{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:45:52Z","timestamp":1789447552889,"version":"build-2803163510"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare a new self-help intervention, habit replacement, against a wait-list control condition for the treatment of BFRBs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Participants were randomized to a self-help intervention, habit replacement, or a wait-list control condition (each n\u2009=\u2009134).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The Generic BFRB Scale-45 (GBS-45, self-report) represented the primary outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Individuals in the 2 conditions (n\u2009=\u2009268; 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, \u03b7<jats:sub>p<\/jats:sub><jats:sup>2<\/jats:sup>\u2009=\u20090.068, <jats:italic>P<\/jats:italic>\u2009=\u2009.001) and the intention-to-treat analyses relative to the wait-list control group (expectation\u2013maximization algorithm; \u03b7<jats:sub>p<\/jats:sub><jats:sup>2<\/jats:sup>\u2009=\u20090.019, <jats:italic>P<\/jats:italic>\u2009=\u2009.02). 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%; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>German Clinical Trials Register Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/drks.de\/search\/en\/trial\/DRKS00030511\">DRKS00030511<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2023.2167","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T15:16:01Z","timestamp":1689779761000},"page":"992","source":"Crossref","is-referenced-by-count":16,"title":["Self-Help Habit Replacement in Individuals With Body-Focused Repetitive Behaviors"],"prefix":"10.1001","volume":"159","author":[{"given":"Steffen","family":"Moritz","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Penney","sequence":"additional","affiliation":[{"name":"Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et de Services Sociaux de l\u2019Ouest-de-l\u2019\u00cele-de-Montr\u00e9al Douglas Mental Health University Institute, Verdun, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Missmann","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Weidinger","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Schmotz","sequence":"additional","affiliation":[{"name":"Department of 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