Self-Help Habit Replacement in Individuals With Body-Focused Repetitive Behaviors: A Proof-of-Concept Randomized Clinical Trial

TY - JOUR

T1 - Self-Help Habit Replacement in Individuals With Body-Focused Repetitive Behaviors: A Proof-of-Concept Randomized Clinical Trial

AU - Moritz, Steffen

AU - Penney, Danielle

AU - Missmann, Franziska

AU - Weidinger, Sarah

AU - Schmotz, Stella

PY - 2023/9/1

Y1 - 2023/9/1

N2 - IMPORTANCE: Body-focused repetitive behaviors (BFRBs; eg, skin picking) encompass a set of conditions at the interface of dermatology and psychiatry/psychology. The disorder is prevalent but currently underdiagnosed and undertreated.OBJECTIVE: To compare a new self-help intervention, habit replacement, against a wait-list control condition for the treatment of BFRBs.DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted online in 2022. Participants were a population-based nonclinical sample with BFRBs and were recruited via social media. Initially, 481 individuals entered the assessment; 213 were excluded blind to results. A final sample of 268 participants were randomized. The intervention period was 6 weeks.INTERVENTIONS: Participants were randomized to a self-help intervention, habit replacement, or a wait-list control condition (each n = 134).MAIN OUTCOMES AND MEASURES: The Generic BFRB Scale-45 (GBS-45, self-report) represented the primary outcome.RESULTS: Individuals in the 2 conditions (n = 268; 241 [89.9%] women; mean [SD] age, 36.8 [11.1] years; skin picking, 68.3%; trichotillomania, 28.4%; nail biting, 36.6%; lip-cheek biting, 26.1%; other, 20.1%) did not differ on any baseline characteristics. The experimental group significantly improved on the primary outcome (GBS-45) for both the per-protocol (technique was used at least once weekly, ηp2 = 0.068, P = .001) and the intention-to-treat analyses relative to the wait-list control group (expectation-maximization algorithm; ηp2 = 0.019, P = .02). The interaction of group and time yielded statistical trends in favor of the experimental condition only on the Patient Health Questionnaire-9 and quality of life. For the Clinical Global Impressions scale, more individuals in the habit replacement group reported improvement (52.8% vs 19.6%; P < .001). User satisfaction in the habit replacement group was high. Moderation analyses that included all baseline variables showed that those who exhibited nail biting particularly benefited from the new technique.CONCLUSIONS AND RELEVANCE: The present proof-of-concept randomized clinical trial tentatively demonstrates that habit replacement is a feasible and effective self-help strategy against BFRBs, especially for nail biting. Study limitations include the lack of external assessment and verified diagnoses. In addition, the study is missing follow-up data. Self-help habit replacement shows promise in reducing BFRBs but not concomitant symptoms.TRIAL REGISTRATION: German Clinical Trials Register Identifier: DRKS00030511.

AB - IMPORTANCE: Body-focused repetitive behaviors (BFRBs; eg, skin picking) encompass a set of conditions at the interface of dermatology and psychiatry/psychology. The disorder is prevalent but currently underdiagnosed and undertreated.OBJECTIVE: To compare a new self-help intervention, habit replacement, against a wait-list control condition for the treatment of BFRBs.DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted online in 2022. Participants were a population-based nonclinical sample with BFRBs and were recruited via social media. Initially, 481 individuals entered the assessment; 213 were excluded blind to results. A final sample of 268 participants were randomized. The intervention period was 6 weeks.INTERVENTIONS: Participants were randomized to a self-help intervention, habit replacement, or a wait-list control condition (each n = 134).MAIN OUTCOMES AND MEASURES: The Generic BFRB Scale-45 (GBS-45, self-report) represented the primary outcome.RESULTS: Individuals in the 2 conditions (n = 268; 241 [89.9%] women; mean [SD] age, 36.8 [11.1] years; skin picking, 68.3%; trichotillomania, 28.4%; nail biting, 36.6%; lip-cheek biting, 26.1%; other, 20.1%) did not differ on any baseline characteristics. The experimental group significantly improved on the primary outcome (GBS-45) for both the per-protocol (technique was used at least once weekly, ηp2 = 0.068, P = .001) and the intention-to-treat analyses relative to the wait-list control group (expectation-maximization algorithm; ηp2 = 0.019, P = .02). The interaction of group and time yielded statistical trends in favor of the experimental condition only on the Patient Health Questionnaire-9 and quality of life. For the Clinical Global Impressions scale, more individuals in the habit replacement group reported improvement (52.8% vs 19.6%; P < .001). User satisfaction in the habit replacement group was high. Moderation analyses that included all baseline variables showed that those who exhibited nail biting particularly benefited from the new technique.CONCLUSIONS AND RELEVANCE: The present proof-of-concept randomized clinical trial tentatively demonstrates that habit replacement is a feasible and effective self-help strategy against BFRBs, especially for nail biting. Study limitations include the lack of external assessment and verified diagnoses. In addition, the study is missing follow-up data. Self-help habit replacement shows promise in reducing BFRBs but not concomitant symptoms.TRIAL REGISTRATION: German Clinical Trials Register Identifier: DRKS00030511.

KW - Humans

KW - Female

KW - Adult

KW - Male

KW - Self-Injurious Behavior/diagnosis

KW - Quality of Life

KW - Trichotillomania/diagnosis

KW - Self Report

KW - Habits

U2 - 10.1001/jamadermatol.2023.2167

DO - 10.1001/jamadermatol.2023.2167

M3 - Short publication

C2 - 37466986

VL - 159

SP - 992

EP - 995

JO - JAMA DERMATOL

JF - JAMA DERMATOL

SN - 2168-6068

IS - 9

ER -