University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Centre Intégré Universitaire de Santé et de Services Sociaux de l'Ouest-de-l'Île-de-Montréal, Douglas Mental Health University Institute, Canada.
Behav Modif. 2022 Jul;46(4):894-912. doi: 10.1177/01454455211010707. Epub 2021 Apr 21.
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.
身体关注性重复行为（BFRBs）包括皮肤搔抓、拔毛癖、咬甲癖和咬颊/唇癖等行为。我们首次比较了三种旨在减少 BFRBs 的不同自助技术。我们探索了这些方法的接受度和初步疗效，以及这些技术是否会因 BFRB 类型而产生不同的效果。
共有 113 名至少有一种 BFRB 的参与者被随机分配到习惯反转训练（HRT；主动元素：意识和竞争反应训练）、去耦（DC）或去耦（DC-is）。4 周后进行重新评估。通用身体关注性重复行为量表（GBS）作为主要结局。与 HRT（57.1%）和 DC（53.5%）相比，DC-is 的完成率最好（68.6%）。DC 组中有 34.8%的完成者在 GBS 上的改善至少为 35%，而 HRT 组为 10.0%，DC-is 组为 23.3%。与之前的工作一致，调节分析表明，在 DC 下的改善对于非皮肤搔抓者最好。出现了剂量-效应关系，特别是对于 HRT。与 DC 相比，DC-is 和 HRT 的主观评估评分更有利。就完成率、主观评估和症状改善而言，DC-is 产生了一致令人满意的结果，而 HRT 显示了良好的主观但较差的客观改善。那些进行了 DC 的人，尤其是非皮肤搔抓者，表现出了良好的改善，但总体完成率和主观疗效都较低。未来的研究应该调查这三种技术在联合使用时是否会产生附加效果，以及通过新媒体（例如视频）演示是否会增加技术的可理解性，从而提高其疗效。
