2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T441,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.31:T99e,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. To compare a new self-help intervention, habit replacement, against a wait-list control condition for the treatment of BFRBs. 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. Participants were randomized to a self-help intervention, habit replacement, or a wait-list control condition (each n = 134). The Generic BFRB Scale-45 (GBS-45, self-report) represented the primary outcome. 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. 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. German Clinical Trials Register Identifier: DRKS00030511.32:Td65,ImportanceBody-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.ObjectiveTo compare a new self-help intervention, habit replacement, against a wait-list control condition for the treatment of BFRBs.Design, Setting, and ParticipantsThis 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.InterventionsParticipants were randomized to a self-help intervention, habit replacement, or a wait-list control condition (each n = 134).Main Outcomes and MeasuresThe Generic BFRB Scale-45 (GBS-45, self-report) represented the primary outcome.ResultsIndividuals 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 &lt; .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 RelevanceThe 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 RegistrationGerman Clinical Trials Register Identifier: DRKS0003051125:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Body-Focused Repetitive Behaviors: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Body-Focused Repetitive Behaviors (condition). Clinician-written summaries and actionable practice insights. Updated daily.\",\"url\":\"https://www.reachrx.ai/hub/tag/condition/Body-Focused%20Repetitive%20Behaviors\",\"breadcrumb\":{\"@type\":\"BreadcrumbList\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https://www.reachrx.ai\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Research Hub\",\"item\":\"https://www.reachrx.ai/hub\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Conditions\",\"item\":\"https://www.reachrx.ai/hub/tag/condition\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Body-Focused Repetitive Behaviors\",\"item\":\"https://www.reachrx.ai/hub/tag/condition/Body-Focused%20Repetitive%20Behaviors\"}]}}"}}]],["$","$L2f",null,{"title":"Body-Focused Repetitive Behaviors: Research & Clinical Takeaways","description":"Discover peer-reviewed research on Body-Focused Repetitive Behaviors with concise clinician summaries and next-step guidance.","papers":[{"doi":"10.1001/jamadermatol.2023.2167","pmid":"37466986","title":"Self-Help Habit Replacement in Individuals With Body-Focused Repetitive Behaviors","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2023-07-19T00:00:00.000Z","url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10357355","source_score":498,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2023-09-25","doi":"10.1001/jamadermatol.2023.2167","days":"30","issn":"2168-6068","rank":"3","field":"Clinical Medicine","score":"498","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1001/jamadermatol.2023.2167","title":"Self-Help Habit Replacement in Individuals With Body-Focused Repetitive Behaviors: A Proof-of-Concept Randomized Clinical Trial.","journal":"JAMA dermatology","methods":"","results":"$30","abstract":"$31","keywords":[],"pubmed_id":"37466986","conclusions":"","publication_date":"2023-07-19T00:00:00"},"crossref":{"DOI":"10.1001/jamadermatol.2023.2167","URL":"https://doi.org/10.1001/jamadermatol.2023.2167","ISSN":["2168-6068"],"link":[{"URL":"https://jamanetwork.com/journals/jamadermatology/articlepdf/2807394/jamadermatology_moritz_2023_br_230011_1695075748.87901.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"992","type":"journal-article","issue":"9","score":1,"title":["Self-Help Habit Replacement in Individuals With Body-Focused Repetitive Behaviors"],"author":[{"given":"Steffen","family":"Moritz","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}]},{"given":"Danielle","family":"Penney","sequence":"additional","affiliation":[{"name":"Centre Intégré Universitaire de Santé et de Services Sociaux de l’Ouest-de-l’Île-de-Montréal Douglas Mental Health University Institute, Verdun, Quebec, Canada"}]},{"given":"Franziska","family":"Missmann","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}]},{"given":"Sarah","family":"Weidinger","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}]},{"given":"Stella","family":"Schmotz","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}]}],"issued":{"date-parts":[[2023,9,1]]},"member":"10","prefix":"10.1001","source":"Crossref","volume":"159","created":{"date-time":"2023-07-19T15:16:01Z","timestamp":1689779761000,"date-parts":[[2023,7,19]]},"indexed":{"date-time":"2025-09-17T15:17:01Z","timestamp":1758122221559,"date-parts":[[2025,9,17]]},"subject":[],"abstract":"$32","language":"en","relation":{},"resource":{"primary":{"URL":"https://jamanetwork.com/journals/jamadermatology/fullarticle/2807394"}},"subtitle":["A Proof-of-Concept Randomized Clinical Trial"],"deposited":{"date-time":"2023-09-20T15:16:24Z","timestamp":1695222984000,"date-parts":[[2023,9,20]]},"issn-type":[{"type":"print","value":"2168-6068"}],"published":{"date-parts":[[2023,9,1]]},"publisher":"American Medical Association (AMA)","reference":[{"DOI":"10.12659/AJCR.889357","key":"dbr230011r1","year":"2013","issue":null,"author":"Kim","volume":"14","first-page":"284","unstructured":null,"article-title":"A near fatal case of pathological skin picking.","journal-title":"Am J Case Rep","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.psychres.2023.115120","key":"dbr230011r5","year":"2023","issue":null,"author":"Lin","volume":"322","first-page":null,"unstructured":null,"article-title":"Characteristics of trichotillomania and excoriation disorder across the lifespan.","journal-title":"Psychiatry Res","doi-asserted-by":"publisher"},{"DOI":"10.1177/0145445511409395","key":"dbr230011r6","year":"2011","issue":"5","author":"Moritz","volume":"35","first-page":"468","unstructured":null,"article-title":"A randomized controlled trial of a novel self-help technique for impulse control disorders: a study on nail-biting.","journal-title":"Behav Modif","doi-asserted-by":"publisher"},{"DOI":"10.1007/s10608-022-10334-9","key":"dbr230011r7","year":"2023","issue":"1","author":"Moritz","volume":"47","first-page":"109","unstructured":null,"article-title":"Habit reversal training and variants of decoupling for use in body-focused repetitive behaviors: a randomized controlled trial.","journal-title":"Cognit Ther Res","doi-asserted-by":"publisher"},{"DOI":"10.1159/000431290","key":"dbr230011r8","year":"2015","issue":"6","author":"Weidt","volume":"84","first-page":"359","unstructured":null,"article-title":"Internet-based self-help for trichotillomania: a randomized controlled study comparing decoupling and progressive muscle relaxation.","journal-title":"Psychother Psychosom","doi-asserted-by":"publisher"},{"DOI":"10.1901/jaba.2001.34-517","key":"dbr230011r9","year":"2001","issue":"4","author":"Twohig","volume":"34","first-page":"517","unstructured":null,"article-title":"Evaluating the duration of the competing response in habit reversal: a parametric analysis.","journal-title":"J Appl Behav Anal","doi-asserted-by":"publisher"},{"DOI":"10.1016/0005-7916(85)90063-1","key":"dbr230011r10","year":"1985","issue":"3","author":"Miltenberger","volume":"16","first-page":"195","unstructured":null,"article-title":"A comparison of contingent vs non-contingent competing response practice in the treatment of nervous habits.","journal-title":"J Behav Ther Exp Psychiatry","doi-asserted-by":"publisher"},{"DOI":"10.1111/ijd.2010.49.issue-7","key":"dbr230011r11","year":"2010","issue":"7","author":"Jafferany","volume":"49","first-page":"784","unstructured":null,"article-title":"The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: results of a survey study.","journal-title":"Int J Dermatol","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.psychres.2018.10.002","key":"dbr230011r12","year":"2018","issue":null,"author":"Houghton","volume":"270","first-page":"389","unstructured":null,"article-title":"Body-focused repetitive behaviors: more prevalent than once thought?","journal-title":"Psychiatry Res","doi-asserted-by":"publisher"},{"DOI":"10.1017/S1352465822000327","key":"dbr230011r13","year":"2022","issue":"6","author":"Moritz","volume":"50","first-page":"620","unstructured":null,"article-title":"The Generic BFRB Scale-8 (GBS-8): a transdiagnostic scale to measure the severity of body-focused repetitive behaviours.","journal-title":"Behav Cogn