The bad habit of biting nails is known as onychophagia, and there are many people who cannot give up this habit, just as it happens with others such as picking their skin or pulling out a lock of hair, especially when they are stressed. However, a new study has found a simple way to avoid these behaviors: it is a strategy known as “habit replacement” and the results show that it helped 53% of the participants to reduce their unwanted behavior in just six weeks.
As its name indicates, it consists of substituting one behavior for another; thus, instead of nibbling, pinching, or pulling, these individuals are advised to touch their skin gently, lightly rubbing the pads of their fingers, the palm, or the back of the arm, at least twice a day. “The rule is to touch the body lightly,” the study’s lead author, Steffen Moritz, head of the clinical neuropsychology working group at University Medical Center Hamburg-Eppendorf in Germany, told NBC News. “If you’re under stress, you can move faster, but not with more self-applied pressure.”
The study involved 268 people who either suffered from trichotillomania, a condition characterized by the fact that those affected respond to stress or calm down by pulling out their hair, or repeatedly bit their nails or the inside of their cheeks. Control group members were told they were on a waiting list for treatment (which they received after completion of the study), while other participants were taught how to form a replacement habit through a manual and video.
Strategies to correct repetitive body-focused behaviors
Those who seemed to benefit the most from the strategy were the nail-biters, with around 80% of people in the treatment group saying they were satisfied with the training and 86% that they would recommend it. Although more research is needed, this strategy could be added to available behavioral techniques, such as uncoupling and habit reversal training, which are used to help people with body-focused repetitive behaviors (BFRBs). The findings have been published in the journal JAMA Dermatology.
In decoupling, someone might replace a behavior like nail biting with something that starts out similar, like hand to face, but ends up touching the earlobe instead of nail biting. In habit reversal training, someone might similarly engage in a different behavior. “So, they could involve, for example, clenching your fists very tightly when you feel like pulling your hair or scratching your skin. It could be sitting on your hands,” Natasha Bailen, a clinical psychologist with the Center for OCD and Related Disorders at Massachusetts General Hospital and Harvard Medical School, told NBC News.
Decoupling might replace a behavior like nail biting with something that starts out similarly, like putting your hand up to your face, but ends up touching your earlobe.
People with these behaviors are sometimes prescribed drugs such as antidepressants, and cognitive behavioral therapy may be another treatment option. Moritz estimated that one-third to one-half of patients benefit from untying, but the rest do not, so “the idea was to find another technique that might be more suitable for these nonresponding patients,” he said.
John Piacentini, chairman of the board of the TLC Foundation for Body-Centered Repetitive Behaviors, has stressed that the study raises awareness about these conditions. “There are reasonably good treatments that most doctors don’t know about or don’t do,” he told NBC News. “In this population, we are looking for treatments that actually impact or reduce the severity of these specific symptoms,” he adds.
The “proof of concept” research needs further confirmation, but experts were encouraged by the findings. “I was very excited that more work is being done in this self-help area,” Bailen said. “Getting access to mental health services can be a real challenge these days and the waiting lists can be incredibly long,” he said, “but I think the more research we can do, and the more we can develop these self-help materials, we can help narrow that treatment gap. And that is definitely important,” she concludes.
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