title: Evaluating the efficacy of habit reversal: comparison with a placebo control.
abstract: BACKGROUND
  The purpose of this study was to compare the effectiveness of habit reversal with a placebo control as a treatment for chronic nail biting in adults.
  
  
  METHODS
  Thirty adults with a chronic nail-biting problem (occurring > or = 5 times/day nearly every day for > or = 4 weeks and causing physical damage or social impairment) were randomly assigned to a placebo control or habit reversal group. Five participants withdrew from the study prior to the completion of treatment. The remaining individuals in both groups received a total of 2 hours of treatment over 3 sessions. Individuals in the habit reversal group (N = 13) received the components of awareness training, competing response training, and social support. Individuals in the placebo control group (N = 12) simply discussed their nail biting. At pretreatment, posttreatment, and a 5-month follow-up, nail length was measured, photographs were taken of the damaged nails and later rated by independent observers, and data on participant depression, anxiety, and self-esteem were obtained. Treatment compliance and acceptability data were collected at posttreatment only.
  
  
  RESULTS
  Results showed that habit reversal produced a greater increase in nail length at posttreatment and follow-up when compared with the placebo. Data from the independent raters confirmed these findings. Habit reversal was also viewed as a more acceptable intervention by the participants. At posttreatment, the habit reversal group had increased their nail length by 22% from pretreatment compared with a 3% increase for the placebo group. At follow-up, the habit reversal group maintained a 19% increase in nail length from pretreatment compared with a 0% increase for the placebo group.
  
  
  CONCLUSIONS
  Findings from this study suggest habit reversal is more effective than a placebo control and should be considered a well-established intervention for body-focused repetitive behaviors.
authors.affiliation: University of Wisconsin-Milwaukee, Milwaukee, 53201, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Twohig
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Woods
authors.forename: Brook A
authors.initials: BA
authors.lastname: Marcks
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Teng
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D001294:Attitude to Health; D001521:Behavior Therapy / Q000379:methods; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009259:Nail Biting / Q000523:psychology / Q000628:therapy*; D010919:Placebos / Q000627:therapeutic use; D012649:Self Concept; D016896:Treatment Outcome
chemical_list: D010919:Placebos