CBT and Medication Treatment for Body Focused Repetitive Behaviors

Body focused repetitive behaviors (BFRBs), including trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder, are chronic psychiatric conditions with significant prevalence rates, comorbidity and associated distress and functional impairment. These disorders have historically been challenging to treat. This course will provide an overview of BFRBS and discuss the most up-to-date assessment instruments and treatment interventions (both CBT and medication). Issues related to treatment selection and sequencing will be reviewed. Challenges to treatment including comorbidity and high relapse rates will also be addressed. Role plays will be used to demonstrate CBT strategies, especially those from DBT and ACT.

Registrants will have access to course materials from the date of their registration through the course expiration date.


All care Providers: $199

NOTE: If you are paying for your registration via Purchase Order, please send the PO to mghcme@mgh.harvard.edu. Our customer service agent will respond with further instructions.

Cancellation Policy

Refunds will be issued for requests received within 10 business days of purchase, but an administrative fee of $35 will be deducted from your refund. No refunds will be made thereafter. Additionally, no refunds will be made for individuals who claim CME or credit, regardless of when they request a refund.

Target Audience

This program is intended for:

  • Physicians
  • Psychiatrists
  • Psychologists
  • Social Workers
  • Licensed Mental Health Counselors
  • Nurses

Learning Objectives

By the end of this program, participants will be able to:

  • Describe how to diagnose and assess BFRBs;
  • Demonstrate ability to develop BFRB treatment plans tailored to the individual;
  • Plan how to manage relapse to optimize maintenance of treatment gains
  • Describe pharmacotherapy options that show potential benefit in treating BFRBs
  • Utilize mindfulness, emotion regulation, distress tolerance and ACT strategies to treat BFRBs
Course summary
Course opens: 
Course expires: 

Participants must complete each week sequentially and all components of each week to receive credit, including:

  • Activity Overview
  • Video Lecture
  • Reading and Resources (required and optional)
  • Discussion Board
  • Case Assessment

Session 1

Overview of BFRBs and CBT for BFRBs

Key Points:

  • Administer a comprehensive multi-modal assessment
  • Select single or dual modality treatment
  • Identify appropriate habit reversal and stimulus control strategies

Session 2

Pharmacological Treatment and medical considerations related to BFRBs

Key Points:

  • Identify which pharmacotherapy options show potential benefit in treating BFRBs
  • Identify common co-occurring conditions in HPD and SPD
  • Identify when would be most appropriate to use N-acetyl cysteine, SSRIs and/or other psychotropic agents to treat BFRBs and comorbid conditions
  • Describe the psychiatric and medical differential for HPD and SPD, and identify possible medical sequelae from BFRBs

Session 3

Advanced Psychosocial Treatment of BFRBs

Key Points:

  • Provide the rationale for augmentation strategies in BFRB treatment;
  • Utilize mindfulness, emotion regulations and distress tolerance strategies for BFRBs;
  • Utilize ACT techniques in treating BFRBs


Please login or register to take this course.
Please login or register to take this course.
Please login or register to take this course.
Please login or register to take this course.
Please login or register to take this course.


Please login or register to take this course.


Nancy Keuthen, PhD
Erica Greenberg, MD
David H. Rubin, MD, Reviewer
Jane Pimental, MPH
Susan E. Sprich, PhD,  Psychologist Reviewer, Moderator

Disclosure Information

In accord with the disclosure policy of McLean Hospital as well as guidelines set forth by the Accreditation Council on Continuing Medical Education, all people in control of educational content, including speakers, course directors, planners, and reviewers, have been asked to disclose all relevant financial relationships with commercial interests of both themselves and their spouses/partners over the past 12 months, as defined below:


Commercial Interest

The ACCME defines a “commercial interest” as any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients. The ACCME does not consider providers of clinical service directly to patients to be commercial interests. For more information, visit www.accme.org.

Financial relationships

Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit.  Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected.  ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.

Relevant financial relationships 

ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity. ACCME has not set a minimal dollar amount for relationships to be significant.  Inherent in any amount is the incentive to maintain or increase the value of the relationship. The ACCME defines “’relevant’ financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest.

Conflict of Interest

Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.


The following planners, speakers, and content reviewers, on behalf of themselves and their spouse or partner, have reported financial relationships with an entity producing, marketing, re-selling, or distributing health care goods or services (relevant to the content of this activity) consumed by, or used on, patients:

Nancy J. Keuthen, PhD
Royalties: New Harbinger, Inc. (book author)
Research grant: TLC Foundation for Body Focused Repetitive Behaviors (PI)
Stock dividents: Pfizer Inc., Merck & Co., Johnson & Johnson, Becton Dickinson, Proctor & Gamble Co. (ownership interest)

Susan E. Sprich, PhD,  Psychologist Reviewer, Moderator
Royalties: Oxford University Press (for co-authoring treatment manual and client workbook), Springer (for co-editing book)

All other individuals including course directors, planners, reviewers, faculty, staff, etc., who are in a position to control the content of this educational activity have, on behalf of themselves and their spouse or partner, reported no financial relationships related to the content of this activity.

Policy on Faculty and Provider Disclosure

It is the policy of McLean Hospital that faculty and providers disclose real or apparent conflicts of interest relating to the topics of this educational activity. McLean Hospital has established policies in place that identify and resolve all conflicts of interest prior to this educational activity.

Hardware/Software Specifications

This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration

Flash Player: Adobe Flash Player 10.1+
Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+
Operating System: Windows XP+ or Mac OS X 10.4+
Internet Connection: 1 Mbps or higher

Minimum Requirements

Windows PC:500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
Macintosh: Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit