Habit Reversal Training Research Articles

Efficacy of cognitive-behavioral therapy combined with habit reversal training on anxiety disorders in children with Tourette's syndrome.

Cognitive-behavioral therapy (CBT) and habit reversal training (HRT) have shown application potential in addressing tic symptoms and comorbid psychiatric conditions. Despite their theoretical potential, empirical evidence on their combined efficacy remains limited. To evaluate the efficacy of CBT combined with HRT on anxiety disorders in children with Tourette's syndrome (TS). Clinical data of children with TS admitted to our hospital from January 2022 to June 2023 were collected, and the patients were grouped into the conventional therapy (control) group and the CBT combined with HRT group. Baseline characteristics, anxiety scores, tic severity scores, treatment adherence, and parental satisfaction were assessed. Statistical analysis was performed using t-tests, chi-square tests, and correlation analysis. A total of 136 patients, including 65 patients in the control group and 71 patients in the CBT combined with HRT group, were included. The CBT combined with HRT group showed remarkable improvements compared with the control group. Post-intervention assessment revealed a decrease in anxiety scores from 63.52 ± 1.81 to 40.53 ± 1.64 (t = 2.022, P = 0.045), and the Yale Global Tic Severity Scale total score decreased from 22.14 ± 5.67 to 16.28 ± 4.91 (t = 2.288, P = 0.024). Treatment adherence was significantly higher in the CBT combined with HRT group (85.47 ± 7.62%) compared with the control group (82.32 ± 6.54%; t = 2.596, P = 0.010). Parental satisfaction scores were also higher in the CBT combined with HRT group (8.69 ± 1.77) compared with the control group (7.87 ± 1.92; t = 2.592, P = 0.011). This study demonstrates that CBT combined with HRT significantly reduces anxiety symptoms and tic severity in children with TS, with higher treatment adherence and parental satisfaction. These findings support the potential application of this comprehensive therapeutic approach for TS treatment.

A preliminary analysis of computer‐based asynchronous awareness training for public speaking disfluencies

AbstractSimple habit reversal training is effective at reducing public speaking disfluencies; however, the time and resources necessary to implement this intervention may reduce practicality for widespread adoption. The purpose of the present study was to evaluate the effectiveness of asynchronous awareness training. Four participants completed a computer‐based training consisting of response description and practice detecting recorded disfluencies prior to taking a quiz in which they scored the frequency of disfluencies in a recorded speech. Relative to baseline, all participants' rates of disfluencies decreased following training. In addition, acceptability ratings were high and all participants indicated greater willingness to participate in asynchronous training than in‐person training.

A Review of Behavioral and Pharmacological Treatments for Adult Trichotillomania

Trichotillomania (TTM) is a psychiatric disorder involving chronic, recurrent urges to pull out one’s own hair, arising frequently in childhood and early adolescence. This disorder predominantly affects women and has a high co-morbidity with many other psychiatric conditions. Currently, the etiology is unknown, which makes treating TTM extremely difficult. While the epidemiology and proposed causes will be discussed briefly, the primary purpose of this review is to provide a comprehensive, updated summary of the psychological and pharmacological management options for patients diagnosed with TTM, as new clinical trial data for previously studied and novel treatments have become available within the last decade. Of the behavioral interventions, cognitive behavioral therapy (CBT) and habit reversal training (HRT) have demonstrated the greatest improvements in hair-pulling severity, with HRT showing the most efficacy for long-term maintenance of progress. Pharmacological therapies with the most success include Olanzapine, Clomipramine, and N-Acetylcysteine, though larger replication studies are needed. Selective serotonin reuptake inhibitors (SSRIs) have yielded inconsistent results in clinical trials, yet they are frequently prescribed for TTM. Naltrexone, Dronabinol, and Inositol are emerging as potential treatments, but the results suggest that additional studies are needed. Future research directions include larger placebo-controlled pharmacological trials, exploring the efficacy of combined behavioral and pharmacological approaches compared to monotherapy, and delving into the potential genetic and neurochemical contributions that may underlie TTM.

Acceptance-Enhanced Behavior Therapy for Trichotillomania in Youth.

