Self-help for body-focused repetitive behaviors: A randomized controlled trial

Body-focused repetitive behaviors (BFRBs) are frequent but under-treated psychological disorders. The present study examined efficacy of three behavioral self-help techniques to reduce BFRBs: habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is). A total of 391 participants with BFRBs were randomly assigned to either HRT, DC, DC-is, or to a waitlist control group (WLC). After six weeks, a post assessment was conducted. The Generic Body-Focused Repetitive Behavior Scale-36 (GBS-36) served as the primary outcome. There were significant main effects for improvement in BFRB and depressive symptomatology over time, regardless of group assignment. For all GBS-36 scales, treatment groups showed greater improvement than WLC. DC and DC-is consistently showed greater improvements compared to WLC. According to moderator analyses individuals with more severe symptoms in the HRT and DC-is conditions benefited to a greater extent compared to WLC in terms of BFRB symptomatology. Also, individuals in DC condition with more severe depressive symptomatology showed a better outcome compared to HRT and WLC. Moreover, individuals with trichotillomania benefited more from DC or DC-is than from HRT. Subjective ratings of the techniques were satisfactory and comparable across groups, with DC-is receiving slightly lower subjective ratings. Future research should address the effects of the techniques when combined with psychotherapy. Also, long-term effects should be evaluated.