Using Habit Reversal to Exterminate Nail Biting in College Student

Brianna Weber

Pennsylvania State University

Psychology of Behavior Modification

 

Abstract

In this study, habit reversal was used to treat nail and skin biting and picking in a female college student using a reversal design and self-assessment. The intervention consisted of the participant engaging in three personally selected activities to reverse the feeling of frustration and boredom. The results showed a decrease in biting and picking during intervention and extinction during posttreatment. This study contributes to helping college students have a procedure that stops biting and picking without disrupting a daily routine.

Keywords: habit reversal, female, college student, onychophagia, differential reinforcement of incompatible (DRI) and alternative (DRA) behavior2

Introduction

Nail and skin biting and picking, also known as onychophagia, is a self-injury habit that involves removal and damage of the skin on an individual’s fingers damaging the nails and the skin present around the nails. Onychophagia can cause swelling, redness, scarring, infection, and pain to the fingers of the individual (Williams, Rose, Chisholm, 2007). It can also leave the individual having feelings of insecurity and depression (Williams, Rose, Chisholm, 2007). There are many causes of onychophagia such as anxiety control, attention seeking, aggression control, obsessive-compulsive disorder, and behavioral and emotional disorders (Siddiqui, Qureshi, 2020). Onychophagia occurs in up to 4% of college students and is most common in females (Twohig, Woods, 2001). The habit commonly occurs in children and young adults and is usually present when the biter is stressed, frustrated, bored, nervous, or embarrassed (Williams, Rose, Chisholm, 2007). Habit reversal has been used to treat repetitive behavioral problems (Twohig, Woods, 2001) and has the potential to decrease or extinct onychophagia in college students based on this study.

Purpose of the Present Study

This study includes a habit reversal procedure that can be used to help college students stop onychophagia and can be implemented into their daily lives without interruption and independent participation. The goal of this study is to have the participant, a 22 year old college female, completely stop nail and skin biting and picking within a time frame of three weeks using the habit reversal procedure provided.

Method

Participants

The participant was a 22 year old Caucasian female (Brianna Weber) and a fourth-year undergraduate student at Pennsylvania State University. For the participant, nail biting started during childhood and proceeded into her undergraduate studies. Nail biting was defined as the participant’s nails, cuticles, and finger skin around the nails coming in contact with her teeth with the motive or goal to remove any nail or skin and any effort to remove nail and skin with the use of her fingers (also known as picking). Due to the consequence of nail biting, the participant reported damage to the fingers with bleeding, inflammation, redness, scarring, pain, and discomfort of open wounds.

Data Collection

Self-monitoring

The participant self-monitored throughout the entirety of the three weeks of the procedure. During the first and third week when intervention was not present, the participant marked down on her phone what time she picked or bit, what action was done (biting, picking, or both), and what she was doing during the time of the picking and or biting (school, leisure, work, or driving). At the end of each day, a total number of nail biting and picks that occurred that day was recorded. During the second week, when intervention was implemented, the participant monitored when she engaged in differential reinforcement of incompatible (DRI) and alternative (DRA) behavior (coloring, gaming, counting).

Photographs

Throughout the three-week procedure, photographs were taken every day to monitor the amount of injury due to nail biting and picking. This was done during pretreatment, intervention, and posttreatment to monitor the progress of biting and picking and to take note of bleeding, inflammation, redness, scarring, pain, and discomfort.

Procedure

A reversal design was used to evaluate the effects of the intervention. Baseline self-monitoring occurred for one week prior to intervention, starting on April 1 and ending on April 7. The intervention consisted of DRI and DRA behavior for one week, starting on April 8 and ending April 14. Every time the participant felt like engaging or engaged in nail biting or fingerpicking, she did one of three activities. She was able to choose to color, play a game on her phone, or count her fingers, which she would engage in for a minimum of two minutes each time. These actions were chosen based on the participant’s self-report that the actions can end the feeling of boredom and frustration. The second baseline phase started on April 15 to April 22, where no activities were done and the participant self-monitored and photographed.

