participants were allowed to use other self-help manuals after completing the post assessment; thus, randomization was removed. However, a minority of the participants chose this option.