Self-Help to Reduce Body-Focused Repetitive Behaviors via Video or Website? A Randomized Controlled Trial

Abstract

Background

Body-focused repetitive behaviors (BFRBs) are common but under-recognized mental disorders. The present study aimed to examine the efficacy of a video presentation of self-help techniques for BFRBs compared to a web-based intervention containing psychoeducation and comprehensive self-help treatment information on BFRBs to reduce symptomatology as well as the same videos as in the first condition.

Methods

A total of 217 participants with BFRBs were randomly assigned to (1) a video condition conveying the established self-help techniques habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is) to reduce BFRBs, (2) a website condition that offered psychoeducational information and treatment material, including the videos from the first treatment condition, or (3) a waitlist control (WLC) condition. A six-week post assessment was conducted. The Generic Body-Focused Repetitive Behavior Scale 45 (GBS-45) served as the primary outcome.

Results

The self-help video condition showed greater improvement in GBS-45 subscales for nail biting in comparison to the self-help website and WLC conditions. For other BFRBs (e.g., joint cracking, trichophagia), the impairment subscale showed significant results in post hoc analyses in favor of the two treatment conditions. Subjective ratings of the techniques were satisfactory and comparable across treatment groups, with slightly higher ratings in favor of the video condition.

Conclusions

The video condition showed better improvement than the control condition on nail biting and other BFRBs. Superior results in the self-help website condition compared to the WLC were shown only for the group of “other” BFRBs (i.e., not trichotillomania, nail biting, dermatillomania, lip/cheek biting). We speculate this might be because users were overwhelmed by the many different approaches described without clear guidelines for how to implement them in daily life. In light of a prior study, we assume that a manualized version of the self-help techniques is superior to the video delivery and recommend that the self-help videos should be used as a complement to a manualized version. Future research should address long-term effects of self-help interventions for BFRBs.