Improving Web-Based Self-Help Adherence for Body-Focused Repetitive Behaviors Using Self-Control Training.

Background: Behavioral treatments of body-focused repetitive behaviors are effective, but access to expert therapists is limited. Access might be improved by use of web-based self-help, but nonadherence limits the efficacy of these programs. This trial tested an intervention derived from the "strength" model of self-control (Baumeister et al in Perspect Psychol Sci 13:141–145, 2018) as a way to improve adherence to StopPulling.com (for trichotillomania; TTM) and StopPicking.com (for Skin Picking Disorder; SPD). Methods: Adult participants (N = 80; 40 with TTM and 40 with SPD) were randomly assigned to (a) 2-week self-control task (avoiding eating sweet foods) or (b) waitlist, followed by access to web-based self-help for 10 weeks and then post-test. Adherence was indexed by the number of days (0–70) on which the participant logged on and entered data in the self-help program. Results: There was no significant difference in adherence between the self-control condition (20% trimmed mean = 11.25) and the waitlist condition (9.37). Secondary analyses (a) replicated earlier work showing that participants who adhered more consistently derived more benefit and (b) suggested that symptom reduction trends were evident in the self-control condition even before the start of web-based self-help. Conclusions: Improving adherence is necessary for maximizing the benefit of web-based self-help. Self-control training does not appear to increase adherence but may have utility on its own for reducing BFRB symptoms. [ABSTRACT FROM AUTHOR]