Using Digital Implementation Intentions to Enhance Habit Formation in Users of an Awareness-Enhancing Wearable Device for Body-Focused Repetitive Behaviors

Abstract

Although wearable devices have become popular vehicles for contemporary health behavior change interventions, early discontinuation by users is an enduring challenge. Not only do long-term wearable device users rely on habit to create successful usage routines, but wearables have also demonstrated early proof of concept in habit-based behavioral disorders, including hair pulling disorder (HPD) and skin picking disorder (SPD). This study tested the effectiveness of an implementation intention (II), a contingency planning technique previously successfully delivered in a digital format, in users of a wearable device for HPD/SPD. Participants (N = 63) were randomized to either use their device daily or receive a supplemental II daily via mobile app. We predicted users in the II condition would report better compliance with study assessments, decreased automaticity and severity of HPD/SPD, and greater satisfaction with the device compared to the control group after three weeks. The impact of the II varied as a function of behavior type: skin pickers in the II group were more compliant than those in the control group, had lower severity than hair pullers irrespective of group and timepoint, and were initially less satisfied with the device, but grew to find it as helpful as hair pullers did by the end of the study. There was no discernable effect of automaticity, but all participants experienced lower BFRB severity after three weeks, irrespective of experimental group. This study supports the initial proof of concept of digitally delivered implementation intentions in combination with wearable devices for HPD and SPD.