Evaluating the Efficacy of Habit Reversal: Comparison With a Placebo Control
J Clin Psychiatry 2003;64:40-48
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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.
Method: Thirty adults with a chronic nail-biting
problem (occurring >=5 times/day nearly every day for >=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.
Conclusion: 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.