Trichotillomania is a debilitating and chronic condition involving repeated hair pulling from various areas of the body. Trichotillomania often begins in childhood, suggesting that the development and understanding of treatments for trichotillomania in youth are of utmost importance, especially for successful early intervention. While habit reversal training (HRT) is considered the gold standard treatment for trichotillomania in young people, this article reviews a nascent treatment approach for trichotillomania in youth, acceptance-enhanced behavior therapy (AEBT). AEBT combines HRT and acceptance and commitment therapy skills. Each component of AEBT is described and reviewed. A detailed case exemplar of the 10-session protocol is presented. Future research directions and important clinical considerations are discussed.

Self-Help to Reduce Body-Focused Repetitive Behaviors via Video or Website? A Randomized Controlled Trial

BackgroundBody-focused repetitive behaviors (BFRBs) are common but under-recognized mental disorders. The present study aimed to examine the efficacy of a video presentation of self-help techniques for BFRBs compared to a web-based intervention containing psychoeducation and comprehensive self-help treatment information on BFRBs to reduce symptomatology as well as the same videos as in the first condition.MethodsA total of 217 participants with BFRBs were randomly assigned to (1) a video condition conveying the established self-help techniques habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is) to reduce BFRBs, (2) a website condition that offered psychoeducational information and treatment material, including the videos from the first treatment condition, or (3) a waitlist control (WLC) condition. A six-week post assessment was conducted. The Generic Body-Focused Repetitive Behavior Scale 45 (GBS-45) served as the primary outcome.ResultsThe self-help video condition showed greater improvement in GBS-45 subscales for nail biting in comparison to the self-help website and WLC conditions. For other BFRBs (e.g., joint cracking, trichophagia), the impairment subscale showed significant results in post hoc analyses in favor of the two treatment conditions. Subjective ratings of the techniques were satisfactory and comparable across treatment groups, with slightly higher ratings in favor of the video condition.ConclusionsThe video condition showed better improvement than the control condition on nail biting and other BFRBs. Superior results in the self-help website condition compared to the WLC were shown only for the group of “other” BFRBs (i.e., not trichotillomania, nail biting, dermatillomania, lip/cheek biting). We speculate this might be because users were overwhelmed by the many different approaches described without clear guidelines for how to implement them in daily life. In light of a prior study, we assume that a manualized version of the self-help techniques is superior to the video delivery and recommend that the self-help videos should be used as a complement to a manualized version. Future research should address long-term effects of self-help interventions for BFRBs.

Cognitive behavioural therapy including habit reversal training for treating dermatillomania in the context of anxiety and low mood

Abstract Dermatillomania is characterised by repetitive skin picking, resulting in tissue damage and significant distress and/or functional impairment. Cognitive behavioural therapy (CBT) is the recommended psychological intervention for dermatillomania in clinical guidelines, with the evidence base also supporting habit reversal training (HRT) as part of CBT. However, research evaluating CBT and HRT for dermatillomania remains scarce. This case study describes a young woman with dermatillomania, in the context of co-morbid anxiety and low mood, treated with 20 sessions of CBT including HRT in a community setting. Guided by her formulation, additional techniques such as those fostering self-compassion were also integrated, and sociocultural factors were adapted for. Improvements were reported in client-centred goals and outcomes of global psychological distress, functioning, anxiety and symptoms and psychosocial impacts of skin picking. The intervention was well received by the client. Limitations as well as clinical practice implications and research recommendations for dermatillomania are discussed. Key learning aims (1) To understand using CBT, including HRT, to treat a case of dermatillomania in the context of anxiety and depression. (2) To use a formulation-driven approach to guide the intervention. (3) To consider adapting interventions for sociocultural factors.

ACT-Enhanced Behavior Therapy for a Hispanic Adult with Trichotillomania: A Case Report

Trichotillomania, also known as Hair-Pulling Disorder, is characterized by recurrent pulling out of one’s hair over brief episodes or sustained periods of time and results in hair loss. ACT-enhanced behavior therapy (A-EBT) has been shown to be an effective approach in the treatment of trichotillomania by promoting psychological flexibility around hair pulling urges and teaching stimulus control and habit reversal training. However, there is limited support of A-EBT for clients with an ethnic minority identity. This case report focuses on an adult, Hispanic female client, Luna (pseudonym), who received eight sessions of A-EBT for the treatment of trichotillomania. At post-treatment, Luna showed significant improvements in number of hairs pulled, trichotillomania specific psychological flexibility, depression and anxiety. Luna’s case highlights barriers to care such as potential resistance in seeking mental health services, the influence of family members’ beliefs on receiving mental health services, and the limited access to specialized treatment of trichotillomania.