Results

During the baseline there was a mean of 68 nail and skin biting and pickings per day. During intervention, the second week, the mean of incidents decreased to 32 per day. This included contact to the mouth and the times the participant felt tempted to engage in nail and skin biting and picking. The third week had a mean of 0 as the participant did not engage in any finger injury.

Figure 1

Number of self-recorded nail and skin biting and picking in a day through the three phases of the procedure

As shown in Figure 1 the participant decreased in nail biting during intervention. She reported that she stopped engaging in finger injury on Day 10. This includes her fingers making any contact with her mouth with the intent of self-injury or using her fingers to injure herself. Though she stopped finger to mouth contact, she still participated in DRA and DRI behaviors for Day 11 to Day 14 due to the temptation of nail and skin biting and picking. The third week, posttreatment, the participant did not engage in any finger injury as she was able to restrain from her fingers encountering her mouth or feeling the need to use her fingers to self-injure herself.

Figure 2

Picture taken during baseline phase to monitor nail and skin biting and picking progress

Figure 3

Picture taken at the end of intervention phase to monitor nail and skin biting and picking progress

Figure 2 shows a picture that was taken during the baseline before intervention was implemented. Figure 3 is a picture taken during intervention. There is a decrease in redness, deep cuts, and cuticle damage. Pictures were used to track decrease in injury to fingers along with the amount recorded of nail and skin biting and picking in the self-assessment log.

Discussion

This study suggests that habit reversal can be effective when applied to nail and skin biting and picking. The study also shows that this procedure works for young adults in undergraduate studies at a university with the activities being accessible and able to be implemented without interruption of a daily routine. Something that should be noted, is habit reversal may not contribute to onychophagia long-term. The participant, though not included in the study, reported that after posttreatment she experienced mouth to finger contact in stressful situations before discontinuing the habit. Though she was able to stop herself from pursuing in self-injury, over time the habit may become a concern again. Considering the mean of the baseline and the participant reporting severe self-injury, a week of intervention may not have been enough for the severity the participant experienced with the habit. The procedure was appropriate to the participant, contributing a helpful procedure for the daily routine of being a college student. The procedure had a strong value to the participant since she underwent consistent frustration and boredom in the four daily life events listed (school, leisure, work, and driving), helping her get rid of her severe consequences of onychophagia. For future research it would be beneficial to the participant and the researchers to take into account how severe the participant experiences onychophagia. This can contribute to choosing an effective intervention timeline. In this study, DRA and DRI behaviors were assigned to the participant based on a self-assessment to discontinue the feeling of frustration and boredom. The feelings associated with onychophagia and the participant must be considered so proper behaviors can be chosen and the study can be modified to fit the needs of those specific participants. For researchers that replicate this study, they need to consider what causes onychophagia in specific college students as it may vary from student to student.

 

References

Gür, K., Erol, S., & İncir, N. (2018). The effectiveness of a nail‐biting prevention program among primary school students. Journal for Specialists in Pediatric Nursing, 23(3), e12219. https://doi.org/10.1111/jspn.12219

Siddiqui, J. A., & Quershi, S. F. (2020). Onychophagia (Nail Biting): an overview. Indian Journal of Mental Health, 7(2), 97. https://doi.org/10.30877/ijmh.7.2.2020.97-104

Twohig, M. P., & Woods, D. W. (2001). HABIT REVERSAL AS A TREATMENT FOR CHRONIC SKIN PICKING IN TYPICALLY DEVELOPING ADULT MALE SIBLINGS. Journal of Applied Behavior Analysis, 34(2), 217–220. https://doi.org/10.1901/jaba.2001.34-217

Williams, T. I., Rose, R., & Chisholm, S. (2007). What is the function of nail biting: An analog assessment study. Behaviour Research and Therapy, 45(5), 989–995. https://doi.org/10.1016/j.brat.2006.07.013