Introduction

Decoupling is a behavioural self-help intervention developed for body-focused and related behaviours (DSM-5) such as trichotillomania, onychophagia (nail biting), skin picking and lip-cheek biting (Mortiz & Rufer, 2011).

Background

The user is instructed to modify the original dysfunctional behavioural path by performing a counter-movement shortly before completing the self-injurious behaviour (e.g. biting nails, picking skin, pulling hair). This is intended to trigger an irritation, which enables the person to detect and stop the compulsive behaviour at an early stage. A systematic review from 2012 showed the efficacy of decoupling, which was corroborated by Lee and colleagues in 2019. Whether or not the technique is superior to other behavioural interventions such as habit reversal training awaits to be tested.

Reference

Lee, M.T., Mpavaenda, D.N. & Fineberg, N.A. (2019) Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials. Frontiers in Behavioral Neuroscience. 13:79. doi:10.3389/fnbeh.2019.00079.

Moritz, S. & Rufer, M. (2011) Movement Decoupling: A Self-Help Intervention for the Treatment of Trichotillomania. Journal of Behavior Therapy and Experimental Psychiatry. 42(1), pp.74-80. doi:10.1016/j.jbtep.2010.07.001.

Further Reading

• Manual: Decoupling – A Technique to Reduce Hair Pulling (Trichotillomania) and Nail Biting (external link).