‘Free from BFRB’: Efficacy of Self-Help Interventions for Body-Focused Repetitive Behaviors Conveyed via Manual or Video

Self-help may help fill the large treatment gap in individuals with body-focused repetitive behaviors (BFRBs). We examined the efficacy of three self-help techniques for BFRBs: habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is) and also tested whether a video demonstration is more efficacious to written instructions. A total of 224 participants with at least one BFRB were randomly assigned to two intervention groups (video, manual) receiving access to all techniques or a wait-list control group (1:1:1). A 6-week follow-up assessment was conducted. The Generic Body-Focused Repetitive Behavior Scale (GBS-9) served as primary outcome. The intention-to-treat analysis showed significant improvements for the manual group compared to the wait-list control group on GBS total score and severity and impairment scores. For the per-protocol analyses (i.e., participants had at least read/watched the manual/video), 26.9% of completers in the manual group improved at least 35% in GBS compared to 23.3% (video group) and 15.9% (control). A dose–response relationship emerged for the video group. Subjective ratings by the video and manual groups did not differ; treatment satisfaction was greater for HRT and DC than for DC-is. Results suggest that the manual group showed somewhat stronger effects than the video group when usage frequency was low. With more frequent usage, improvements in the video condition increased. Future studies should investigate potential order effects of the techniques as well as add-on effects when techniques are used along with other treatment approaches.

Two-year Follow-up of Habit Reversal Training and Decoupling in a Sample with Body-Focused Repetitive Behaviors

BackgroundSelf-help habit reversal training and decoupling are effective in improving body-focused repetitive behaviors (BFRBs). However, most studies to date on self-help techniques have assessed short-term effects only. The present study aimed to elucidate whether treatment effects would be sustained over a longer period of time.MethodsWe conducted a 2-year follow-up study of a cohort of 391 participants with mixed BFRBs who were initially randomized to four conditions (wait list control, habit reversal training, decoupling, decoupling in sensu). At post assessment, participants were allowed to use other treatment techniques, enabling us to explore treatment effects in those who continued to use the initial method only versus those who used additional techniques. The Generic Body-Focused Repetitive Behavior Scale (GBS-36) served as the primary outcome.ResultsImprovements achieved at post assessment were maintained at follow-up for all experimental conditions, with decoupling showing significantly greater treatment gains at follow-up relative to the wait list control group (last observation carried forward: p = .004, complete cases: p = .015). Depression at follow-up slightly improved compared to baseline and post assessment similarly across all conditions, arguing against “symptom displacement” to other psychopathological syndromes. Retention rates were similarly low across the four conditions (48.5–54.6%), making bias unlikely (but not firmly excluding it). Participants who adhered to the initial protocol until follow-up showed a pattern of improvement similar to those using additional techniques.DiscussionOur study speaks for the long-term effectiveness of behavioral self-help techniques to reduce BFRBs, particularly decoupling. Of note, participants were allowed to use other self-help manuals after completing the post assessment; thus, randomization was removed. However, a minority of the participants chose this option.

When and for Whom to Pick In-Person or Telehealth Delivery of Habit Reversal Training for Body Focused Repetitive Behaviors: An Assessment of Provider Perceptions

When and for Whom to Pick In-Person or Telehealth Delivery of Habit Reversal Training for Body Focused Repetitive Behaviors: An Assessment of Provider Perceptions

A Test of the Behavioral Model of Tic Disorders Using a Dynamical Systems Framework

Tic disorders are a class of neurodevelopmental disorders characterized by involuntary motor and/or vocal tics. It has been hypothesized that tics function to reduce aversive premonitory urges (i.e., negative reinforcement) and that suppression-based behavioral interventions such as habit reversal training (HRT) and exposure and response prevention (ERP) disrupt this process and facilitate urge reduction through habituation. However, previous findings regarding the negative reinforcement hypothesis and the effect of suppression on the urge-tic relationship have been inconsistent. The present study applied a dynamical systems framework and within-subject time-series autoregressive models to examine the temporal dynamics of urges and tics and assess whether their relationship changes over time. Eleven adults with tic disorders provided continuous urge ratings during separate conditions in which they were instructed to tic freely or to suppress tics. During the free-to-tic conditions, there was considerable heterogeneity across participants in whether and how the urge-tic relationship followed a pattern consistent with the automatic negative reinforcement hypothesis. Further, little evidence for within-session habituation was seen; tic suppression did not result in a reduction in premonitory urges for most participants. Analysis of broader urge change metrics did show significant disruption to the urge pattern during suppression, which has implications for the current biobehavioral model of tics.

