by Ruggiero Corcella
Study with good results suggests new behavioral therapy: Instead of nipping, picking or pulling, touch skin gently twice a day
Anyone who suffers from it knows how difficult it is to quit. Even if the damage and discomfort that result from these “nervous tics” are obvious. In common terms we know them as nail biting and hair pulling. But nail biting, trichotillomania (hair pulling disorder or HPD) and dermatillomania (excoriation disorder or skin picking disorder (SPD) are body-focused repetitive behavior (BFRB) disorders characterized respectively by the compulsive pulling or removal of hair and skin. A study just published in Jama Dermatology suggests a possible therapy that appears to have achieved good results.
Instead of nipping, picking or pulling, simply touch the skin in a gentle way, such as lightly rubbing the fingertips, palm or back of the arm, at least twice a day. That strategy, called habit replacement, helped 53 percent of 268 participants in a new six-week study reduce their unwanted behavior. In short, it is a matter of a kind of “pretend”, which repeats the gestures of the disturbance without however going all the way and harming itself.
5% of the world‘s population affected
The results
The new study included 268 people. Either they had trichotillomania, or they 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 the study ended). Other participants were taught how to form a replacement habit through a manual and video. Those who bit their nails seemed to have the most benefit. About 80% of people in the treatment group said they were satisfied with the training and 86% would recommend it (see VIDEO above, ed).
Common strategies
While more research is needed, this strategy could merge existing behavioral techniques such as decoupling and habit-reversal training, which are being used to help people with BFRB
. In decoupling, you replace a behavior like nail biting with something that starts in a similar way, like raising your hand to your face, but ends with touching an earlobe instead of chewing your nails. In habit reversal training, however, you engage in a different behavior.
“So, for example, clenching your fists really hard when you feel the need to pull your hair or pick at your skin. Or sit on your hands,” Natasha Bailen, a clinical psychologist at the Center for Obsessive-Compulsive and Related Disorders at Massachusetts General Hospital and Harvard Medical School, told NBC News.
Alternative to drugs
Sometimes people with these behaviors are prescribed medications such as antidepressants, and cognitive behavioral therapy can be another treatment option. Moritz estimated that one third to one half of patients benefit from decoupling, but the rest do not. “And so the idea was to find another technique that was perhaps more suitable for these ‘non-responders’,” adds Moritz.
John Piacentini, chair of the board of directors of the TLC Foundation for Body-Focused Repetitive Behaviors says the study raises awareness about these conditions. “There are reasonably good treatments out there that most doctors either don’t know about or don’t do,” he told NBC News. “In this population, we’re looking for treatments that really impact or really reduce the severity of these specific symptoms,” he adds.
Feasibility test
The research is a ‘proof of concept’ and needs further confirmation, but experts were encouraged by the results. “Getting access to mental health services can be quite a challenge these days and waiting lists can be incredibly long,” says Bailen. “But I think the more research we are able to do and the more we are able to develop these self-help materials, the more we can help narrow the treatment gap. And that’s definitely important.”
August 5, 2023 (change August 5, 2023 | 09:52)
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