IMPROVING WEB-BASED SELF-HELP ADHERENCE FOR BODY FOCUSED REPETITIVE BEHAVIORS USING SELF-CONTROL TRAINING

Behavior therapy is an effective treatment for body-focused repetitive behaviors (BFRBs), such as hair pulling and skin picking. However, access to treatment is limited due to a shortage of trained professionals. Web-based self-help programs offer a promising way to improve access to evidence-based treatments, like behavioral therapy for BFRBs, but nonadherence is a pervasive problem that likely limits the efficacy of these programs. As self-control is a crucial factor in adherence to health-related behaviors, increasing self-control capacity may be an innovative way to improve adherence to web-based self-help programs. The present study tests the utility of a self-control intervention in increasing adherence, measured by the number of days participants logged on to and entered data, to web-based self-help platforms for hair pulling and skin picking. Participants (N = 80) with trichotillomania (TTM; n = 40) and skin picking disorder (SPD; n = 40) were randomly assigned to either a two-week self-control intervention or a waitlist before receiving access to 10 weeks of a web-based self-help program for either TTM (Stoppulling.com) or SPD (Stoppicking.com). Symptom severity, impairment, and treatment readiness were assessed at baseline, pretreatment, and posttreatment. Treatment satisfaction and additional feedback were also collected posttreatment. Adherence did not significantly differ between participants who received the self-control intervention (20% trimmed M = 11.25) and those who did not (20% trimmed M = 9.37). Participants who had better adherence to the programs had greater reductions in symptom severity and impairment after treatment; however, none of the variables included in an exploratory model were found to predict adherence. Exploratory analyses found the self-control intervention effectively reduced symptom severity in the self-control condition, indirectly suggesting improvements in self-control capacity. Results reinforce the need to improve adherence to maximize the effectiveness of web-based self-help programs. While self-control training did not increase adherence here, several factors may have stymied its effects, such as a limited sample size, low treatment satisfaction, and variability in the self-control intervention. Future studies should address these concerns to better understand the utility of self-control interventions in addressing nonadherence.