Short-term intervention complemented by wearable technology improves Trichotillomania - A naturalistic single-case report.

There is a growing interest in using wearable technology for the treatment of body-focused repetitive behaviors (BFRBs), such as Trichotillomania. Yet, to our knowledge, few studies address the applicability and use of wearable technology as a therapeutic element in more naturalistic situations. Here we would like to introduce its potential use combined with a Habit-Reversal Training in a single-case experimental design. In practice, individuals with BFRBs frequently show complex constellations of psychiatric disorders. Accordingly, the here presented participant was diagnosed with Trichotillomania as well as comorbid ADHD and examination phobia. The participant was offered to wear an unobtrusive and user-friendly vibration device that sent an alarm when her critical hairpulling behaviors occurred. The complementing Habit-Reversal Training included an Awareness Training supported by the vibration alarm of the wearable device. It further included a Competing Response Training by learning benign behaviors that could replace the hairpulling behavior. The frequency of hairpulling episodes was assessed using daily self-reports and by using the monitoring function of the wearable device. The intervention procedure was implemented into the participant's everyday life and evaluated over the course of 214 days. The results indicated a significant reduction in the daily episodes of hair pulling. Our preliminary findings suggest that the here applied intervention has the potential to effectively treat Trichotillomania in individuals with comorbid disorders in psychotherapeutic outpatient care. Certainly, group-studies will need to further validate the approach's effectiveness.

Body-Focused Repetitive Behavior Disorders in Children and Adolescents: Clinical Characteristics and Treatment Outcomes in a Naturalistic Setting

Body-focused repetitive behavior disorders, including trichotillomania (hair-pulling disorder) and excoriation (skin picking) disorder, typically emerge in early adolescence, but little is known about the clinical characteristics and treatment outcomes of these disorders in young people, particularly in real-world clinical settings. Participants were 63 children and adolescents (51 girls; age range 9–17) with a diagnosis of trichotillomania (n = 33) and/or skin-picking disorder (n = 33) attending a specialist outpatient clinic in Stockholm, Sweden. Demographic and clinical characteristics were gathered at the initial assessment. Of the 63 assessed youths, 56 received manual-based behavior therapy mainly focusing on habit reversal training, which was combined with medication when deemed appropriate. The mean clinician-reported trichotillomania and skin-picking disorder symptom severity at baseline (n = 63) was in the moderate range. We observed high rates of psychiatric comorbidity (63.5%) and use of psychiatric medication (54.8%). For the 56 individuals undertaking treatment at the clinic, mixed-effects regression models showed a significant decrease in symptom severity from baseline to posttreatment, with gains maintained up to the 12-month follow-up. Substantial and durable improvements were also seen on self-reported symptoms, self-reported depression, and global functioning. Specialist care should be made more widely available to improve the prognosis and quality of life of young people with trichotillomania and skin-picking disorder.

Habit-reversal training: a psychotherapeutic approach in treating body-focused repetitive behaviour disorders.

Body-focused repetitive behaviours (BFRBs) are recurrent, compulsive, destructive behaviours directed towards the body. Although studies have demonstrated a 12-14% prevalence rate, researchers found that dermatologists and psychiatrists show a lack of knowledge regarding psychodermatology resources and information about BFRB disorders (BFRBDs) such as trichotillomania (TTM). There is limited research about treatments including ones investigating the clinical applications of various self-help training such as decoupling (DC) and DC in sensu (DC-is) as well as about habit-reversal training (HRT). HRT is a five-component behavioural intervention that aims to develop a competing response to a specific unwanted behaviour. Studies have found substantial support for HRT's efficacy in treating a variety of maladaptive repetitive behaviours including onychotillomania, TTM, skin-picking disorder and chronic cheek biting. Additionally, many psychotherapies can augmented HRT. Psychotherapies include acceptance and commitment therapy, dialectical behaviour therapy, psychodynamic psychotherapy, mindfulness mediation and the cognitive psychophysiological model. A recently investigated variant of HRT, DC-is, resulted in consistently satisfactory objective and subjective improvement for treating BFRBDs, and HRT showed good subjective but poor objective improvement compared with standard DC. HRT and HRT variants are effective therapeutic treatments for BFRBDs; however, further randomized double-blinded and placebo-controlled trials are required to examine HRT's therapeutic profile.

