Decoupling

Domain II · Behavioural & cognitive · Steffen Moritz, Michael Rufer · 2010 · Hamburg

What it is

Decoupling is a brief self-help technique for body-focused repetitive behaviours (BFRBs): hair pulling (trichotillomania), nail biting, skin picking, and lip or cheek biting. It was developed in Hamburg in 2010 by Steffen Moritz and Michael Rufer and is delivered as a free downloadable manual with…

Format

• Decoupling is a single technique delivered as self-help, not a multi-phase therapy. The authors give a sequence of steps rather than formal phases. In the trials participants used the manual alone for about 4 weeks. The phases below are the manual's sequence; the session plan for clinicians is.
• DC-is: 5 repetitions, several times a day; the manual's per-session duration is ambiguous.

Who practises it, and how they are trained or regulated

• Decoupling is a brief self-help technique for body-focused repetitive behaviours (BFRBs): hair pulling (trichotillomania), nail biting, skin picking, and lip or cheek biting. It was developed in Hamburg in 2010 by Steffen Moritz and Michael Rufer and is delivered as a free downloadable manual with photographs. No practitioner training is required. The authors describe it as a variant of habit reversal training…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• The earlobe touch becoming a fidget. Keep it light and brief.
• Aids replacing practice entirely, or growing social avoidance.
• Alarms dismissed without practice. Working: at least about 80% of blocks done.
• All-or-nothing thinking after a slip, and dropping practice once symptoms fall.
• Mouth guards should come through a dentist, per the manual. Refer to a dentist if there are lesions.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.