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.

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 Agenda

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


  • Staff Psychiatrist
    Massachusetts General Hospital Pediatric Neuropsychiatry and Immunology Program
    OCD and Related Disorders Program

    Instructor in Psychiatry
    Harvard Medical School
  • Director of Trichotillomania Clinic and Research Program
    Chief Psychologist
    OCD and Related Disorders Unit
    Massachusetts General Hospital

    Associate Professor in Psychology
    Harvard Medical School

Target Audience

This program is intended for:

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


All care Providers: $199

NOTE: If you are paying for your registration via Purchase Order, please send the PO to 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.

Additional Online Courses

We offer several online courses on cognitive behavioral therapy that complement the course you are currently viewing.

View our online CBT course offerings

CE Information

Release Date: January 1, 2019
Expiration Date: December 31, 2022






AMA PRA Category 1 CreditsTM

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of McLean Hospital and Massachusetts General Hospital. McLean Hospital is accredited by the ACCME to provide continuing medical education for physicians.

McLean Hospital designates this enduring material for a maximum of 5.50AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Psychologists CE Credits

The Massachusetts General Hospital Department of Psychiatry is approved by the American Psychological Association to sponsor continuing education for psychologists. The Massachusetts General Hospital Department of Psychiatry maintains responsibility for this program and its content.

This offering meets the criteria for 5.50 continuing education credits for psychologists.


Nursing Contact Hours

Massachusetts General Laws, Chapter 13, sections 13, 14, 14A, 15 and 15D and Chapter 112, sections 74 through 81C authorize the Board of Registration in Nursing to regulate nursing practice and education.

This program meets the requirements of the Massachusetts Board of Registration in Nursing at (244 CMR 5.00) for 5.50 contact hours of nursing continuing education credit.Advance practice nurses, please note: Educational activities which meet the requirements of the ACCME (such as this activity) count towards 50% of the nursing requirement for ANCC accreditation.

Licensed Mental Health Counselors CE Credit

MaMHCA, and its agent, MMCEP has been designated by the Board of Allied Mental Health and Human Service Professions to approve sponsors of continuing education for licensed mental health counselors in the Commonwealth of Massachusetts for licensure renewal, in accordance with the requirements of 262 CMR 7.00.

Application for licensed mental health counselor continuing education credits has been submitted. Please contact us at 866-644-7792 or for the status of licensed mental health counselor continuing CE accreditation.

Social Work CE Credit Hours

The Collaborative of NASW, Boston College, and Simmons College Schools of Social Work authorizes social work continuing education credits for courses, workshops, and educational programs that meet the criteria outlined in 258 CMR of the Massachusetts Board of Registration of Social Workers.

This program has been approved for 5.5 Social Work Continuing Education hours for relicensure, in accordance with 258 CMR. Collaborative of NASW and the Boston College and Simmons Schools of Social Work Authorization Number D80336.



Other Professions

Other Providers can claim a Participation Certificate upon successful completion of this course.

Participation Certificates will specify the title, location, type of activity, date of activity, and number of AMA PRA Category 1 CreditsTM associated with the activity. Providers should check with their regulatory agencies to determine ways in which AMA PRA Category 1 CreditsTM may or may not fulfill continuing education requirements. Providers should also consider saving copies of brochures, agenda, and other supporting documents.


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

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

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