Dialectical Behaviour Therapy Enhanced Habit Reversal Training: A Clinical Case of Childhood-Onset Trichotillomania in an Adult With Impulsive Personality Features

Research has recognised the psychosocial impairments linked to Trichotillomania (TTM) and established a relationship between problematic hair-pulling and affective regulation. Significant relationships between pulling triggers, their severity, and emotional dysregulation have also been predicted. The current case focused on the efficacy of combined DBT (Dialectical Behaviour Therapy) and HRT (Habit Reversal Training) in a client with TTM and Impulsive Personality features. The client received 11 weekly sessions of DBT-enhanced HRT, which took 3 months to complete. Following the end of this acute treatment phase, four maintenance sessions (two sessions per month) were delivered. The maintenance of treatment benefits was assessed using self-report measures and therapist observations at four time points: at pre-treatment, after the acute treatment phase (at the end of 3 months), and then at a 3-month and a 6-month follow-up. The intervention results suggested a substantial reduction in hair-pulling, hair regrowth in affected parts of the scalp, and self-reported improvements in mood. The study also shows preliminary evidence of DBT-enhanced HRT’s efficacy in a client with TTM and Impulsive Personality features, suggesting the importance of addressing personality structures and distressing emotional regulation that cause functional impairment during TTM treatment.

Is Self-Help Dangerous? Examination of Adverse Effects of a Psychological Internet-Based Self-Help Intervention for Body-Focused Repetitive Behavior (Free From BFRB)

Despite the proven effectiveness of psychotherapy for psychiatric disorders, adverse events or unwanted effects may occur. Unwanted effects, however, are rarely assessed. In self-help interventions, which usually are not supported by a therapist, such effects have received even less attention even though special caution is needed regarding unwanted effects such as those related to misapplication. For the present study, we present the newly developed Positive and Negative Effects of Psychotherapy Scale for Internet-Based Intervention (PANEPS-I) and examine possible unwanted effects of an internet-based self-help intervention in individuals with body-focused repetitive behaviors (BFRBs), aggregating three different techniques: habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is). Some HRT users have expressed concern that the suppression of the problematic behavior could lead to rebound effects, but this has not been examined rigorously. Following baseline assessment, 141 participants with at least one BFRB were randomly assigned to two intervention groups that differed only with respect to the delivery mode (video, manual); the content was the same. After 6 weeks, a post-assessment was conducted. Unwanted effects were assessed using the PANEPS-I. A total of 70% of the participants (both treatment groups combined) reported at least one positive effect of the intervention. Negative effects were reported by 14–92% of participants, depending on the effect. The highest agreement rates were found for “no positive goal orientation” (52.5%), “did not address personal problems” (48.8%), “time/performance pressure” (20.9%), shame (16.3%), and concerns about data privacy (14.3%). Participants in the manual intervention group reported unethical procedures (e.g., data privacy concerns) more often (Cohen’s d = .44) than those in the video intervention group. Responders reported more positive effects and nonresponders more malpractice (|d| = .80, .54, respectively). HRT users (self-report) showed no significant differences compared to nonusers regarding negative effects. Stepwise hierarchical regression analyses indicated a dose-response relationship for reported positive effects and malpractice. Side effects may occur in any kind of intervention. Usage of HRT did not lead to more reported negative effects compared to nonusage. To improve the quality and effectiveness and ensure the safety of the user, especially those using digital self-help interventions, it is important to regularly assess unintended effects since there is no supervision of the patient in unguided self-help interventions.

Self-help for body-focused repetitive behaviors: A randomized controlled trial

Body-focused repetitive behaviors (BFRBs) are frequent but under-treated psychological disorders. The present study examined efficacy of three behavioral self-help techniques to reduce BFRBs: habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is). A total of 391 participants with BFRBs were randomly assigned to either HRT, DC, DC-is, or to a waitlist control group (WLC). After six weeks, a post assessment was conducted. The Generic Body-Focused Repetitive Behavior Scale-36 (GBS-36) served as the primary outcome. There were significant main effects for improvement in BFRB and depressive symptomatology over time, regardless of group assignment. For all GBS-36 scales, treatment groups showed greater improvement than WLC. DC and DC-is consistently showed greater improvements compared to WLC. According to moderator analyses individuals with more severe symptoms in the HRT and DC-is conditions benefited to a greater extent compared to WLC in terms of BFRB symptomatology. Also, individuals in DC condition with more severe depressive symptomatology showed a better outcome compared to HRT and WLC. Moreover, individuals with trichotillomania benefited more from DC or DC-is than from HRT. Subjective ratings of the techniques were satisfactory and comparable across groups, with DC-is receiving slightly lower subjective ratings. Future research should address the effects of the techniques when combined with psychotherapy. Also, long-term effects should be evaluated.