Psychother","doi-asserted-by":"publisher"},{"DOI":"10.1001/jamanetworkopen.2022.1967","key":"dbr230011r14","year":"2022","issue":"3","author":"Lundström","volume":"5","first-page":null,"unstructured":null,"article-title":"Effect of internet-based vs face-to-face cognitive behavioral therapy for adults with obsessive-compulsive disorder: a randomized clinical trial.","journal-title":"JAMA Netw Open","doi-asserted-by":"publisher"},{"DOI":"10.1001/jamapsychiatry.2020.4364","key":"dbr230011r15","year":"2021","issue":"4","author":"Karyotaki","volume":"78","first-page":"361","unstructured":null,"article-title":"Internet-based cognitive behavioral therapy for depression: a systematic review and individual patient data network meta-analysis.","journal-title":"JAMA Psychiatry","doi-asserted-by":"publisher"},{"DOI":"10.4324/9781003299097","key":"dbr230011r2","year":"2022","issue":null,"author":"Nakell","volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"crossref"},{"DOI":null,"key":"dbr230011r3","year":"2019","issue":null,"author":"Mansueto","volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":null,"key":"dbr230011r4","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"TLC Foundation. Expert consensus treatment guidelines: body-focused repetitive behaviors: hair pulling, skin picking, and related disorders. Published 2016. Accessed June 12, 2023. https://global-uploads.webflow.com/626958af73c43200cd878b35/62f551b797e279202e49d315_Expert_Consensus_Treatment_Guidelines_2016w.pdf","article-title":null,"journal-title":null,"doi-asserted-by":null}],"short-title":[],"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9,1]]}},"content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["JAMA Dermatology"],"published-print":{"date-parts":[[2023,9,1]]},"reference-count":15,"published-online":null,"references-count":15,"short-container-title":["JAMA Dermatol"],"is-referenced-by-count":12},"unpaywall":{"doi":"10.1001/jamadermatol.2023.2167","is_oa":true,"title":"Self-Help Habit Replacement in Individuals With Body-Focused Repetitive Behaviors","updated":"2025-07-30T00:59:52+00:00","published_date":"2023-07-19","best_oa_location":{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10357355","pmh_id":"oai:pubmedcentral.nih.gov:10357355","url_for_pdf":null,"url_for_landing_page":"https://www.ncbi.nlm.nih.gov/pmc/articles/10357355"}}},"created_at":"2025-09-20T19:03:11.495Z","updated_at":"2025-09-20T22:56:47.429Z","tags":[{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"condition","value":"Body-Focused Repetitive Behaviors","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"modality","value":"Behavioral Therapy","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"sample_size","value":"n=268","value_numeric":268},{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"warning","value":"Diagnoses and outcomes were self-reported without external assessment.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"warning","value":"No follow-up; durability of effect is unknown.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.2167","tag_type":"warning","value":"Wait-list control rather than an active comparator.","value_numeric":null}],"summaries":{"what_studied":"An online randomized clinical trial in 2022 compared a 6-week self-help habit replacement program with a wait-list control in individuals with body-focused repetitive behaviors (n=268; 134 per arm), using the self-reported Generic BFRB Scale-45 as the primary outcome.","key_result":"Habit replacement outperformed wait-list on the GBS-45 in both per-protocol (ηp2=0.068; P=.001) and intention-to-treat analyses (ηp2=0.019; P=.02). On the Clinical Global Impressions scale, 52.8% in the habit replacement group reported improvement vs 19.6% with wait-list (P<.001); moderation suggested greater benefit for nail biting.","limitations":"Diagnoses were not externally verified and assessments were self-reported. No follow-up data were collected.","practice_takeaway":"A brief self-help habit replacement approach reduced BFRB severity over 6 weeks vs wait-list, with about half reporting global improvement; benefits appeared strongest for nail biting. Expect limited impact on concomitant symptoms, and note the absence of follow-up."}}],"initialOffset":1,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Body-Focused Repetitive Behaviors"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Body-Focused Repetitive Behaviors"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Body-Focused Repetitive Behaviors"}}}]]

Papers