‘Free from BFRB’: Efficacy of Self-Help Interventions for Body-Focused Repetitive Behaviors Conveyed via Manual or Video

Abstract

Self-help may help fill the large treatment gap in individuals with body-focused repetitive behaviors (BFRBs). We examined the efficacy of three self-help techniques for BFRBs: habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is) and also tested whether a video demonstration is more efficacious to written instructions. A total of 224 participants with at least one BFRB were randomly assigned to two intervention groups (video, manual) receiving access to all techniques or a wait-list control group (1:1:1). A 6-week follow-up assessment was conducted. The Generic Body-Focused Repetitive Behavior Scale (GBS-9) served as primary outcome. The intention-to-treat analysis showed significant improvements for the manual group compared to the wait-list control group on GBS total score and severity and impairment scores. For the per-protocol analyses (i.e., participants had at least read/watched the manual/video), 26.9% of completers in the manual group improved at least 35% in GBS compared to 23.3% (video group) and 15.9% (control). A dose–response relationship emerged for the video group. Subjective ratings by the video and manual groups did not differ; treatment satisfaction was greater for HRT and DC than for DC-is. Results suggest that the manual group showed somewhat stronger effects than the video group when usage frequency was low. With more frequent usage, improvements in the video condition increased. Future studies should investigate potential order effects of the techniques as well as add-on effects when techniques are used along with other treatment approaches.