A Head-to-Head Comparison of Three Self-Help Techniques to Reduce Body-Focused Repetitive Behaviors
Self-help decoupling-in-sensu keeps adults with BFRBs engaged, but face-to-face habit reversal still gives stronger results.
01Research in Context
What this study did
Moritz and team pitted three self-help tricks against each other for body-focused repetitive behaviors. They used habit reversal training, decoupling, and a new twist called decoupling-in-sensu.
People with hair pulling, skin picking, or nail biting tried one method on their own at home. The study tracked who finished the program and how much their habits dropped.
What they found
Decoupling-in-sensu won the popularity contest. Most users stuck with it and felt okay, but symptom gains were small.
Plain decoupling helped non-skin-pickers the most, yet many quit early. Habit reversal had friendly ratings but the weakest real-world change.
How this fits with other research
Viefhaus et al. (2020) also used habit reversal training and saw big tic reduction in kids after sixteen weekly meetings. The new study shows the same technique works less well when people go it alone.
Sievers et al. (2020) found ten sessions of ACT beat a wait-list for hair pulling. Their positive result makes the modest gains here look even smaller, hinting that self-help HRT may need a booster.
Adams (1980) cracked a tough hair-pulling case with ammonia fumes long before self-help existed. That old success reminds us that severe BFRBs sometimes need heavy-duty clinic tools, not apps or booklets.
Why it matters
If you offer self-help options, steer clients toward decoupling-in-sensu first; they are more likely to finish it. For skin picking, skip plain decoupling unless you add check-ins to curb drop-out. Keep habit reversal training for clinic visits where you can coach the steps and give feedback.
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02At a glance
03Original 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.
Behavior Modification, 2021 · doi:10.1177/01454455211010707