Trichotillomania – therapeutic possibilities

Introduction: Trichotillomania is a mental disorder in which the patient persistently and recurrently pulls out his own hair, which results in varying degrees of hair loss. This causes considerable suffering and impairs quality of life, but patients rarely seek specialist help. It affects 0.5–3% of the general population, but data may be underestimated due to low reporting. Aim of the study: The aim of our study is to summarize the current state of knowledge on the treatment of trichotillomania. Materials and methods: The literature available in the PubMed and Google Scholar database was reviewed using the following keywords: "trichotillomania", "trichophagia", "trichobeozar", "trichotillomania treatment". Results: Treatment of TTM is difficult and involves many methods. The division of therapeutic methods focuses mainly on psychotherapy and pharmacological treatment. The greatest effectiveness is attributed to cognitive-behavioral therapy, especially habit reversal training. Medications can help reduce symptoms, especially in the presence of other disorders, e.g. depression, anxiety disorders. Conclusions: Trichotillomania contributes to significant suffering and negatively affects functioning in social and professional life. The basis of its treatment is psychotherapy, but there are many reports on the effectiveness of selected drugs (SSRIs, clomipramine, antipsychotics, N-acetylcysteine, naltrexone, lamotrigine, bupropion, dronabinol, inositol), but they require further research on a larger group of patients.

Chapter 23 - Tourette syndrome and other tic disorders of childhood

Tics are repetitive, patterned, and nonrhythmic movements or vocalizations/audible sounds that are misplaced in context. Phenomenology and characteristics of tics (e.g., premonitory urge, suppressibility) differentiate them from compulsions, stereotypies, functional tic-like behaviors, and other types of hyperkinetic movement disorders. With a prevalence of approximately 1% in school-aged boys, Tourette syndrome (TS) is considered a common childhood-onset neurodevelopmental disorder, defined by the combination of at least two motor tics and at least one phonic tic lasting more than 1 year. TS is a highly heritable disorder, with a wide spectrum of severity. In some individuals, tics can cause pain, distress, functional impairment, or stigmatization. About 90% of individuals with TS have at least one mental health comorbidity (attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety/depressive disorders). These comorbidities significantly impact patients' quality of life and must therefore be screened and managed accordingly in this population. Treatment of tics is based on behavioral therapies targeting tics (habit reversal training included in the comprehensive behavioral intervention for tics, and exposure and response prevention for tics), in association with medication if needed (e.g., alpha-2-agonists, second-generation antipsychotics). Deep brain stimulation is considered an experimental option in the most severe, treatment-resistant patients. In adulthood, less than 25% of individuals still have moderate or severe tics.

Alternative Psychotherapeutic Approaches to the Treatment of Eczema.

Patients with eczema suffer from high psychological burden, often caused and exacerbated by chronic pruritus, which leads to a vicious itch-scratch cycle. Although much of the literature focuses on treating the physiological factors that lead to pruritus, little attention has been given to the cognitive, behavioral, and social factors associated with the itch-scratch cycle. We conducted a literature review to investigate whether treatments aimed at psychosocial factors could be effective for patients with eczema. A systematic literature review was conducted through PubMed and EMBASE. Original investigative articles that focused on psychotherapeutic interventions for eczema and/or eczema-related psychological morbidities were reviewed. Psychotherapeutic interventions alongside standard medical care are shown to be beneficial compared to conventional treatments alone, both for eczema and for eczema-associated psychological symptoms. Such interventions include meditation and mindfulness, stress-reduction, habit-reversal training, hypnotherapy, music therapy, massage therapy, and standard psychological treatments such as cognitive behavioral therapy. It is important to recognize the reciprocal relationship between eczema and psychosocial distress. Alternative treatment options to address psychological factors associated with eczema can improve disease trajectory and quality of life.