Cognitive psychophysiological treatment of bodily-focused repetitive behaviors in adults: An open trial

J Clin Psychol. 2018 Mar;74(3):273-285. doi: 10.1002/jclp.22501. Epub 2017 Aug 16.


Background: Body-focused repetitive behaviors (BFRBs), such as hair pulling, skin picking, and nail biting, are repetitive, destructive, and nonfunctional habits that cause significant distress. Separate BFRBs form a cohesive group and could be assessed as part of the Tourette/tic spectrum or obsessive-compulsive spectrum of disorders. The treatment of choice is either antidepressant or behavioral treatment, both of which have shown effectiveness. The cognitive psychophysiological (CoPs) model focuses on the tension and emotional build up that triggers habits by addressing cognitive-behavioral, emotional and psychophysiological processes preceding onset rather than the habit itself. The CoPs approach has already shown efficacy in treatment of tic and Tourette disorder.

Objective: The aim of the current open trial was to view whether BFRBs can be validly assessed on a standard tic scale (Tourette Symptom Global Scale; TSGS) and evaluate the efficacy of the CoPs intervention on 64 participants (54 completers) with 1 of 3 subtypes of BFRBs (hair pulling, nail biting, and skin picking) compared to a waitlist control.

Method: Participants were assessed at baseline on an adapted TSGS and after receving 14 weeks of CoPs therapy with six months follow up.

Results: The TSGS was reliably and validly adapted to measure BFRBs. The CoPs intervention was effective for all BRFB subtypes with a large effect size (intention-to-treat g = 1.54; completers g = 2.04), with 74% of patients showing clinically significant improvement. Mood and self-esteem also improved posttreatment. The decrease in symptoms was maintained at the 6-month follow-up, with a further decrease in perfectionism.

Conclusion: BFRBs can be reliably assessed as a tic spectrum disorder rather than as part of the obsessive-compulsive spectrum. The CoPs model may offer a complementary treatment for BFRBs.

Keywords: body-focused repetitive behavior; cognitive therapy; emotion; metacognition; style of planning.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy / methods*
  • Disruptive, Impulse Control, and Conduct Disorders / classification
  • Disruptive, Impulse Control, and Conduct Disorders / diagnosis*
  • Disruptive, Impulse Control, and Conduct Disorders / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales / standards*
  • Tic Disorders / classification
  • Tic Disorders / diagnosis*
  • Tic Disorders / therapy*
  • Treatment Outcome